[Moebius syndrome. Clinical case report]. / Síndrome de Moebius. Informe de un caso clínico.

BACKGROUND: Moebius syndrome (MBS) is an infrequent disease, having an incidence of 1 in 10,000 births, mainly characterized by a congenital bilateral facial paralysis due to an agenesia of the sixth and seventh cranial nerves. In addition, orofacial and limb anomalies are frequently found in these patients. The diagnosis is fundamentally based on different clinical manifestations of the disorder. CLINICAL CASE: a female newborn with the clinical picture of Moebius syndrome is presented, and genetic or environmental aspects are discussed. Since the use of misoprostol for abortion and inducing uterine activity in combination with NSAIDs, the number of newborns with MBS associated with this drug has increased. Nowadays, either genetic or environmental factors are associated with MBS. CONCLUSIONS: it is necessary that the general and medical community be aware of the risk of teratogenic effects of misoprostol, and the usefulness of genetic counseling whenever there is a newborn with Moebius syndrome.

Introducción: el síndrome de Moebius (MBS) es una enfermedad poco frecuente que tiene una incidencia de 1 por cada 10 000 nacimientos. Se caracteriza principalmente por parálisis facial bilateral congénita debido a una agenesia de los núcleos de los nervios craneales del VI y VII par. Además, es frecuente encontrar anomalías orofaciales y de extremidades torácicas y pélvicas en estos pacientes. El diagnóstico se basa fundamentalmente en las distintas manifestaciones clínicas del trastorno. Caso clínico: niña recién nacida con el cuadro clínico de síndrome de Moebius. Se discuten los aspectos genéticos y medioambientales asociados a esta patología. Desde la introducción del misoprostol y su uso inadecuado como agente abortivo e inductor de actividad uterina, y en combinación con antiinflamatorios no esteroideos, se ha observado un incremento en la frecuencia de recién nacidos con síndrome de Moebius asociados al uso de este medicamento. Actualmente, el factor genético y el medioambiental se encuentran asociados a este síndrome. Conclusiones: es importante alertar a la comunidad médica y a la población en general acerca del riesgo teratogénico del misoprostol y de la importancia del consejo de los genetistas cuando nace un paciente con síndrome de Moebius.

[Preeclampsia: main maternal risk factor for low weight in preterm newborn]. / Preeclampsia: principal factor de riesgo materno para bajo peso del recién nacido pretérmino.

BACKGROUND: In 3 to 8% of pregnancies there are preeclampsia, and it is considered an irreversible disease that affects several organs, and causes injuries in fetus and mother alike. OBJECTIVE: To identify maternal risk factors related to low birth weight in preterm newborns born at Hospital de Ginecología-Pediatría con Medicina Familiar no. 31 from IMSS, at Mexicali, BC, Mexico. PATIENTS AND METHOD: Case-control study (1:2 ratio) made in 114 prematures (38 cases and 76 controls) who were evaluated for socioeconomic and biological maternal risk factors influencing low birth weight in preterm newborns. Odds ratio and confidence intervals of 95% were used to calculate epidemiologic correlation, and logistic regression to specific importance of risks. RESULTS: Preeclampsia persists as a risk factor for low birth weight: OR 3.16 (95% CI 3.15-8.40, p = 0.00). In logistic regression meaningful variables were: preeclampsia 5.27 (95% CI 1.45-19.14, p = 0.01), and in premature newborn: thrombocytopenia 6.0 (95% CI 1.2-11.2, p = 0.00), and neonatal sepsis 4.31 (95% CI 1.73-10.70, p = 0.00). CONCLUSIONS: Preeclampsia was the major risk factor related to low birth weight and was associated with thrombocytopenia in preterm newborn. Neonatal sepsis is secondary to low birth weight. We need to observe and obey prenatal care of pregnant women in our hospital to reduce negative impact of low birth weight in preterm newborns.

