Salvage reirradiation for recurrent glioblastoma: a retrospective case series analysis.

PURPOSE: To assess the clinical outcome of patients with recurrent glioblastoma treated with salvage reirradiation. METHODS: Between 2005 and 2022, data from adult patients with glioblastoma treated with surgery and radio-chemotherapy Stupp regimen who developed a local in-field relapse and received stereotactic radiotherapy (SRT) were retrospectively reviewed. RESULTS: The study population included 44 patients with recurrent glioblastoma (median of 9.5 months after the first radiotherapy). Reirradiation alone was given to 47.7% of patients. The median maximum diameter of the recurrence was 13.5 mm. The most common SRT regimen (52.3%) was 35 Gy in 10 fractions. Acute toxicity was mild, with transient worsening of previous neurological symptoms in only 15% of patients. After a median follow-up of 15 months, 40% presented radiological response, but a remarkable number of early distant progressions were recorded (32.5%). The median time to progression was 4.8 months, being the dose, the scheme, the size of the recurrence or the strategy (exclusive RT vs. combined) unrelated factors. The median overall survival (OS) was 14.9 months. Karnofsky index < 70 and the size of the recurrence (maximum diameter < 25 mm) were significant factors associated with OS. Radiological changes after reirradiation were commonly seen (> 50% of patients) hindering the response assessment. CONCLUSIONS: Reirradiation is a feasible and safe therapeutic option to treat localized glioblastoma recurrences, able to control the disease for a few months in selected patients, especially those with good functional status and small lesions. Hypofractionated schemes provided a suitable toxicity profile. Radiological changes were common.

SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021).

Central nervous system (CNS) dissemination is a severe complication in cancer and a leading cause of cancer-related mortality. Brain metastases (BMs) are the most common types of malignant intracranial tumors and are reported in approximately 25% of patients with metastatic cancers. The recent increase in incidence of BMs is due to several factors including better diagnostic assessments and the development of improved systemic therapies that have lower activity on the CNS. However, newer systemic therapies are being developed that can cross the blood-brain barrier giving us additional tools to treat BMs. The guidelines presented here focus on the efficacy of new targeted systemic therapies and immunotherapies on CNS BMs from breast, melanoma, and lung cancers.

Uso ambulatorio de cefalosporinas en una población colombiana: estudio de prescripción-indicación / Outpatient cephalosporin use in a Colombian population: prescription-indication study

INTRODUCCIÓN: El uso indebido de cefalosporinas puede provocar resistencia de las bacterias. OBJETIVO: Determinar el perfil de prescripción e indicación de cefalosporinas en un grupo de pacientes afiliados al Sistema de Salud de Colombia. MÉTODOS: Estudio transversal. A partir de una base de datos poblacional se obtuvo una muestra aleatoria de pacientes atendidos en consulta ambulatoria para identificar las indicaciones de cefalosporinas en registros clínicos. Se evaluaron variables farmacológicas relacionadas con formulación no indicada según guías de práctica clínica. RESULTADOS: En 381 pacientes, con edad media 41,2 ± 15,4 años, el 61,4% (n = 234) eran mujeres. Cefalexina fue la más utilizada (n=318; 83,5%), con duración media del tratamiento de 7,3 ± 3,2 días, seguida de cefradina (n = 43, 11,3%) y ceftriaxona (n = 20, 5,2%). Se prescribieron para infecciones de piel y tejidos blandos (n = 177; 46,4%, de las cuales 47,5% eran purulentas), del tracto urinario (n = 70; 18,4%), de vías respiratorias superiores (n = 57; 15,0%), e infecciones de transmisión sexual (n = 21; 5,5%). Estaban indicadas en 169 pacientes (44,4%), pero sólo 103 (60,9%) tenían prescripciones que cumplían las recomendaciones de dosificación. CONCLUSIONES: Más de la mitad de pacientes prescritos con cefalosporinas en un contexto ambulatorio tenían prescripciones consideradas no indicadas, en particular por su uso en infecciones de piel y tejidos blandos purulentas.

BACKGROUND: Misuse of cephalosporins can lead to bacterial resistance. Aim: To determine the prescription profile and indication of cephalosporins in the patients affiliated to the Colombian Health System. METHODS: Cross-sectional study. From a population database, a random sample of patients treated in an outpatient consultation was obtained, to identify the indications of the prescribed cephalosporins in their clinical record. Pharmacological variables, and those related to non-indicated formulations were evaluated according to the clinical practice guidelines. RESULTS: In 381 patients, the mean age was 41.2 ± 15.4 years, and 61.4% (n = 234) were women. Cefalexin was the most widely used (n=318; 83.5%), with a mean duration of treatment of 7.3 ± 3.2 days; followed by cefradine (n = 43; 11.3%), and ceftriaxone (n = 20; 5.2%). The most common uses were for skin and soft tissue infections (n = 177; 46.4% of which 47.5% were purulent), urinary tract infections (n = 70; 18.4%), upper respiratory airway infections (n = 57; 15.0%) and sexually transmitted diseases (n = 21; 5.5%). The use was considered indicated in 169 patients (44.4%), but only 103 (60.9%) had prescriptions that met the dosage recommendations from the clinical practice guidelines. CONCLUSIONS: More than half of the patients prescribed with cephalosporins in the outpatient setting had prescriptions considered not indicated, particularly for their use in purulent skin and soft tissue infections.

