[Demographic factors and comorbidity associated to prehypertension]. / Factores demográficos y de comorbilidad asociados a prehipertensión arterial.

BACKGROUND: prehypertension is the category established in JNC-7, which designates the individuals that present diastolic blood pressure of 80-89 mm Hg and systolic blood pressure of 120-139 mm Hg, and it is associated to high rates of cardiovascular disease. The purpose of the study was to identify prevalence rates and their correlation with sociodemographic factors and comorbidity in a sample of a population of Veracruz, Mexico. METHODS: a cross-sectional and representative survey was chosen by means of probability sampling. Sociodemographic factors, lifestyle and anthropometric characteristics were assessed. Odds ratios and 95 % confidence intervals were obtained. RESULTS: the prehypertension prevalence found was 33.8 %, with an average age of 40.9 ± 14.2 years in prehypertensive subjects, and 50.6 ± 12.7 in hypertension subjects (p < 0.05). In relation with prehypertension, males presented a 1.48 (1.18-1.86) OR. Also, those who had more than 40 years had an OR of 1.9 (1.51-2.38); the ones with basic schooling, an OR of 1.73 (1.38-2.17); subjects with hyperglycemia, OR 3.0 (1.5-3.75); with overweight, OR 1.41 (1.01-1.68); and those with other comorbidities an OR of 1.61 (1.09-2.36). CONCLUSIONS: a high prevalence of prehypertension was found in the sample, and it was associated to male gender subjects, aged above 40 years, with basic schooling and relevant comorbidities, such as diabetes and cardiovascular disease.

Introducción: la prehipertensión arterial es la categoría establecida en el JNC-7 para definir las cifras de presión arterial diastólica de 80-89 y sistólica de 120-139 mm Hg que se asocian a riesgo cardiovascular. El objetivo del estudio fue determinar su prevalencia y su asociación con factores sociodemográficos y de comorbilidad en una muestra representativa de la población del estado de Veracruz. Métodos: por medio de muestreo probabilístico y una encuesta transversal, se registraron variables sociodemográficas, estilo de vida, antropometría, presión arterial y glucosa. Se obtuvieron razones de momios (RM) e intervalos de confianza (IC) del 95 % para los factores de riesgo mencionados. Resultados: la prevalencia de prehipertensión fue de 33.8 %, con edad promedio de 40.9 ± 14.2 años en prehipertensos y 50.6 ± 12.7 en hipertensos (p < 0.05). Para prehipertensión, el sexo masculino presentó RM de 1.48 (1.18-1.86). Asimismo, aquellos mayores de 40 años tuvieron una RM de 1.9 (1.51-2.38); los que tenían escolaridad básica, RM de 1.73 (1.38-2.17); aquellos con hiperglucemia de ayuno, RM de 3.0 (1.5-3.75); con sobrepeso, RM de 1.41 (1.01-1.68); y con otras comorbilidades, una RM de 1.61 (1.09-2.36). Conclusiones: se encontró una elevada prevalencia de prehipertensión en esta muestra de la población y su asociación de riesgo fue con las personas de sexo masculino que eran mayores de 40 años y que tenían escolaridad básica y comorbilidades como diabetes y enfermedad cardiovascular.

Expresión clínica del dengue en usuarios del Instituto Mexicano del Seguro Social, Veracruz, México / Clinical expression of dengue in beneficiaries of the Instituto Mexicano del Seguro Social in Veracruz, Mexico