[Prevalence of burnout syndrome in nurses in 2 Mexican hospitals]. / Prevalencia del síndrome de burnout en el personal de enfermería de 2 hospitales mexicanos.

OBJECTIVE: To determine the prevalence of burnout syndrome in nursing staff in 2 different second level hospitals in the city of Mexicali, Baja California, Mexico. METHOD: A cross-sectional study was conducted in all nursing staff (n = 698) in 2 second level hospitals (the Gynecology, Pediatrics and Family Medicine Hospital No. 31 and the General Specialist Hospital No. 30 in Mexicali). A stratified random sample was obtained from the 698 nurses, with a sample size of 184 nurses from each hospital. The Maslach Burn-out Inventory and a general questionnaire on demographic factors were used. Statistical analysis consisted of descriptive statistics and analysis of proportions using the chi-squared test. RESULTS: A total of 368 nurses were studied, of whom 345 (93.75%) were women. The mean age was 41.21 SD (standard deviation) = 6.59 years. The mean length of service was 15.87 (SD = 6.12) years. In both hospitals, the prevalence of burnout syndrome was 6.79% (25). CONCLUSIONS: Previous publications on burn-out have included studies performed in Mexico and in nurses in the emergency department of a tertiary hospital in Barcelona, as well as in other health care professionals. In comparison with these studies, the prevalence of burn-out observed in the present study was significantly lower.

Prevalencia del síndrome de burnout en el personal de enfermería de 2 hospitales mexicanos / Prevalence of burnout syndrome in nurses in 2 Mexican hospitals

Objetivo. Determinar la prevalencia del síndrome de burnout en el personal de enfermería en 2 hospitales de segundo nivel en la ciudad de Mexicali, BC (México). Método. Diseño transversal, realizado en el profesionales de enfermería del Hospital de Gineco-Pediatría con Medicina Familiar n.º 31, y el Hospital General de Especialidades n.º 30, en Mexicali, BC. Se obtuvo una muestra probabilística estratificada para la población finita de los 698 profesionales de enfermería que trabajaban en dichos hospitales, y se seleccionaron aleatoriamente 184 sujetos de cada hospital. Se aplicó el cuestionario de Maslach para identificar el síndrome y el cuestionario general para factores sociodemográficos. Posteriormente se utilizaron estadísticas descriptivas e inferenciales mediante prueba para proporciones de x2. Resultados. Se estudiaron 368 sujetos, 345 (93,75%) mujeres, con una edad media de 41,21 años (desviación estándar [DE] = 6,59); la antigüedad laboral fue de 15,87 años (DE = 6,12). La prevalencia de burnout en los profesionales de enfermería de ambos hospitales fue del 6,79% (25). Conclusiones. La prevalencia obtenida fue menor a la reportada en otros estudios, tanto los realizados en México como otro realizado con profesionales de enfermería que trabajaban en la sala de urgencias de un hospital de tercer nivel de Barcelona, así como en los realizados con otros profesionales de la salud

Objective. To determine the prevalence of burnout syndrome in nursing staff in 2 different second level hospitals in the city of Mexicali, Baja California, Mexico. Method. A cross-sectional study was conducted in all nursing staff (n = 698) in 2 second level hospitals (the Gynecology, Pediatrics and Family Medicine Hospital No. 31 and the General Specialist Hospital No. 30 in Mexicali). A stratified random sample was obtained from the 698 nurses, with a sample size of 184 nurses from each hospital. The Maslach Burn-out Inventory and a general questionnaire on demographic factors were used. Statistical analysis consisted of descriptive statistics and analysis of proportions using the chi-squared test. Results. A total of 368 nurses were studied, of whom 345 (93.75%) were women. The mean age was 41.21 SD (standar deviation) = 6.59 years. The mean length of service was 15.87 (SD = 6.12) years. In both hospitals, the prevalence of burnout syndrome was 6.79% (25). Conclusions. Previous publications on burn-out have included studies performed in Mexico and in nurses in the emergency department of a tertiary hospital in Barcelona, as well as in other health care professionals. In comparison with these studies, the prevalence of burn-out observed in the present study was significantly lower

[Burnout syndrome associated factors in gynecologists]. / Factores relacionados con el síndrome de burnout en ginecólogos.

