Concordance between tomographic and surgical AAST injury grades in liver, spleen, and kidney due to blunt abdominal trauma / Concordancia entre los grados de lesión AAST tomográficos y quirúrgicos en hígado, bazo y riñón por trauma cerrado de abdomen

OBJETIVO: Determinar la concordancia entre los grados de lesión de la escala AAST (American Association for the Surgery of Trauma) tomográficos y quirúrgicos en lesiones hepáticas, esplénicas y renales por trauma abdominal cerrado. Método: Estudio prospectivo, unicéntrico, observacional, comparativo y transversal, en pacientes mayores de 15 años con lesión hepática, esplénica o renal por trauma abdominal cerrado, sometidos a tomografía abdominal y posterior laparotomía exploradora, en quienes se determinó la concordancia de los grados de lesión AAST tomográficos y quirúrgicos de estos órganos, de marzo de 2017 a diciembre de 2020, en el Hospital Civil de Culiacán, Sinaloa, México. RESULTADOS: Se incluyeron 48 pacientes, con una edad promedio de 27.9 ± 10.9 años; de ellos, 41 eran hombres (85%). La lesión esplénica fue la más frecuente, en 30 pacientes (63%), seguida de la hepática en 20 (42%) y la renal en 15 (31%). La concordancia del grado de lesión AAST entre la tomografía y la cirugía fue baja o moderada, con valores kappa de 0.234 (p < 0.001), 0.419 (p < 0.001) y 0.415 (p < 0.001) para las lesiones hepáticas, esplénicas y renales, respectivamente. CONCLUSIONES: Los grados de lesión AAST tomográficos y quirúrgicos en el hígado, el bazo y los riñones por trauma abdominal cerrado tienen baja y moderada concordancia, y los grados tomográficos son menores que los quirúrgicos.

Risk factors associated to intestinal anastomotic leakage in elective surgery.

BACKGROUND: The intestinal anastomotic leakage is the most feared surgical complication of a digestive surgery and is associated with a significant increase of morbidity, mortality and hospital stay. OBJECTIVE: Analyze the risk factors to the intestinal anastomotic leakage in elective surgery. METHOD: Observational and retrospective study in which we include patients with intestinal anastomosis, in elective surgery at the second level hospital from January 2007 to January 2017. RESULTS: 64 patients were included in the study, in which 7 presented anastomotic leakage. The statistically significant risk factors associated with anastomotic leakage were, cocaine use (p = 0.030), neoplasia as a primary pathology (p = 0.008), neoadjuvant treatment for neoplasia (p = 0.003), and end-to-end anastomosis (p = 0.037). Patients with a leakage had a longer hospital stay and a mortality of 14.3%. CONCLUSIONS: The risk factors associated with the presence of anastomotic leakage found in this study are consistent with the reported worldwide literature. However, in our results, it is worth highlighting the use of cocaine as a risk factor, with statistical significance.

ANTECEDENTES: La fuga de una anastomosis intestinal es la complicación quirúrgica más temida de la cirugía digestiva y se asocia con un aumento significativo de la morbimortalidad y de la estancia hospitalaria. OBJETIVO: Analizar los factores de riesgo asociados a la fuga de anastomosis intestinal en cirugía electiva. MÉTODO: Estudio observacional y retrospectivo en el que se recabaron los expedientes de los pacientes operados de anastomosis intestinal en forma electiva en un hospital de segundo nivel de enero de 2007 a enero de 2017. RESULTADOS: Se incluyeron 64 pacientes, de los cuales siete presentaron fuga de la anastomosis. Los factores de riesgo asociados a fuga anastomótica estadísticamente significativos fueron consumo de cocaína (p = 0.030), neoplasia como patología primaria (p = 0.008), tratamiento con neoadyuvantes para neoplasia (p = 0.003) y anastomosis término-terminal (p = 0.037). Los pacientes con fuga tuvieron una estancia intrahospitalaria más prolongada y una mortalidad del 14.3%. CONCLUSIONES: Los factores de riesgo asociados con la presencia de fuga anastomótica encontrados en este estudio son consistentes con los reportados en la literatura mundial. Sin embargo, en nuestros resultados cabe destacar el uso de cocaína como factor de riesgo, con significancia estadística.

Phenotypic traits of carbon source utilization in environmental Salmonella strains isolated from river water.

Salmonella in the environment have evolved genetically to maintain a stable cell metabolism. Nevertheless, a lack of common nutrients (such as glucose) causes these strains to metabolize alternative carbon sources. In this study, 21 strains of Salmonella Oranienburg isolated from subtropical river water were evaluated to compare their adaptation and preconditioning abilities for the consumption of environmental carbon sources (ECS). The results obtained in this study attributed important biological characteristics to the adaptation of the metabolism of Salmonella strains to diverse ECS; these characteristics include but are not limited to variations in plasticity and natural preconditioning in closely related microorganisms, such as environmental isolates belonging to the serotype Oranienburg.

