Factors Associated With Urgency Urinary Incontinence Among Older Mexican American Women Aged 65 years and Older.

The purpose of this study was to determine which socio-demographic, clinical, or functional factors are associated with urgency urinary incontinence (UUI) over 20-years of follow-up in a community-dwelling sample of Mexican American women aged 65 years and older without UUI at baseline. We included 1,358 women participants from the Hispanic Established Population for the Epidemiologic Study of the Elderly study conducted in the southwestern of US (Arizona, California, Colorado, New Mexico, and Texas). Measures included self-reported UUI, socio-demographics, smoking status, body mass index, medical conditions, depressive symptoms, physical and cognitive function, and handgrip strength. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of UUI as a function of socioeconomic, clinical, and functional factors. Self-reported UUI increased from 3.1% to 21.9% from baseline (1993/1994) to follow-up (2012/2013). Current smokers, obesity, arthritis, previous heart attacks, and depressive symptoms were factors associated with greater odds of UUI over time. Identification of these factors can help clinicians determine those at high risk of developing UUI. Preventing and/or treating the risk factors early may delay UUI and increase quality of life in this underserved population.

Concordance between tomographic and surgical AAST injury grades in liver, spleen, and kidney due to blunt abdominal trauma / Concordancia entre los grados de lesión AAST tomográficos y quirúrgicos en hígado, bazo y riñón por trauma cerrado de abdomen

OBJETIVO: Determinar la concordancia entre los grados de lesión de la escala AAST (American Association for the Surgery of Trauma) tomográficos y quirúrgicos en lesiones hepáticas, esplénicas y renales por trauma abdominal cerrado. Método: Estudio prospectivo, unicéntrico, observacional, comparativo y transversal, en pacientes mayores de 15 años con lesión hepática, esplénica o renal por trauma abdominal cerrado, sometidos a tomografía abdominal y posterior laparotomía exploradora, en quienes se determinó la concordancia de los grados de lesión AAST tomográficos y quirúrgicos de estos órganos, de marzo de 2017 a diciembre de 2020, en el Hospital Civil de Culiacán, Sinaloa, México. RESULTADOS: Se incluyeron 48 pacientes, con una edad promedio de 27.9 ± 10.9 años; de ellos, 41 eran hombres (85%). La lesión esplénica fue la más frecuente, en 30 pacientes (63%), seguida de la hepática en 20 (42%) y la renal en 15 (31%). La concordancia del grado de lesión AAST entre la tomografía y la cirugía fue baja o moderada, con valores kappa de 0.234 (p < 0.001), 0.419 (p < 0.001) y 0.415 (p < 0.001) para las lesiones hepáticas, esplénicas y renales, respectivamente. CONCLUSIONES: Los grados de lesión AAST tomográficos y quirúrgicos en el hígado, el bazo y los riñones por trauma abdominal cerrado tienen baja y moderada concordancia, y los grados tomográficos son menores que los quirúrgicos.

Risk factors associated to intestinal anastomotic leakage in elective surgery.

BACKGROUND: The intestinal anastomotic leakage is the most feared surgical complication of a digestive surgery and is associated with a significant increase of morbidity, mortality and hospital stay. OBJECTIVE: Analyze the risk factors to the intestinal anastomotic leakage in elective surgery. METHOD: Observational and retrospective study in which we include patients with intestinal anastomosis, in elective surgery at the second level hospital from January 2007 to January 2017. RESULTS: 64 patients were included in the study, in which 7 presented anastomotic leakage. The statistically significant risk factors associated with anastomotic leakage were, cocaine use (p = 0.030), neoplasia as a primary pathology (p = 0.008), neoadjuvant treatment for neoplasia (p = 0.003), and end-to-end anastomosis (p = 0.037). Patients with a leakage had a longer hospital stay and a mortality of 14.3%. CONCLUSIONS: The risk factors associated with the presence of anastomotic leakage found in this study are consistent with the reported worldwide literature. However, in our results, it is worth highlighting the use of cocaine as a risk factor, with statistical significance.

