Lithium: A Promising Anticancer Agent.

Lithium is a therapeutic cation used to treat bipolar disorders but also has some important features as an anti-cancer agent. In this review, we provide a general overview of lithium, from its transport into cells, to its innovative administration forms, and based on genomic, transcriptomic, and proteomic data. Lithium formulations such as lithium acetoacetate (LiAcAc), lithium chloride (LiCl), lithium citrate (Li3C6H5O7), and lithium carbonate (Li2CO3) induce apoptosis, autophagy, and inhibition of tumor growth and also participate in the regulation of tumor proliferation, tumor invasion, and metastasis and cell cycle arrest. Moreover, lithium is synergistic with standard cancer therapies, enhancing their anti-tumor effects. In addition, lithium has a neuroprotective role in cancer patients, by improving their quality of life. Interestingly, nano-sized lithium enhances its anti-tumor activities and protects vital organs from the damage caused by lipid peroxidation during tumor development. However, these potential therapeutic activities of lithium depend on various factors, such as the nature and aggressiveness of the tumor, the type of lithium salt, and its form of administration and dosage. Since lithium has been used to treat bipolar disorder, the current study provides an overview of its role in medicine and how this has changed. This review also highlights the importance of this repurposed drug, which appears to have therapeutic cancer potential, and underlines its molecular mechanisms.

Factors associated with the stigma-discrimination complex towards healthcare workers among university students during the coronavirus pandemic in Mexico / Factores asociados al complejo estigma-discriminación hacia trabajadores de la salud entre estudiantes universitarios durante la pandemia de coronavirus en México

Introduction: COVID-19-related stigma towards healthcare professionals negatively influences their job performance and well-being, however, this issue has not been sufficiently investigated. Objective: To determine the frequency and variables associated with COVID-19-related stigma toward health care workers in a university population in Mexico. Materials and methods: Cross-sectional study. An online questionnaire was sent to 1,054 students between 18 and 29 years of age. Demographic variables, religiosity, fear of COVID-19 and its association with COVID-19-related stigma-discrimination towards health workers (dependent variable) were analyzed. Bivariate analysis and a generalized linear model were performed to calculate adjusted prevalence ratios. Results: The proportion of high stigma-discrimination was 12.4% and was associated with high fear of COVID-19 RPa= 1.51 (95% CI 1.06 - 2.23). Conclusion: The findings highlight the importance of establishing programs to reduce COVID-19-related stigmatization towards healthcare professionals.

Introducción: El estigma relacionado con la COVID-19 hacia los profesionales de la salud influye negativamente en su desempeño laboral y bienestar, sin embargo, este tema no ha sido suficientemente investigado. Objetivo: Determinar la frecuencia y las variables asociadas al estigma relacionado con el COVID-19 hacia los trabajadores de la salud en una población universitaria de México. Materiales y métodos: Estudio transversal. Se envió un cuestionario en línea a 1.054 estudiantes de entre 18 y 29 años. Se analizaron variables demográficas, religión, miedo al COVID-19 y su asociación con el estigma-discriminación hacia el personal de salud relacionado con la COVID-19 (variable dependiente). Se realizó un análisis bivariado y un modelo lineal generalizado para calcular las razones de prevalencia ajustadas. Resultados: La proporción de estigma-discriminación alto fue de 12,4% y se asoció con miedo alto a la COVID-19 RPa=1,51 (IC=95% 1,06-2,23). Conclusión: Los hallazgos destacan la importancia de establecer programas para reducir la estigmatización relacionada con COVID-19 hacia los profesionales de la salud.

Ranking the importance of their own diseases: A positioning analysis in rheumatic patients and their proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Ranking the importance of their own diseases: A positioning analysis in rheumatic patients and their proxies / La importancia que dan los pacientes reumáticos a sus propias enfermedades: un análisis de posicionamiento

Introduction/objective: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. Methods: Subjects completed a self-administered questionnaire to rank 11 diseases from “worst” to “least bad”. Then they defined the “worst” disease and ranked 10 diseases from highest to lowest importance from a list including “my rheumatic disease/my relative's disease”. The lists of the included diseases represented the mindshare from a sample of healthy adults. Results: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. “My disease/my relative's disease” was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. Discussion and conclusions: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.(AU)

