Epidemiology of environmental factors related to beta-catenin pathway and its impact on the development and progression of colorectal cancer.

Colorectal cancer (CRC) is a complex disease, determined by genetic, environmental and lifestyle-associated risk factors. Genetic (inherited) factors have great influence on its development; however, most cases of CRC are sporadic and gradually develop over several years. The main environmental risk factors are associated with b-catenin signaling pathway, including obesity, lack of physical activity, consumption of red and processed meats, alcoholism, and smoking. The pathway is related to cell homeostasis regulation and cell self-renewal during embryogenesis and adulthood. The main recommendation for preventing the development of CRC is to reduce the risk factors, increase the consumption of fruits, vegetables and grains, exercise regularly and limit the consumption of both alcohol and tobacco. However, family history and the presence of a hereditary syndrome increase the risk, which is why carrying out periodic examinations to detect CRC is suggested, using development predictors such as biochemical and molecular markers, which are discussed in this work.

El cáncer colorrectal (CCR) es una enfermedad compleja determinada por factores de riesgo genéticos, ambientales y de estilo de vida. Los factores genéticos (hereditarios) tienen gran influencia en su desarrollo, sin embargo, la mayoría de los casos de CCR son esporádicos y se desarrollan gradualmente a lo largo de varios años. Los principales factores ambientales de riesgo están asociados a la vía de señalización de ß-catenina, entre ellos obesidad, falta de actividad física, consumo de carnes rojas y procesadas, alcoholismo y tabaquismo. La vía está relacionada con la regulación de la homeostasis celular, autorrenovación celular durante la embriogénesis y edad adulta. La principal recomendación para evitar el desarrollo del CCR es reducir los factores de riesgo, aumentar el consumo de frutas, verduras y granos, hacer ejercicio de manera rutinaria y limitar el consumo tanto de alcohol como de tabaco. Dado que los antecedentes familiares y la presencia de un síndrome hereditario aumentan el riesgo, se sugiere hacer exámenes periódicos para detectar CCR y emplear predictores del desarrollo como los marcadores bioquímicos y moleculares, los cuales se presentan en este trabajo.

Epidemiología de los factores ambientales relacionados con la vía β-catenina y su impacto en el desarrollo y progresión del cáncer colorrectal / Epidemiology of environmental factors related to beta-catenin pathway and its impact on the development and progression of colorectal cancer

Resumen El cáncer colorrectal (CCR) es una enfermedad compleja determinada por factores de riesgo genéticos, ambientales y de estilo de vida. Los factores genéticos (hereditarios) tienen gran influencia en su desarrollo, sin embargo, la mayoría de los casos de CCR son esporádicos y se desarrollan gradualmente a lo largo de varios años. Los principales factores ambientales de riesgo están asociados a la vía de señalización de β-catenina, entre ellos obesidad, falta de actividad física, consumo de carnes rojas y procesadas, alcoholismo y tabaquismo. La vía está relacionada con la regulación de la homeostasis celular, autorrenovación celular durante la embriogénesis y edad adulta. La principal recomendación para evitar el desarrollo del CCR es reducir los factores de riesgo, aumentar el consumo de frutas, verduras y granos, hacer ejercicio de manera rutinaria y limitar el consumo tanto de alcohol como de tabaco. Dado que los antecedentes familiares y la presencia de un síndrome hereditario aumentan el riesgo, se sugiere hacer exámenes periódicos para detectar CCR y emplear predictores del desarrollo como los marcadores bioquímicos y moleculares, los cuales se presentan en este trabajo.

Abstract Colorectal cancer (CRC) is a complex disease, determined by genetic, environmental and lifestyle-associated risk factors. Genetic (inherited) factors have great influence on its development; however, most cases of CRC are sporadic and gradually develop over several years. The main environmental risk factors are associated with β-catenin signaling pathway, including obesity, lack of physical activity, consumption of red and processed meats, alcoholism, and smoking. The pathway is related to cell homeostasis regulation and cell self-renewal during embryogenesis and adulthood. The main recommendation for preventing the development of CRC is to reduce the risk factors, increase the consumption of fruits, vegetables and grains, exercise regularly and limit the consumption of both alcohol and tobacco. However, family history and the presence of a hereditary syndrome increase the risk, which is why carrying out periodic examinations to detect CRC is suggested, using development predictors such as biochemical and molecular markers, which are discussed in this work.

