[Association between diabetes mellitus and cognitive decline in older adults. A population based study]. / Asociación de diabetes mellitus con deterioro cognitivo en adultos mayores. Estudio basado en población.

BACKGROUND: The association between diabetes and cognitive decline is already known; however, there is not much literature that document if this association is different according to gender. The aim of this study was to determine this relationship and to establish if there is a difference according to gender in older adults of Mérida, Yucatán, México. METHODS: 1293 older than sixty years old individuals without severe depression, history of psychiatric disease or stroke were included in the study. A structured survey was applied to them, including mini-mental state examination, anthropometry, capillary glucose and lipid measurements. These parameters were compared between diabetic and non-diabetic patients. The association between diabetes and cognitive decline was determined first to general population and then in each sex with logistic regression. RESULTS: Prevalence of diabetes was 27.38 %. Diabetic patients were younger (p = 0.049), with less years of formal education (p = 0.014) and with a larger waist circumference (p = 0.004) than non-diabetics. Diabetes was associated to a greater frequency of cognitive decline only in women (ß = 2.897, IC 95 % 1.428-5.877, p = 0.003). CONCLUSIONS: There is an association between diabetes and cognitive decline in women older than 60 years of age. However, there is a need of longitudinal studies that confirm these findings.

Introducción: la asociación entre diabetes y deterioro cognitivo es conocida; sin embargo, existen pocos datos respecto a si esta asociación es diferente a partir del sexo. Este estudio pretende determinar esta asociación y establecer si existe diferencia de acuerdo al sexo, en adultos mayores de Mérida, Yucatán, México. Métodos: participaron 1293 personas mayores de 60 años sin depresión grave, historia de enfermedad psiquiátrica, o evento vascular cerebral, a quienes se les aplicó una encuesta estructurada que incluyó el mini examen del estado mental, antropometría y medición capilar de glucosa y lípidos. Se compararon estos parámetros entre pacientes diabéticos y no diabéticos. Se determinó la asociación de diabetes con deterioro cognitivo mediante regresión logística para la población en general y para cada uno de los sexos. Resultados: la prevalencia de diabetes fue del 27.38 %. Los pacientes diabéticos fueron más jóvenes (p = 0.049), con menor escolaridad (p = 0.014) y con mayor circunferencia abdominal (p = 0.004) que los no diabéticos. La diabetes estuvo asociada a una mayor frecuencia de deterioro cognitivo únicamente en las mujeres (ß = 2.897, IC 95 % 1.428-5.877, p = 0.003). Conclusión: existe asociación entre diabetes y deterioro cognitivo en mujeres mayores de 60 años. Hacen falta estudios longitudinales que confirmen estos hallazgos.

[Factors associated with dental consultation in children in Talca (Chile) and in Chilean immigrants in Montreal (Canada)]. / Factores asociados a la consulta odontológica en niños/as y jóvenes de Talca (Chile) e inmigrantes chilenos de Montreal, (Canadá).

OBJECTIVE: To identify the factors that influence the use of dental services in 4-7-year-olds and in 10-13-year-olds resident in the cities of Talca (Chile) and Montreal (Canada). METHODS: A nonprobabilistic cross-sectional study was carried out in 147 boys and girls in Talca and in 94 boys and girls in Montreal between 2009 and 2011. Sociodemographic variables were recorded in parents and children, including age and sex. Data were also gathered on parental education, family composition, and proximity to health centers within neighborhoods. The data were analyzed with Fisher's exact test and the robust Cox regression model (with constant time) with a significance level of 0,05. RESULTS: In Talca, parental education was significantly associated with dental care visits at least twice a year. The children of parents with university education were 2.20 times more likely to consult a dentist (95% CI: 1.30-3.73). Children whose parents perceived their children's health positively were 53% (OR = 0,47; 95% CI: 0,28-0,77) less likely to consult a dentist. In Montreal, the children of parents with university education were 2.10 times more likely to consult a dentist (95%CI: 1.17-3.76), while older children (10-13 years) were 2.11 (95% CI: 1.15-3.88) times more likely to consult a dentist. CONCLUSIONS: In both cities, parental education level was associated with the use of dental services.

