External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Neurobehcet, a propósito de un caso / Neurobechet, about a case

El neurobehcet (NB) es una manifestación poco frecuente y grave de la enfer-medad de Behcet (EB) con diferentes formas de presentación según el aérea del sistema nervioso que se vea afectada. Se presenta el caso de una paciente de sexo femenino de 38 años de edad con historia de larga data de psicosis de posible cau-sa orgánica. Durante su última hospitalización por deterioro funcional y cognitivo se rescata el antecedente de úlceras orales y genitales y un episodio previo de es-cleritis. Se complementa el estudio con punción lumbar, resonancia y angioreso-nancia nuclear magnética de cerebro y antígeno de histocompatibilidad los cuales sugieren el diagnóstico de NB. Se trata con corticoides e inmunosupresores, pero a pesar de mejoría en el líquido cefalorraquídeo no hay mejoría clínica, que se presume sería consecuencia de lo tardío del diagnóstico y tratamiento.

Neurobehcet (NB) is a rare and serious manifestation of Behcet's disease (EB), with different forms of presentation depending on the area of the nervous system involved. A clinical case of a 38-year-old female patient with a long-standing his-tory of psychosis of possible organic cause is presented. During her last hospital-ization due to functional and cognitive impairment the history of oral and genital ulcers and a previous episode of scleritis is obtained. The study is complemented with a lumbar puncture, magnetic resonance, magnetic nuclear angioresonance of the brain and histocompatibility antigen which suggests the diagnosis of NB. It is treated with corticosteroids and immunosuppressants, but despite improve-ment in cerebrospinal fluid there is no clinical improvement, which is presumed to be a consequence of the late diagnosis and treatment.

Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.

Factors Associated with Health-Related Quality of Life in Mexican Lupus Patients Using the LupusQol.

INTRODUCTION: Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE). OBJECTIVE: To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE. METHODS: A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman's rank correlation coefficient and linear regression analysis. RESULTS: A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (ß = -3.756, p<0.005), fibromyalgia (ß = -0.920, p<0.005), depression (ß = -0.911, p<0.005) and disease activity (ß = -0.911, p<0.005) were associated with poor HRQOL. CONCLUSION: SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients.

Genetic ancestry in relation to the metabolic response to a US versus traditional Mexican diet: a randomized crossover feeding trial among women of Mexican descent.

BACKGROUND/OBJECTIVES: Certain populations with a large proportion of indigenous American (IA) genetic ancestry may be evolutionarily adapted to traditional diets high in legumes and complex carbohydrates, and may have a detrimental metabolic response to US diets high in refined carbohydrates and added sugars. We tested whether IA ancestry modified the metabolic response to a US versus traditional Mexican diet in a controlled dietary intervention. SUBJECTS/METHODS: First and second generation Mexican immigrant women (n=53) completed a randomized crossover feeding trial testing the effects of a US versus traditional Mexican diet. The metabolic response to the diets was measured by fasting serum concentrations of glucose, insulin, insulin-like growth factor-1 (IGF-1), IGF-binding protein-3 (IGFBP-3), adiponectin, C-reactive protein, interleukin-6 and computed homeostasis model assessment for insulin resistance (HOMAIR). Blood collected at baseline was used for genotyping, and estimation of African, European and IA ancestries with the use of 214 ancestry informative markers. RESULTS: The genetic ancestral background was 56% IA, 38% European and 6% African. Women in the highest IA ancestry tertile (>62%) were shorter in height, less educated and less acculturated to the US lifestyle, and tended to have higher waist-to-hip ratio compared with women in the middle and lowest IA ancestry tertiles, respectively. Compared with the US diet, the traditional Mexican diet tended to reduce glucose, insulin, IGF-1, IGFBP-3 and HOMAIR among women in the middle IA ancestry group (IA ancestry ⩽45-62%), whereas having no effect on biomarkers related to inflammation. CONCLUSIONS: We observed modest interactions between IA ancestry and the metabolic response to a US versus traditional Mexican diet among Mexican immigrant women.

