[Key recommendations of the clinical guidelines of arterial hypertension in primary care]. / Recomendaciones de la guía de práctica clínica de hipertensión arterial en el primer nivel de atención.

BACKGROUND: Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making. METHODS: The guide is integrated with recommendations of international guidelines and evidence of published studies indicated the changes regarding the management and treatment of hypertension, as well as differences between the target populations of the guide. Searching for information it is performed by means of a standardized sequence in PubMed and Cochrane Library Plus, from the questions asked. The key recommendations were chosen by a consensus of a group of professionals and health managers. CONCLUSIONS: The key recommendations evidence-based standardized help you make decisions about prevention, diagnosis and treatment in patients with hypertension, and will contribute to reducing cardiovascular risk, promote changes in lifestyle, control the disease and reduce complications.

Introducción: la hipertensión arterial (HA) ocupa el primer lugar de atención en unidades médicas de primer nivel. La mitad de los pacientes con HA no están controlados. El objetivo de este documento es proporcionar las recomendaciones de la guía de diagnóstico y tratamiento de HA en el primer nivel de atención que han sido consideradas clave para el proceso de atención, con el fin de ayudar a los profesionales de la salud, en la toma de decisiones clínicas. Métodos: la guía se integró con recomendaciones de guías internacionales y evidencias de estudios publicados que señalaron los cambios ocurridos en el abordaje y tratamiento de la HA, así como las diferencias entre los grupos poblacionales blanco de la guía. La búsqueda de información se realizó por medio de una secuencia estandarizada en Pubmed y Cochrane Library Plus. Las recomendaciones clave se eligieron por consenso de un grupo de profesionales y gestores de la salud. Conclusiones: las recomendaciones clave, basadas en evidencias, ayudarán a tomar decisiones estandarizadas sobre prevención, diagnóstico y tratamiento en pacientes con HA, y coadyuvarán a disminuir el riesgo cardiovascular, impulsar cambios en el estilo de vida, controlar la enfermedad y reducir las complicaciones.

Modifying cancer patients' attitudes towards medical care received in the oncology service.

BACKGROUND: Attitude changing involves a holistic change on individual biopsychosocial structure. That attitude is understood by behaviors, thoughts, feelings and higher mental processes involved with behavior. This attitude will be considered in two ways: favorable or unfavorable, through a part of the environment. If unfavorable, the most common way to change it is through teaching and learning processes. The aim of this study was to evaluate the impact of a program directed to modify cancer patients' attitudes. METHODS: This study was performed in three stages from February to September 2009 in the Medical Oncology Area of the UMAE Oncology Hospital, Instituto Mexicano del Seguro Social (IMSS), according to a before and after quasi-experimental design to evaluate the effect of the intervention. The first stage was to diagnose through semantic networks using the results to create and validate a survey. The second stage was the educative intervention focused on providing general information to patients in the area of medical oncology. Finally, the initial survey was used in order to measure the impact of the intervention, which had been previously implemented and validated. The cumulative total of patients during the three stages was 4,200. RESULTS: Patients attitudes were modified with a specific favorable tendency on the instrument from 51% to 94% (p = 0.05) of total instrument perceptions. CONCLUSIONS: This intervention significantly changed patients' attitudes related to the medical oncology area.

[Primary melanoma of the oral mucosa. Experience of the Oncology Hospital of Centro Médico Nacional Siglo XXI]. / Melanoma primario de la mucosa oral. Experiencia del Hospital de Oncología.

BACKGROUND: Primary intraoral melanoma is extremely rare and carries a poor prognosis. Treatment of choice remains controversial. Our aim was to define the clinical features of this disease and to evaluate treatment methods. METHODS: We retrospectively studied 14 patients with primary malignant melanoma of the oral cavity seen at the Oncology Hospital of the Mexican Institute of Social Security (IMSS), 21st Century National Medical Center (CMN-SXXI) between 1991 and 2005. The main variables studied were clinical findings, response to therapy, and outcome. RESULTS: In five males (35.7%) and nine females (64.3%) with a mean age of 65 years, tumor locations included hard palate (nine cases), maxillary gingiva (three cases), hard/soft palate (one case) and lip (one case). Pre-existing melanotic pigmentation was present in two patients. Nine patients were in stage I, four in stage II, and one was in stage III. Surgical excision was the primary treatment in 11 cases; four patients underwent simultaneous neck dissections. All patients in stage II received adjuvant radiation therapy. After a 3-year follow-up, three patients of those presenting stage I are still alive (33.3%, 3/9 cases), and all patients in stages II and III eventually died of the disease. CONCLUSIONS: Early diagnosis of pigmented lesions in the mouth along with adequate tumor resection may improve the prognosis of this disease; however, in advanced disease stage it may be reasonable to infer that major improvements in outcome after treatment of malignant melanoma of the oral cavity may not be carried out until more effective systemic therapy becomes available.