Estudio comparativo, cruzado, al azar, para la determinación de la bioequivalencia entre dos formulaciones de oxcarbazepina en tabletas / Bioequivalence comparison of two formulations of oxcarbazepine tablets: a two period, single dose, randomized, cross-over study

Dos formulaciones de oxcarbazepina (Trileptal®, Novartis, y Oxcarbazepina®, Tecnoquímicas S. A.), previamente demostradas como equivalentes farmacéuticos, fueron evaluadas en cuanto a bioequivalencia por medio de un estudio aleatorizado, cruzado, en dos períodos, con dosis oral única de 1.200 mg, en 24 hombres adultos voluntarios sanos entre 18-35 años. Se evaluaron los siguientes parámetros farmacocinéticos: Área bajo la curva (AUC), Concentración máxima (Cmáx) y Tiempo para alcanzar la concentración máxima (Tmáx). Hubo un intervalo de lavado de siete días entre los dos períodos. Las concentraciones plasmáticas se evaluaron por HPLC/UV con el método de la adición estándar. No se encontraron diferencias significativas entre las dos preparaciones. Se concluyó que las dos preparaciones son equivalentes farmacéuticos y bioequivalentes y que, en consecuencia, son intercambiables para propósitos terapéuticos.

Two formulations of oxcarbazepine (Trileptal®, Novartis, y Oxcarbazepina®, Tecnoquímicas S. A.), previously shown to be pharmaceutical equivalents, were evaluated concerning their bioequivalence by means of a randomized, crossover, single oral dose (1.200 mg), two-period study in 24 healthy adult males. The following pharmacokinetic parameters were determined: Area under the curve (AUC), Maximal concentration (Cmax), and Time to reach maximal concentration (Tmax). There was a wash-out interval of seven days between the two periods. Plasmatic concentrations of the drug were measured with HPLC/UV with standard addition. No significant differences were found between the two preparations. It was concluded that they are pharmaceutical equivalents as well as bioequivalent. Consequently, they are interchangeable for therapeutic purposes.

Direct medical costs for partial refractory epilepsy in Mexico.

BACKGROUND: The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. METHODS: We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). RESULTS: We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. CONCLUSIONS: Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.

[Prevalence and functional impact of arthropathies in elderly adults]. / Prevalencia e impacto funcional de las artropatías en adultos mayores.

INTRODUCTION: Musculoskeletal disorders are public health issues in the entire world; their impact seems to be higher on elderly people. OBJECTIVE: To establish the prevalence and the functional impact of arthropathies on the elderly people from Mérida, Yucatán, México. MATERIAL AND METHODS: The SABE-PAHO survey was administered to a random sample of people older than 60 Mérida, Yucatán, México. Arthropathy was evaluated by self report; on the other hand, physical function was evaluated using the modified Katz's scale (basic activities of daily living, BADL) and the Lawton's scale (instrumental activities of daily living, IADL). RESULTS: 1747 patients (68.6% females, 31.4% males), aged 71.5 +/- 8.5 years old, were studied; 498 (28.5%; 95% CI = 26.4 to 30.6) had arthropathy. After logistic regression and adjustment for chronic obstructive lung disease, ischemic cardiopathy, and stroke presence or to be older than 80 were performed, arthropathy was found associated to BADL (p=0.03) as well to IADL (p=0.04) impairment. CONCLUSIONS: The prevalence of arthropathy in elderly people from Mérida, México, was 28.5%, it was found to be independently associated to impairment for BADL and IADL.

[Neurosarcoidosis. Report of one case in Mexico]. / Neurosarcoidosis. Informe de un caso un México.