Lack of Effects of the Genetic Polymorphisms of Interleukin-10 in Clinical Outcomes of COVID-19.

Interleukin-10 (IL-10) gene polymorphisms have been associated with severity and outcomes in patients with respiratory and nonrespiratory viral infections. The aim of this study was to assess whether rs1800871 and rs1800872 polymorphisms of IL-10 gene are associated with the clinical outcomes of COVID-19 in a Mexican population. Study subjects were 193 COVID-19 patients. The genotyping was carried out with real-time PCR and serum IL-10 levels were measured with enzyme-linked immunosorbent assay. Logistic regression analysis was used for analysis association with clinical outcomes. There was no evidence of an association between alleles, genotypes, or haplotypes frequencies between patient groups according to severity and outcomes. The rs1800871 and rs1800872 polymorphisms might not be genetic risk factors for severity and mortality for COVID-19 in Mexican mestizos patients from northwest Mexico.

Time of ureteral ejection of sodium fluorescein in the cystoscopic assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy

Objective: To evaluate the time of ureteral ejection of intravenous sodium fluorescein in the assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy (TLH). Material and Methods: Fifty-four women undergoing TLH were studied in a public teaching hospital in Culiacan, Sinaloa, Mexico. They underwent cystoscopic evaluation of ureteral patency after intravenous administration of 100 mg of sodium fluorescein. The present study analyzed the time elapsed in minutes from the intravenous administration of fluorescein to the outflow of stained urine by one or both ureteral meatus, the degree of urine staining, and the impact of body mass index (BMI) (BMI; normal, overweight, and obesity) on ejection time. Results: The overall average time elapsed to visualize the ejection of fluorescein through at least one ureteral meatus was 7.5 minutes [95% confidence interval (CI): 6.3-8.7]. There were no significant differences in the time of ureteral ejection of fluorescein taking BMI into account (p=0.579), with a mean time for normal BMI of 8.1 minutes (95% CI: 5.1-11.2), for overweight of 7.0 minutes (95% CI: 5.5-8.5), and for obesity of 7.8 minutes (95% CI: 5.3-10.3). Conclusion: Intravenously administered 10% sodium fluorescein dye is rapidly eliminated and strongly stains urine, which makes it useful for identifying ureteral patency during cystoscopy after TLH. Fluorescein excretion is not affected by patient BMI.

Estrógeno tópico vaginal y dehiscencia de la cúpula vaginal en pacientes con histerectomía total laparoscópica / Topical vaginal estrogen and vaginal vault dehiscence in patients rather than a laparoscopic total hysterectomy

Resumen OBJETIVO: Comparar la frecuencia de dehiscencia de la cúpula vaginal en pacientes tratadas con y sin estrógenos equinos conjugados por vía vaginal antes de la histerectomía total laparoscópica. MATERIALES Y MÉTODOS: Ensayo clínico controlado, comparativo, ciego simple, efectuado en pacientes atendidas entre enero de 2013 y agosto de 2016 en el Hospital Civil de Culiacán con indicación de histerectomía total laparoscópica por enfermedad benigna. Criterios de inclusión: haber recibido durante tres semanas previas al procedimiento estrógenos equinos conjugados por vía vaginal (grupo de estudio) o crema lubricante vaginal como placebo (grupo control). Criterios de exclusión: pacientes con diabetes mellitus tratadas con esteroides y antecedente de un evento tromboembólico reciente. Se evaluó la frecuencia de dehiscencia de la cúpula vaginal a los 7 y 30 días posteriores a la cirugía. Se utilizó la prueba t de Student para comparar medias y la χ2 para la comparación de proporciones, con cálculo de riesgo relativo para evaluar el riesgo de dehiscencia de la cúpula vaginal. RESULTADOS: Se estudiaron 236 pacientes con edad promedio, en ambos grupos, de 47.1 y 47.7 años, respectivamente (p > .05). Los antecedentes ginecoobstétricos y las indicaciones para histerectomía fueron similares en ambos grupos (p = .340). La incidencia total de dehiscencia de la cúpula vaginal fue de 4.6% (n = 11/236) con frecuencia de 6.8% (n = 8/118) en las pacientes del grupo tratado con lubricante vaginal y de 2.5% (n = 3/118) en el grupo tratado con estrógenos equinos conjugados por vía vaginal, sin diferencias entre ambos grupos (p = .123; RR=.359; IC95%: .093-1.387). CONCLUSIONES: El riesgo de dehiscencia de la cúpula vaginal fue similar entre el grupo que recibió lubricante y el de estrógenos tópicos vaginales, pero con una tendencia menor en la frecuencia de dehiscencia de la cúpula vaginal en el grupo tratado con estrógenos tópicos.