Efectividad de una superficie especial de manejo de presión sustituto en la prevención de las lesiones por presión / Effectiveness of a Special Substitute Pressure Management Surface in Preventing Pressure Ulcers

Introducción: El alto índice de lesiones por presión en la Atención Primaria de Salud del municipio San José, generó la necesidad de utilizar una superficie especial de manejo de presión sustituto para su prevención. Objetivo: Evaluar la efectividad de una superficie especial de manejo de presión sustituto en la prevención de lesiones por presión. Métodos: Intervención cuasi-experimental con grupo control en pacientes encamados con lesiones por presión estadíos I y II en consultorios del Policlínico "Luis A. Turcios Lima", Mayabeque, durante 2018. Universo de 57 pacientes, se conformaron dos grupos por muestreo aleatorio simple. El grupo experimental con 27 pacientes (medidas generales de prevención y superficie especial de manejo de presión sustituto) y grupo control (medidas generales de prevención) 30 pacientes. Se calculó media aritmética y desviación estándar, se estimó Odds Ratio a través de modelo multivariado de regresión logística, con intervalo de confianza del 95 por ciento y un nivel de significancia p < 0.05. Resultados: Predominó el sexo femenino (66,67 por ciento grupo experimental, 73,33 por ciento grupo control). La edad media fue mayor en el grupo control (74,3 años), prevalecieron las lesiones estadio I (50,88 por ciento) y las regiones sacra y calcánea las más afectadas (45,61 por ciento y 24,56 por ciento, respectivamente), el tiempo de tratamiento promedio fue 10 días 8 horas. Se constató la efectividad de la superficie especial de manejo de presión sustituto en grupo experimental (92,59 por ciento), frente a la efectividad de medidas preventivas del grupo control (26,67 por ciento). Conclusiones: La utilización de una superficie especial de manejo de presión sustituto, diseñada con materiales de fácil acceso fue efectiva en la prevención de las lesiones por presión(AU)

ABSTRACT Introduction: The high rate of pressure injuries in primary health care of San José Municipality generated the need to use a special substitute pressure management surface for its prevention. Objective: To assess the effectiveness a special surrogate pressure management surface in preventing pressure injuries. Methods: Quasiexperimental intervention with a control group in bedridden patients with pressure injuries at stages I and II, carried out, during 2018, in family medical offices of Luis A. Turcios Lima Polyclinic, Mayabeque Province. The universe was 57 patients. Two groups were formed by simple random sampling. The experimental was made up of 27 patients (general preventive measures and special surrogate pressure management surface) and the control group was made up of 30 patients (general preventive measures). Arithmetic mean and standard deviation were calculated and odds ratio was estimated through multivariate logistic regression model, with a 95 percent confidence interval and a significance level of p < 0.05. Results: The female sex predominated (66.67 percent from the experimental group and 73.33 percent from the control group). The mean age was higher in the control group (74.3 years). Stage I lesions prevailed (50.88 percent), while the sacral and calcaneal regions were the most affected (45.61 percent and 24.56 percent, respectively). Average treatment time was ten days and eight hours. Effectiveness of the special surrogate pressure management surface was found in the experimental group (92.59 percent), compared to the effectiveness of preventive measures in the control group (26.67 percent). Conclusions: The use of a special surrogate pressure management surface, designed with easily accessible materials, was effective in preventing pressure injuries(AU)

[Outpatient cephalosporin use in a Colombian population: prescription-indication study]. / Uso ambulatorio de cefalosporinas en una población colombiana: estudio de prescripción-indicación.

BACKGROUND: Misuse of cephalosporins can lead to bacterial resistance. AIM: To determine the prescription profile and indication of cephalosporins in the patients affiliated to the Colombian Health System. METHODS: Cross-sectional study. From a population database, a random sample of patients treated in an outpatient consultation was obtained, to identify the indications of the prescribed cephalosporins in their clinical record. Pharmacological variables, and those related to non-indicated formulations were evaluated according to the clinical practice guidelines. RESULTS: In 381 patients, the mean age was 41.2 ± 15.4 years, and 61.4% (n = 234) were women. Cefalexin was the most widely used (n=318; 83.5%), with a mean duration of treatment of 7.3 ± 3.2 days; followed by cefradine (n = 43; 11.3%), and ceftriaxone (n = 20; 5.2%). The most common uses were for skin and soft tissue infections (n = 177; 46.4% of which 47.5% were purulent), urinary tract infections (n = 70; 18.4%), upper respiratory airway infections (n = 57; 15.0%) and sexually transmitted diseases (n = 21; 5.5%). The use was considered indicated in 169 patients (44.4%), but only 103 (60.9%) had prescriptions that met the dosage recommendations from the clinical practice guidelines. CONCLUSIONS: More than half of the patients prescribed with cephalosporins in the outpatient setting had prescriptions considered not indicated, particularly for their use in purulent skin and soft tissue infections.