OBJECTIVE: To determine risk factors associated to Burnout Syndrome in medical gynecologist staff who works at the Gynecology-pediatrics with Family Medicine Hospital number 31 of the IMSS at Mexicali city, Baja California. MATERIAL AND METHOD: A cross sectional study was performed in 27 gynecologists (100% of the total gynecologist that works at that particular hospital). A validated survey instrument developed by Maslach was applied to them in order to identify the presence of the syndrome and a general questionnaire including sociodemographic information was also applied to the doctors. The statistical analysis was both descriptive and inferential including chi square, Student t and logistic regression. RESULTS: 74.1% of the doctors who showed signs of Burnout Syndrome were males and 25.9% were females. The average doctors age of the group who developed Burnout was 44.81 +/- 6.11 years. The mean time in years of work for the doctors with the syndrome was 15.56 +/- 7.11 years. Only one doctor was divorced and she presented Burnout Syndrome, on the other hand, 62.5% of the married doctors showed evidence of Burnout Syndrome (p > 0.05). The general prevalence was 59.2%. Of those who showed signs of burnout, 87.5% presented it in low degree, 6.2% presented moderate degree, 6.2% presented high burnout degree. Out of all the organizational factors type, none resulted significative. CONCLUSIONS: The prevalence of the reported syndrome is apparently high when compared to the medical anesthesiology staff of the same hospital; however this difference is not statistically significative. In the unvaried and multivariate analyses, no organizational factor shows significance as a potential risk. It is necessary to consider psychological support to the affected doctors and to value the organization of the service, looking for an administrative reengineering.

[Prevalence of Burnout syndrome among anesthesiologists in Mexicali]. / Prevalencia del Síndrome de Agotamiento Profesional en médicos anestesiólogos de la ciudad de Mexicali.

OBJECTIVE: To determine the prevalence of Burnout syndrome among anesthesiologists in Mexicali, Mexico. STUDY DESIGN: We carried out a descriptive, cross-sectional study. Burnout syndrome was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We administered the inventory to 92 anesthesiologists between October 2001 and February 2002. Statistical analysis included Chi square tests for categorical variables. RESULTS: 89 questionnaires were returned, 22 females and 67 males. Burnout prevalence was 44% divided as follows: 17% reported high emotional exhaustion, 12.3% reported symptoms compatible with depersonalization, and 10% experienced a sense of low personal accomplishment. CONCLUSIONS: Our study differs slightly from the literature, although this may be attributed to the medical specialty we chose to survey. We suggest similar studies be carried out in other cities in Mexico to be able to have comparison groups.

Prevalencia del Síndrome de Agotamiento Profesional en médicos anestesiólogos de la ciudad de Mexicali / Prevalence of Burnout Syndrome among anesthesiologists in Mexicali

Objetivo: Obtener la prevalencia del Síndrome de Agotamiento Profesional en los médicos anestesiólogos de la ciudad de Mexicali, B.C. México. Material y Métodos: Se realizó un estudio poblacional, transversal y descriptivo, mediante cuestionario autoadministrado de Maslach a 92 médicos anestesiólogos de la ciudad de Mexicali, B.C., durante los meses de octubre del 2001 a febrero del 2002. Análisis estadístico: Chi cuadrada para las variables categóricas. Resultados: Se encuestaron a 22 mujeres y 67 hombres ( n = 89 ) obteniendo prevalencia de 44% con síndrome de agotamiento profesional, de los cuales 17% presentó alto grado de agotamiento emocional, 10% presentó alto grado de despersonalización y el 12.3% presentó baja realización personal. Conclusiones: De lo reportado por otros autores hay diferencias con nuestro estudio, posiblemente por corresponder a otras especialidades. Sugerimos estudios similares en otras ciudades del país para obtener prevalencia en este grupo de médicos especialistas.