Abstract OBJECTIVE: To compare the frequency of vaginal cuff dehiscence in patients managed with and without conjugated equine estrogens vaginally prior to total laparoscopic hysterectomy (TLH). MATERIALS AND METHODS: In a single-blind controlled clinical trial, 236 patients with indications for laparoscopic total hysterectomy for benign pathology at the Hospital Civil de Culiacán and who agreed to participate in the study were randomly assigned to receive vaginally conjugated equine estrogens (study group) or vaginal lubricating cream as a placebo (control group) for 3 weeks prior to the procedure. Patients with diabetes mellitus, treated with steroids and history of a recent thromboembolic event were excluded. The frequency of vaginal cuff dehiscence was evaluated at 7 and 30 days after surgery. The student's t-test was used to compare means and the Chi-square test was used to compare proportions, with relative risk (RR) calculation to evaluate the risk of vaginal cuff dehiscence. RESULTS: We studied 236 patients with average age, in both groups, 47.1 and 47.7 years, respectively (p > .05). The mean age of the patients was similar between the groups (47.1 vs 47.7 years, p>.05). The gynecological-obstetric history and indications for hysterectomy were similar between both groups (p = .340). The incidence of vaginal cuff dehiscence was 2.5% (n = 3) in the group treated with conjugated equine estrogens vaginally and 6.8% (n = 8) in the patients of thse group treated with vaginal lubricant (p= .123; RM= .359; IC95%: .093-1.387). CONCLUSIONS: The risk of presenting vaginal cuff dehiscence was similar between the group of lubricant and topical vaginal estrogens, but with a lower tendency in the frequency of vaginal cuff dehiscence in the group of topical estrogens.

Association of Intron-2 Variable Numbers of an 86-bp Tandem Repeat-Polymorphisms of Interleukin-1 Receptor Antagonist Gene and Idiopathic Recurrent Spontaneous Abortion.

BACKGROUND: It has been proposed that abnormal modulation of inflammatory response is involved in the physiopathology of idiopathic recurrent spontaneous abortion (iRSA). Factors that may participate in this process include the genetic background such as carrying specific polymorphisms of genes with functional effects. OBJECTIVE: The objective is to study the association between iRSA and the frequency of intron-2 variable number tandem repeat-polymorphisms of interleukin-1 receptor antagonist gene (IL1RN). METHODS: We conducted a case-control study including 108 women with iRSA and 103 controls. Five allelic variants of IL1RN were determined by polymerase chain reaction (PCR) product length analysis. RESULTS: The most frequent IL1RN allele in this population was IL1RN*1, which was present in 78% of cases and 94% of controls, and allele IL1RN*2, in 45 (20.8%) cases and 12 (5.8%) controls. Allele IL1RN*2 was significantly associated with iRSA (odds ratio = 4.28, 95% confidence interval 2.2-8.4; p = 0.000). CONCLUSION: Carrying allele IL1RN*2 had a strong association with iRSA in Mexican women. This polymorphism codifies for a low-function protein, which may allow for increased activity of IL-1 pro-inflammatory axis in iRSA.

[Comparative analysis of diagnostic scales of acute appendicitis: Alvarado, RIPASA and AIR]. / ARTÍCULO ORIGINAL Análisis comparativo de escalas diagnósticas de apendicitis aguda: Alvarado, RIPASA y AIR.

INTRODUCTION: Acute appendicitis is the most common surgical disease in emergency surgery, however, it remains a diagnostic problem and represents a challenge despite the experience and the different clinical and paraclinical diagnostic methods. OBJECTIVE: To evaluate in a comparative way the scale of Alvarado, AIR and RIPASA to determine which one is best as a diagnostic test of acute appendicitis in our population in order to arrive to an accurate diagnosis in the shortest possible time and cost. METHOD: Observational, prospective, transversal and comparative study of 137 patients to whom the scale of Alvarado, AIR and RIPASA was applied, who entered the emergency service of the Civil Hospital of Culiacán (México) with abdominal pain syndrome suggestive of acute appendicitis. RESULTS: The Alvarado scale presented sensitivity 97.2% and specificity of 27.6%. AIR presented sensitivity of 81.9% and specificity of 89.5%. RIPASA showed the same results as Alvarado. All tests showed diagnostic accuracy above 80. CONCLUSIONS: Alvarado and RIPASA presented good sensitivity, however, AIR is more specific, and has better accuracy for the diagnosis of acute appendicitis, making a better screening and thus reducing unnecessary surgeries. Therefore, it is recommended to use more AIR than Alvarado and RIPASA.