Prevalence and genotypic diversity of ostreid herpesvirus type 1 in Crassostrea gigas cultured in the Gulf of California, Mexico.

In bivalve mollusk aquaculture, massive disease outbreaks with high mortality and large economic losses can occur, as in northwest Mexico in the 1990s. A range of pathogens can affect bivalves; one of great concern is ostreid herpesvirus 1 (OsHV-1), of which there are several strains. This virus has been detected in the Gulf of California in occasional or sporadic samplings, but to date, there have been few systematic studies. Monthly samples of Crassostrea gigas, water, and sediment were taken in the La Cruz coastal lagoon and analyzed by PCR. The native mollusk, Dosinia ponderosa, which lives outside the lagoon, was sampled as a control. The virus was found throughout the year only in C. gigas, with prevalence up to 60%. In total, 9 genotype variants were detected, and genetic analysis suggests that linear genotypic evolution has occurred from strain JF894308, present in La Cruz in 2011. There has been no evidence of the entry of new viral genotypes in the recent past, thus confinement of the virus within the lagoons of the Gulf of California could promote a native genotypic diversity in the short term.

The uncertain future of protected lands and waters.

Protected areas are intended to safeguard biodiversity in perpetuity, yet evidence suggests that widespread legal changes undermine protected area durability and efficacy. We documented these legal changes-protected area downgrading, downsizing, and degazettement (PADDD) events-in the United States and Amazonian countries and compiled available data globally. Governments of the United States and Amazonian countries enacted 269 and 440 PADDD events, respectively. Between 1892 and 2018, 73 countries enacted 3749 PADDD events, removing 519,857 square kilometers from protection and tempering regulations in an additional 1,659,972 square kilometers; 78% of events were enacted since 2000. Most PADDD events (62%) are associated with industrial-scale resource extraction and development, suggesting that PADDD may compromise biodiversity conservation objectives. Strategic policy responses are needed to address PADDD and sustain effective protected areas.

[Validation of a clinical nutritional sucking scale]. / Validación de una escala clínica de la succión nutricia.

OBJECTIVE: Suck dysfunction in breastfeeding infants has an impact on their appropriate nutrition. The objective was to build and validate one clinical nutritional sucking scale in the components of sucking, swallowing, and respiration. METHODS: The scale was carried out in two phases: face-validity and psychometric validity. The first was done by expert consensus. For the second phase, 179 infants (153 healthy newborn and 26 infant less than 6 month of age) and 86 infants with high risk for abnormal sucking were evaluated with the new scale. Three observers evaluated all patients during their feeding. With an initial scale of 10 items we calculated the inter-observer concordance and the internal consistence. With an analysis of the mail components and a discrimination index we reduced to pertinent items. Each component of the scale was compared with clinical variables. RESULTS: We reached a 7 items scale, which showed high reliability (Cronbach's alpha of 0.77 and inter-observer concordance of 0.98. The suck component correlated positively with the ingested volume (Ro = 0.61), the swallow component with the peripheral oxygen saturation (Ro = 0.24), and the breath component with the respiratory frequency (Ro = 0.50). With this scale, we can establish different patterns of sucking abnormalities related with history of neurological abnormalities, hemodynamic alteration and immaturity. CONCLUSIONS: In this study the clinical nutritional scale showed to be reliable and valid for its use in sucking problems classification. More studies are required to evaluate its application for oral stimulation therapies.

Introducción: la disfunción de la succión nutricia de los lactantes incide en la eficiencia de su alimentación. El objetivo fue construir y validar una escala clínica para evaluar la succión nutricia en sus componentes de succión-deglución-respiración. Métodos: se llevó a cabo en dos fases: validación de apariencia y validación psicométrica. La primera se validó por consenso de expertos. La segunda con su aplicación en 179 lactantes (153 recién nacidos sanos y 26 lactantes < seis meses de edad) y 86 lactantes con alto riesgo de alteración de la succión. Todos fueron valorados por tres evaluadores durante una alimentación. Con una escala inicial de 10 ítems se calculó la concordancia interobservador y la consistencia interna. Se determinaron los ítems más pertinentes. Cada componente de la escala se comparó con variables clínicas. Resultados: se obtuvo una escala de siete ítems, la cual mostró alta consistencia (alfa de Cronbach de 0.77) con una concordancia interobservador de 0.98. El componente de la succión se correlacionó positivamente con el volumen ingerido (Ro = 0.61); el de la deglución, con la saturación periférica (Ro = 0.24), y el de la ventilación, con la frecuencia respiratoria (Ro = 0.50). Con la escala se establecieron patrones de alteración según antecedentes de afección neurológica, estabilidad hemodinámica e inmadurez. Conclusión: esta escala es consistente y válida para la clasificación de problemas de la succión. Se requieren más estudios para evaluar su aplicación en la evaluación de terapias de estimulación oral.