Introducción/objetivo: Evaluar el posicionamiento que pacientes con lupus eritematoso sistémico (LES), artritis reumatoide (AR), espondilitis anquilosante (EA) y sus acompañantes dan a sus enfermedades. Métodos: Los participantes completaron un cuestionario para clasificar 11 enfermedades de «peor» a «menos mala». Luego definieron la «peor» enfermedad y el ranking de 10 enfermedades de una lista que incluía «mi enfermedad reumática/de mi familiar». Las listas de enfermedades incluidas representaron la «conciencia de marca» de un grupo de adultos sanos. Resultados: Hubo 570 encuestados (104 LES, 99 AR, 82 EA y 285 acompañantes). La AR se posicionó como la tercera peor enfermedad (en primer lugar, por el 41% de pacientes, segundo por el 49% y tercero por el 10%). La definición preferida para «peor» enfermedad fue aquella que mata. «Mi enfermedad reumática/de mi familiar» fue la cuarta más importante (primer lugar por el 41% de pacientes, segundo por el 38% y tercero por el 21%). El posicionamiento no estuvo asociado con edad, escolaridad, duración de la enfermedad ni centro de atención. Discusión y conclusiones: La mayoría de los encuestados calificaron su enfermedad reumática más abajo que otros padecimientos no reumáticos.(AU)

Indole-3-Carbinol, a Phytochemical Aryl Hydrocarbon Receptor-Ligand, Induces the mRNA Overexpression of UBE2L3 and Cell Proliferation Arrest.

Cervical cancer (CC) is one of the most common cancers in women, and is linked to human papillomavirus (HPV) infection. The virus oncoprotein E6 binds to p53, resulting in its degradation and allowing uncontrolled cell proliferation. Meanwhile, the HPV E7 protein maintains host cell differentiation by targeting retinoblastoma tumor suppressor. The host cell can ubiquitinate E6 and E7 through UBE2L3, whose expression depends on the interaction between the aryl hydrocarbon receptor (AhR) with Xenobiotic Responsive Elements (XREs) located in the UBE2L3 gene promoter. In this study, we used cell culture to determine the effect of indole-3-carbinol (I3C) over cellular viability, apoptosis, cell proliferation, and mRNA levels of UBE2L3 and CYP1A1. In addition, patients' samples were used to determine the mRNA levels of UBE2L3 and CYP1A1 genes. We found that I3C promotes the activation of AhR and decreases cell proliferation, possibly through UBE2L3 mRNA induction, which would result in the ubiquitination of HPV E7. Since there is a strong requirement for selective and cost-effective cancer treatments, natural AhR ligands such as I3C could represent a novel strategy for cancer treatment.

Preliminary Identification of the Aerobic Cervicovaginal Microbiota in Mexican Women With Cervical Cancer as the First Step Towards Metagenomic Studies.

Cervical cancer (CC) is considered a public health problem. Recent studies have evaluated the possible relationship between the cervicovaginal microbiome and gynecologic cancer but have not studied the relationship between aerobic bacterial communities and neoplasia. The study aimed to identify the cultivable aerobic bacterial microbiota in women with cervical cancer as a preliminary approach to the metagenomic study of the cervicovaginal microbiome associated with cervical cancer in Mexican women. An observational cross-sectional study was conducted, including 120 women aged 21-71 years, divided into two study groups, women with locally advanced CC (n=60) and women without CC (n=60). Sociodemographic, gynecological-obstetric, sexual, and habit data were collected. Cervicovaginal samples were collected by swabbing, from which standard microbiological methods obtained culturable bacteria. The strains were genetically characterized by PCR-RFLP of the 16S rRNA gene and subsequently identified by sequencing the same gene. Variables regularly reported as risk factors for the disease were found in women with CC. Differences were found in the prevalence and number of species isolated in each study group. Bacteria commonly reported in women with aerobic vaginitis were identified. There were 12 species in women with CC, mainly Corynebacterium spp. and Staphylococcus spp.; we found 13 bacterial species in the group without cancer, mainly Enterococcus spp. and Escherichia spp. The advanced stages presented a more significant number of isolates and species. This study provided a preliminary test for cervicovaginal metagenomic analysis, demonstrating the presence of aerobic cervicovaginal dysbiosis in women with CC and the need for more in-depth studies.