INTRODUCCIÓN: La apendicitis aguda es la enfermedad quirúrgica más común en cirugía de urgencia; sin embargo, sigue siendo un problema diagnóstico y representa un reto a pesar de la experiencia y los diferentes métodos de diagnóstico clínicos y paraclínicos. OBJETIVO: Evaluar en forma comparativa las escalas de Alvarado, AIR y RIPASA para determinar cuál es superior como prueba diagnóstica de apendicitis aguda en nuestra población, llegando a un diagnóstico preciso en el menor tiempo y costo posibles. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo de 137 pacientes a quienes se aplicó las escalas de Alvarado, AIR y RIPASA, que ingresaron al servicio de urgencias del Hospital Civil de Culiacán (México) con síndrome doloroso abdominal sugestivo de apendicitis aguda. RESULTADOS: La escala de Alvarado presentó una sensibilidad del 97.2% y una especificidad del 27.6%. AIR tuvo una sensibilidad del 81.9% y una especificidad del 89.5%. RIPASA arrojó los mismos resultados que Alvarado. Todas las pruebas tuvieron una exactitud diagnóstica por arriba del 80. CONCLUSIONES: Alvarado y RIPASA presentaron buena sensibilidad, mientras que AIR es más específica y tiene mayor exactitud diagnóstica de apendicitis aguda, realizando un mejor tamizaje y permitiendo disminuir las cirugías innecesarias, por lo que se recomienda usar más AIR que Alvarado y RIPASA.

Obstrucción intestinal secundaria a endometriosis infiltrante profunda del íleon / Bowel obstruction secondary to deep infiltrating endometriosis of the ileum

No disponible

Bowel obstruction secondary to deep infiltrating endometriosis of the ileum.

Deep infiltrating endometriosis (DIE) of the ileum is an uncommon lesion that may be severe in its clinical presentation. Its diagnosis is challenging in the absence of a gynecological history of endometriosis and because of its anatomical location. We read the article by Sánchez, Candel, and Albarracín, and now report an additional case that was managed urgently.

Patrón menstrual y reserva ovárica en pacientes con salpingectomía y oclusión tubárica para esterilización definitiva / Menstrual pattern and ovarian reserve in patients undergoing to salpingectomy and tubal occlusion for definitive sterilization

Resumen Objetivo: Evaluar el patrón menstrual y la reserva ovárica mediante la determinación de FSH y conteo de folículos antrales en pacientes con salpingectomía y oclusión tubárica bilateral como métodos de esterilización definitiva. Material y métodos: Estudio prospectivo, longitudinal, comparativo, experimental, con asignación al azar, ciego simple, al que se incluyeron pacientes con deseos de esterilización definitiva como método anticonceptivo. Las pacientes se asignaron al azar a dos grupos, el primero con oclusión tubárica bilateral y el segundo con salpingectomía. A los seis meses posprocedimiento se evaluaron en forma ciega el patrón menstrual y la determinación sérica de hormona folículo estimulante (FSH) y el recuento de folículos antrales por ultrasonido transvaginal como marcadores de reserva ovárica. El análisis estadístico se llevó a cabo con t de Student para muestras independientes (comparación entre los grupos) y dependientes (comparación intragrupo) para comparación de medias y la prueba x2 para comparación de proporciones. Resultados: Se estudiaron 60 pacientes, 31 con oclusión tubárica bilateral y 29 con salpingectomía. Se registraron aumentos significativos en los días de sangrado menstrual con respecto a la basal después de la oclusión tubaria bilateral (p = .002) y salpingectomía (p = .008). No hubo diferencias entre oclusión tubárica bilateral y salpingectomía con respecto al tiempo quirúrgico para llevar a cabo la técnica de esterilización (p = .83), duración del ciclo menstrual (p = .35), duración de los días de sangrado menstrual (p = .40). Tampoco resultaron diferencias en las concentraciones séricas de FSH (p = 0.75) ni en el recuento de folículos antrales (p = .44) entre los grupos. Conclusiones: El patrón menstrual y la reserva ovárica son muy similares en pacientes con oclusión tubárica bilateral o salpingectomía. Ambas técnicas incrementan la duración del sangrado menstrual posterior al procedimiento. La salpingectomía implica un aumento ligero en el tiempo quirúrgico, sin diferencias en la frecuencia de complicaciones.