[Lymphatic mapping and sentinel lymph node biopsy in patients with high risk squamous cell carcinoma of the skin]. / Mapeo linfático y biopsia del ganglio centinela en pacientes con carcinoma epidermoide cutáneo de alto riesgo.

BACKGROUND: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors. OBJECTIVE: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC. MATERIAL AND METHODS: Between January 2002 and March 2004, a total of 20 patients received pre-operative lymphoscintigraphy and sentinel lymphadenectomy for high-risk CSCC with clinically non-palpable regional lymph nodes. RESULTS: In one of each 5 patients (20%), sentinel lymph node showed histological evidence of microinvolvement. No patients with negative sentinel node showed tumor dissemination during follow-up, with a mean of 23.5 months (range 7-44). CONCLUSIONS: Sentinel lymph node biopsy is technically feasible with low morbidity. Sentinel lymphadenectomy may play an important role in the management of high-risk CSCC with clinically non-palpable regional lymph nodes. This technique can help identify patients with regional lymph node metastases who may benefit from complete lymphadenectomy. This improved staging may allow clinicians to better stratify patients who might benefit from adjuvant therapy.

Mapeo linfático y biopsia del ganglio centinela en pacientes con carcinoma epidermoide cutáneo de alto riesgo / Lymphatic mapping and sentinel lymph node biopsy in patients with high risk squamous cell carcinoma of the skin

Introducción: Un subgrupo de pacientes con carcinoma epidermoide cutáneo (CEC) tiene alto riesgo de presentar metástasis ganglionares regionales. El mapeo linfático y biopsia del ganglio centinela (MLBGC) ha sido exitosamente utilizado para evaluar la presencia de metástasis ganglionares subclínicas en diversos tumores. bjetivo: Evaluar la utilidad de la técnica del MLBGC en los pacientes con CEC de alto riesgo para detectar la presencia de metástasis ganglionares regionales subclínicas. Material y métodos: De enero 2002 a marzo 2004, un total de 20 pacientes con CEC de alto riesgo con ganglios linfáticos regionales clínicamente no palpables fue evaluado con linfografía preoperatoria y MLBGC. Resultados: En 1 de cada 5 pacientes (20 %), el ganglio centinela reveló la presencia de micrometástasis. Ningún paciente con GC negativo manifestó progresión tumoral ganglionar regional durante un seguimiento medio de 23.5 meses (rango de 7 a 44 meses). Conclusiones: El MLBGC fue técnicamente posible con baja morbilidad. El MLBGC puede tener un importante papel en el tratamiento de los pacientes con CEC de alto riesgo con ganglios linfáticos regionales no palpables. Esta técnica puede ayudar a identificar los pacientes con metástasis en los ganglios linfáticos regionales que pueden beneficiarse de una disección ganglionar radical. Además provee importante información para utilizar terapias adyuvantes a la cirugía.

BACKGROUND: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors. OBJECTIVE: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC. MATERIAL AND METHODS: Between January 2002 and March 2004, a total of 20 patients received pre-operative lymphoscintigraphy and sentinel lymphadenectomy for high-risk CSCC with clinically non-palpable regional lymph nodes. RESULTS: In one of each 5 patients (20%), sentinel lymph node showed histological evidence of microinvolvement. No patients with negative sentinel node showed tumor dissemination during follow-up, with a mean of 23.5 months (range 7-44). CONCLUSIONS: Sentinel lymph node biopsy is technically feasible with low morbidity. Sentinel lymphadenectomy may play an important role in the management of high-risk CSCC with clinically non-palpable regional lymph nodes. This technique can help identify patients with regional lymph node metastases who may benefit from complete lymphadenectomy. This improved staging may allow clinicians to better stratify patients who might benefit from adjuvant therapy.

[Cost-effectiveness analysis of nuclear cardiology and its impact on total expense for diagnosis of coronary artery disease]. / Costo-efectividad de los estudios de gamagrafía miocárdica e impacto al gasto total por diagnóstico de cardiopatía isquémica.

BACKGROUND: Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies. The goal of this study is to evaluate the economical impact of the diagnostic process in patients suspected of having coronary artery disease, referred to our service (Nuclear Medicine, Hospital de Cardiología CMN, IMSS) in 2002. METHODS: We analyzed 1966 reports of myocardial gammagrams. Patient reports were stratified according to their referring unit. The sum of the unitary fixed cost was converted to the unitary cost for each reason for referral. Kappa was used to evaluate concordance. RESULTS: Patients were 62 +/- 11.39 years old, 52% male. Concordance between the referring diagnosis and the myocardial gammagram was <1% (p <0.001). The cost of cardiac gammagrams varied between $2,613.11 and $3,306.77 (Mexican pesos). Waste was calculated at 30%, which represented $1.8 million (Mexican pesos). CONCLUSIONS: Cost-effective studies are important tools in the administration of resources. In this particular case the results indicate the necessity for systematic registration of financial information, periodic review of operation costs by service, and criteria for use of high-cost services.