The high methylation level of a novel 151-bp CpG island in the ESR1 gene promoter is associated with a poor breast cancer prognosis.

BACKGROUND: The ESR1 gene suffers methylation changes in many types of cancers, including breast cancer (BC), the most frequently diagnosed cancer in women that is also present in men. Methylation at promoter A of ESR1 is the worse prognosis in terms of overall survival; thus, the early detection, prognostic, and prediction of therapy involve some methylation biomarkers. METHODS: Therefore, our study aimed to examine the methylation levels at the ESR1 gene in samples from Mexican BC patients and its possible association with menopausal status. RESULTS: We identified a novel 151-bp CpG island in the promoter A of the ESR1 gene. Interestingly, methylation levels at this CpG island in positive ERα tumors were approximately 50% less than negative ERα or control samples. Furthermore, methylation levels at ESR1 were associated with menopausal status. In postmenopausal patients, the methylation levels were 1.5-fold higher than in premenopausal patients. Finally, according to tumor malignancy, triple-negative cancer subtypes had higher ESR1 methylation levels than luminal/HER2+ or luminal A subtypes. CONCLUSIONS: Our findings suggest that methylation at this novel CpG island might be a promising prognosis marker.

Genotoxicity of Mercury and Its Derivatives Demonstrated In Vitro and In Vivo in Human Populations Studies. Systematic Review.

Beside partial coverage in three reviews so far (1994, 2009, 2019), there is no review on genotoxic studies dealing with mercury (Hg) and human exposure using the most usual genotoxic assays: sister chromatid exchanges (SCE), chromosomal aberrations (CA), cytochalasin B blocked micronucleus assay (CBMN), and single-cell gel electrophoresis (SCGE or alkaline comet assay). Fifty years from the first Hg genotoxicity study and with the Minamata Convention in force, the genotoxic potential of Hg and its derivatives is still controversial. Considering these antecedents, we present this first systematic literature overview of genotoxic studies dealing with Hg and human exposure that used the standard genotoxic assays. To date, there is not sufficient evidence for Hg human carcinogen classification, so the new data collections can be of great help. A review was made of the studies available (those published before the end of October 2021 on PubMed or Web of Science in English or Spanish language) in the scientific literature dealing with genotoxic assays and human sample exposure ex vivo, in vivo, and in vitro. Results from a total of 66 articles selected are presented. Organic (o)Hg compounds were more toxic than inorganic and/or elemental ones, without ruling out that all represent a risk. The most studied inorganic (i)Hg compounds in populations exposed accidentally, occupationally, or iatrogenically, and/or in human cells, were Hg chloride and Hg nitrate and of the organic compounds, were methylmercury, thimerosal, methylmercury chloride, phenylmercuric acetate, and methylmercury hydroxide.

Changes in the diversity of local cervical bacteria in women with cervical cancer receiving antineoplastic treatment.

BACKGROUND: Some studies show changes in the microbiota in people undergoing antineoplastic treatment. Currently, there is not enough evidence of this effect in the treatment of cervical cancer (CC). The objective was to determine changes in the diversity of local cervical bacteria in women with CC receiving chemotherapy, radiotherapy, and brachytherapy. MATERIALS AND METHODS: A descriptive, longitudinal, and prospective study was conducted in 68 women with locally advanced CC with a treatment plan based on the administration of chemotherapy, external beam radiotherapy, and brachytherapy. Cervical-vaginal fluid samples were taken during antineoplastic treatment. The samples were used to isolate bacterial strains. The bacteria were identified at the molecular level by comparing sequences of the 16S ribosomal RNA gene. RESULTS: The bacteria identified belonged to three phyla: Firmicutes, Proteobacteria, and Actinobacteria. Nine genera and 25 species of bacteria were identified. The most frequent species were Staphylococcus epidermidis, Corynebacterium amycolatum, and Enterococcus faecalis. There were statistically significant differences when comparing bacterial diversity found in the different stages of treatment (≤0.05). Bacterial diversity decreased as antineoplastic treatment progressed and increased at the end of therapy. CONCLUSION: Antineoplastic treatments generate changes in the diversity of local cervical bacterial communities of women with CC.