Abstract Objective: To evaluate the menstrual pattern and ovarian reserve in patients undergoing salpingectomy and bilateral tubal occlusion as definitive sterilization methods. Material and methods: A prospective, longitudinal, comparative, experimental, randomized, single blind study was carried out in patients with a desire for definitive sterilization as a contraceptive method. Patients were randomly assigned to perform bilateral tubal occlusion or salpingectomy. Six months after the procedure in each patient, the menstrual pattern and the serum determination of follicle stimulating hormone (FSH) and the antral follicle count were evaluated by transvaginal ultrasound as markers of ovarian reserve. The statistical analysis was carried out using the student's t-test for independent samples (comparison between groups) and dependent samples (intra-group comparison) for comparison of means and the x2 test for comparison of proportions. Results: Sixty patients were studied, 31 with bilateral tubal occlusion and 29 with salpingectomy. Significant increases were observed in the days of menstrual bleeding with respect to the baseline after bilateral tubal occlusion (p = .002) and salpingectomy (p = .008). No differences were observed between bilateral tubal occlusion and salpingectomy with respect to the surgical time to carry out the sterilization technique (p = .83), menstrual cycle duration (p = .35), duration of the days of menstrual bleeding (p = .40). No differences were observed in the serum levels of FSH (p = .75) nor in the antral follicle count (p = .44) between the groups. Conclusions: The menstrual pattern and the ovarian reserve are very similar in patients who undergo bilateral tubal occlusion and salpingectomy, although the two techniques increase the duration of menstrual bleeding after the procedure.

Differences in carbon source utilization of Salmonella Oranienburg and Saintpaul isolated from river water.

Long-term exposure to river water by non-indigenous micro-organisms such as Salmonella may affect metabolic adaptation to carbon sources. This study was conducted to determine differences in carbon source utilization of Salmonella Oranienburg and Salmonella Saintpaul (isolated from tropical river water) as well as the control strain Salmonella Typhimurium exposed to laboratory, river water, and host cells (Hep-2 cell line) growth conditions. Results showed that Salmonella Oranienburg and Salmonella Saintpaul showed better ability for carbon source utilization under the three growth conditions evaluated; however, S. Oranienburg showed the fastest and highest utilization on different carbon sources, including D-Glucosaminic acid, N-acetyl-D-Glucosamine, Glucose-1-phosphate, and D-Galactonic acid, while Salmonella Saintpaul and S. Typhimurium showed a limited utilization of carbon sources. In conclusion, this study suggests that environmental Salmonella strains show better survival and preconditioning abilities to external environments than the control strain based on their plasticity on diverse carbon sources use.

Calidad de vida relacionada con la salud en adultos con síndrome de intestino irritable en un hospital de especialidades de México. Estudio transversal / Health-related quality of life in adults with irritable bowel syndrome in a Mexican specialist hospital. A cross-sectional study

Introducción: existe evidencia del impacto negativo del síndrome de intestino irritable (SII) en la calidad de vida de los pacientes que lo padecen en comparación con la población general. Objetivo: el objetivo de este estudio fue determinar la calidad de vida relacionada con la salud (CVRS) en adultos con SII en la consulta de un hospital de especialidades de México. Material y métodos: se realizó un diseño transversal y se incluyeron prospectivamente pacientes consecutivos con diagnóstico de SII con criterios de Roma III que acudieron a consulta externa. Se aplicó el cuestionario SF-36 en español versión estándar y sus resultados se compararon con puntuaciones referenciales poblacionales en México. En el análisis estadístico se utilizó t de Student, análisis de varianza y Chi cuadrado, y se consideró una significancia del 0,05%. Resultados: fueron estudiados 154 pacientes, 137 (89%) mujeres y 17 (11%) hombres; la edad media fue de 52,8 (DE 12,6) años. Los subtipos estreñimiento, diarrea y mixto fueron 85 (55,2%), 27 (17,5%) y 42 (27,3%) pacientes respectivamente. La calidad de vida de pacientes con SII vs. puntuaciones referenciales poblacionales en México fueron: subescala salud física 50 vs. 79 y subescala salud mental 59,1 vs. 76,7, respectivamente (p = 0,000). No existió diferencia significativa en la calidad de vida entre los subtipos de SII (p > 0,05). Conclusiones: la CVRS es menor en pacientes con SII en una población al noroeste de México con respecto a datos de un estudio de referencia poblacional realizado en el mismo país, pudiendo realizar inferencia a población de mujeres pero con cautela en los resultados por la muestra pequeña estudiada en hombres. No existió diferencia significativa en la calidad de vida según el subtipo clínico de SII (AU)