ANTECEDENTES: La fuga de una anastomosis intestinal es la complicación quirúrgica más temida de la cirugía digestiva y se asocia con un aumento significativo de la morbimortalidad y de la estancia hospitalaria. OBJETIVO: Analizar los factores de riesgo asociados a la fuga de anastomosis intestinal en cirugía electiva. MÉTODO: Estudio observacional y retrospectivo en el que se recabaron los expedientes de los pacientes operados de anastomosis intestinal en forma electiva en un hospital de segundo nivel de enero de 2007 a enero de 2017. RESULTADOS: Se incluyeron 64 pacientes, de los cuales siete presentaron fuga de la anastomosis. Los factores de riesgo asociados a fuga anastomótica estadísticamente significativos fueron consumo de cocaína (p = 0.030), neoplasia como patología primaria (p = 0.008), tratamiento con neoadyuvantes para neoplasia (p = 0.003) y anastomosis término-terminal (p = 0.037). Los pacientes con fuga tuvieron una estancia intrahospitalaria más prolongada y una mortalidad del 14.3%. CONCLUSIONES: Los factores de riesgo asociados con la presencia de fuga anastomótica encontrados en este estudio son consistentes con los reportados en la literatura mundial. Sin embargo, en nuestros resultados cabe destacar el uso de cocaína como factor de riesgo, con significancia estadística.

Impact of demographic, clinical, and treatment compliance characteristics on quality of life of Venezuelan patients with systemic lupus erythematosus.

BACKGROUND: We have here assessed the impact of demographic, clinical, and treatment compliance characteristics on health-related quality of life (HRQoL) of Venezuelan patients with systemic lupus erythematosus (SLE). We have used a disease-specific questionnaire, the Lupus Quality of Life (LupusQoL), validated in our patient population, to measure HRQoL. METHODS: A cross-sectional study was conducted among 100 patients with SLE from outpatient clinics. Patients completed a form with demographic, clinical, and treatment compliance data, and the LupusQoL questionnaire. HRQoL was classified as better or worse according to previously established cut-off points for this patient population. Spearman's r test was used to determine the correlations between age, years of education, disease duration, SLEDAI, and SLICC-DI with the eight domains of the LupusQoL. Mann-Whitney U test was used to compare the HRQoL between the two groups of patients according to treatment compliance. Binomial logistic regression using the backward stepwise selection method was performed to identify the risk factors associated with each of the eight domains of the LupusQoL among patients with inactive (SLEDAI < 4) and active (SLEDAI ≥ 4) SLE. RESULTS: HRQoL of our patients was classified as better in all domains of the LupusQoL. Age correlated negatively with all domains of the LupusQoL, except with "burden to others", and disease activity correlated negatively with all domains of the LupusQoL, except with "intimate relationships" and "burden to others" (p < 0.05). Patients who fully complied with indicated treatment had higher scores in "physical health" domain compared to patients who did not comply with at least one of the prescribed medications (p < 0.05). In patients with active SLE, a risk factor associated with worse "planning" and "intimate relationships" was advanced age, while having had SLE flare-ups in the previous six months was a risk factor associated with worse "physical health" (p < 0.05). CONCLUSION: Age and disease activity were negatively correlated with almost all domains of the LupusQoL, and treatment compliance was associated with higher score in the "physical health" domain. Disease control and treatment compliance should be the main goals for a better HRQoL in our patients with SLE.

Antibodies: Friends, Foes, or Both? Lessons From COVID-19 for the Rheumatologist.