INTRODUCTION: The sarcoidosis is a granulomatous, multisystemic disease, of unknown etiology that mainly affects the lungs, skin and lymphatic ganglia. The definitive diagnosis is made by the presence of granulomas non-caseous in diverse organs. Sarcoidosis is rare in Mexico and reports of its incidence do not exist. In Spain the incidence is low (1.2 to 1.5 cases by 100,000 inhabitants). In the United States incidence is 5.9 to 6.3 cases by 100,000 inhabitants (males and females respectively). Neurosarcoidosis is present in 5 to 26% of all the patients with sarcoidosis. The neurological manifestations are diverse, depending on the location site. CLINICAL CASE: We present the case of a male 33 years old, with recurrent facial paralysis, optic neuritis and affection of the third cranial nerve; the tomography of skull reveled an grow of left cavernous sinus and reinforcing bilateral temporal giral, and the nuclear magnetic resonance showed leptomeningeal reinforcing in the temporal lobe. CONCLUSION: Although the neurosarcoidosis is rare in Mexico, it should be considered in patients with suggestive clinical manifestations and compatible imaging findings. It should be done an intense search of systemic affection with biopsy and verification of non-caseous granulomas.

Aspectos prácticos sobre el tamaño de la muestra en la investigación clínica / Practical aspects about the size of the sample in clinical research

Antecedentes: El conocimiento el tamaño apropiado de una muestra nos permite estar seguros de si los resultados publicados en diversos informes de la literatura médica tuvieron como base, además de un diseño cuidadoso, una conclusión apropiada, en función de la significancia de la diferencia observada. Para caulcular el tamaño de la muestra debemos tener en cuenta los errores tipo I y II, la varianza, la magnitud del efecto, el nivel de significancia y el poder de la prueba. Para decidir qué tipo de fórmula matemática se utlizará, lo primero que debemos observar es si nuestro estudio es de prevalencia de valores promedio o comparativo. En este artículo se explican algunos conceptos básicos de estadística y se dan cuatro ejemplos sencillos de cálculo de tamaño de muestra.

Participación de la familia en el desarrollo de la comprensión de lectura. Estrategias metodológicas / Family participation in reading comprehension development. Methodological strategies

La propuesta metodológica planteada en este artículo está sustentada desde una perspectiva psicolinguística, en la que se acepta que el lector cumple un papel muy activo: recrea sentidos, moviliza sentimientos, forma imágenes mentales y aprende; en fin, trasciende los pensamientos, ideas y sentimientos expresados por el autor a través del texto escrito. Numerosas investigaciones han demostrado que los niños no llegan al sistema escolar en completo desconocimiento del lenguaje escrito; y si son estimulados desde el hogar presenciando y participando en actos de lectura y escritura, desarrollan esquemas cognitivos y lingûísticos que les permiten aprender con facilidad y provecho. Aunque muchos padres de familia están interesados en colaborar desde sus hogares en la formación de lectores y escritores, por lo general, no saben cómo orientar sus buenos deseos. Así que, pensando en ellos, a continuación se expone, de forma abreviada, información teórica sobre el proceso lector y sugerencias sobre actividades para acompañar la lectura de los cuentos y de otros tipos de materiales de lectura, de modo que puedan ejercer acciones pedagógicas que armonicen con los intereses de los niños y les posibilite, además, momentos placenteros. En la última parte, se ofrecen algunas sugerencias para los niños que ya saben leer y escribir.

El estudio de la función renal a traves de la depuración de la creatina / Correlation between renal function and creatine plasma concentration

En este trabajo se correlaciona el nivel plasmático de la creatinina con su depuración. De la curva obtenida se estudian tres segmentos: 1) Cuando la filtración es mayor de 60 ml/min, el nivel plasmático fluctúa entre 0.44 y 1.59 mg/dl. 2)Cuando la filtración fluctúa entre 30 y 60 ml/min, el nivel plasmático llega hasta 2.4 mg/dl y 3) Cuando la filtración es menor de 30 ml/min, los niveles plasmáticos aumentan hasta valores de 28 mg/ml. La concentración urinaria de creatinina puede dividirse en dos grandes grupos dependiendo de la filtración glomerular. La frontera de esta división está dada alrededor de 60 ml/min. Esto sugiere que cuando la filtración glomerular está deprimida existiría una limitación de la secreción tubular de la creatinina o problemas de dilución urinaria. Se demuestra que existe una pobre correlación entre la depuración de la creatinina y su nivel plasmático, lo que hace imperativo el estudio reiterado de la depuración de la creatinina en el control de los pacientes.