Objective: To determine the prevalence of Burnout syndrome among anesthesiologists in Mexicali, Mexico. Study design: We carried out a descriptive, cross sectional study. Burnout syndrome was measured using the Maslach Burnout Inventory Human Services Survey (MBIHSS). We administered the inventory to 92 anesthesiologists between October 2001 and February 2002. Statistical analysis included Chi square tests for categorical variables. Results: 89 questionnaires were returned, 22 females and 67 males. Burnout prevalence was 44% divided as follows: 17% reported high emotional exhaustion, 12.3% reported symptoms compatible with depersonalization, and 10% experienced a sense of low personal accomplishment. Conclusions: Our study differs slightly from the literature, although this may be attributed to the medical specialty we chose to survey. We suggest similar studies be carried out in other cities in Mexico to be able to have comparison groups.

Factores de riesgo organizacionales asociados al síndrome de Burnout en médicos anestesiólogos

resumen está disponible en el texto completo

Abstract: Introduction Burnout Syndrome is considered by the WHO as a worker's risk, that causes mental and physical deterioration (headaches, gastrointestinal illness, high blood pressure, muscular tension and chronic fatigue). This is a result of chronic stress and of the workplace environment, which today is cold, hostile, demanding, both economically and psychologically. People are becoming cynical, with negative feelings toward their patients and their professional roll; they feel emotional exhaustion. This occurs frequently in health workers who deal with people who are dependent. What is the cause of this syndrome that is damaging the community of the workers? It is due to many facts, such as organizations where there is work overload (workload is a dimension of organizational life, this means productivity. In their scramble for increased productivity, organizations push people beyond what they can sustain, making work more intense, demanding more time and becoming more complex; this is the major risk factor, in which is shown an uncorrelation between the people and their work); lack of control (of the capacity to set priorities in their own work, to select and to make decisions regarding resources that are central in the professional roll; politics of the organization that interfere with this capacity, reduce individual autonomy an involvement with work); lack of reward (lack of community harmony, lack of fairness and also value conflict); breakdown of community (the loss of harmony in the community is made evident by greater conflicts among people, less mutual support and respect, and a growing sense of isolation); absence of fairness (trust, openness and respect, are all three, elements of fairness essential to maintain a person's engagement with work. Their absence contributes directly to burnout); conflicting valúes (this occurs when there is no correlation between the sources of workplace and the personal values, in some cases work overload makes people work with no ethics, causing them conflict with their own values). This syndrome has three dimensions: Exhaustion. When people experience exhaustion, they feel overextresed, both emotionally and physically; they feel drained, unable to recover, they don't sleep enough, and lack of energy needed to face new projects. Exhaustion is the first reaction to the stress of job demands or major change. Cynicism. They take a distant attitude toward work and the people on the job. They minimise their involvement at work and even give up their ideals. In some way, this is a form of protecting themselves from exhaustion and disappointment, persons feel it's safer to be indifferent, especially when the future is uncertain. Such a negative attitude can seriously damage a person's well-being and capacity to work. Ineffectiveness. Persons feel a growing sense of inadequacy, every project seems overwhelming, they think everybody conspires against them, and whatever they do, seems to be trivial. They lose confidence in themselves, and at the same time, others lose confidence in them. They become vulnerable to family strangements, and to abandon social activities, they tend to remain alone. By this time they can incur in drug abuse, become mentaly insane, and in extreme cases, comit suicide. The measurement instrument for the diagnosis of Burnout Syndrome is Maslach Burnout Inventory, which allows to sample large populations under this condition; it was developed by Maslach in 1976, and a large number