Dolor postoperatorio: frecuencia y caracterización del manejo / Postoperative pain: frequency and management characterization

Abstract Introduction: Acute postoperative pain is a usual symptom and a surgical challenge. Objective: To determine the frequency of pain in the postoperative period of patients undergoing elective surgery and to characterize pain management at a second-level public hospital. Material and methods: A cross-section study of 175 postop patients was conducted, analyzing variables such as level of pain 24 hours after surgery according to the visual analog scale, type of surgery, use of analgesics, and anesthetic technique. Results: The findings indicate that the frequency of moderate, severe, and excruciating pain is 66.3%. In all cases, the analgesia treatment was prescribed by the treating service, and 2 to 3 nonsteroidal anti-inflammatory drugs were used in 86.4% of the cases, with a minimal use of opioids in 13% of the patients. The anesthetic techniques used included balanced general anesthesia, neuro-axial block, and a mixed technique; the latter improved pain control. Conclusion: The frequency of postoperative pain is similar to the level reported in other trials (30%-70%), pointing to the need to review our current management, with more extensive participation and training of the staff involved in pain control.

Resumen Introducción: El dolor agudo postoperatorio es un síntoma frecuente, el cual representa un reto en el ámbito quirúrgico. Objetivo: determinar la frecuencia de dolor en el paciente postoperado de cirugía electiva y caracterizar el manejo del mismo en un hospital público de segundo nivel de atención. Material y métodos: se realizó un estudio transversal en 175 pacientes postoperados, analizando las variables de grado de dolor a las 24 horas del postoperatorio con la escala visual análoga, tipo de cirugía, uso de analgésicos, técnica anestésica. Resultados: Se encontró que la frecuencia de dolor moderado, severo o insoportable es del 66.3%. El tratamiento analgésico en todos los casos fue prescrito por el servicio tratante y en el 86.4% de los casos se emplearon AINE'S, en número de uno a tres. Con un uso mínimo de opioides en el 13% de los pacientes. Las técnicas anestésicas usadas fueron AGB, BNA y técnica mixta; con mejoría en el grado de dolor con la técnica mixta. Conclusión: Existe una frecuencia de dolor postoperatorio similar a lo reportado en otros estudios (30-70%), reflejando la necesidad de revisión del manejo actual, mayor participación y capacitación del personal involucrado en su manejo.

Risk factors for three-vessel coronary artery disease in patients of Northwest Mexico.

INTRODUCTION: Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis, with high prevalence in Mexico. OBJECTIVE: The aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico. METHODS: A cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016. The disease was defined when ≥70% stenosis was present in each major epicardial coronary artery. Anthropometric and biochemical parameters were measured in each patient. Ankle-Brachial Index was measured with vascular ultrasound, and Syntax score calculation with an on-line application. Statistical analysis for qualitative differences was performed using Pearson X2 test, with p<0.05 being considered as significant. RESULTS: The study included 100 patients, of whom 75 were male (mean age 63±9 years) and 25 female (mean age 69±9 years). The coronary risk factors observed were diabetes (58%), hypertension (86%), smoking (68%), dyslipidaemia (100%), metabolic syndrome (71%), and obesity/overweight (75%). Diabetes and metabolic syndrome prevalence was higher in women (p=0.03), but smoking was higher in men (76%, p=0.003). Ankle-Brachial Index was abnormal in 58% of patients, the mean Syntax score was in 36.9±11.5, and the prevalence of left main coronary heart disease was 36%. CONCLUSIONS: This group of patients with complex coronary lesions has a high prevalence of coronary risk factors, which could represent a worse prognosis.

Chitosan treatment for skin ulcers associated with diabetes.

Infections, ulcerations, gangrene and, in severe cases, extremity amputation, are common complications among diabetic subjects. Various biomaterials have been utilized for the treatment of these lesions. Chitosan is an amino sugar with a low risk of toxicity and immune response. In this study, we evaluated chitosan topical gel and film treatments for subjects with diabetic ulcerations and wounds associated with diabetes mellitus. In a pre-experimental design, we described the result of chitosan gel and film treatment for wounds and skin ulcers among patients with long-standing diabetes mellitus. We studied 8 diabetic patients with wounds and skin ulcers (long duration and Wagner degree 1-2). Initially, most lesions had some degree of infection, tissue damage and ulceration. At the end of the treatment (topical chitosan) period, the infections were cured. All patients experienced a significant improvement in the initial injury and developed granulation tissue and a healthy skin cover. This report represents one of the few published clinical experience regarding the chitosan for the treatment of skin lesions among diabetic subjects. These results are relevant and promising for the treatment of this disease.