Myostatin Levels and the Risk of Myopenia and Rheumatoid Cachexia in Women with Rheumatoid Arthritis.

Background: Myostatin is a regulator of muscle size. To date, there have been no published studies focusing on the relation between myostin levels and myopenia in rheumatoid arthritis (RA). Objective: Evaluate the value of serum myostatin as a biomarker of cachexia and low skeletal muscle mass (LSMM) in RA patients, along with whether high serum myostatin is associated to these conditions after adjusting for potential confounders. Methods: This cross-sectional study included 161 female RA patients and 72 female controls. In the RA group, we assessed several potential risk factors for LSMM and rheumatoid cachexia. Dual-energy X-ray absorptiometry was used to quantify the skeletal muscle mass index (SMMI) (considering LSMM ≤ 5.5 kg/m2) and the presence of rheumatoid cachexia (a fat-free mass index ≤ 10 percentile and fat mass index ≥ 25 percentile of the reference population). Serum myostatin concentrations were determined by ELISA. To identify a cut-off for high serum myostatin levels, we performed ROC curve analysis. Multivariable logistic regression analysis was used to identify the risk factors for LSMM and rheumatoid cachexia. The risk was expressed as odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: Compared to the controls, the RA group had a higher proportion of LSMM and exhibited high serum myostatin levels (p < 0.001). ROC curve analysis showed that a myostatin level ≥ 17 ng/mL was the most efficient cut-off for identifying rheumatoid cachexia (sensitivity: 53%, specificity: 71%) and LSMM (sensitivity: 43%, specificity: 77%). In the multivariable logistic regression, RA with high myostatin levels (≥17 ng/mL) was found to increase the risk of cachexia (OR = 2.79, 95% CI: 1.24-6.29; p = 0.01) and LSMM (OR = 3.04, 95% CI: 1.17-7.89; p = 0.02). Conclusions: High serum myostatin levels increase the risk of LSMM and rheumatoid cachexia. We propose that high myostatin levels are useful biomarkers for the identification of patients in risk of rheumatoid cachexia and myopenia.

New Genetic Polymorphisms as an Epidemiological Factor of Arterial Hypertension in Patients with Hyposodical Diet.

Hypertension is a major public health problem, affecting more than a quarter of the world's population causing serious cardiovascular problems. In recent years, different polymorphisms have been studied and helped to identify some candidate genes and hereditary syndromes associated with the molecular mechanisms involved in the development of hypertension. Therefore, it is important to identify these molecular mechanisms. This review exposes all the genes and polymorphisms that increase or decrease the risk of hypertension in different populations that are related to the renin angiotensin aldosterone system, G protein, salt excretion, aldosterone synthesis, lipid metabolism, mechanism of insulin resistance, vitamin metabolism, purines and sodium reabsorption. This document can be a useful tool in clinical practice, in addition to serving as a support for future research on this topic.

Palatopharyngeal vesicular enanthem, early finding of COVID-19.

Early diagnosis of SARS-CoV-2 infection is very important to establish timely treatment. In the present report, through the examination carried out in otorhinolaryngology, we found a pearlescent vesicular enanthema in the upper palate in 954/958 patients with the classic strain and it was not found in patients with the English strain. This finding had not been reported. The patients were successfully treated on time, only two patients died, which was associated with decompensated diabetes mellitus. The present report suggests that the vesicular enanthem found is pathognomonic for Covid-19 classic strains.

