Abordaje multidisciplinario de la enfermedad humana por infiltración de sustancias modelantes / Multidisciplinary management of adjuvant human disease by injection of modeling substances

En la búsqueda por mejorar la apariencia del cuerpo y de la cara con fines estéticos o reconstructivos por alguna deformidad, han aparecido técnicas no quirúrgicas que consisten en inyectar diversas sustancias modelantes bajo la premisa de que son métodos sencillos, poco dolorosos, económicos y aparentemente seguros. La sociedad actual exige una mayor preocupación por los patrones estéticos, lo que ha motivado la práctica cada vez más frecuente de la aplicación de sustancias ilícitas con el fin de aumentar el volumen y modelar ciertas partes del cuerpo sin someterse a procedimientos quirúrgicos. La ignorancia que existe en algunos países como México y otros de Latinoamerica, ha propiciado que el número de pacientes que se somete a este tipo de tratamientos por personal no capacitado y en lugares no autorizados sea cada vez mayor, sin considerar el daño irreversible que causarán a su salud física, a su autoestima y finalmente a su calidad de vida futura. Los Servicios de Cirugía Plástica y Reumatología del Hospital General de México, han sido pioneros en el estudio integral y multidisciplinario de la enfermedad humana por modelantes, han ampliado el conocimiento de la historia natural de la enfermedad, de su tratamiento médico y quirúrgico, asi como de su pronóstico. El objetivo principal de este trabajo es concentrar toda esta información en un protocolo de manejo sistematizado, mediante búsqueda en el archivo del Servicio de Cirugia Plástica "Dr. Fernando Ortiz Monasterio" del Hospital General de Mexico. Esta búsqueda abarcó 35 pacientes de los cuales se obtuvieron resultados con datos durante el periodo 2006 a 2010, demostrando la importancia de diagnosticar a los pacientes, llevar un control estrecho, explicar paso a paso el proceso de su enfermedad, el tratamiento multidiciplinario, así como el pronóstico en cuanto a si es candidato a una reconstrucción o continuará con tratamiento médico

In seeking to improve the appearance of the body and face for cosmetic or reconstructive purposes for any deformity, non-surgical techniques have appeared consisting on the injection of various modeling substances, under the premise that they are simple methods, painless, economic and apparently safe. Nowadays society requires a greater concern with aesthetic standards, has led this practice to increase the frequent application of illegal substances in order to enhance the volume and shape in certain parts of the body without undergoing surgical procedures. The ignorance that exists in some countries like Mexico and others in Latin-America, has meant that the number of patients attending with untrained personnel and unauthorized sites has increased, regardless of that cause irreversible damage to their physical health, self-esteem and finally their future quality of life. The Services of Plastic Surgery and Rheumatology, at General Hospital of Mexico have been pioneers in the comprehensive and multidisciplinary human modeling disease, expanding the knowledge of the natural history of the disease, the proper medical and surgical treatment, as well as its prognosis. The main objective of this paper is to focus all this information in a systematic management protocol. We did a research on the files of the Plastic Surgery Department "Dr. Fernando Ortiz Monasterio ¨ at General Hospital of Mexico. This search covers 35 patients obtaining data from 2006 to 2010, and demonstrating the importance of diagnosing these patients, keeping a tight handling, explaining step by step process of his illness, multidisciplinary management, forecast and if the patient must be candidate for a reconstructive procedure or continue with medical treatment

Cardiovascular risk factors in the urban Mexican population: the FRIMEX study.

BACKGROUND: Atherosclerotic ischaemic heart disease is the second leading cause of general mortality in Mexico due to the growing prevalence of atherosclerotic risk factors in our society. The data of the FRIMEX study (Factores de Riesgo en México, Risk Factors in Mexico), considered together with those of other contemporary epidemiological surveys, will aid in our comprehension of the current state of cardiovascular epidemics in Mexico. METHODS: Frequencies of obesity, hypertension and smoking, and total cholesterol and glucose in capillary blood were estimated in a non-probabilistic sample comprised of 140017 individuals (aged 44+/-13 years; 42% men and 58% women), from six Mexican cities (Mexico City, Guadalajara, Monterrey, Puebla, Leon and Tijuana). RESULTS: Obesity or overweight status was found in 71.9% of participants. Hypertension was found in 26.5%, and the proportions of awareness, treatment and control for this disease were 49.3, 73 and 36%, respectively. Prevalence of hypertension increased with age; while it was higher in men under 60 years of age, in the more aged individuals it was higher in women. Hypercholesterolaemia was found in 40% of the individuals and cholesterolaemia > or =240 mg/dl was significantly higher in women. Thirty-five and a half percent of men and 18.1% of women were smokers. Type 2 diabetes mellitus was found in 10.4% of participants. There was significant Pearson's correlation between body mass index and blood pressure, between hypertension and glucose levels, and between hypertension and total cholesterol concentrations. CONCLUSIONS: We conclude that this population has a high cardiovascular risk profile and a high probability of the occurrence of metabolic syndrome.