Ranking the Importance of Their Own Diseases: A Positioning Analysis in Rheumatic Patients and Their Proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Effect of phthalates exposure during perinatal period on hormonal profile in Mexican males during their first months of life.

Phthalates affect development of male reproductive system acting as an antiandrogenic agents. We sought to explore if perinatal exposure to phthalates could alter male hormone levels in humans during the first months of life. A cohort of 83 pregnant women and their male infants were studied. Five phthalate metabolites were measured in the mother's urine during the first, second, and third trimesters of pregnancy and during the first, third, and sixth months of life in the infants. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and inhibin B were analyzed. Association between phthalate exposure and hormone variation was assessed using regression models for longitudinal data. Mono-butyl phthalate reduced FSH concentration (ß = -0.0012 international units [IU]/L, p < 0.01), mono-ethylhexyl phthalate reduced inhibin B (ß = -0.0094 pg/mL, p = 0.02), monoethyl phthalate reduced testosterone (ß = -0.0071 ng/L, p = 0.07), mono-ocytl phthalate reduced LH (ß = -0.0041 IU/L, p = 0.13). No effects were observed for exposure to mono-methyl phthalate. Our results are consistent with the findings in animal and human studies. Special precaution should be taken when measuring phthalate exposure in susceptible populations such as pregnant women and infants.

Phthalates exposure during pregnancy a study in a Mexican cohort.

A prospective cohort study was conducted to measure the concentration levels of three primary phthalate metabolites (MBP, MEHP, MEP) during pregnancy in a group of women from the State of Mexico. The urinary concentration levels of the three phthalate primary metabolites were measured by gas chromatography mass spectrometry during the first, second and third trimesters of pregnancy. The geometric mean and 95 % CI for MBP was 20.38 µg/mL (15.35-27.09); for MEHP 13.43 µg/mL (8.93-20.20), and MEP 52.47 µg/mL (39.88-69.04) adjusted to one g of creatinine. No significant trends were observed among the studied metabolites during the pregnancy period. MBP was higher in less educated women, while women who resided in industrialized zones showed higher levels of MEHP and MEP than women from non-industrialized zones. Consumption of plastic bottled beverages was associated with MBP and MEHP phthalate exposure. Women who used non-registered brands of plastic food containers for storage or for microwave oven use showed the highest levels of MBP and MEP phthalates. The pregnant women in our study were exposed to the three studied primary phthalate metabolites, and this could present a risk to their newborns. To better integrate public health policies, major exploration of potential exposure sources and effects at the regional level is required.

Breast cancer-related single-nucleotide polymorphism and their risk contribution in Mexican women.

CONTEXT: Four single-nucleotide polymorphisms (SNPs) in Mexican patients and their association with the development of breast cancer (BC). AIMS: This work is focused on determining the association of fibroblast growth factor receptor (rs12196489), TOX3 (rs3803662), human telomerase reverse transcriptase (h TERT, rs10069690), and FTO (rs17817449) polymorphisms and BC in a cohort of Mexican women. SETTINGS AND DESIGN: The study included 56 patients with a confirmed diagnosis of BC and 83 controls. Clinical characteristics were obtained from medical records. SUBJECTS AND METHODS: Genomic DNA from the samples was obtained from lymphocytes, and the genotyping of rs12196489, rs3803662, rs10069690, and rs17817449 polymorphisms was performed by real-time polymerase chain reaction using specific TaqMan probes. Statistical analysis was assessed to evaluate the distribution of genotype frequencies between cases and controls. STATISTICAL ANALYSIS: We used the STATA Statistical Package (version 10.1; STATA Corp., College Station, TX, USA). Student's t-test, χ2 test, or Fisher's exact test was used to evaluate the distribution of genotype frequencies. RESULTS: No statistical differences in allelic and genotypic frequencies were found between patients with BC and controls for SNPs: rs1219648, rs3803662, and rs17817449. Interestingly, according to the χ2 test, a significant difference was exhibited for rs10069690 (odds ratio = 0.095; 95% confidence interval = 0.038-0.214; P < 0.001). CONCLUSIONS: The h TERT (rs10069690) polymorphism might be associated with BC in Mexican women. Nevertheless, additional studies in a larger cohort are required to confirm this association and to possibly use this polymorphism as a potential biomarker in the early diagnosis of BC.