El diagnóstico temprano de la infección por SARS-CoV-2 es muy importante para establecer un tratamiento oportuno. En el presente reporte, en la exploración realizada en otorrinolaringología encontramos un enantema vesicular aperlado en el paladar superior en 954 de 958 pacientes con la cepa clásica, y no se encontró en pacientes con la cepa inglesa. Este hallazgo no se había reportado. Los pacientes fueron tratados a tiempo exitosamente y solo dos pacientes murieron, lo cual se asoció a diabetes mellitus descompensada. Este reporte sugiere que el enantema vesicular encontrado es patognomónico de ­COVID-19 por cepas clásicas.

Dimensiones culturales del concepto pie diabético en personas con diabetes mellitus y en estudiantes de medicina mexicanos / Cultural Dimensions of the Diabetic Foot Concept in People with Diabetes Mellitus and in Mexican Medical Students

RESUMEN Objetivo: Analizar las dimensiones culturales del concepto pie diabético en personas con diabetes mellitus y en estudiantes de medicina. Material y métodos: Estudio descriptivo exploratorio con base en los fundamentos de la antropología cognitiva y la teoría del consenso cultural. Participaron 40 personas (20 personas con diabetes y 20 estudiantes de medicina de séptimo semestre). El estudio se realizó en Guadalajara (México), en un hospital de segundo nivel, en los primeros tres meses de 2019. Se utilizaron listados libres y pile sort para identificar el contenido y la organización de las dimensiones. En el caso de los valores agregados, las matrices fueron analizadas mediante conglomerados jerárquicos. En el caso de los valores individuales, las matrices fueron analizadas mediante un modelo de consenso cultural. Resultados: Para las personas con diabetes, el concepto de pie diabético se conformó por las dimensiones de consecuencias y prevención. Para los estudiantes de medicina, el concepto de pie diabético se conformó por las dimensiones consecuencias y complicaciones. Se encontró consenso cultural en ambos grupos (Razón F1:F2, personas con diabetes: 3.14; estudiantes de medicina: 6.73). Las dimensiones tuvieron valores de ajuste adecuados: stress 0.21 en las personas con diabetes y 0.13 en los estudiantes. Conclusiones: Gracias a los resultados y acercamiento hacia ambos grupos, se pudieron reconocer elementos claves para la futura aplicación de programas de prevención para la salud, y una atención más integral para las personas con diabetes mellitus.

ABSTRACT Objective: Analyze the cultural dimensions of the diabetic foot concept in people with diabetes mellitus and in medical students. Material and Methods: Exploratory descriptive study based on the foundations of cognitive anthropology and the theory of cultural consensus. Forty people participated (20 people with diabetes and 20 medical students in the seventh semester). The study was conducted in Guadalajara, Mexico, in a second level hospital, in the first three months of the year 2019. Free lists and pile sort were used to identify the content and the organization of the dimensions. In the case of the aggregated values, hierarchical conglomerates analyzed the matrices. In the case of individual values, the matrices were analyzed using a cultural consensus model. Results: People with diabetes mellitus conformed the concept of diabetic foot by the dimensions of consequences and complications, whereas the medical students conformed the concept by the dimensions of consequences and complications. The cultural consensus was found in both groups with the following reasons F1:F2, people with diabetes: 3.14; medical students: 6.73. The dimensions had adequate values with the stress of 0.21 for the people with diabetes, and of 0.13 for the medical students. Conclusions: Gratefully, these results and the approach towards these two groups' key elements could be found for a future application of programs of health prevention and deeper and integral treatment process for the people with diabetes mellitus.

Structure and content of the maternal representations of Mexican teenagers during their first pregnancy / Estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo

Abstract Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations.