Factors associated with nosocomial surgical-site infections for craniotomy in Mexico City hospitals.

BACKGROUND: Nosocomial surgical-site infection (NSSI) after craniotomy is responsible for an increase in deaths and/or disabilities that affect quality of life. It is necessary to identify factors to be included in an index for their control. The aim of this study was to a) identify intrinsic and extrinsic factors associated with NSSI after craniotomy and b) obtain the infection risk attributed to both intrinsic and extrinsic factors as well as to compare their predictive capability with the NNISS (National Nosocomial Infection Surveillance System) index. METHODS: A case-control study was conducted during a 2-year period in patients who underwent craniotomy in hospitals affiliated with the Instituto Mexicano del Seguro Social. Patients were selected according to the Centers for Disease Control and Prevention criteria for NSSI. RESULTS: During the study period 737 craniotomies were performed, 41 of which presented with NSSI. Intrinsic factors associated with NSSI were the presence of chronic diseases (OR = 2.18) and craniotomy due to nontraumatic causes (OR = 1.87), whereas extrinsic factors were procedures performed during the late shift (OR = 2.6) and another surgery at the same surgical site (OR = 5.2). These factors comprised the index with intrinsic and extrinsic factors. Extrinsic factors were 1.7 times higher than intrinsic factors, in addition to having a larger area under the ROC curve (0.731). The risk obtained with the NNISS index for patients who had one factor was 1.5, whereas that for patients who had two or three factors was 4.7. CONCLUSIONS: In the studied population, patients who underwent a craniotomy with extrinsic factors showed a higher association with NSSI.

Factores asociados a infecciones nosocomiales en sitio quirúrgico para craneotomía / Factors associated with nosocomial surgical-site infections for craniotomy in Mexico City hospitals

Introducción: La infección nosocomial en sitio quirúrgico (INSQ) en craneotomía puede ocasionar la muerte o discapacidad que modifica la calidad de vida, por lo que se requiere encontrar factores que puedan ser utilizados para incluir en los índices de control. Por ello es necesario identificar factores asociados a esta infección y obtener el riesgo de infección atribuible y comparar su capacidad predictiva con el índice del NNISS (Sistema de Vigilancia Nacional de Infecciones Nosocomiales de Estados Unidos). Material y métodos: Se realizó un estudio de casos y controles durante dos años, en pacientes con craneotomía en hospitales del Instituto Mexicano del Seguro Social. Los pacientes cumplieron los criterios de los Centros de Control de Enfermedades de Atlanta para INSQ. Resultados: Se practicaron 737 craneotomías durante el estudio, 41 pacientes presentaron INSQ. Factores intrínsecos asociados: presencia de enfermedades crónicas (OR = 2.18) y craneotomía debida a causas no traumáticas (OR = 1.87); factores extrínsecos: turno vespertino (OR = 2.6) y la práctica de otra cirugía en el mismo sitio quirúrgico (OR = 5.2). Estos factores conformaron los índices de factores intrínsecos y extrínsecos. Con factores extrínseco se presentó 1.7 veces más riesgo en comparación con los factores intrínsecos, así como mayor área bajo la curva ROC (0.731). El riesgo con el índice NNISS con un factor fue de 1.5 y con dos a tres factores, de 4.7. Conclusiones: En esta población en estudio, los pacientes sometidos a una craneotomía tuvieron mayor asociación a INSQ con los factores extrínsecos.