Objective: To describe and compare the clinical behavior of Dengue Fever (DF) and Hemorrhagic Dengue Fever (HDF) in beneficiaries of the Instituto Mexicano del Seguro Social (IMSS). Methods: Transversal study in beneficiaries from Veracruz, selected among those who sought attention at two medical attention units, with probable dengue diagnosis. Surveys were performed to know personal and epidemiological data, as well as a clinical follow up. Blood samples were taken for RT-PCR viral identification and antibodies against Dengue. In the same way, platelet, hemoglobin, and hematocrit tests were performed for their determination. The SPSS 12.0 software was used for the process and analysis of the information, and simple frequencies, proportions, and means were estimated. Results: 109 patients were studied, classified as 72 DF and 37 as HDF. 40 isolations were performed, and the circulation of the four types of dengue virus was identified, although most of the isolations corresponded to serotype 2 (Asian-American genotype). In one patient, a simultaneous infection of dengue viruses 1 and 2 was identified. A group of patients did not present hemorrhages, capillary fragility, or liquid permeation, but with important thrombocytopenia and hemoconcentration, all infected with den-1 and den-2. Conclusions: The presence of cases with atipical behavior of the diseases were identified. The characteristics and immunologic experience of the populations, as well as the simultaneous circulation of various dengue viruses and their changing structure could be related with the current clinical behavior of Dengue in Mexico. It is important to continue the research to confirm these asseverations.

Estrategia educativa para la toma de citología cervical / Educational Strategy to improve the Quality of Cervical Cytology Making

Resumen

Objetivo: evaluar la estrategia educativa de visita del profesor para mejorar la calidad en la toma de citología cervical del programa DOCCACU en IMSS Zona Xalapa, Veracruz.

Metodología: en la primera fase se aplicó un instrumento con preguntas abiertas y una lista de verificación que describe la técnica, al personal que toma las muestras. En la segunda fase se desarrolló la intervención educativa visita de profesor y en la tercera fase nuevamente se aplicó la misma herramienta con observación directa del procedimiento. El impacto se midió comparando la proporción de laminillas adecuadas antes del estudio y tres meses después de la intervención educativa.

Resultados: se evaluaron 89 enfermeras antes de la capacitación con una media de aciertos de seis, después de la capacitación la media fue de 11, con un valor de p < 0.05. En cuanto al impacto de la capacitación sobre el programa, encontramos que en el 2009 de junio a septiembre, las muestras inadecuadas fueron 208, en el 2010 en el mismo periodo de tiempo, después de la estrategia educativa fueron 151, con un valor de p < 0.05.

Conclusión: dentro de las instituciones del sector salud existen indicadores que nos hablan de cobertura e impacto en la población pero muy pocos que nos hablen de la calidad de los procesos, lo cual se ve reflejado en las tasas de mortalidad. La estrategia educativa de visita del profesor mejora la calidad de la toma de la muestra al disminuir el número de muestras inadecuadas y aumentar la detección de lesiones así como mejora el conocimiento en los alumnos.

Summary

Objective: to evaluate the educational strategy of teacher’s visit to improve the quality of the specimen collection for Cervicovaginal Cytology of the Program Opportune detection of Cervico-uterine Cancer in the units of Familiar Medicine of the Instituto Mexicano del Seguro Social (IMSS) of the Zone Xalapa, Veracruz, Mexico.

Methodology: in the first phase a questionnaire was applied by opened questions and a list of check that describes the technique, to the personnel that takes the slides. The second phase developed the educational intervention (the visit of the teacher) and in the third phase again the same tool was applied by direct observation of the procedure. The impact was measured up comparing the proportion of good technique realized slides before the study and the ones realized 3 months after the educational intervention

Results: there were evaluated a total of 89 nurses finding before the training an average of successes of 6 slides, and after the training an average of 11, with a value of p minor of 0.05. As for the impact of the training on the program, we find that in 2009 from June to September, the inadequate technique realized slides samples were 208, in 2010 in the same period of time, after the educational strategy they were 151, with a value of p of 0.001.

Conclusion: the Health Sector has documents that indicate about coverage and Impact in the population but very few ones which speak about the quality of the process, which seems reflected in the rates of mortality. The educational strategy of teacher’s visit improves the quality of the specimen collection, decreasing the number of inadequate specimen collection and increasing the detection of injuries, as well as it improves the knowledge in the pupils.

[Epilepsy and remission in primary care level]. / Epilepsia y su remisión en primer nivel de atención.