Resumen Objetivos: comprender la estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo. Métodos: se llevó a cabo un estudio con metodología cualitativa basado en el concepto de representación materna y la teoría de las representaciones sociales con 30 adolescentes que asistieron a control prenatal al Hospital Civil de Guadalajara "Fray Antonio Alcalde", ubicado en Jalisco, México. Las participantes fueron entrevistadas con previo consentimiento de sus tutores. Se utilizaron técnicas de análisis de contenido clásico para obtener códigos y categorías temáticas para desarrollar un mapa conceptual que explique las representaciones maternas. Resultados: se identificó la representación materna: "Embarazada pero juntada, una mala decisión legitimada", la cual se compuso de significados sociales hacia el embarazo adolescente, la dinámica familiar, las expectativas hacia la maternidad, y los sentimientos vividos por la adolescentedurante el embarazo. El contenido de la representación materna fue heterogéneo, empero, se identificó que el deseo por el embarazo guía las expectativas de la adolescente sobre su futura manera de ser madre. Conclusiones: el deseo de la mujer por el embarazo, el nivel de participación de la pareja, y los significados sociales del embarazo adolescente, tienen un papel sobresaliente en el desarrollo de las representaciones maternas.

Validación en español del instrumento Core competencies for public health professionals en Guadalajara (Jalisco, México) / Spanish validation of the «Core Competencies for Public Health Professionals» tool in Guadalajara, Jalisco, Mexico

OBJETIVO: Validar en español el instrumento Core competencies for public health professionals (CCPHP), en población de Guadalajara (Jalisco, México). MÉTODO: Estudio transversal. Se tradujo al español el instrumento CCPHP. Se aplicó a una muestra propositiva de 460 estudiantes de medicina y 460 expertos en salud pública. Se determinó la validez de constructo y la consistencia interna y externa del instrumento con el 95% de confianza (p ≤ 0,05). RESULTADOS: La muestra la formaron 460 estudiantes de medicina (62,1% femeninos y 37,9% masculinos), con edad media de 19,55 ± 0,87 años y 460 expertos en salud pública (50% femeninos y 50% masculinos), con edad media de 52,20 ± 10,26 años, el 90% con doctorado y el 10% con posdoctorado. La consistencia interna fue del 89% (alfa de Cronbach = 0,890) y la consistencia externa del 80,4% (ρ de Spearman = 0,804). En cuanto a la validez de constructo: mediana en estudiantes 195; intervalo 113-332; mediana en expertos 281,5; intervalo 226-365; U de Mann-Whitney = 34,5 (p < 0,001). CONCLUSIONES: El CCPHP en español demostró elevadas consistencias interna y externa, así como validez de constructo. Al carecer de un estándar de oro, es necesario comparar los resultados de este instrumento con pruebas objetivas de esta competencia para sustentar su validez de criterio

OBJECTIVE: To validate the «Core Competencies for Public Health Professionals» (CCPHP) tool in Spanish in a population from Guadalajara, Jalisco, Mexico. METHODS: A cross-sectional study was conducted after translating the CCPHP tool into the Spanish language. It was then applied to a purposing sample of 460 medical students and 460 public health experts. The tool construct validity, as well as internal and external consistency, was determined, with 95% of confidence limits (p ≤ 0.05). RESULTS: The study included a total of 460 medicine students, 62.1% females and 37.9% males, with mean age 19.55 ± 0.87 years. As regards the 460 public health experts, of whom 50% were females and 50% males, with mean age 52.20 ± 10.26 years, there 90% with a doctorate degree and 10% with post-doctorate degree. Internal consistency: 89% (Alpha de Cronbach = 0.890). External consistency: 80.4% (Spearman ρ = 0.804). Construct validity: student median 195, interval 113-332, expert median 281.5, interval 226-365, Mann-Whitney's U = 34.5 (P <.001). CONCLUSIONS: The CCPHP in Spanish showed high internal and external consistencies, as well as construct validity. Lacking a gold standard, a comparison of the results of this tool against objective evidence of this competency is needed in order to sustain its criterion validity

Efecto de un plan de estudios de Medicina sobre las competencias para la promoción de la salud y la participación social / Effect of a medical curriculum on the competencies for promotion of health and social participation