BACKGROUND: Nosocomial surgical-site infection (NSSI) after craniotomy is responsible for an increase in deaths and/or disabilities that affect quality of life. It is necessary to identify factors to be included in an index for their control. The aim of this study was to a) identify intrinsic and extrinsic factors associated with NSSI after craniotomy and b) obtain the infection risk attributed to both intrinsic and extrinsic factors as well as to compare their predictive capability with the NNISS (National Nosocomial Infection Surveillance System) index. METHODS: A case-control study was conducted during a 2-year period in patients who underwent craniotomy in hospitals affiliated with the Instituto Mexicano del Seguro Social. Patients were selected according to the Centers for Disease Control and Prevention criteria for NSSI. RESULTS: During the study period 737 craniotomies were performed, 41 of which presented with NSSI. Intrinsic factors associated with NSSI were the presence of chronic diseases (OR = 2.18) and craniotomy due to nontraumatic causes (OR = 1.87), whereas extrinsic factors were procedures performed during the late shift (OR = 2.6) and another surgery at the same surgical site (OR = 5.2). These factors comprised the index with intrinsic and extrinsic factors. Extrinsic factors were 1.7 times higher than intrinsic factors, in addition to having a larger area under the ROC curve (0.731). The risk obtained with the NNISS index for patients who had one factor was 1.5, whereas that for patients who had two or three factors was 4.7. CONCLUSIONS: In the studied population, patients who underwent a craniotomy with extrinsic factors showed a higher association with NSSI.

[Incidence of nosocomial surgical-site infections. Application of National Nosocomial Infections Surveillance System (NNIS) index and description of clinical and biochemical features from patients undergoing first-time ventriculoperitoneal shunt]. / Incidencia de infección nosocomial en sitio quirúrgico (índice del NNIS y características clínicas y bioquímicas prequirúrgicas de pacientes sometidos por primera vez a derivación ventrículo-peritoneal).

OBJECTIVE: We undertook this study to determine the incidence of nosocomial surgical-site infections, apply the National Nosocomial Infections Surveillance (NNIS) index, and describe the clinical and biochemical characteristics of patients prior to a first-time ventriculoperitoneal shunt (VPS). METHODS: We conducted a cohort study for 1 year with patients aged 18 years or older who underwent VPS. Patients were followed up for 30 days to identify the presence of an infection. Infection diagnosis was made according to the criteria established by the Centers for Disease Control (Atlanta, GA). A questionnaire was developed to obtain the data regarding the factors contained in the NNIS and the clinical and biochemical characteristics prior to surgery. RESULTS: The annual incidence of nosocomial surgical-site infections was 12.3% (9/73). Distribution of factors according to the NNIS index was as follows: 55% without any factor, 38% with one factor, 7% with two factors, and no patients with three factors. ASA RR = 2.0, 95% CI 0.4-11.4, wound type RR = 5.1, 95% CI 0.5-48.9 and surgical time RR = 0.6, 95% CI 0.1-4.2. No differences were found in the frequency of concomitant diseases. CONCLUSIONS: Even though the clinical and biochemical characteristics of patients who underwent first-time VPS were normal and no associated NNIS factors were identified, 12.3% of the patients developed a nosocomial surgical-site infection. These results suggest the existence of factors other than those contained in the NNIS, which are possibly extrinsic to the individual and may influence the development of infections.

Incidencia de infección nosocomial en sitio quirúrgico (índice del NNIS y características clínicas y bioquímicas prequirúrgicas de pacientes sometidos por primera vez a derivación ventrículo-peritoneal) / Incidence of nosocomial surgical-site infections. Application of National Nosocomial Infections Surveillance System (NNIS) index and description of clinical and biochemical features from patients undergoing first-time ventriculoperitoneal shunt

Objetivo: Determinar la incidencia de infección nosocomial en sitio quirúrgico, aplicar el índice del NNIS y describir las características prequirúrgicas clínicas y bioquímicas de los pacientes sometidos a derivación ventrículo-peritoneal por primera vez. Material y métodos: Se realizó un estudio de cohorte durante un año. Se incluyeron pacientes mayores de 18 años sometidos a derivación ventrículo-peritoneal. El seguimiento se efectuó durante 30 días. El diagnóstico de infección se realizó de acuerdo con los criterios establecidos por los Centros de Control de Enfermedades en Atlanta. Se elaboró un cuestionario para identificar los factores contenidos en el índice del NNIS, así como las características clínicas y bioquímicas prequirúrgicas. Resultados: La incidencia anual de infección nosocomial en sitio quirúrgico fue de 12.3 % (9/73). En cuanto al número de factores de acuerdo al NNIS, 55 % de los pacientes no presentó ningún factor; 38 %, uno; 7 %, dos; ningún paciente, tres. ASA: RR = 2.0, IC 95 % = 0.4-11.4. Tipo de herida: RR = 5.1, IC 95 % = 0.5-48.9. Tiempo quirúrgico: RR = 0.6, IC 95 % = 0.1- 4.2. No se observaron diferencias en la frecuencia de enfermedades concomitantes. Conclusiones: Aun cuando las características clínicas y bioquímicas de los pacientes sometidos a derivación ventrículo-peritoneal de primera vez se encontraban dentro de los parámetros normales y no se identificaron factores del NNIS asociados, hubo infección en el sitio quirúrgico en 12.3 % de los pacientes, lo cual sugiere que existen factores que pueden influir en el desarrollo de infección diferentes a los contendidos en el NNIS.