Risk factors for three-vessel coronary artery disease in patients of Northwest Mexico / Factores de riesgo para la enfermedad arterial coronaria de tres vasos en pacientes del noroeste de México

Abstract Introduction: Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis, with high prevalence in Mexico. Objective: The aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico. Methods: A cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016. The disease was defined when ≥70% stenosis was present in each major epicardial coronary artery. Anthropometric and biochemical parameters were measured in each patient. Ankle-Brachial Index was measured with vascular ultrasound, and Syntax score calculation with an on-line application. Statistical analysis for qualitative differences was performed using Pearson X2 test, with p < 0.05 being considered as significant. Results: The study included 100 patients, of whom 75 were male (mean age 63 ± 9 years) and 25 female (mean age 69 ± 9 years). The coronary risk factors observed were diabetes (58%), hypertension (86%), smoking (68%), dyslipidaemia (100%), metabolic syndrome (71%), and obesity/overweight (75%). Diabetes and metabolic syndrome prevalence was higher in women (p = 0.03), but smoking was higher in men (76%, p = 0.003). Ankle-Brachial Index was abnormal in 58% of patients, the mean Syntax score was in 36.9 ± 11.5, and the prevalence of left main coronary heart disease was 36%. Conclusions: This group of patients with complex coronary lesions has a high prevalence of coronary risk factors, which could represent a worse prognosis.

Resumen Introducción: La enfermedad coronaria de tres vasos (ECTV) es una manifestación avanzada de aterosclerosis, con alta prevalencia en el noroeste de México. Objetivo: Describir los factores de riesgo coronario (FRC) en un grupo de enfermos con ECTV en el noroeste de México. Métodos: De mayo de 2015 a febrero de 2016 se realizó un estudio transversal en una población del noroeste de México diagnosticada con ECTV. Se definió ECTV cuando existía estenosis ≥70% en cada una de las arterias coronarias epicárdicas mayores. Se midieron parámetros antropométricos y bioquímicos en cada paciente. Los parámetros para el índice tobillo-brazo (ITB) se obtuvieron con ultrasonido vascular (Edan SonoTrax 8 Hz) y un cálculo de puntaje Syntax con una aplicación en línea. Análisis estadístico con 32 de Pearson para diferencias cualitativas Se consideró significativo cuando p ≤ 0.05. Resultados: Se estudiaron 25 mujeres (edad 69 ± 9 años) y 75 varones (edad 63 ± 9 años). Los FRC observados fueron diabetes (58%), hipertensión (86%), antecedente de tabaquismo (68%), dislipidemia (100%), síndrome metabólico (71%) y sobrepeso/obesidad (75%). En las mujeres la prevalencia de diabetes y síndrome metabólico fue mayor que en los varones (p = 0.03), pero el tabaquismo fue más prevalente en los varones (76%, p = 0.003). El ITB se encontró anormal en el 58% de los pacientes, el puntaje Syntax promedio fue de 36.9 ± 11.5 y la prevalencia de la enfermedad del tronco de la arteria coronaria izquierda fue del 36%. Conclusión: En este grupo de estudio con lesiones coronarias complejas existe alta prevalencia de FRC que se refleja en y posiblemente un peor pronóstico.

Aterosclerosis placentaria y marcadores de disfunción endotelial en neonatos hijos de madres con diabetes gestacional / Placental atherosclerosis and markers of endothelial dysfunction in infants born to mothers with gestational diabetes

Antecedentes y objetivo: La fisiopatología de la diabetes gestacional provoca por sí misma una hiperestimulación del tejido adiposo y de las células placentarias que aumenta la producción de citocinas inflamatorias, las cuales provocan cambios en los tejidos expuestos como la placenta y el feto, por lo que en este estudio el objetivo fue comparar los marcadores metabólicos y de disfunción endotelial en sangre de cordón umbilical, así como determinar la presencia de aterosclerosis en las placentas de hijos neonatos de pacientes con diabetes gestacional y en pacientes con embarazo normoevolutivo. Pacientes y método: Se realizó un estudio transversal analítico en 84 pacientes, de las cuales se obtuvieron datos como edad, tabaquismo y ganancia de peso en el embarazo; del recién nacido se determinó la edad gestacional por Capurro, el peso y el destino posterior al nacimiento. Además se utilizaron las placentas para la búsqueda de aterosclerosis mediante estudio anatomopatológico y en las muestras sanguíneas obtenidas de cordón umbilical se determinaron glucosa, insulina, colesterol, c-VLDL, c-HDL, triglicéridos, fibrinógeno, PCR y los marcadores de disfunción endotelial (adiponectina, VCAM-1, ICAM-1 e IL-6). Resultados: La aterosclerosis placentaria se presentó en un 28,94% del grupo que cursó con diabetes gestacional frente a un 10,52% del grupo con embarazo normoevolutivo (p=0,044); se encontraron diferencias en glucosa, colesterol, triglicéridos, fibrinógeno, HOMA-IR, PCR-us y c-HDL, no encontrándose en c-VLDL. El 21,05% de los recién nacidos de las pacientes con diabetes gestacional requirieron hospitalización frente al 5,2% del grupo control. Conclusiones: Los embarazos que cursan con diabetes presentan una mayor proporción de aterosclerosis, de hospitalización en el recién nacido, de resistencia a la insulina, así como de elevación de marcadores relacionados con inflamación y disfunción endotelial en sangre de cordón umbilical (AU)