OBJECTIVE: To identify the epilepsy remission period in a primary care unit. METHODS: There were 330 patients with diagnosis of epilepsy in remission according to the international criteria treated in a Primary Care Unit of the Instituto Mexicano del Seguro Social, Xalapa, Veracruz; There were 216 patients who were controlled (without epilepsy crisis) 150 of them were interviewed with a structure instrument designed for this purpose. RESULTS: The history of epilepsy was from five to nine years (49%). Partial crisis was identified in 54%. The age of diagnosis was established in 44% between one to ten years. The patients received drug treatment during a period of three to eight years in 51% of them. The monotherapy was used in 51% of the cases. CONCLUSIONS: Remission of epilepsy crisis can be obtained in most patients with two years drug treatment. However, we can not talk about definitive cure.

[Validation of an instrument to measure the clinical aptitude of the pregraduated intern attention of the diabetic patient with chronic complications in home]. / Instrumento para medir aptitud clínica del interno de pregrado en atención domiciliaria del diabético con complicaciones crónicas.

OBJECTIVE: To validate an instrument to evaluate the clinic aptitude of the pregraduate intern in the integral attention of the diabetic patient with chronic complications at home. METHODS: A comparative cross-sectional study; 114 pregraduate interns from five medical units were included to determine the clinic aptitude by an instrument with five real clinical cases of diabetic patients. Seven clinical indicators and 175 statements were used. The instrument was validated with two rounds of experts and the trustworthiness with a pilot group. Nonparametric statistics were used. RESULTS: The consistency of the instrument was of 0.91. The clinic aptitude of the pregraduate interns was low and very low, except in a medical units that resulted intermediate. When comparing the five medical units, there were significant differences in the global qualification in six of the seven indicators. CONCLUSIONS: The instrument fulfilled the requirements of validity.

Identificación de un caso de fenilcetonuria a través del tamizaje neonatal / Diagnosis of phenylketonuria by newborn screening

Introducción. La fenilcetonuria es una enfermedad hereditaria autosómica recesiva, causada por un defecto de la enzima fenilalanina hidroxilasa, la cual es responsable de la conversión de la fenilalanina en tirosina. Es la segunda causa más frecuente de retardo mental prevenible. Se desconoce su incidencia en México. En el caso que aquí se presenta, el diagnóstico precoz fue realizado con el tamiz neonatal ampliado y el tratamiento consistió en una dieta baja en fenilalanina. Caso clínico. Paciente masculino de 2 meses de edad sin datos de retardo psicomotor. Se le realizó la prueba de tamiz neonatal a los 3 días de nacido con valores de fenilalanina de 15.25 mg/dL y control a los 2 meses de 39.7 mg/dL. El diagnóstico fue confirmado con el análisis cuantitativo de la concentración de fenilalanina y de tirosina, por medio de la cromatografía de líquidos de alta resolución. Se recomendó un tratamiento de fórmula láctea libre de fenilalanina y dieta vegetariana. Conclusión. Las pruebas de tamizaje neonatal permiten la detección oportuna de enfermedades metabólicas en pacientes asintomáticos, como en el caso de la fenilcetonuria.

Introduction. Phenylketonuria is an autosomic recessive hereditary disease caused by a defect of the enzyme phenylalanine hydroxylase, which is responsible for the phenylalanine conversion to tyrosine. It is the second most frequent although preventable cause of mental retardation. Its incidence in Mexico is unknown. Early diagnosis is made through extended newborn screening, and treatment consists of a low-phenylalanine diet. Case report. Masculine 2-months old with no data of psycho-motor retardation. Newborn screening tests were performed. Values of phenylalanine were 15.25 mg/dL 3 days after delivery, whereas follow-up values at 2 months of age were 39.7 mg/dL. Diagnosis was confirmed with quantitative analysis of phenyla-lanine and tyrosine concentration by HPLC. Treatment consisted of phenylalanine-free infant formula and vegetarian diet. Conclusion. Newborn screening tests allow early detection of metabolic diseases in asymptomatic patients, such as phenylketonuria.

Apoyo social en la diabetes tipo 2 / Social support in type 2 diabetes

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[Effectiveness of the topical application of fluor on the moderate gingivitis in diabetic type 2]. / Eficacia de la aplicación tópica de flúor sobre la gingivitis moderada en diabéticos tipo 2.