Introduction: There are only few reports regarding the use of intragastric-balloons (IGB®) to achieve weight loss and subsequently decrease surgical complications. In this study, we try to assess whether presurgery weight loss using IGB decreases the postsurgical mortality after bariatric surgery. Methods: This is a prospective case-control study. We matched 1:1 by gender, age (± 10 y-o) and type of surgery (sleeve resection [LSG] or gastric bypass [LGBP]), matching cases (A) and controls (H, from a historic cohort). Morbidly obese patients with an indication for bariatric surgery were included in the study. Cases (A) were recruited from an ongoing clinical trial, and the controls (H) came from a historic cohort prior to the start of the clinic trial. The presurgical weight loss in group A was reached by IGB combined with diet, versus only diet in group H. Results: We included 58 patients, 65.5% women, 69% LGBP/31% LSG. The mean age of group A was 42 and 43.4 years old for group H. ASA III of 24.1% group A vs 58.6% group H, p = 0.012. The mean total weight loss (TWL) before surgery was greater in group A (16.2 kg, SD 9.75) than in group H (1.2 kg, SD 6.4), p < 0.0001. The % of EWL before surgery was 23.5 (SD 11.6) in group A vs 2.4 (SD 8) in group H, p < 0.001. Hospital stay was seven days for group A, and eight days for group H, p = 0.285. The rate of unsuccessful IGB treatment to accomplish the scheduled weight loss was 34.5%. The balloon morbidity was 17.2% (6.9% severe). All in all, morbidity (due to bariatric surgery and IGB) was 41% in both groups. Postsurgical morbidity moderate-severe was 20.3% in group A (6.9% severe) and 27.3% in group H (17.2% severe) without statistical significance. One patient died in group H (mortality rate, 3.44%). Conclusion: Preoperative IGB treatment in morbid obesity has not been found to be effective at decreasing postsurgical morbidity LSG and LGBP, despite the fact that it acheives a greater weight loss than diet and exercise (AU)

Health-related quality of life in adults with irritable bowel syndrome in a Mexican specialist hospital. A cross-sectional study.

BACKGROUND: Evidence shows the negative impact of irritable bowel syndrome on the quality of life of patients who suffer from the condition as compared to the general population. OBJECTIVE: The objective of this study was to determine the health-related quality of life in adults with irritable bowel syndrome who are receiving treatment at a specialist hospital. MATERIAL AND METHODS: The study had a cross-sectional prospective design. The study included consecutive patients diagnosed with irritable bowel syndrome under the Rome III criteria and attending outpatient appointments. The SF-36 questionnaire was applied in its standard Spanish version and the results were compared with population reference scores in Mexico. Statistical analysis was performed with the Student's t test, analysis of variance and the Chi-squared test, considering a significance of 0.05%. RESULTS: One hundred and fifty-four patients were included in the study, 137 (89%) women and 17 (11%) men, with an average age of 52.8 (SD 12.6). The constipation, diarrhea and mixed subtypes comprised 85 (55.2%), 27 (17.5%) and 42 (27.3%) patients, respectively. The quality of life of patients with irritable bowel syndrome vs the population reference scores in Mexico were 50 vs 79 for the physical health sub-scale and 59.1 vs 76.7 for the mental health sub-scale, respectively (p = 0.000). No significant difference was found in quality of life among the irritable bowel syndrome subtypes (p > 0.05). CONCLUSIONS: Health-related quality of life is lower in patients with irritable bowel syndrome in a population in the North East of Mexico compared to the data taken from a population reference study undertaken in the same country, enabling an inference in the female population and a cautious one from the results found in the small male sample studied. There was no significant difference found in the quality of life according to the clinical subtype of irritable bowel syndrome.

Regresión de la metaplasia intestinal gástrica tras la erradicación de la infección por Helicobacter pylori en un hospital de México / Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico

Introducción: la metaplasia intestinal es una lesión precursora del cáncer gástrico. La infección por Helicobacter pylori es la principal causa de metaplasia. Aunque se ha demostrado evidencia de regresión de metaplasia intestinal tras el tratamiento erradicador de esta infección, aún existen controversias al respecto. Objetivo: el objetivo de este estudio fue determinar la frecuencia de la regresión de la metaplasia intestinal gástrica al año de haber erradicado Helicobacter pylori.Métodos: se realizó un diseño prospectivo, longitudinal. La población estudiada fueron pacientes que acudieron a la Unidad de Endoscopia para la realización de una endoscopia digestiva alta por distintas indicaciones, comprobándose metaplasia intestinal asociada a Helicobacter pylori, y que recibieron terapia triple estándar empírica con erradicación de la bacteria. Se realizó una endoscopia digestiva alta con toma de cuatro muestras de biopsias gástricas (dos en antro y dos en cuerpo) antes y después del tratamiento erradicador, estudiándose los hallazgos endoscópicos e histológicos al año de seguimiento. Análisis estadístico con prueba exacta de Fisher y McNemar. Resultados: fueron estudiados 46 pacientes, 20 (43,5%) hombres y 26 (56,5%) mujeres, con edad media de 58,9 (DE 11,2) años. Se encontró metaplasia intestinal en 46 (100%) pacientes antes del tratamiento y en 21 (45,7%) tras la erradicación; metaplasia intestinal completa (tipo I) en 35 pacientes (76,1%) antes del tratamiento y en 11 (23,9%) posterior a la erradicación (p = 0,000); metaplasia intestinal incompleta (tipo II) en 10 (21,7%) pacientes antes del tratamiento y en 10 (21,7%) posterior a la erradicación; y gastritis crónica no atrófica en 35 (76,1%) pacientes antes del tratamiento y en 32 (69,6%) pacientes posterior a la erradicación. Conclusiones: en este estudio la metaplasia intestinal gástrica asociada a la infección por Helicobacter pylori presentó una regresión al año del 54,3% posterior a la erradicación de este microorganismo. Este tratamiento podría modificar la historia natural del desarrollo del cáncer gástrico (AU)