Background and objective: The pathophysiology of gestational diabetes itself causes hyperstimulation of adipose tissue and of the placenta cells increasing the production of inflammatory cytokines, which cause changes in the tissues exposed such as the placenta and foetus. Therefore, the objective of this study was to compare metabolic markers and endothelial dysfunction in umbilical cord blood, as well as to determine the presence of atherosclerosis in the placentas of newborn infants of patients with gestational diabetes and in patients with normally progressing pregnancies. Patients and method: An analytical cross-sectional study was carried out in 84 patients, obtaining data such as age, smoking and weight gain in pregnancy; the gestational age of the newborns was determined by Capurro, and their weight and destination subsequent to birth, the placentas were also collected in order to look for atherosclerosis through histological studies and glucose, insulin, VLDL-C, HDL-C, triglycerides, cholesterol, fibrinogen, PCR and markers of endothelial dysfunction (adiponectin, VCAM-1, ICAM-1 and IL-6) were determined in blood samples obtained from the umbilical cord. Results: Placental atherosclerosis presented in 28.94% of the group with gestational diabetes compared to 10.52% of the group with normally progressing pregnancies (P=.044); differences were found in glucose, cholesterol, triglycerides, fibrinogen, HOMA-IR, PCR-us, HDL-C, not in VLDL-C. Twenty-one point five percent of the newborns of the gestational diabetes patients required hospitalization, against 5.2% in the control group, Conclusions: Pregnancies that involve diabetes have higher proportion of atherosclerosis, hospitalization of the newborn, insulin resistance, as well as elevation of markers associated with inflammation and endothelial dysfunction in umbilical cord blood (AU)

[Placental atherosclerosis and markers of endothelial dysfunction in infants born to mothers with gestational diabetes]. / Aterosclerosis placentaria y marcadores de disfunción endotelial en neonatos hijos de madres con diabetes gestacional.

BACKGROUND AND OBJECTIVE: The pathophysiology of gestational diabetes itself causes hyperstimulation of adipose tissue and of the placenta cells increasing the production of inflammatory cytokines, which cause changes in the tissues exposed such as the placenta and foetus. Therefore, the objective of this study was to compare metabolic markers and endothelial dysfunction in umbilical cord blood, as well as to determine the presence of atherosclerosis in the placentas of newborn infants of patients with gestational diabetes and in patients with normally progressing pregnancies. PATIENTS AND METHOD: An analytical cross-sectional study was carried out in 84 patients, obtaining data such as age, smoking and weight gain in pregnancy; the gestational age of the newborns was determined by Capurro, and their weight and destination subsequent to birth, the placentas were also collected in order to look for atherosclerosis through histological studies and glucose, insulin, VLDL-C, HDL-C, triglycerides, cholesterol, fibrinogen, PCR and markers of endothelial dysfunction (adiponectin, VCAM-1, ICAM-1 and IL-6) were determined in blood samples obtained from the umbilical cord. RESULTS: Placental atherosclerosis presented in 28.94% of the group with gestational diabetes compared to 10.52% of the group with normally progressing pregnancies (P=.044); differences were found in glucose, cholesterol, triglycerides, fibrinogen, HOMA-IR, PCR-us, HDL-C, not in VLDL-C. Twenty-one point five percent of the newborns of the gestational diabetes patients required hospitalization, against 5.2% in the control group, CONCLUSIONS: Pregnancies that involve diabetes have higher proportion of atherosclerosis, hospitalization of the newborn, insulin resistance, as well as elevation of markers associated with inflammation and endothelial dysfunction in umbilical cord blood.

[Family structure of obese/overweight and normal weight adolescents in México]. / Estructura familiar y estado de nutrición en adolescentes de Sonora, México.

BACKGROUND: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. AIM: To determine differences in family structure of adolescents according to their nutritional status. MATERIAL AND METHODS: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. RESULTS: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. CONCLUSIONS: There are differences in the family structure of overweight/obese and normal weight adolescents.