A recurrent frameshift mutation in exon 19 of the type VII collagen gene (COL7A1) in Mexican patients with recessive dystrophic epidermolysis bullosa.

Dystrophic epidermolysis bullosa (DEB) is an inherited blistering skin disorder caused by mutations in the type VII collagen gene (COL7A1). In this study, we determined the molecular basis of autosomal recessive DEB in a 19-year-old Hispanic Mexican woman by PCR amplification of genomic DNA, heteroduplex analysis, and automated sequencing of heteroduplex bandshifts. This approach revealed a homozygous frameshift mutation, 2470insG, in exon 19 of COL7A1 and resulted in attenuated basement membrane zone expression of type VII collagen, a reduced number of anchoring fibrils at the dermal-epidermal junction, and a sub-lamina densa level of blister formation. Clinically, the patient had widespread trauma-induced skin fragility and complete loss of the nails, but had less pseudosyndactyly of the fingers and toes and milder mucosal involvement compared to most patients with the generalized form of this genodermatosis. We also screened 7 other Hispanic-Mexican patients with recessive DEB, none of whom were known to be related to this individual, for the mutation 2470insG using heteroduplex analysis and direct sequencing and detected this mutation on 7/14 alleles. Haplotype analysis using intragenic COL7A1 and flanking polymorphisms and microsatellite markers revealed that all the mutant alleles had arisen on similar allelic backgrounds, consistent with propagation of a common Hispanic Mexican ancestral haplotype. In view of the high allelic frequency of the mutation 2470insG in the patients studied, we recommend initial screening for this mutation when attempting to identify the molecular pathology of recessive DEB in Hispanic Mexican patients.

Groundwater flow system in the valley of Toluca, Mexico: an assay of natural radionuclide specific activities.

Natural radionuclides and physicochemical parameters have been evaluated in groundwater samples from boreholes belonging to the drinking water supply system of the Toluca City, Mexico. The results obtained for radon and radium, together with the physicochemical parameters of the studied samples, indicate a fast and efficient recharge pattern. The presence of a local and a regional groundwater flows was also observed. The local flow belongs to shallower water, recognized by its low radon content and dissolved ions, as compared with the regional, deeper groundwater flow with a longer residence time.

Improving quality through an integrated partnership model.

Improved models for quality management/quality improvement (QM/QI) activities must include a partnership with other disciplines and integration of functions and responsibilities. Current and projected changes in health care dictate the need to change policy, roles, behavior, standards, and patient care delivery systems to be more cost efficient. Nursing leaders must be proactive in this new arena to ensure the continued survival of nursing. The incorporation of the integrated partnership model into QM/QI activities provides methods to review issues at the most appropriate level to ensure speedy resolution.

Total therapeutic paracentesis (TTP) with and without intravenous albumin in the treatment of cirrhotic tense ascites: a randomized controlled trial.

We studied 35 cirrhotic patients with tense ascites assigned at random into two groups: Group I consisted of 17 patients treated by total therapeutic paracentesis (TTP) (6-15 l) plus i.v. albumin (5 g/l of fluid) and Group II consisted of 18 patients treated by TTP (5.5-15.5 l) without albumin. On 19 patients we performed a sequential assessment of cardiac output (CO), plasma renin activity (PRA) and plasma aldosterone (PA). Both groups were similar in age, sex, and etiology of cirrhosis. CO, PRA and PA values were expressed as mean changes occurring in relation to their respective baseline values. CO changes after TTP (l/min): Group I: 2.5 after 6 h and 2.2 after 12 h; Group II: 2.2 after 6 h and -0.4 after 12 h, (p < 0.05 comparing values after 12 h between the two groups). PRA changes after TTP (ng/dl/h): Group I: -7.4 after 1 h, -7.8 after 6 h and -3.2 after 24 h; Group II: -2.4 after 1 h, -0.8 after 6 h and 3.9 after 24 h (p < 0.05 comparing values between both groups after 6 and 24 h). PA changes after TTP (ng/dl): Group I: -50.5 after 1 h, -36.7 after 6 h and -34.6 after 24 h; Group II: -18.2 after 1 h, -2.2 after 6 h and 20 after 24 h, (p < 0.05 comparing values between both groups after 1 and 6 h). Complications were minimal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Radon concentration levels in ground water from Toluca, Mexico.