ABSTRACT: Antibodies are a fundamental tool to fight infections but are intrinsically built as a double-edged sword. One side recognizes the microbial antigen, and the other gives a call to arms to fight infection by recruiting immune cells and triggering inflammation. A balanced immune response must combine a potent neutralizing antibody and a swift disposal of the invading agent by innate immune cells with the least tissue damage possible. The longer the immune system takes to control the infection, the higher the possibility for a self-sustaining inflammatory process with potentially fatal consequences for the host. In addition to quantity, the quality of antibodies also matters, because posttranslational modifications altering the N-glycan composition in Fc fractions may help tilt the balance to the effector side, by modifying their affinity for Fc receptors in immune cells. The COVID-19 pandemic has provided a wealth of data bolstering our understanding of the rules governing the production of protective and nonprotective antibodies. Also, it has broadened our understanding of the role of viruses in triggering autoimmunity and inflammation, and widened our knowledge of the different mechanisms that can be activated by viral infection and lead to autoantibody production, inflammation, and progressive tissue damage. In addition, the COVID-19 infection has contributed a great deal to our comprehension of the role of antibodies in the causation of cytokine storms and systemic inflammatory response syndrome, also seen in patients with systemic autoimmune diseases.

Gender differences in activity-limiting pain trajectories over a 17-year period in the Mexican Health and Aging Study.

ABSTRACT: Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico. We used data from 5 waves (over 2001-2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 years and older. Pain was categorized as self-reported frequent pain that makes it difficult to do usual activities. Latent class mixture models were used to create pain trajectories (n = 9824). The sample was majority female (56.15%), with a mean age of 61.72 years. We identified 2 pain trajectories: low-stable (81.88%) and moderate-increasing (18.12%). Women had 1.75 times the odds of being in the moderate-increasing group compared with men (95% confidence interval= 1.41, 2.17). In addition, having zero years of education was associated with higher odds of being in the moderate-increasing group, compared with having any years of education. Fair/poor self-rated health, obesity, arthritis, elevated depressive symptoms, and falls were positively associated with pain for both trajectory groups. Being married was positively associated with pain in the low-stable group. Insurance status was negatively associated with pain in the low-stable group, but positively associated with pain in the moderate-increasing group. We identified 2 trajectories of activity-limiting pain, among older Mexican adults (50+) over 17 years of follow-up. Understanding gender differences in pain trajectories in later life and the factors associated with trajectory development is crucial to improve quality of life, especially in vulnerable populations.

Arthritis, physical function, and disability among older Mexican Americans over 23 years of follow-up.

OBJECTIVE: Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. DESIGN: A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility - disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. RESULTS: Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09-1.68] and mobility (OR = 1.34, 95% CI = 1.18-1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value < .010). CONCLUSIONS: Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up.

Characterization of Venezuelan patients with systemic sclerosis: a study in a tertiary hospital in Caracas / Caracterización de los pacientes venezolanos con esclerosis sistémica: estudio en un hospital terciario en Caracas

Objective: The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. Methods: Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. Results: Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077).(AU)

Objetivo: El objetivo de este estudio fue investigar las características demográficas y clínicas de los pacientes venezolanos con esclerosis sistémica (ES) examinados en un hospital terciario. Métodos: Se seleccionaron para el estudio pacientes consecutivos mayores de 18 años, que cumplieron los criterios de la clasificación ACR/EULAR de 2013 para ES, sometidos a seguimiento en la clínica ambulatoria del Departamento de Reumatología del Hospital Universitario de Caracas. Se registraron las variables demográficas y clínicas en el momento de la inclusión, utilizando un protocolo estándar. Resultados: Se incluyó a 48 pacientes con ES, de los cuales 46 (95,8%) eran mujeres; la edad media fue de 55,1±13,7 (media±DE) años, todos ellos de etnia hispana. Treinta y uno de ellos (64,6%) tenían ES limitada y 17 (35,4%) ES difusa. La duración media de la enfermedad fue de 13,4±11,7 (media±DE) años: 16,74±12,99 años para ES limitada y 7,52±5,25 años para ES difusa (p=0,0077). El fenómeno de Raynaud fue la manifestación más frecuente (100%), seguida de la artritis (68,8%), la telangiectasia (60,4%), la disnea (60,4%), la disfagia (58,3%) y la hinchazón de manos (56,3%). La puntuación de la escala cutánea de Rodnan modificada (mRSS) y la frecuencia de la disnea fueron más altas en aquellos sujetos con ES difusa con respecto a los sujetos con ES limitada (p=0,0211 y p=0,0003, respectivamente). Realizamos una TAC de alta resolución pulmonar a 31 pacientes; 14 (45,2%) tenían evidencia de enfermedad pulmonar intersticial (EPI), 11 (68,8%) de ellos con ES difusa (p=0,0052). El patrón más frecuente de anticuerpos anti-nucleares fue de tipo nucleolar, representando 18 (42,8%) de los casos. Los anticuerpos anti-centrómeros estuvieron presentes en el 16,7% de los casos, asociándose al subconjunto de ES limitada (p=0,0443) con calcinosis (p=0,0020). Los anticuerpos anti-topoisomerasa estuvieron asociados a la EPI (p=0,0077).(AU)