Efectos de la educación comunitaria sobre factores de riesgo en adultos mayores prediabéticos / Effects of community-based education on the risk factors in prediabetic older adults

Introducción: la educación es piedra angular en la prevención, atención y tratamiento de la diabetes mellitus. Promueve efectos positivos en la salud de los enfermos y sus familiares a través del conocimiento, con la finalidad de prevenir o retardar las complicaciones de la diabetes, por lo que ningún grupo etario debe ser excluido de este beneficio. Objetivo: determinar el efecto de la educación comunitaria sobre el sedentarismo, los hábitos alimentarios y la glucemia, en adultos mayores con prediabetes. Métodos: estudio cuasi experimental en 20 adultos mayores de ambos géneros, con glucemia capilar de 100 mg/dL a 125 mg/dL, derechohabientes del Instituto Mexicano del Seguro Social, adscritos a la Unidad de Medicina Familiar No. 17 del Instituto Mexicano del Seguro Social, en Villa Juárez, Sonora, México. Resultados: el promedio de edad fue 67 ± 6 años, con predominio del género femenino (60 %) y escolaridad baja. El 72 % de la población tenía familiares directos con diabetes mellitus. Luego de la estrategia educativa, mejoraron los conocimientos sobre diabetes, y hubo cambios significativos antes-después en la evaluación global (p= 0,0001), glucemia capilar (p= 0,0001) y hemoglobina glucosilada (p= 0,003). Así mismo, mejoraron los hábitos dietéticos y de ejercicio físico. Conclusiones: la estrategia educativa tiene un efecto benéfico sobre variables metabólicas y favorece cambios en el estilo de vida(AU)

Introduction: education is the milestone in the prevention, care and treatment of diabetes mellitus. It promotes positive effects for the patient's and the relatives' health through acquisition of knowledge for the purpose of preventing or delaying the diabetes complications, so any age group should be excluded from this benefit. Objective: to determine the effect of community-based education on sedentary and feeding habits and glycemia in pre-diabetic older adults. Methods: quasi-experimental study of 20 older adults of both sexes with capillary glycemia of 100 mg/dL a 125 mg/dL, rightful owners of the Instituto Mexicano del Seguro Social and ascribed to the family medicine unit no. 17 of Instituto Mexicano del Seguro Social in Villa Juarez, Sonora, Mexico. Results: the average age was 67 ± 6 years, females (60 percent) and low schooling prevailed. Seventy two percent of the population had first-line relatives with diabetes. After the educational strategy implementation, knowledge on diabetes improved and significant changes occurred when comparing before and after this intervention in terms of global assessment (p= 0.0001), capillary glycemia (p= 0.0001), and glycosylate hemoglobin (p= 0.003). Feeding habits and physical exercising showed some improvement. Conclusions: educational strategy has beneficial effects on the metabolic parameters and encourages lifestyle changes(AU)

Estructura familiar y estado de nutrición en adolescentes de Sonora, México / Family structure of obese/overweight and normal weight adolescents in México

Background: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. Aim: To determine differences in family structure of adolescents according to their nutritional status. Material and Methods: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. Results: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. Conclusions: There are differences in the family structure of overweight/obese and normal weight adolescents.

[Telemetric monitoring reduces visits to the emergency room and cost of care in patients with chronic heart failure]. / El seguimiento telemétrico disminuye la visita a la sala de urgencias y coste de atención en enfermos con insuficiencia cardíaca crónica.

BACKGROUND: Tele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. OBJECTIVE: To determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. MATERIAL AND METHODS: A randomized, controlled and open clinical trial was conducted on 40 patients with Heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. RESULTS: The telemetric monitoring group decreased their weight and improved control of the disease (P=.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group (P>.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. CONCLUSION: In patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up.

[Seroprevalence of antinuclear antibodies in blood donors in the Yaqui Valley]. / Seroprevalencia de anticuerpos antinucleares en donadores de sangre del valle del Yaqui.

BACKGROUND: Antinuclear antibodies are immunoglobulins that recognize autologous nuclear and cytoplasmic cellular components. In healthy persons they are not associated with autoimmune disease. However, they may be related to an immune risk phenotype that has not been sufficiently studied. We undertook this study to examine the presence of antinuclear antibodies in serum from blood donors. METHODS: Cross-sectional study on 379 blood donors between 18 and 65 years old. Serum for the presence of antinuclear antibodies by indirect immunofluorescence in HEp-2 cells was analyzed. The prevalence and pattern of expression were compared with age, gender, and history of rheumatic or thyroid disease. RESULTS: Prevalence of antinuclear antibodies in the study population was 13%. Most of the positive subjects were between 21 and 40 years old. Male gender expressed a greater proportion of positivity (11%) than females (2%). Likewise, 82% of males had low titers (1:80) and nucleolar type in 66% of cases (OR = 10.66 [1.83 to 62.18], p = 0.007). CONCLUSIONS: The presence of antinuclear antibodies in healthy individuals at low levels may not mean an autoimmune condition; however, it could reflect exposure to environmental factors that have not been sufficiently studied. New studies of healthy individuals are necessary in order to explain the association between the presence of these antibodies and toxic and environmental factors and their effects on health.