OBJECTIVE: To evaluate the efficiency of the fluor topic application vs. oral washing gel in diabetic patients type 2 with moderate gingivitis. METHODS: Controlled clinical test double blind in a Primary Care Unit from February 2003 to May 2004. Both gender patients from 40 to 60 year old diagnosed with moderate gingivitis were included and randomly assigned to each group. Cherry flavored fluor gel and hygienic measures were applied to the cases during 10 consecutive days of treatment. Hygienic measures and oral washing gel were applied to the control group during 10 days. The relative risk and confidence interval of 95 %. RESULTS: The fluor group (n = 14) reported a greater efficacy than oral washing gel group at the end of the treatment. No adverse effects were found. CONCLUSIONS: The topic application of Fluor and hygienic measures were effective diminishing gingivitis without adverse effects and at a low cost.

Aptitud clínica de enfermería en el manejo del paciente con diálisis peritoneal intermitente / Clinical aptitude of nurses about management patients with intermittent peritoneal dialysis (IPD)

Introducción: Hospitales con más de 15 mil nacimientos por año, requieren de personal de enfermería con aptitudes clínicas basadas en pensamiento crítico, ya que deben tomar decisiones claras y oportunas. Objetivo: Evaluar una estrategia educativa promotora del desarrollo de aptitudes clínicas en el cuidado del recién nacido críticamente enfermo. Metodología: Intervención educativa promotora de la participación con duración de 40 horas en nueve enfermeras(os) que laboran en la unidad de cuidados intensivos neonatales. La estrategia educativa consistió en la discusión de casos clínicos con base en una guía que les fue entregada para ser contestada en casa. Posteriormente se aplicó medición inicial y final con instrumento previamente validado. Resultados: Posterior a la intervención todos los alumnos rebasaron lo explicable por efecto del azar. En la calificación por indicadores existió una diferencia significativa a favor de la estrategia (Kruskal Wallis 0.476 y 0.004 ). La aptitud clínica global mejoró significativamente después de la implementación de la estrategia (McNemar 0.0001). Conclusiones: La estrategia educativa promotora de la participación aumentó la aptitud clínica en enfermeras(os) ante el cuidado de neonatos críticamente enfermos.

Introduction: Hospitals with more than 15,000 births per year require nurses with clinical aptitude based on critical thinking because they should make clear and opportune decisions. Objective: To evaluate an educational strategy that promotes development of clinical aptitudes during taking care of criticallyill newborns. Methodology: Educational intervention that promotes participation was implemented during 40 hours length on nine nurses who worked in neonatal intensive care unit. The educational strategy consisted on discussion of clinical cases based on a given guideline to be answered at home. Afterwards, an initial and a final measurement were applied with an instrument previously validated. Results: After intervention, all students surpassed what is explainable randomized effect. On scoring by indicators, there was a significant difference in favor of the strategy (Kruskal Wallis 0.476 and 0.004). The global clinical aptitude improved significantly after the implementation of the strategy (McNemar 0.0001). Conclusions: The educational strategy that promotes participation increased clinical aptitude in nurses taking care of criticallyill newborns.

[Dengue fever during pregnancy. Cases report]. / Dengue durante el embarazo. Comunicación de casos.

Dengue is known as an endemic disease of tropical and subtropical regions. It was considered a disease very frequent on kids, but recently an increase was reported on adult people. Some of these cases were related to pregnant women, for that reason, we decided to check eight cases, including just the mothers who presented dengue virus infection through ELISA IgM. IgG and ELISA IgM studies. Five products were determined between 3 and 9-born-babies. Eight cases of dengue were analyzed during pregnancy, three cases of fever dengue and five cases of hemorrhagic dengue; main complications detected were threat of abortion, and premature labour, postsurgical bleeding with desiccant haematoma of uterine artery, oligohydramnios, as well as pleural effusion, two of the neonates were classified as septic for presenting fever. In no case, IgG or IgM for fever dengue was detected in neonates.