Characterization of Venezuelan patients with systemic sclerosis: a study in a tertiary hospital in Caracas.

OBJECTIVE: The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. METHODS: Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. RESULTS: Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077). CONCLUSIONS: Typical clinical and serological manifestations were present in this sample of Venezuelan patients with SSc, with an expected distribution according to disease subtype. The autoantibody profile allows clinicians to identify those patients with limited forms of the disease and those without pulmonary involvement.

Characterization of Venezuelan Patients With Systemic Sclerosis: A Study in a Tertiary Hospital in Caracas.

OBJECTIVE: The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. METHODS: Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. RESULTS: Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077). CONCLUSIONS: Typical clinical and serological manifestations were present in this sample of Venezuelan patients with SSc, with an expected distribution according to disease subtype. The autoantibody profile allows clinicians to identify those patients with limited forms of the disease and those without pulmonary involvement.

Life-Space Mobility in the Elderly: Current Perspectives.

Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.

Role of depressive symptoms in the health-related quality of life of Venezuelan patients with rheumatoid arthritis. Results from a tertiary care center.

INTRODUCTION/OBJECTIVE: To examine the effect of depressive symptoms on health-related quality of life (HR-QoL) in Venezuelan patients with rheumatoid arthritis (RA). METHODS: HR-QoL was assessed in a cross-sectional, single-center study of 212 consecutive Venezuelan patients with RA (1987 American College of Rheumatology criteria) using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS); depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Covariates included socio-demographics, comorbidities, disease characteristics, body mass index, and disability. Unadjusted and multivariable linear regression analysis were used to determine the effect of depressive symptoms on HR-QoL. RESULTS: Mean age was 50.2 years and 89.6% were female. Twenty-five percent of patients had depressive symptoms. In the multivariable regression analysis, the presence of depressive symptoms changed the mental SF-36 scores by - 4.81 (p = 0.0052) and the physical SF-36 scores by - 3.33 (p = 0.0527). Other factors significantly associated with scores on the PCS of the SF-36 were functional class, disability and job loss due to RA. CONCLUSIONS: The presence of depressive symptoms negatively affected the HR-QoL in our patients, with a predominant effect on the MCS of the SF-36. The PCS of the SF-36 was mainly affected by those symptoms related to the functional impairment and inflammatory activity of the disease. The routine assessment and early treatment of depressive symptoms, targeting mental and mood manifestations, may improve the HR-QoL and thus contribute to healthier outcomes in Venezuelan RA patients.

Educando con el ejemplo. Alimentación y actividad física en los futuros promotores de salud / Training with the example. Food and physical activity in the future health promoters

FUNDAMENTOS: Los universitarios de enfermería y de actividad física y del deporte por su formación y futura actividad profesional deberían destacar por sus hábitos saludables. Estudiamos la implicación de la actividad física en sus estilos de vida y salud mental. MÉTODOS: Estudio transversal en 283 universitarios valorando actividad física (cuestionarios Minnesota y AMPEF sobre motivación), alimentación (recordatorio 24 horas y adherencia dieta mediterránea), EAT26 y calidad de vida (SF12). RESULTADOS: 54,4% realizaron actividad física continuadamente. El consumo de alcohol y tabaco disminuyó al incrementarse la actividad física. Encontramos mayor consumo de frutas y variedad de alimentos en aquellos con más de 300 minutos/semana de ejercicio físico. La adherencia a dieta mediterránea fue más elevada cuando la actividad física fue moderada. La motivación principal para la práctica física-deportiva fue estética y por salud en la mujer frente a competitiva, adquisición fuerza y resistencia en hombres. La actividad física se asoció a puntuación elevada en salud mental (SF12) aunque en la mujer tiempos muy elevados se asociaron a mayor riesgo para trastornos del comportamiento alimentario. CONCLUSIONES: La promoción de la salud sigue siendo una tarea que se enseña y se conoce pero no se aplica suficientemente ni siquiera en los futuros promotores de la salud