Antecedentes: los anticuerpos antinucleares son inmunoglobulinas que reconocen componentes celulares nucleares y citoplasmáticos autólogos. En personas sanas no se relacionan con alguna enfermedad autoinmune; sin embargo, pueden estar vinculados con un fenotipo inmunológico de riesgo que no ha sido suficientemente estudiado. Objetivo: examinar la existencia de anticuerpos antinucleares en el suero de donadores de sangre. Material y métodos: estudio transversal y analítico en búsqueda de anticuerpos antinucleares en suero mediante inmunofluorescencia indirecta en células HEp-2. La prevalencia y patrón de expresión se contrastaron con la edad, el género y los antecedentes de enfermedad reumática o tiroidea. Resultados: se estudiaron 379 donadores de sangre con límites de edad entre 18 y 65 años. La prevalencia de anticuerpos antinucleares en la población estudiada fue de 13%. La mayoría de los sujetos positivos tenía entre 21 y 40 años de edad. El género masculino expresó mayor proporción de positividad (11%) en comparación con las mujeres (2%). De la misma forma, 82% de los hombres tenía títulos bajos (1:80) y en 66% eran de tipo nucleolar (RM = 10.66 [1.83 a 62.18]; p = 0.007). Conclusiones: en individuos sanos, la existencia de anticuerpos antinucleares a títulos bajos puede no significar un estado de autoinmunidad; sin embargo, podría ser el reflejo de una exposición a factores ambientales que no han sido lo suficientemente estudiados. Es necesario realizar nuevos estudios en población sana que permitan explicar la asociación entre estos anticuerpos y los factores tóxicoambientales, así como sus efectos en la salud.

[Anthropometric measures in urban child population from 6 to 12 years from the northwest of México]. / Medidas antropométricas en la población infantil urbana de 6 a 12 años del noroeste de México.

BACKGROUND: The degree of overweight-obesity varies according to the conditions of each population and depending on geographical area, race or ethnicity, socioeconomic status, and susceptibility of each individual. The aim of this study was to determine anthropometric measures in urban child population from 6 to 12 years of Ciudad Obregón, Sonora. METHODS: We studied 684 schoolchildren from 6 to 12 years of age, of both genders in the urban area of Ciudad Obregón, Sonora. We measured weight, height, arm circumference (AC), waist, and body mass index (BMI). We used descriptive statistics (frequencies, percentages), and to compare the growth charts of this study vs. the reference standards (CDC and Ramos-Galván), we employed statistical inference (Student t test). RESULTS: On average, weight, height, AC, BMI for age by gender were higher than the reference standards at all ages. Seventy-four boys (22 %) and 51 girls (14.5 %) were above 95th percentile. With regards to size, 42 children (12.6 %) were below the 5th percentile and 37 (10.5 %) above the 95th percentile. CONCLUSION: Schoolchildren in the southern zone of Sonora showed a higher anthropometric pattern than the reference standards.

INTRODUCCIÓN: el grado de sobrepeso-obesidad tendrá variaciones de acuerdo con las condiciones de cada población, según el ámbito geográfico, la raza o etnia, el status socioeconómico y la susceptibilidad de cada individuo. El objetivo de este estudio fue determinar medidas antropométricas en la población infantil urbana de 6 a 12 años de Ciudad Obregón, Sonora. MÉTODOS: se estudiaron 684 escolares de 6 a 12 años de edad, sanos y de ambos géneros de la zona urbana de Ciudad Obregón, Sonora, en quienes se midieron peso, talla, perímetro braquial (PB), cintura e índice de masa corporal (IMC). Se realizó estadística descriptiva mediante frecuencias, porcentajes, e inferencial mediante t de Student para comparar las tablas de crecimiento de Ramos Galván y las del Centro para el Control y Prevención de Enfermedades (CDC). RESULTADOS: en promedio, peso, talla, PB, IMC por edad según el género fueron superiores a los estándares de referencia en todas las edades. Setenta y cuatro niños (22 %) y 51 niñas (14.5 %) se situaron por arriba del percentil 95. Con respecto a la talla, 42 niños (12,6 %) se encontraron por abajo del percentil 5 y 37 (10.5 %) por arriba del percentil 95. CONCLUSIÓN: los escolares de la zona sur del estado de Sonora presentaron un patrón antropométrico superior a los patrones de referencia conocidos.

[Depression and state of nutrition in schoolchildren from Sonora]. / Depresión y estado de nutrición en escolares de Sonora.