OBJECTIVE: We undertook this study to determine the incidence of nosocomial surgical-site infections, apply the National Nosocomial Infections Surveillance (NNIS) index, and describe the clinical and biochemical characteristics of patients prior to a first-time ventriculoperitoneal shunt (VPS). METHODS: We conducted a cohort study for 1 year with patients aged 18 years or older who underwent VPS. Patients were followed up for 30 days to identify the presence of an infection. Infection diagnosis was made according to the criteria established by the Centers for Disease Control (Atlanta, GA). A questionnaire was developed to obtain the data regarding the factors contained in the NNIS and the clinical and biochemical characteristics prior to surgery. RESULTS: The annual incidence of nosocomial surgical-site infections was 12.3% (9/73). Distribution of factors according to the NNIS index was as follows: 55% without any factor, 38% with one factor, 7% with two factors, and no patients with three factors. ASA RR = 2.0, 95% CI 0.4-11.4, wound type RR = 5.1, 95% CI 0.5-48.9 and surgical time RR = 0.6, 95% CI 0.1-4.2. No differences were found in the frequency of concomitant diseases. CONCLUSIONS: Even though the clinical and biochemical characteristics of patients who underwent first-time VPS were normal and no associated NNIS factors were identified, 12.3% of the patients developed a nosocomial surgical-site infection. These results suggest the existence of factors other than those contained in the NNIS, which are possibly extrinsic to the individual and may influence the development of infections.

[Comparative clinical study of dexamethasone vs. nebulized salbutamol in acute bronchiolitis]. / Uso de dexametasona y salbutamol nebulizados en bronquiolitis aguda. Estudio clínico comparativo.

OBJECTIVE: Asess the efficacy of nebulized salbutamol and dexamethasone compared with nebulized salbutamol, in patients with bronchiolitis. MATERIAL AND METHODS: A blinded clinical trial was performed with 49 patients between 1-18 months diagnosed with bronchiolitis with three days or less of disease evolution. Participant's parents signed an informed consent and patients did not receive prior medication. Patients were randomly assigned to two groups: nebulized salbutamol or salbutamol plus dexamethasone, which they received every four hours during twenty-four hours. We measured heart and respiratory rate; respiratory distress index, oxygen saturation, and Silverman Andersen scores. RESULTS: No significant differences were found between groups for treatment response; but the frequency of hospital release at 24 hrs was significant among groups; 75 vs 96 % respectively (p = 0.04). CONCLUSIONS: The administration of salbutamol plus dexamethasone is more effective in the control of respiratory distress in children with bronchiolitis compared with the use of salbutamol alone.

Uso de dexametasona y salbutamol nebulizados en bronquiolitis aguda: estudio clínico comparativo / Comparative clinical study of dexamethasone vs. nebulized salbutamol in acute bronchiolitis

Objetivo: Evaluar la eficacia de salbutamol y dexametasona nebulizados comparados con salbutamol solo en pacientes con bronquiolitis aguda. Material y métodos: Estudio clínico controlado, aleatorizado, en pacientes de 1 a 18 meses de edad con diagnóstico de bronquiolitis aguda y evolución menor de tres días. Se asignaron dos grupos: 1) salbutamol (n = 24) o 2) salbutamol más dexametasona (n = 25) administrado por micronebulizaciones cada cuatro horas por 24 horas. Se midieron las frecuencias cardiaca y respiratoria, la gravedad del cuadro mediante el Respiratory Distress Assigment Index, el Silvermann-Andersen, saturación de O2 y tiempo de desaparición de la dificultad respiratoria y frecuencia de altas en 24 horas. Resultados: No se encontraron diferencias significativas entre los grupos de estudio, excepto en la frecuencia de altas hospitalarias en las primeras 24 horas, 75 vs 96 % p < 0.04 respectivamente. Conclusiones: La aplicación de salbutamol más dexametasona es más rápida para controlar la dificultad respiratoria en niños con bronquiolitis aguda en comparación con la aplicación de salbutamol solo.

OBJECTIVE: Asess the efficacy of nebulized salbutamol and dexamethasone compared with nebulized salbutamol, in patients with bronchiolitis. MATERIAL AND METHODS: A blinded clinical trial was performed with 49 patients between 1-18 months diagnosed with bronchiolitis with three days or less of disease evolution. Participant's parents signed an informed consent and patients did not receive prior medication. Patients were randomly assigned to two groups: nebulized salbutamol or salbutamol plus dexamethasone, which they received every four hours during twenty-four hours. We measured heart and respiratory rate; respiratory distress index, oxygen saturation, and Silverman Andersen scores. RESULTS: No significant differences were found between groups for treatment response; but the frequency of hospital release at 24 hrs was significant among groups; 75 vs 96 % respectively (p = 0.04). CONCLUSIONS: The administration of salbutamol plus dexamethasone is more effective in the control of respiratory distress in children with bronchiolitis compared with the use of salbutamol alone.

Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: a randomized clinical trial.

OBJECTIVE: To assess the efficacy of two different doses of a Psidii guajavae folium extract in the management of primary dysmenorrhea. METHODOLOGY: A double-blinded randomized clinical trial was conducted in 197 women with primary dysmenorrhea. Four intervention groups were defined: two extract doses (3 and 6 mg/day); ibuprofen (1200 mg/day); placebo (3mg/day). Participants were followed-up individually for 4 months. The main outcome variable was abdominal pain intensity measured according to a visual analogue scale (VAS). RESULTS: The average age of participants was 19 years; menarche occurred around age 12 years. Participants had menstrual cycles of 28 or 29 days, with menstruation lasting 5 days and mean of pain intensity of 8.2 on the VAS. During each successive treatment cycle, participants experienced a lower pain intensity score. Multiple regression analysis, after adjusting each cycle for baseline pain, treatment compliance and other variables, showed that the group receiving 6 mg/day extract had significantly reduced pain intensity (p<0.001). This effect was maintained in cycles 2 and 3, although the reduction in the mean of pain intensity was lower. The group receiving the 3mg/day extract did not show a consistent effect throughout the three cycles. CONCLUSION: At a dose of 6 mg/day, the standardized phyto-drug (Psidii guajavae folium extract) reduced menstrual pain significantly compared with conventional treatment and placebo.

[Elaboration and validation of an index for preeclampsia diagnosis]. / Elaboración y validación de un indice para el diagnóstico de preeclampsia.

OBJECTIVE: To build a consistent and valid preeclampsia diagnosis index (IDP) for its Spanish acronyms. PATIENTS AND METHOD: The study was done in a Gyneco-Obstetrics Hospital and a Family Medicine Unit from March 2000 to February 2001. Fifty items were chosen from the literature, with a design to validate diagnostic tests, which were assessed by family doctors and gyneco-obstetricians in regard to their appearance and content validity. Concurrent criterion validity. Golden standard: Two gyneco-obstetricians diagnosed pre-eclampsia (hypertension and proteinuria). Simultaneously a family doctor (in an independent and blinded way) questioned, examined and recorded laboratory data of 219 preeclamptic patients and 251 non preeclamptic patients. RESULTS: Preeclampsia diagnosis index is an additive index with 21 clinical and paraclinical parameters weighted according to their individual diagnostic capacity. It has two parts: The first one with 82% (95%CI 80-84) sensitivity; 93% (95%CI 91-95) specificity; the second one with 86% (95%CI 83-89) sensitivity; 75% (95%CI 65-85) specificity. CONCLUSIONS: Preeclampsia diagnosis index is easily applied and has immediate results, which makes easier the physician's decisions.

[Depression prevalence and risk factors found in women attended by a family physician]. / Prevalencia de depresión y factores de riesgo en mujeres atendidas en medicina familiar.

OBJECTIVES: Determine the prevalence of depressive symptoms in adult woman who was attended by family physician, to explore risk factors for depression and estimate how often depression is registered as a diagnosis by the family physician. MATERIALS AND METHODS: We did a prospective, analytic, and transversal study with simple randomized sampling at a Mexico City Family Medicine Clinic from March to December 2004. The size of the study was 384 patients. It includes women from 20 to 59 years of age. We excluded women without a clinical file for at least 1 year of reliable information. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Family Apgar Scale were applied. RESULTS: The survey included a total of 400 patients with the following characteristics: average age, 39 +/- 11 years; married, 74%; homemakers, 68%, and women with education level of high school or less were 79%. Prevalence of depressive symptoms was 52% (95% confidence interval [95% CI], 47-57). In women between 20 and 39 years of age, there was an association between depression and family dysfunction; the average number of healthcare appointments for the year prior to the study was significantly higher in patients 40 years old or more. CONCLUSIONS: There is a high prevalence of depressive symptoms in adult women, and depression diagnosis is frequently omitted. Depression-associated factors differ according to chronological age. In young women, family dysfunction is the main risk factor.

Incidence of leukemias in children from El Salvador and Mexico City between 1996 and 2000: population-based data.