Trombosis venosa cerebral en una paciente puérpera con preeclampsia con datos de severidad / Cerebral venous thrombosis in a post-partum patient with preeclampsia with signs of severity

Resumen ANTECEDENTES: la trombosis venosa cerebral es infrecuente, pero con mayor incidencia durante la gestación y el puerperio. OBJETIVO: revisar la bibliografía más reciente y proponer una opción de tratamiento de la paciente con trombosis venosa cerebral durante el puerperio. CASO CLÍNICO: paciente de 30 años de edad, con antecedente de dos embarazos y dos cesáreas. En el séptimo día de puerperio tuvo edema de miembros inferiores, cifras tensionales elevadas, cefalea y alteraciones visuales. Con el tratamiento antihipertensivo con nifedipino y neuroprotección con sulfato de magnesio se logró el control de la hipertensión, aunque persistieron la cefalea y los síntomas de visión borrosa y diplopía. La resonancia magnética reportó: trombosis venosa de seno transverso lateral izquierdo. Con el tratamiento anticoagulante hubo disminución importante de los síntomas neurológicos. CONCLUSIONES: puesto que la preeclampsia y la eclampsia pueden ocultar los síntomas de la trombosis venosa cerebral, es importante tener siempre en mente ambos padecimientos para el diagnóstico y tratamiento oportuno de uno y otro.

Abstract BACKGROUND: cerebral venous thrombosis is infrequent, but with the highest incidence during pregnancy and puerperium. OBJECTIVE: to review the most recent bibliography and propose a treatment option for the patient with cerebral venous thrombosis during puerperium. CLINICAL CASE: a 30 year old patient with a history of two pregnancies and two Cesarean sections. On the seventh day of puerperium she presented edema of the lower limbs, high blood pressure, headache and visual disorders. Antihypertensive treatment with nifedipine and neuroprotection with magnesium sulfate, hypertension was controlled although the headache and blurry vision and double vision symptoms persisted. The MRI results reported: venous thrombosis of the left lateral transverse sinus. With anticoagulant treatment there was significant decrease of neurological symptoms. CONCLUSIONS: since preeclampsia and eclampsia can hide symptoms of cerebral venous thrombosis, it is important to always consider both conditions for the timely diagnosis and treatment of both.

Population Fluctuation of Ceratitis capitata (Diptera: Tephritidae) as a Function of Altitude in Eastern Guatemala.

Population fluctuations of Ceratitis capitata (Wiedemann) were evaluated over a period of 12 mo in four altitudinal strata (400-750, 750-1,100, 1,100-1,450, and 1,450-1,800 meters above sea level, masl) in Eastern Guatemala. Within each altitudinal range, sampling plots were established in coffee plantations and adjacent areas, in which Jackson traps were set and baited with Trimedlure. Coffee berries and other host fruits were collected. Population density was lowest at the 400-750 masl stratum and highest at 1,450-1,800 masl. At every altitudinal range, the fluctuations of the pest were associated mainly with the availability of ripe coffee berries as a primary host. From 750-1,450 masl, the pest was also associated with the availability of sweet orange and mandarins in commercial and backyard orchards. The highest densities of the pest were recorded in the dry season. Citrus were the main alternate host where ripe coffee berries were not available. This knowledge on population dynamics of C. capitata will contribute to develop more effective area-wide pest management strategies including the use of sterile insects, natural enemies, and bait sprays.

Manejo y administración de hemoderivados por personal de enfermería en un hospital de segundo nivel / Handling and management of blood-derived products by the nursing staff in a second level hospital

Introducción: El manejo y administración de hemoderivados es una actividad que realiza el personal de enfermería, por lo cual es de gran importancia tener presente que un uso inadecuado de éstos puede tener consecuencias graves en los pacientes, siendo fundamental el buen desempeño del personal de enfermería para la práctica segura. Objetivo: Evaluar el desempeño de enfermería en el manejo y administración de hemoderivados en un hospital de segundo nivel. Métodos: Estudio de diseño transversal. Se incluyeron enfermeras durante el 1º Enero al 30 junio del 2013. Se utilizó un instrumento validado que consta de 4 criterios con 27 ítems de respuestas dicotómicas para identificar el desempeño en el manejo y ministración de hemoderivados. La población fue dividida por categoría contractual. Análisis estadístico: prueba Chi-cuadrada y/ exacta de Fisher. Resultados: Se incluyeron un total de 110 observaciones a personal de enfermería que administró hemoderivados. Se obtuvo un índice de eficiencia global parcial (IEG) parcial a excelente de 64.5%. No se encontró asociación en el turno (p=0.16), servicio (p=0.31) y/o categoría contractual (p=0.25). Los porcentajes de excelente en el IEF fueron bajos (por turno: matutino y nocturno de 10 y 13 respectivamente, medicina interna y cirugía general 5 y 7%, y conforme a la categoría contractual, la enfermera general obtuvo en excelente sólo el 7.5%). Conclusiones: Nuestros resultados nos alertan para implantar programas de capacitación a enfermeras, para otorgar atención de calidad, disminuyendo los riesgos que comprometan la vida del paciente.