BACKGROUND: Pediatric obesity has become a problem of epidemic proportions, due to the inadequate and excessive consumption of food, sedentary lifestyle, and the restricted socio-economic development. This causes a major risk in health complications that have an effect on the psychological and social spheres of the child, which makes him endure such diseases as depression and anxiety. The aim of this study was to determine the association between depression and the nutritional status of schoolchildren from a family medicine unit in Sonora. METHODS: Cross-sectional study performed during 2011 in 101 schoolchildren from Sonora. Kovacs test was applied to detect depressive symptoms; nutritional status was determined by weight and height; body mass index was calculated according to the Center for Disease Control and Prevention (CDC) percentiles. The results were analyzed in SPSS version 18 using Mann-Whitney U and chi-square. RESULTS: Of all the patients with depression, 19 were obese; the other 10 showed a normal nutrition status. Patients with low weight did not show depression. The odds ratio (OR) for depression in students with obesity was 3.16, 95 % CI = 1.13, 7.12. CONCLUSIONS: The detection and management of depression should be considered in the treatment of obesity.

INTRODUCCIÓN: la obesidad infantil se ha convertido en un problema cuyas proporciones son epidémicas, debido al consumo excesivo e inadecuado de alimentos, al sedentarismo y al limitado desarrollo socioeconómico. Esto ocasiona un mayor riesgo en complicaciones en la salud que repercuten en el ámbito psicológico y social del infante, lo cual lo lleva a padecer enfermedades como la depresión y la ansiedad. El objetivo de este estudio fue determinar la asociación entre la depresión y el estado de nutrición en escolares adscritos a una unidad de medicina familiar en Sonora. MÉTODOS: estudio transversal analítico que se llevó a cabo durante el 2011 en 101 escolares de Sonora. Se aplicó el test de Kovacs para detectar síntomas depresivos; se determinó el estado nutricional mediante peso y talla, y el cálculo del índice de masa corporal se hizo de acuerdo con los percentiles de las tablas del Centro para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) de Atlanta. El análisis de los resultados se realizó con U de Mann-Whitney y chi cuadrada en el programa SPSS, versión 18. RESULTADOS: del total de pacientes con depresión, 19 presentaron obesidad y el resto presentó estado de nutrición normal (10); los pacientes con bajo peso no presentaron depresión. La razón de momios para depresión en escolares con obesidad fue de 3.16 con un IC al 95 % de 1.13; 7.12. CONCLUSIÓN: la detección y manejo de depresión debe ser considerada dentro del tratamiento de la obesidad.

[Family intervention for the management of overweight and obesity in schoolchildren]. / Intervención familiar para el manejo de sobrepeso y obesidad en escolares.

BACKGROUND: The management of obesity is complex and it must be multidisciplinary. Behavioral treatments for control of childhood obesity are based on family; these have a high degree of efficiency. It has been argued that when children and their parents are the main goal of the changes of behavior as a group, results of weight loss generally are better. The objective of this study was to establish the effect of an intervention based on family to reduce weight in students with overweight or obesity. METHODS: Quasi-experimental study in schoolchildren from 6 to 12 years of age, from a family medicine unit in Ciudad Obregón, Sonora, México. The intervention group corresponded to 30 schoolchildren with overweight or obesity, and one or both of their parents with overweight or obesity; the control group included 30 schoolchildren with overweight or obesity, and normal-weight parents. Weight, height and body mass index (BMI) were measured at baseline, monthly, and at the end of the study. Student t test was used to contrast quantitative variables using the SPSS v.15 program. RESULTS: There were differences in weight, but not in BMI, probably due to the effect of size. Compared with the control group, a higher proportion of schoolchildren showed an improvement with regard to nutritional status. CONCLUSIONS: The family intervention is basic for the treatment of overweight and obesity in schoolchildren.

INTRODUCTIÓN: el manejo de la obesidad es complejo y debe ser multidisciplinario; los tratamientos conductuales basados en la familia para el control de la obesidad infantil tienen un alto grado de eficacia. Se ha argumentado que cuando los niños y los padres son blanco de los cambios de comportamiento en conjunto, los resultados de pérdida de peso generalmente mejoran. El objetivo es determinar el efecto de una intervención basada en la familia para la reducción de peso en escolares con sobrepeso u obesidad. MÉTODOS: estudio cuasi experimental en escolares de 6 a 12 años de la Unidad Médica Familiar 1 en Ciudad Obregón, Sonora. El grupo de intervención correspondió a 30 escolares con sobrepeso u obesidad, además de que uno o ambos padres presentaron sobrepeso u obesidad; en el grupo control se incluyeron 30 escolares con sobrepeso u obesidad, y padres con peso normal. Se midió peso, talla e índice de masa corporal (IMC) basal, final y mensual. Se utilizó t de Student para contrastar las variables cuantitativas, por medio del programa SPSS, versión 15. RESULTADOS: hubo diferencias en peso, pero no en IMC, probablemente por el efecto de la talla. Mayor proporción de escolares presentó mejoría en estado de nutrición comparado con el grupo control. CONCLUSIONES: es básica la intervención familiar para el tratamiento del sobrepeso y la obesidad en escolares.

[Ankle-brachial index associated with diabetic foot: case-control study]. / Índice tobillo-brazo asociado a pie diabético. Estudio de casos y ontroles.