of studies have been developed by this time. Chronic stress could have important effects on the quality of family relationships and have a negative influence in anesthesiology performance as well. Because of this important problem that affects physical condition of illness, mental health and performance and quality of medical services, and also because there are no studies in the anesthesiologist environment, we performed this study to asses burnout among anesthesiologist in the city of Mexicali, Baja California. The object of this study was to determine and evaluate the organizational factors associated to burnout, because anesthesiologist performs at surgery rooms, where they have to manage chronic and sustained stress; moreover they get involved with patients, and are exposed to organizational factors. Burnout may affect mental health, and thus, the performance of the anesthesiologist practice, fact that even may put in serious risk the life of patients. Material and methods Control and cases study was performed, universe included all anesthesiologist in Mexicali City (n=92), excluding thoses that are not active in anesthesiologist practice, and who refused to respond the surveys. Cases group was constituted by anesthesiologists with burnout syndrome and control group was constitute by anesthesiologists without burnout. Sampling was obtained by Cochran's formula obtaining n=28 for each group. Independent variables were vicious organizational factors (work overload, lack of control, lack of reward, breakdown of community, absence of fairness, conflicting values). Dependent variable was Burnout Syndrome. Valídate instruments use were Maslach's Inventory for diagnosis of Burnout and a general sociodemographic inventory, for risk factors. Statistic analysis performed were descriptive analysis, proportion tests for two populations, Odds ratios, and Chi2, at the same time Logistic regression was performed, the statistic program use was BMDP and Epi Info 6. Results First of all, we estimated the prevalence of burnout, excluding three anesthesiologists that refused to answer the inventory test, of 89 persons analyzed we obtained 37 cases, that gives us a prevalance of 44%. The group case was constituted by 23 males and five females, control group by 19 males and 9 females (p>0.05). Mean age of case group was 43.7 years; control group 45.8 years. Civil state for cases group was 85.7% married, 7.1% divorced, 3.5% single, 3.5% not married couple, for control group 71.4% married, 14.3% single, 7.1% widows and 7.1% not married couple; working time for case group range from 24 years to two years, mean age 13.5 years, control group range from 28 years to two years, mean age 16.4 years. For no organizational factors, being married or divorced was a risk for burnout with OR 5.20, having children's was a risk for burnout with OR 33.2, and having more years at work was also significant for developing burnout with OR 1.17. For organizational factors, the two variables for risk for burnout were work overload with p = 0.003, and conflicting values with p = 0.034, the other factors were no significant. Discussion The most important findings of the present study, were that work overload is a factor risk for burnout, this agrees with literature reports, where it is said that work overload is the factor that most affects health workers. In relation to conflicting values it also agrees with Maslach's studies, where the author says that this occurs where there is no correlation between work demand and moral values. In most cases, work overload can lead people to act with no ethics in their work, this creating conflicts with their moral values. In this study conflicting values result in being an protecting factor, considering Maslach's publishing, this is a form that health workers assume to try to protect themselves against exhaustion and deception, thus adopting the form of cynicism. The sieges we can find in this study is the honesty in the answers of the persons, besides this is assume by the inventory, this exist. Another siege is the sample size, but this was affront by an statistic manner. It is so important to continue with new investigation lines, because as long as a medical doctor has good mental and physical health, he will be apt to give qualified attention to patients. At the same time is important that organizations recognize this health problem, so they can provide psychiatric intervention for those medical doctors who are affected by this syndrome, and try also to reestructure their organization in order to avoid this problems.