Background: Intestinal metaplasia is a precursor lesion of gastric cancer. Infection by Helicobacter pylori is the principal cause of metaplasia. While evidence of the regression of metaplasia after treatment to eradicate this infection has been demonstrated, controversy remains with regard to this subject. Objective: The objective of this study was to determine the frequency of the regression of gastric intestinal metaplasia one year after the eradication of Helicobacter pylori. Methods: A prospective longitudinal designed study was carried out. The population studied in this research consisted of patients attending the Endoscopy Unit to undergo an upper endoscopy, in whom various symptoms indicated intestinal metaplasia associated with Helicobacter pylori, and who received standard empiric triple therapy to eradicate the bacteria. An upper endoscopy was performed in which four gastric biopsy samples were taken (two from the antrum and two from the body) before and after the eradicating treatment, with the endoscopic and histological findings studied after one year of monitoring. The statistical analysis was conducted using the Fisher’s exact test and the McNemar’s test. Results: Forty-six patients were studied, of whom 20 (43.5%) were men and 26 (56.5%) were women, with an average age of 58.9 (DE 11.2). Intestinal metaplasia was found in 46 (100%) patients before treatment and in 21 (45.7%) patients post-eradication. Complete intestinal metaplasia (type I) was found in 35 patients (76.1%) before treatment and in 11 (23.9%) patients post-eradication (p = 0.000), while incomplete intestinal metaplasia (type II) was found in 10 (21.7%) patients before treatment and in 10 (21.7%) patients post-eradication. Non-atrophic chronic gastritis was found in 35 (76.1%) patients before treatment and in 32 (69.6%) patients post-eradication. Conclusions: In this study, gastric intestinal metaplasia associated with Helicobacter pylori infection showed a regression of 54.3% one year after the eradication of this microorganism. This treatment could modify the natural history of the development of gastric cáncer (AU)

Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico.

BACKGROUND: Intestinal metaplasia is a precursor lesion of gastric cancer. Infection by Helicobacter pylori is the principal cause of metaplasia. While evidence of the regression of metaplasia after treatment to eradicate this infection has been demonstrated, controversy remains with regard to this subject. OBJECTIVE: The objective of this study was to determine the frequency of the regression of gastric intestinal metaplasia one year after the eradication of Helicobacter pylori. METHODS: A prospective longitudinal designed study was carried out. The population studied in this research consisted of patients attending the Endoscopy Unit to undergo an upper endoscopy, in whom various symptoms indicated intestinal metaplasia associated with Helicobacter pylori, and who received standard empiric triple therapy to eradicate the bacteria. An upper endoscopy was performed in which four gastric biopsy samples were taken (two from the antrum and two from the body) before and after the eradicating treatment, with the endoscopic and histological findings studied after one year of monitoring. The statistical analysis was conducted using the Fisher's exact test and the McNemar's test. RESULTS: Forty-six patients were studied, of whom 20 (43.5%) were men and 26 (56.5%) were women, with an average age of 58.9 (DE 11.2). Intestinal metaplasia was found in 46 (100%) patients before treatment and in 21 (45.7%) patients post-eradication. Complete intestinal metaplasia (type I) was found in 35 patients (76.1%) before treatment and in 11 (23.9%) patients post-eradication (p = 0.000), while incomplete intestinal metaplasia (type II) was found in 10 (21.7%) patients before treatment and in 10 (21.7%) patients post-eradication. Non-atrophic chronic gastritis was found in 35 (76.1%) patients before treatment and in 32 (69.6%) patients post-eradication. CONCLUSIONS: In this study, gastric intestinal metaplasia associated with Helicobacter pylori infection showed a regression of 54.3% one year after the eradication of this microorganism. This treatment could modify the natural history of the development of gastric cancer.

Comparison between unidirectional barbed and polyglactin 910 suture in vaginal cuff closure in patients undergoing total laparoscopic hysterectomy.

The aim of the study was to compare the efficacy and safety of barbed unidirectional vs. polyglactin 910 suture in vaginal cuff closure on patients submitted to total laparoscopic hysterectomy. From November 2011 until March 2012, a prolective, comparative, longitudinal, non-randomized study was performed on patients submitted to total laparoscopic hysterectomy (TLH). On entry, patients were assigned to two different groups, Group 1: Vaginal cuff closure with unidirectional #00 (n = 25) barbed suture, and Group 2: Vaginal cuff closure with polyglactin 910 #1 suture. The length of closure time and the frequency of dehiscence in vaginal vault were measured on the 14th postoperative day. We did not find significant differences between the groups on the general characteristic analysis. However, significant differences were found (P = .029) in the average vaginal cuff closure time (12.7 ± 3.1 min. for barbed suture group vs. 20.4 ± 7.1 min. for polyglactin 910 group). No dehiscence case was found in any group. Based on the results of this study, we can conclude that unidirectional barbed suture reduces the surgical time for vaginal cuff closure during total laparoscopic hysterectomy and doesn't increase the vaginal cuff dehiscence risk.

Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico. Cross-sectional study.

INTRODUCTION: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. MATERIAL AND METHODS: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. Forthe statistical analysis, we used Student´s t-test and Chi-square, 95 % confidence intervals and significance 0.05 %. RESULTS: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal anti-inflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. CONCLUSIONS: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries.

Índice de masa corporal materno y su asociación con la vía de resolución del embarazo y los resultados perinatales / Maternal body mass index and its association with mode of delivery and perinatal outcomes

Evaluar si un índice de masa corporal anormal (IMC) se asocia con mayor frecuencia de operación cesárea y resultados perinatales adversos. Material y métodos: De noviembre de 2010 a diciembre de 2011 se llevó a cabo un estudio de cohortes comparativas en 595 pacientes embarazadas, divididas en tres grupos de acuerdo con su IMC al inicio del embarazo: normal: 18.5 a 24.99 kg/m2, (n = 146), sobrepeso: 25 a29.99 kg/m2 (n = 240) y obesidad: > 30 kg/m2 (n = 209). Se analizaron las siguientes variables: frecuencia de operación cesárea, RPM, parto pretérmino, inducción del trabajo de parto, embarazo prolongado y los resultados perinatales (peso, puntaje de Apgar, vitalidad y malformación congénita en el recién nacido).Resultados: No hubo diferencias significativas en la frecuencia de operación cesárea entre los grupos (p = 0.988). Se observó mayor ganancia de peso en el grupo de pacientes obesas (p = 0.000). La frecuencia de complicaciones transoperatorias fue significativamente mayor en el grupo de sobrepeso (p = 0.012). La frecuencia de macrosomía fue mayor en pacientes del grupo de obesidad (p = 0.001). No hubo diferencias en otros resultados perinatales entre los grupos. Conclusiones: La frecuencia de operación cesárea no difiere entre pacientes con peso normal, sobrepeso y obesidad. El sobrepeso incrementa el riesgo de complicaciones operatorias durante la cesárea. La obesidad se asoció con mayor riesgo de macrosomía fetal...

Indicaciones inadecuadas en el consumo crónico de inhibidores de bomba de protones en un hospital de México. Estudio transversal / Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico. Cross-sectional study

Introducción: los IBP han sido un avance terapéutico enorme en las enfermedades relacionadas con el ácido. Sin embargo se ha detectado que hay mayoritariamente un abuso en su consumo. El objetivo del estudio fue determinar en nuestro medio la frecuencia de indicación inadecuada en el consumo crónico de IBP en pacientes ambulatorios en un hospital de especialidades. Material y métodos: se realizó un estudio de revisión transversal descriptivo. La población estudiada fueron pacientes de un hospital de trabajadores del Estado, consumidores crónicos de IBP que acudieron a consulta externa. Se definió como consumidor crónico de IBP la toma diaria del medicamento durante más de un año e indicación inadecuada (no aprobada por guías clínicas). El muestreo fue aleatorio simple. Se investigaron los siguientes parámetros: diagnóstico e indicación de los IBP, tiempo de uso, en qué nivel de atención se prescribió (atención primaria o especializada), automedicación, con o sin endoscopia digestiva. Para el análisis estadístico se utilizó t de Student y Chi cuadrado, intervalos de confianza 95 % y significancia 0,05 %. Resultados: se revisaron 153 pacientes, 40 (26,1 %) hombres y 113 (73,9 %) mujeres, edad promedio 58 (DE 11,4) años. La indicación de tratamiento crónico con IBP era adecuada en el 64,7 % de los pacientes e inadecuada en el 35,3 %. La indicación apropiada más frecuente (31,3 %) del consumo crónico de IBP fue la ERGE. La indicación inadecuada más frecuente fue la prescripción sin diagnóstico (22,2 %), polifarmacia sin AINE (16,6 %) y gastritis crónica (16,6 %). Antecedentes de endoscopia no tuvieron significación estadística (p > 0,05). Conclusiones: la frecuencia de indicaciones inadecuadas en el consumo crónico de IBP fue alta y del 35,3%, similar a los publicados en hospitales de países desarrollados(AU)

Introduction: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. Material and methods: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. For the statistical analysis, we used Student’s t-test and Chi-square, 95% confidence intervals and significance 0.05 %. Results: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal antiinflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. Conclusions: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries(AU)