INTRODUCTION: The diabetic foot has been associated with substantial morbidity and mortality in diabetic patients. The ankle-brachial index is a simple diagnostic method for peripheral arterial disease. OBJECTIVE: to evaluate the usefulness of the physical ankle-brachial index and known risk factors in the development of diabetic foot. METHODS: In a case-control study, we studied 60 diabetic patients between 20 and 70 years old who were divided according to the presence of diabetic foot (cases); controls were assigned for patients without injury to their feet or other morbidities. The variables studied included: glucose, cholesterol, triglycerides, body mass index, blood pressure, ankle-brachial index, physical exercise, smoking, and alcoholism. RESULTS: Mean age was 55 years for cases and 56 for controls (p = 0.548), with an average of disease progression 15 years for both groups. No differences in metabolic variables were found. A history of smoking (OR = 4.8, 95% CI = 1.50 to 15.80, p = 0,006) and an ankle-brachial index = 0.9 left (OR = 10.6, 95% CI = 1.80 to 55.60, p = 0.004) or right (OR = 5.2, 95% = 1.16 to 24.00, p = 0.049) were associated with development of peripheral arterial disease. Instead, the exercise proved to be a protective factor. CONCLUSIONS: The ankle-brachial index, should be used in primary care clinics for the study of the arterial circulation of the lower limbs, especially in patients with diabetes mellitus of medium and long evolution or cardiovascular risk factors.

Factores de riesgo para hipertensión arterial en escolares del noroeste de México / Risk factors for hypertension among school-age children in the northwest of Mexico

Introducción: Estudios epidemiológicos han demostrado que la hipertensión arterial sistémica (HTAS) puede comenzar desde los primeros años de vida. El objetivo de este estudio fue determinar la prevalencia de HTAS y factores de riesgo (FR) en escolares de una comunidad en el noroeste de México. Material y métodos: Estudio polietápico, aleatorizado en escolares sanos de 6 a 12 años de edad. Medición de presión arterial (PA) y variables antropométricas (VA). Se consideró HTAS cuando la PA con relación a talla fuera ≥ al porcentil 95 en tablas locales (TL) y Task Force (TF). Evaluación de los FR mediante cuestionario aplicado a padres y alumnos. Resultados: En 684 niños, 51.3% mujeres y 46.8% hombres, la prevalencia de HTAS según TF fue de 7.74% y 2.63% con TL. Se observó una asociación entre PA con VA. El peso y la edad son FR para PAS, en cambio el peso sólo para PAD. Conclusiones: La prevalencia de HTAS fue similar a reportes en la literatura según TL, pero se encuentra aumentada según el TF. Hubo correlación directa entre la PA con VA y resultaron como FR para HTAS el peso y edad.

Introduction:Epidemiological studies have shown that arterial hypertension can start since the first years of life. The aim of this study was to determine the prevalence of hypertension and risk factors (RF) among school-age children from one community in the northwest of Mexico. Material and methods: A poly-stage, randomized study was carried out in healthy pupils aged 6 to 12 years old. Blood pressure (BP) and anthropometrical variables were measured. Hypertension was considered whenever BP in relation to body height was ≥ 95 percentil in local tables (LT) and task force (TF). RF was assessed using a questionnaire applied to parents and students. Results: In 684 children, 51.3% females and 46.8% males, the prevalence of hypertension according to TF was 7.74% and 2.63% according to LT. An association between hypertension and anthropometrical variables was observed. Weight and age are RF for systolic hypertension, while weight was RF for diastolic hypertension. Conclusion: Hypertension prevalence according to LT was similar to the one reported in other studies; however, it is increased according to TF. There was a direct correlation between hypertension and anthropometrical variables. Weight and age were RF for hypertension.

Are Mexican agricultural farmlands PCDD/F soil reservoirs?

Our aim was to identify polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzo-p-furans (PCDFs) in agricultural farmland soils in the Northwest of Mexico. We obtained ≈50 g of soil in five Yaqui Valley (VY) agricultural fields in the north-western Mexican State of Sonora and in five Culiacán Valley (VC) agricultural fields in the north-western Mexican State of Sinaloa. Fields with minimal tillage, with ferti-irrigation, and those with intensive aerial and manual tillage were included. All soil samples were subjected to the chemical activated luciferase gene expression (CALUX(®)) test to determine PCDD/F. On average, samples contained 4.2 ± 1.2 PCDD/F ppt TEQ; VY soil samples contained 4.72 ± 1.23 PCDD/F ppt TEQ, while VC soil samples showed 3.6 ± 1.1 PCDD/F ppt TEQ (p = 0.47). On considering tillage-type, in agricultural fields catalogued as intensive tillage, PCDD/F concentrations were 4.40 ± 0.43 in agricultural fields catalogued as intensive tillage, while in farmlands of another tillage-type these concentrations were slightly higher (5.53 ± 0.8).