BACKGROUND: University students of nursing and of physical activity and sport due to their training and attitudes, present healthy habits to a greater extent than other young people. We set out to know the implication of physical activity in the lifestyles and mental health. METHODS: Cross-sectional study in 283 university students. We assessment physical activity (Minnesota and AMPEF questionnaires about practice reasons), 24 hour consumption reminder survey, Mediterranean diet adherence, riskeating disorder (EAT26) and quality of life (SF12). RESULTS: 54.4% performed physical activity continuously. The consumption of alcohol and tobacco decreased with increasing physical activity. We found greater fruit consumption and variety of foods in those who practice more than 300 minutes/week of physical activity. Adherence to the Mediterranean diet was higher when sports activity reached moderate levels. The main motivation for physical-sport practice was aesthetics and health in women versus competitive and strength in men. We found better mental health in young people with more sport activity, only in the female when increasing this time of sports activity, the risk of eating disorders increased. CONCLUSIONS:The promotion of health continues to be a task that is taught and known but not applied enough even in future health promoters

Prevalence of undifferentiated inflammatory arthropathy in patients with Hashimoto's thyroiditis in an endocrinology clinic.

AIM: Rheumatic manifestations are common in patients with Hashimoto's thyroiditis (HT). Since previous reports on the prevalence of arthritis in this disease may have a rheumatology referral bias, we sought to establish the prevalence of undifferentiated inflammatory arthropathy (UIA) in unselected HT patients as seen in an endocrinology clinic. METHODS: Cross-sectional study of 92 consecutive HT patients and no definite rheumatic disease from the Endocrinology Division, Hospital Universitario de Caracas diagnosed by the presence of anti-thyroid peroxidase antibodies (n = 68) or typical ultrasonographic findings (n = 24). Undifferentiated inflammatory arthropathy was defined as combination of morning stiffness and joint pain with ≥2 characteristics of inflammatory joint pain. The study was revised and approved by the Ethics Committee of our hospital and all patients signed an informed consent form. RESULTS: Twenty-three patients (25%; 95% CI 16-34) met the criteria for UIA. Joints most commonly affected were the knees, hands and ankles and the most common pattern was oligoarticular (82.6%). In the multivariate analysis, variables associated to the presence of UIA were the presence of myalgia (odds ratio [OR] = 19.41; 95% CI = 2.38-158.38) and Raynaud's phenomenon (OR = 4.32; 95% CI = 1.01-18.60). No association was found with demographics, duration of disease, comorbidities or thyroid function status. CONCLUSIONS: Almost 1 in 4 patients with HT had no definite rheumatic disease present with UIA. An early identification of concurrent arthritis in HT patients is necessary for thorough differential diagnosis and prompt treatment initiation to halt potential joint damage and disability.

[Photographic documentation during safe laparoscopic cholecystectomy]. / Documentación fotográfica durante la colecistectomía laparoscópica segura.

INTRODUCTION: Laparoscopic cholecystectomy is the most frequent procedure for the general surgeon. Biliary injury is a concern that must be addressed with the purpose of lowering the rate. The critical view of safety (CVS) is a target of dissection that impulses safety during the procedure. OBJECTIVE: Determine by an ambispective analysis the safety during dissection of laparoscopic cholecystectomy in Hospital Civil de Culiacán (México). METHODS: Descriptive, ambispective, observational, cross-sectional. Patients admitted to the operating room for a laparoscopic cholecystectomy were scored with Doublet photography rating criteria from January 1st 2015 to January 31, 2017. RESULTS: 321 patients were evaluated, 77.9% were female and 22.1% male. The mean age was 45.57 ± 16.17 years. 65.4% had admission diagnosis of cholelithiasis, 24.3% acute cholecystitis, 5.9% chronic cholecystitis, 3.7% hydrocolecist and 0.6% pyocolecist. Surgeries were scored with Doublet photography. The CVS was obtained in 41.4% of the procedures with a statistical significance between a HPB surgeon and a general surgery resident (p ≤ 0.05). CONCLUSION: Recording Doublet photography provides a reliable CVS dissection criterion. It can be easily reproduced during laparoscopic cholecystectomy. The identification of cystic structures adds to the culture of safety during laparoscopic cholecystectomy.