Concentration levels of 222Rn have been analysed in water samples from deep wells of the aquifers around the City of Toluca, Mexico. The 222Rn source is the decay of 226Ra within the solid matrix of the aquifer. With a half life of 1600 years the 226Ra continuously releases 222Rn to the pores, from which it diffuses into the main body of water. This paper describes the methods used for sampling and measuring solubilized and 226Ra-supported 222Rn in the water samples, in order to evaluate possible health hazards due to the presence of radon in the drinking water supplies. The relationship of 222Rn with the hydrogeologic characteristics of the zone is also described. The analytical method involves laboratory extraction of 222Rn into toluene. Alpha disintegrations of 222Rn and contributions from short-lived daughters are counted by the liquid scintillation technique. The system was calibrated using a 226Ra standard solution. Results up to 11.3 Bq/l of 222Rn were obtained in the water samples.

[The Apgar score as a predictor of neurologic sequellae]. / El puntaje de Apgar como predictor de secuelas neurológicas.

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

Familism, machismo and child rearing practices among Mexican Americans.

PIP: Mexican Americans form the 2nd largest minority group in the US. Fertility is 50% higher than in any other ethnic group. Income levels are inordinately low. In 1970, 42% of Mexican Americans were indigent, making approxiamtely 4200 annually. The Mexican American poor can be categorized into newly arrived aliens or 2nd or 3rd generation American citizens. In the 1st instance, the couple is young and English is not spoken. 2nd or 3rd generation Mexican Americans speak English. The persistent socioeconomic status of the Mexican American relates directly to the level of education. 52% of all Mexican Americans do not finish high school. Paz and Remos described the Mexican in terms of Adler's inferiority model. Murillo stated that to an individual, the family--whether nuclear or extended--is the center of life. The inherent responsibility is that the individual behave properly lest the family be disgraced. The family provides emotional and material security. Familism was seen as a deterrant to utilization of health care services, although some studies claim opposing views. Familism and occupational stability related positively to seeking medical care when ill. Hayden believed that supreme male dominance, individualism, pride, wife beating, aversion to contraceptives, and other characteristics were attributable to machismo. A predominant pattern in Mexican American culture is that of elders' ordering young men and women to establish obedience and male dominance. The husband represents authority and the wife-mother maintains a role of complete devotion to her husband and children. Role differentiation is taught implicitly and explicitly from infancy. Studies on the psychological differences between the sexes indicated that females were oppressed and had lower self esteem than males. 18-24 year old Mexican Americans are becoming less insistent upon strict separation of sex roles and are beginning to reject the traditional Mexican notion of masculine superiority. The word machismo is derived from macho, which means male. The real macho possesses many traits of honor, dignity, and courage. he exemplifies masculine aggressiveness and sexual virility. The negative extremes of machismo center on absolute power in the form of violence and exploitation. Machismo is the underlying cause of family conflicts.^ieng

Relaxation training as a nursing intervention versus pro re nata medication.

To determine the effect of relaxation training on the frequency of intake of pro re nata medication for relief of tension and to compare the difference between live and taped instructions of this training 60 patients on PRN minor tranquilizers and sedatives in one nursing unit were studied. Subjects were randomly assigned to three groups: group A, control; group B, live instruction; group C, taped instruction. Dependent variables monitored were: 1) frequency of intake of PRN medication; 2) pre- and postinstruction change in blood pressure, pulse, and respiration; 3) change in the Taylor Manifest Anxiety Scale; and 4) change on the Minnesota Multiphasic Personality Inventory score. Although no significant difference was found between method of relaxation training, there was evidence that group B surpassed group C in terms of benefit of the treatment. Physiologic variables as well as MMPI scales K, I, and VII yielded better results for group B. Not all variables demonstrated significant differences. Groups B and C were more similar at the conclusion of the study than had been anticipated-perhaps because subjects responded favorably to inclusion in the study regardless of method of training.