[Geometric coding and cluster analysis to assess metabolic control of patients with type 2 diabetes mellitus]. / Codificación geométrica y análisis de conglomerados para evaluar el control metabólico de pacientes con diabetes mellitus tipo 2.

OBJECTIVE: Determine the frequency of combinations of higher-than-normal metabolic control parameters, using geometric coding and hierarchical cluster analysis, in patients with type 2 diabetes (DM2) METHODOLOGY: A descriptive cross-sectional study was conducted in Mexico to assess a group of 1 051 patients with DM2. The inclusion criteria were to have one or more of the following values: fasting glucose of 130 mg/dL, total cholesterol of 240 mg/dL, total triglycerides of 200 mg/dL, Body Mass Index of 27 kg/m(2), and systolic blood pressure higher than 130 mmHg or diastolic blood pressure higher than 85 mmHg. Through geometric coding, the frequencies of all combinations were obtained. Cluster analysis was used to determine similarities among the combinations. RESULTS: Using the proposed instrument, it was observed that the paired combinations with the highest number of subjects were hyperglycemia-hypertriglyceridemia (7.3%) and hyperglycemia-hypercholesterolemia (3.6%). The most frequent polycombinations were hyperglycemia-hypercholesterolemia-hypertriglyceridemia (13.2%) and hyperglycemia-hypertriglyceridemia-hypercholesterolemia-hypertension (10.5%). CONCLUSIONS: Geometric coding and cluster analysis could become a suitable instrument for assessing the metabolic control of patients with DM2, as well as for identifying parameters that will help improve their monitoring and treatment.

Codificación geométrica y análisis de conglomerados para evaluar el control metabólico de pacientes con diabetes mellitus tipo 2 / Geometric coding and cluster analysis to assess metabolic control of patients with type 2 diabetes mellitus

Objetivo: Determinar la frecuencia de las combinaciones de los parámetros de control metabólico por arriba de lo normal, usando la codificación geométrica y el análisis jerárquico de conglomerados, en pacientes con diabetes mellitus tipo 2 (DM2). Métodos: Se desarrolló en México un estudio transversal descriptivo para evaluar a un grupo de 1 051 pacientes con DM2, cuyos criterios de inclusión eran tener uno o más de los siguientes valores: glucosa en ayunas > 130 mg/dL, colesterol total > 240 mg/dL, triglicéridos totales > 200 mg/dL, índice de masa corporal > 27 kg/m², y presión arterial sistólica mayor de 130 mmHg o presión arterial diastólica mayor de 85 mmHg. Por medio de codificaciones geométricas se obtuvieron las frecuencias de todas las combinaciones. Para definir similitudes entre las combinaciones se utilizó el método de análisis de conglomerados. Resultados: Utilizando el instrumento propuesto, se observó que la combinación en pares con mayor número de sujetos estuvo representada por hiperglucemia-hipertrigliceridemia (7,3 por ciento) e hiperglucemia-hipercolesterolemia (3,6 por ciento). Las policombinaciones de mayor frecuencia fueron hiperglucemia-hipercolesterolemia-hipertrigliceridemia (13,2 por ciento) e hiperglucemia- hipertrigliceridemia-hipercolesterolemia-hipertensión (10,5 por ciento). Conclusiones: La codificación geométrica y el análisis por conglomerados podrían llegar a ser un instrumento idóneo para evaluar el control metabólico de los pacientes con DM2, así como para identificar parámetros que contribuyan a mejorar su monitoreo y su tratamiento.

Objective: Determine the frequency of combinations of higher-than-normal metabolic control parameters, using geometric coding and hierarchical cluster analysis, in patients with type 2 diabetes (DM2) Methodology: A descriptive cross-sectional study was conducted in Mexico to assess a group of 1 051 patients with DM2. The inclusion criteria were to have one or more of the following values: fasting glucose of 130 mg/dL, total cholesterol of 240 mg/dL, total triglycerides of 200 mg/dL, Body Mass Index of 27 kg/m², and systolic blood pressure higher than 130 mmHg or diastolic blood pressure higher than 85 mmHg. Through geometric coding, the frequencies of all combinations were obtained. Cluster analysis was used to determine similarities among the combinations. Results: Using the proposed instrument, it was observed that the paired combinations with the highest number of subjects were hyperglycemia-hypertriglyceridemia (7.3 percent) and hyperglycemia-hypercholesterolemia (3.6 percent). The most frequent polycombinations were hyperglycemia-hypercholesterolemia-hypertriglyceridemia (13.2 percent) and hyperglycemia-hypertriglyceridemia-hypercholesterolemia-hypertension (10.5 percent). Conclusiones: Geometric coding and cluster analysis could become a suitable instrument for assessing the metabolic control of patients with DM2, as well as for identifying parameters that will help improve their monitoring and treatment.