BACKGROUND: There are very few studies that report the incidence of acute leukemias in children in Latin America. This work assesses the incidence of acute leukemias, between 1996 and 2000, in children from 0-14 years old who were attended at the Mexican Social Security Institute in Mexico City and in children from 0-11 years old in El Salvador. DESIGN: Population-based data. Hospitals: In San Salvador, El Salvador, Hospital Nacional de Niños "Benjamin Bloom", the only center in El Salvador which attends all children, younger than 12 years, with oncologic disease. The Pediatric Hospital and the General Hospital of the Mexican Social Security Institute in Mexico City, the only centers in Mexico City which attend all those children with acute leukemia who have a right to this service. DIAGNOSIS: All patients were diagnosed by bone marrow smear and were divided into acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and unspecified leukemias (UL). The annual incidence rate (AIR) and average annual incidence rate (AAIR) were calculated per million children. Cases were stratified by age and assigned to one of four age strata: 1) <1 year; 2) 1-4 years; 3) 5-9 years, or 4) 10-14 or 10-11 years, for Mexico City and El Salvador, respectively. RESULTS: The number of cases was 375 and 238 in El Salvador and Mexico City, respectively. AAIRs in Mexico City were 44.9, 10.6, 2.5, 0.5, and 58.4 per million children for ALL, AML, CML, UL, and total leukemias, respectively. The AAIRs in El Salvador could not be calculated because the fourth age stratum in El Salvador included children only from 0-11 years old. The incidence rates for the Salvadorian group of 0-11 year olds were 34.2, 7.1, 0.6, 0.2, and 43.2 per million children for ALL, AML, CML, UL, and total leukemias, respectively. CONCLUSION: Reported AIRs for each age group in El Salvador were similar to those from other American countries. The AAIR of ALL in Mexico City is one of the highest reported for North America.

Frequency of cancer in children residing in Mexico City and treated in the hospitals of the Instituto Mexicano del Seguro Social (1996-2001).

BACKGROUND: The objective of this article is to present the frequency of cancer in Mexican children who were treated in the hospitals of the Instituto Mexicano del Seguro Social in Mexico City (IMSS-MC) in the period 1996-2001. METHODS: The Registry of Cancer in Children, started in 1996 in the IMSS-MC, is an on-going, prospective register. The data from 1996 through 2001 were analyzed and the different types of cancer were grouped according to the International Classification for Cancer in Children (ICCC). From this analysis, the general and specific frequencies by age and by sex were obtained for the different groups of neoplasms. Also, the frequency of the stage of the disease that had been diagnosed in cases of children with solid tumors was obtained. RESULTS: A total of 1,702 new cases of children with cancer were registered, with the male/female ratio at 1.1/1. Leukemias had the highest frequency with 784 cases (46.1%) and, of these, acute lymphoblastic leukemias were the most prevalent with 614 cases (78.3%). Thereafter, in descending order of frequency, were tumors of the central nervous system (CNST) with 197 cases (11.6%), lymphomas with 194 cases (11.4%), germinal cell tumors with 110 cases (6.5%), and bone tumors with 97 cases (5.7%). The highest frequency of cancer was found in the group of one to four year-olds that had 627 cases (36.8%). In all the age groups, leukemias were the most frequent. In the present work, the frequency of Hodgkin's disease (~4%) was found to be lower than that (~10%) in previous studies and the frequency of tumors of the sympathetic nervous system was low (2.3%). Of those cases of solid tumors for which the stage of the disease had been determined, 66.9% were diagnosed as being Stage III or IV. CONCLUSIONS: The principal cancers in the children treated in the IMSS-MC were leukemias, CNST, and lymphomas, consistent with those reported by developed countries. A 2.5-fold reduction in the frequency of Hodgkin's disease was found. Of the children, the stage of whose disease had been determined, two thirds were diagnosed as having advanced stages of the disease.

[Clinical significance of the laboratory determinations in preeclamptic patients]. / Significado clínico de los resultados de laboratorio en las pacientes preeclámpticas.

OBJECTIVE: To determine the clinical significance and optimal cutting points of laboratory tests more frequently used in patients with pre-eclampsia of recent diagnosis. MATERIALS AND METHODS: We made an analytic cross-sectional study for evaluation of diagnostic test. Non probabilistic sampling. Sample size 400 patients. We used the American College of Obstetricians and Gynecologists criteria as gold standard. Laboratory personnel was blinded to the clinical classification of the patients. RESULTS: We studied 192 patients without pre-eclampsia, 63 with mild and 153 with severe pre-eclampsia. Hematocrits, prothrombin time, partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase and bilirubins did not show significative differences among groups. Platelets counting showed low sensitivity. Lactic dehydrogenase showed 71% sensitivity (65-85 CI95%), specificity 74% (68-80 CI95%) positive likelihood ratio 2.7 and negative 0.4. Uric acid showed sensitivity of 75% (69-81 CI95%) specificity 79% (73-85 CI95%) positive likelihood ratio of 3.5 and negative of 0.3. Seric creatinine with sensitivity of 81% (76-86 CI95%) specificity of 60% (53-67 CI95%) positive likelihood ratio of 2 and negative of 0.3. CONCLUSIONS: Seric uric acid, seric creatinine and lactic dehydrogenase are useful for diagnosis and severity classification of pre-eclampsia. Platelets counting is not useful for diagnosis but is useful for severity classification. In patients with thrombocytopenia prothrombin time is useful for severity classification.