INTRODUCCIÓN: La colecistectomía laparoscópica es la cirugía realizada con más frecuencia. La tasa de lesión en la vía biliar impulsa para implementar métodos de seguridad, como la visión crítica de seguridad (VCS). OBJETIVO: Determinar la documentación fotográfica ambispectiva durante la colecistectomía laparoscópica segura en el Hospital Civil de Culiacán. MÉTODO: Estudio descriptivo, observacional, ambispectivo, transversal, de pacientes sometidos a colecistectomía laparoscópica en el Hospital Civil de Culiacán, evaluados con criterios fotográficos de Doublet para asegurar si la VCS se obtuvo de manera satisfactoria, del 1 de enero de 2015 al 31 de enero de 2017. RESULTADOS: Se analizaron 321 pacientes (77.9% del sexo femenino y 22.1% del sexo masculino), con una edad promedio de 45.57 ± 16.17 años, y diagnóstico de colelitiasis (65.4%), colecistitis aguda (24.3%), colecistitis crónica (5.9%), hidrocolecisto (3.7%) o piocolecisto (0.6%). Los cirujanos realizaron la calificación de las fotografías otorgando puntajes en la vista anterior, posterior y Doublet. Se determinó un 41.4% de VCS satisfactoria mediante análisis Doublet, con diferencia estadísticamente significativa entre las calificaciones del cirujano hepatobiliar y el médico residente (p ≤ 0.05). CONCLUSIONES: La realización de las fotografías en pacientes con registros confiables de la VCS es ideal para la colecistectomía laparoscópica, permitiendo identificar adecuadamente las estructuras císticas y evitar la lesión de vía biliar.

[Comparative analysis of diagnostic scales of acute appendicitis: Alvarado, RIPASA and AIR]. / ARTÍCULO ORIGINAL Análisis comparativo de escalas diagnósticas de apendicitis aguda: Alvarado, RIPASA y AIR.

INTRODUCTION: Acute appendicitis is the most common surgical disease in emergency surgery, however, it remains a diagnostic problem and represents a challenge despite the experience and the different clinical and paraclinical diagnostic methods. OBJECTIVE: To evaluate in a comparative way the scale of Alvarado, AIR and RIPASA to determine which one is best as a diagnostic test of acute appendicitis in our population in order to arrive to an accurate diagnosis in the shortest possible time and cost. METHOD: Observational, prospective, transversal and comparative study of 137 patients to whom the scale of Alvarado, AIR and RIPASA was applied, who entered the emergency service of the Civil Hospital of Culiacán (México) with abdominal pain syndrome suggestive of acute appendicitis. RESULTS: The Alvarado scale presented sensitivity 97.2% and specificity of 27.6%. AIR presented sensitivity of 81.9% and specificity of 89.5%. RIPASA showed the same results as Alvarado. All tests showed diagnostic accuracy above 80. CONCLUSIONS: Alvarado and RIPASA presented good sensitivity, however, AIR is more specific, and has better accuracy for the diagnosis of acute appendicitis, making a better screening and thus reducing unnecessary surgeries. Therefore, it is recommended to use more AIR than Alvarado and RIPASA.