Infección cervicovaginal y riesgo de parto prematuro / Cervico vaginal infection and risk of premature labor

Objetivo: determinar la asociación entre infec-ción cervicovaginal y trabajo de parto prematuro.Material y métodos: estudio de casos (n = 48) y controles (n = 48) en el área de admisión de Tococirugía del Hospital de Gineco-Pediatría con Unidad de Medicina Familiar 31, Instituto Mexicano del Seguro Social, Mexicali, Baja California, México. Resultados: por análisis univariado se encontró asociación entre infección global y trabajo de parto prematuro (p < 0.05 c2), al igual que desarrollo de Candida albicans en intensidad moderada y abundante (OR = 4.72). En análisis multivariado, la urosepsis y los antecedentes de aborto o parto prematuro se asociaron con trabajo de parto prematuro (p < 0.05 c2).Conclusiones: la infección cervicovaginal moderada o abundante por Candida albicans puede constituir un factor de riesgo para trabajo de parto prematuro. La infección de vías urinarias, los antecedentes de prematurez o aborto no mostraron relación entre sí o con otros factores de riesgo como los higiénicos, ambientales y laborales.

Patrón de crecimiento del lactante sano / Growth patterns for healthy infants

Basados en la premisa una nutrición infantil es satisfactoria cuando los ritmos de crecimiento son adecuados, comparamos el patrón de crecimiento entre un grupo de recién nacidos alimentados al seno materno exclusivo y otro alimentado con fórmula modificada en proteínas, seleccionado de acuerdo con la tabla de números aleatorios. Se llevó a cabo un estudio descriptivo durante un periodo de seis meses en el Hospital de Ginecopediatría con Unidad de Medicina Familiar Núm. 31, Instituto Mexicano del Seguro Social, Mexicali, Baja California. Las mediciones de peso, talla y perímetro cefálico se efectuaron según las recomendaciones de National Center for Health Statistics y la Norma Oficial Mexicana. Para el análisis estadístico fueron utilizadas la prueba no paramétrica de porcentajes y la X² (alfa 0.05 y 95 por ciento intervalo de confianza para medias). En el análisis intragrupos, los lactantes alimentados con fórmula modificada presentaron la misma diferencia significativa (p < 0.05) de peso, talla y perímetro cefálico durante los primeros cuatro meses de vida; los alimentados al seno materno mostraron el mismo comportamiento en peso y talla, no así en perímetro cefálico, donde se encontró diferencias significativa (p < 0.05) exclusivamente los primeros tres meses. El primer trimestre de vida el aumento de la talla fue mayor en los lactantes alimentados con fórmula modificada (p <0.05), y el perímetro cefálico en los lactantes alimentados al seno materno (p < 0.05), pero al cuarto mes las dos variantes se igualaron en ambos grupos. El comportamiento del crecimiento durante los tres primeros meses de vida presentó diferencias en los dos grupos pero al final del estudio fue similar

Ruptura prematura de membranas. ¿Son necesarios los antibióticos? / Premature rupture of membranes. Is necessary the use antibiotics?

Se incluyeron 33 recién nacidos (RN) a término con antecedentes de ruptura prematura de membranas (RPM), hijos de madres sanas, a los que se les tomó muestras sanguíneas para biometría hemática, recuento leucocitario, relación B/N, plaquetas, y proteínas C reactiva; además se registró su sexo, Apgar al minuto y a los cinco minutos, el tiempo de ruptura, la cantidad eliminada de líquido amniótico y su evolución clínica. El Apgar al minuto fue de 8 y 9 a los 5 minutos. La RPM varió desde 12 hasta 96 horas (cuatro días) con una media de 22.4 horas. La cantidad de líquido amniótico al nacimiento fue adecuada en 29 casos, en cuatro se consideró disminuido. Los cuatro niños nacidos de estas mujeres fueron mantenidos en observación hasta obtener los resultados de exámenes. El recuento leucocitario reportó una media de 15,854, con una relación B/N que osciló de 0 a 0.125. Las plaquetas variaron entre 22,000 y 370,000 con una media de 210,393.9. La proteína C reactiva fue negativa en todos los niños, y en las evaluaciones clínicas no tuvieron signos características de infección. Los resultados concuerdan con lo informado en la literatura; muchos niños son tratados innecesariamente, por lo que es preciso documentar la infección mediante métodos sencillos. El empleo de antibióticos debe hacerse sólo en aquellos niños que se amerite