OBJETIVO: Evaluar el efecto del plan de estudios de la Licenciatura en Medicina de la Universidad Guadalajara LAMAR sobre las competencias profesionales para la promoción de la salud y la participación social. MATERIAL Y MÉTODOS: Estudio cuasiexperimental de tipo preexperimental de comparación con un grupo estático. Emplazamiento: Campus Vallarta. Temporalidad: septiembre-diciembre de 2017. Universo: 182 estudiantes de Medicina. Muestra: no probabilística, n = 114 estudiantes de Medicina, 62 de primer semestre (G1, intervención momento «A») y 52 de sexto semestre (G2, intervención momento «B»), más 50 estudiantes de primer semestre de licenciatura no relacionada con salud (G0, control). Muestreo: propositivo. Criterios de selección: cualquier edad y sexo, y responder instrumentos. VARIABLES: edad, sexo y competencias profesionales para la promoción de la salud y la participación social. Instrumentos: Instrumento en Español para Evaluar Prácticas de Salud Pública. Procedimientos: las evaluaciones se realizaron al término del semestre 2017B. Análisis: comparación mediante estadística inferencial no paramétrica (p ≤ 0,05). RESULTADOS: Niveles de competencias profesionales para la promoción de la salud y participación social: G0 100% poco o nada competentes, G1 64,5% poco o nada competentes y 35,5% medianamente competentes, G2 11,5% poco o nada competentes y 88,5% medianamente competentes. El nivel de competencia fue mayor al estar expuestos al plan de estudios, y aumentó a mayor tiempo de exposición (Chi2, p ≤ 0,05 en todos los casos). CONCLUSIONES: El plan de estudios de Medicina evaluado desarrolla en sus estudiantes competencias profesionales para la promoción de la salud y la participación social, pero es susceptible de ser mejorado

OBJECTIVE: To evaluate the effect of medical curriculum from Universidad Guadalajara LAMAR over professional competencies for promotion of health and social participation in medical students. MATERIAL AND METHODS: Quasi-experimental study type pre-experimental of comparison with static group. Emplacement: Vallarta's Campus. Temporality: September-December 2017. Universe: 182 medical students. Sample: non-randomized, n = 114 medical students, 62 from first semester (G1, intervention's moment "A") and 52 from sixth semester (G2, intervention's moment "B"), and additionally 50 from first semester of bachelor not related with health (G0, control). Sampling: propositive. Selection criteria: any age and gender, and to answer instruments. VARIABLES: age, gender and professional competencies for promotion of health and social participation. Instruments: Instrument in Spanish for to Evaluate Public Health Practices. Procedures: the evaluation it achieved to term of 2017B scholar cycle. Analysis: comparison by mean of non-parametric inferential statistics (P ≤ 0.05). RESULTS: Professional competencies level for promotion of health and social participation: G0 100% little or nothing competent, G1 64.5% little or nothing competent and 35.5% fairly competent, G2 11.5% little or nothing competent and 88.5% fairly competent. The competency level was higher in exposed to medical curriculum and increased to a longer exposure time (Chi2, P ≤ 0.05 in all cases). CONCLUSIONS: The medical curriculum from Universidad Guadalajara LAMAR develop professional competencies for promotion of health and social participation in your students, but this can be improved because nobody was highly competent

Autopercepción del estado de salud en pensionados por complicaciones de diabetes mellitus en Guadalajara, México / Self-perception of health status in people retired due to diabetes mellitus complications from Guadalajara, Mexico

RESUMEN Objetivo Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. Métodos Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. Resultados Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. Conclusiones La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.(AU)

ABSTRACT Objective To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. Materials and Methods Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. Results 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. Conclusion The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.(AU)

[Self-perception of health status in people retired due to diabetes mellitus complications from Guadalajara, Mexico]. / Autopercepción del estado de salud en pensionados por complicaciones de diabetes mellitus en Guadalajara, México.

OBJECTIVE: To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. MATERIALS AND METHODS: Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. RESULTS: 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. CONCLUSION: The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.

OBJETIVO: Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. MÉTODOS: Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. RESULTADOS: Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. CONCLUSIONES: La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.