INTRODUCCIÓN: La apendicitis aguda es la enfermedad quirúrgica más común en cirugía de urgencia; sin embargo, sigue siendo un problema diagnóstico y representa un reto a pesar de la experiencia y los diferentes métodos de diagnóstico clínicos y paraclínicos. OBJETIVO: Evaluar en forma comparativa las escalas de Alvarado, AIR y RIPASA para determinar cuál es superior como prueba diagnóstica de apendicitis aguda en nuestra población, llegando a un diagnóstico preciso en el menor tiempo y costo posibles. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo de 137 pacientes a quienes se aplicó las escalas de Alvarado, AIR y RIPASA, que ingresaron al servicio de urgencias del Hospital Civil de Culiacán (México) con síndrome doloroso abdominal sugestivo de apendicitis aguda. RESULTADOS: La escala de Alvarado presentó una sensibilidad del 97.2% y una especificidad del 27.6%. AIR tuvo una sensibilidad del 81.9% y una especificidad del 89.5%. RIPASA arrojó los mismos resultados que Alvarado. Todas las pruebas tuvieron una exactitud diagnóstica por arriba del 80. CONCLUSIONES: Alvarado y RIPASA presentaron buena sensibilidad, mientras que AIR es más específica y tiene mayor exactitud diagnóstica de apendicitis aguda, realizando un mejor tamizaje y permitiendo disminuir las cirugías innecesarias, por lo que se recomienda usar más AIR que Alvarado y RIPASA.

Falls in Mexican older adults aged 60 years and older.

BACKGROUND: Falls are a major cause of disability, morbidity, institutionalization, and mortality in older adults. OBJECTIVES: The purpose of the study was to examine the risk factors for falls among Mexican older adults aged 60 years and older. METHODS: This study included 6247 participants and their spouse or partner aged 60 years and older from the Mexican Health and Aging Study, an ongoing longitudinal study (2001-2012) conducted in Mexico. Measures included socio-demographics, falls, physical activity, comorbid conditions, pain, vertigo, vision and hearing impairments, urinary incontinence, lower extremity functional limitation, activities of daily living (ADLs), cognitive function, and depressive symptoms. RESULTS: Mean age was 69.6 years (standard error = 0.18) and 51.8% were female. Forty percent reported one or more falls at baseline. Older age, being female, obesity, arthritis, fractures, stroke, suffering pain, vertigo, lower extremity functional limitations, physical activity, depressive symptoms, urinary incontinence, and ADL disability were significant factors associated with one or more falls over time. DISCUSSION: Early detection and treatment of the risk factors for falls in this population will help improve the quality of life and reduce medical complications and health care costs.

Association of arthritis and vitamin D insufficiency with physical disability in Mexican older adults: findings from the Mexican Health and Aging Study.

Arthritis and vitamin D insufficiency are prevalent in older adults and are risk factors for disability. The objective of this study was to examine the effect of co-occurring arthritis and vitamin D deficiency on upper-lower extremity functional limitations and disability in older adults. We examined 1533 participants aged ≥50 years from a subsample of the Mexican Health and Aging Study. Measures included sociodemographics, body mass index, comorbid conditions, falls, physical activity, physical function tests, functional limitations, activities of daily living (ADL), and vitamin D. Participants were categorized into four groups according to arthritis and vitamin D status: no vitamin D insufficiency and no arthritis (58.80%), vitamin D insufficiency only (27.49%), arthritis only (8.47%), and arthritis and vitamin D insufficiency (5.24%). Fourteen percent reported arthritis, and 31.2% had vitamin D insufficiency. The arthritis and vitamin D insufficiency group was associated with upper-lower extremity functional limitations [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06-3.15, and OR 1.90, 95% CI 1.00-3.62, respectively] and ADL disability (OR 3.00, 95% CI 1.63-5.51) when compared with the no vitamin D insufficiency and no arthritis group (reference group). The arthritis only group was three times more likely to report upper-lower extremity functional limitations and ADL disability. The vitamin D insufficiency only group was not significantly associated with functional limitations nor ADL disability. Arthritis and vitamin D insufficiency increased the risk of ADL disability in this population. However, the effect of arthritis and vitamin D insufficiency on upper-lower extremity functional limitations was not higher than the effect of arthritis only, but higher than the effect on vitamin D insufficiency alone.