Quality and Safety in Healthcare for Medical Students: Challenges and the Road Ahead.

Background: The development of skills, behaviors and attitudes regarding patient safety is of utmost importance for promoting safety culture for the next generation of health professionals. This study describes our experience of implementing a course on patient safety and quality improvement for fourth year medical students in Mexico during the COVID-19 outbreak. The course comprised essential knowledge based on the patient safety curriculum provided by the WHO. We also explored perceptions and attitudes of students regarding patient safety. Methods: Fourth year medical students completed a questionnaire regarding knowledge, skills, and attitudes on patient safety and quality improvement in medical care. The questionnaire was voluntarily answered online prior to and after the course. Results: In total, 213 students completed the questionnaires. Most students were able to understand medical error, recognize failure and the nature of causation, perform root-cause analysis, and appreciate the role of patient safety interventions. Conversely, a disapproving perspective prevailed among students concerning the preventability of medical errors, utility of reporting systems, just culture and infrastructure (p < 0.05). Conclusion: We found students had a positive perspective concerning learning quality in healthcare and patient safety during our course; nevertheless, their perception of the usefulness of reporting systems to prevent future adverse events and prevent medical errors is uncomplimentary. Medical education should promote error reporting and just culture to change the current perception of medical students.

Night Shift Work and Risk of Breast Cancer in Women.

BACKGROUND: Night shift work involving circadian disruption has been associated with increased breast cancer rates in some epidemiological studies, but the evidence is still on debate. AIM OF THE STUDY: The objective of this study is to assess the association between night shift work and breast cancer in Mexican women. METHODS: A Case-control study was conducted with incident cases of breast cancer at the Instituto de Seguridad Social del Estado de México y Municipios. Cases were interviewed about past exposures prior to the final diagnosis. Controls were women without breast cancer matched on multiple sociodemographic characteristics. RESULTS: 101 cases and 101 matched controls were interviewed; this small sample size provided consistent, but wide estimates of the assessed associations. The multivariate conditional logistic regression showed that breast-feeding was associated with reduced risk for breast cancer (OR 0.12; 95% CI: 0.02-0.60); women who experienced early menarche (12 years) were more likely to develop breast cancer (OR 18.58; 95% CI 18: 2.19-148). Women who worked at night were more likely to develop breast cancer compared to women who never did (OR = 8.58; 95% CI: 2.19-33.8). CONCLUSIONS: Our results are consistent with studies from other countries, which positively associated night shift work with breast cancer.

Allopurinol-Induced Toxic Epidermal Necrolysis.

Toxic epidermal necrolysis (TEN) is an extremely rare condition characterized by separation of dermoepidermal junctions, necrosis, and subsequent detachment of the epidermis over large cutaneous areas. TEN can emerge after exposure to certain medications such as allopurinol, aromatic anticonvulsants, NSAIDs, nevirapine, and antibacterial sulfonamides. There is no standard protocol for TEN, and the therapy of choice varies from one patient to another. Some of these therapies include silver-releasing wraps/dressings, glucocorticoids, antibodies to inhibit Fas-mediated keratinocyte apoptosis, and cyclosporine A. A 35-year-old male with an allergy to antibacterial sulfonamides who was being treated for arterial hypertension and hyperuricemia with captopril and allopurinol, respectively, was admitted to hospital. The patient showed skin detachment affecting approximately 95% of his surface area, including his face, upper and lower extremities, trunk, back, oropharyngeal mucosa, anal mucosa, ocular mucosa, and genital mucosa. Intravenous methylprednisolone at a dosage of 40 mg/day for 7 days along with abrasive cures was found to be an appropriate treatment in this case.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity.

OBJECTIVE: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. RESULTS: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). CONCLUSIONS: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

OBJETIVO: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIAL Y MÉTODOS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. RESULTADOS: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017.Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraronpuntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM .55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. CONCLUSIONES: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity / Fallas en el diseño del Examen Nacional para Aspirantes a Residencias Médicas generan inequidad

Abstract: Objective: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. Results: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). Conclusion: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

Resumen_ Objetivo: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. Resultados: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017. Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraron puntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM 1.55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. Conclusión: Los resultados sugieren que el atributo de equidad del ENARM está en duda.