Introduction: Handling and managing blood-derived products is a nursing staff activity and thus, it is very important to keep in mind that an inadequate handling of these products can have serious consequences on patients. Therefore, a safe practice from the nursing staff is fundamental. Objective: To assess the nursing performance related to the handling and management of blood-derived products in a second level hospital. Methods: A transversal study design. Nurses were observed from January 1 to June 30, of 2013. A validated instrument with 27 dichotomy-items, and based on 4 criteria, to assess the handling and management of blood-derived products was used. The population was divided by contractual category. Statistical analysis: Chi square and/or Fisher exact test. Results: A total of 110 observations to the nursing staff handling and managing blood-derived products were included. An index of global efficiency (IGE) of partial to excellent of 64.5% was obtained. No associations were found with shift (p=.16), service (p=.31) and/or contractual category (p=.25). The percentages of excellent in the IEF were low (per shift: morning and night of 10 and 13 respectively; per service: internal medicine and general surgery 5 and 7%, and according to the contractual category, overall excellent nurse obtained only 7.5%). Conclusions: Our results encourage us to foster training programs for nurses in order to enhance the quality of care and also decrease the life risks on the patients.

Health related quality of life in Mexican women with systemic lupus erythematosus: a descriptive study using SF-36 and LupusQoL(C).

The LupusQoL© questionnaire is a disease-specific health related quality of life (HRQOL) instrument for adults with systemic lupus erythematosus (SLE). The Short Form-36 (SF-36) is a generic instrument that captures the physical, psychological, and social impact. We conducted a descriptive study of women aged ≥ 18 years attending our Lupus Clinic. HRQOL was assessed by applying the LupusQoL© and SF-36. Lupus activity was measured using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and chronic damage using the Systemic Lupus Collaborative Clinics Damage Index (SDI). Data were analyzed using descriptive statistics, the chi-square test and Pearson's product moment correlation coefficient. A total of 127 patients were included with a mean age of 40.5 ± 12.6 years. The mean disease duration was 8.2 ± 5.6 years, the mean disease activity score was 2.4 ± 3.0, and the mean SDI score 0.77 ± 1.06. The mean SF-36 score was 58.1 ± 21.1 and the mean LupusQoL© score was 69 ± 22.7. The correlation between global scores of the SF-36 and LupusQoL© was rho = 0.73 (p < 0.001). The correlation between lupus disease activity and the SF-36 and the LupusQoL© was -0.26 (p = 0.003) and -0.25 (p = 0.004), respectively. The correlation between the SDI and the SF-36 and the LupusQoL© was -0.28 (p = 0.001) and -0.38 (p < 0.0001), respectively. In conclusions: both LupusQoL© and SF-36 were useful instruments in assessing HRQOL in Mexican lupus female patients. The usefulness of the LupusQoL© should be evaluated in lupus patients with moderate to severe disease activity.

Educational outcomes of an otitis media workshop for primary care providers in Latin America.

Otitis media is a prevalent condition that can be diagnosed and treated by primary care providers skilled in otoscopy. Previous analysis demonstrated that brief, intensive instruction at one site in rural Mexico improved the test scores of health care providers and changed long-term practices (Eavey R, et al. Otolaryngol Head Neck Surg 1993; 109:895-8). We wanted to confirm these test score findings at other sites. A didactic course on otitis media with a practical otoscopy workshop was conducted at six Mexican locations and in one Venezuelan city by an interdisciplinary group of physicians. The same coded test was given immediately before and after the course. The Wilcoxon test for significance of intrasubject performance before and after intervention was used as a nonparametric assessment. At all seven sites (n = 190 subjects), test scores demonstrated statistically significant improvement (range = p < 0.001 to p < 0.0001). We conclude that this educational method consistently improved short-term knowledge of otitis media and that further teaching efforts and a longer term practice-impact study are warranted.

An education model for otitis media care field-tested in Latin America.

The World Health Organization has designated the teaching of otitis media management skills a "priority" status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% (p < 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers in rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.

Epidemic neonatal gentamicin-methicillin--resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin.

One hundred sixteen infants in an intensive care nursery acquired Staphylococcus aureus resistant to gentamicin and methicillin; 54 patients acquired S. aureus sensitive to gentamicin and methicillin. Topical application of gentamicin ointment was significantly associated with acquisition of GMRS. Of 78 infants who acquired GMRS, 38 had received GmO before GMRS was first cultured, whereas only one of 49 infants with GMSS had previously received GmO (P = 8.6 X 10(-8)). Infants with GMRS were also more likely than patients with GMSS to have had a lower mean birth weight, Apgar score, and gestational age; systemic antibiotic therapy and incubator care were significantly prolonged for patients with GMRS, but these factors did not explain susceptibility to GMRS infection. Multivariate logistic regression analysis showed that use of GmO was the single most important risk factor.