Nasal eosinophilic angiocentric fibrosis with IgG4-positive plasma cell infiltration.

INTRODUCTION: Eosinophilic angiocentric fibrosis (EAF) is a rare lesion that predominantly affects the upper respiratory tract. Its etiology is unknown and it has been recently associated with the IgG4- related disease (IgG4-RD) spectrum. To the author's knowledge, this is the sixth case report of the relationship between EAF and IgG4-RD. CASE REPORT: We report the case of a 37-year-old woman with nasal deformity and facial pain. The lesion was surgically excised. Histological examination revealed features of EAF with an IgG4/IgG plasma cell ratio ≷73% and 31 IgG4 stained cells per high power field. No clinical or radiological recurrence was detected during follow-up. Serum IgG4 quantification one year after surgery was within normal limits. DISCUSSION: The relationship between both entities may have therapeutic impact because IgG4-RD of the head and neck has a high remission rate with corticosteroids and immunosuppressive therapy. Additional reports of this infrequent disease are necessary to elucidate appropriate treatment and prognosis.

Increased detection of latent tuberculosis by tuberculin skin test and booster phenomenon in early rheumatoid arthritis patients.

The incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients is up to four times higher when compared to the general population, but their risk increases with the use of TNF-a drugs. Appropriate screening of latent tuberculosis infection (LTBI) and proper management of such cases substantially reduce the incidence of active TB. Tuberculin skin test (TST) is a widely used method for the detection of LTBI. The time of diagnosis of RA as well as the age of the patient might modify the TST performance. We did an observational, comparative study of RA patients with early and established disease, with the objective to know the prevalence of LTBI using the TST and booster test; an induration ≥5 mm was considered reactive. We evaluated 143 patients (83 [58 %] early RA patients). We found 31.3 and 21.7 % TST positivity in early and established RA patients, respectively. With the use of booster test, the positivity increased to 46.5 and 28.8 %, respectively (p = 0.048, OR 1.33, 95 % CI 1.01-1.75). In conclusion, we found that TST and booster test increased LTBI detection in early RA patients, which may suggest that time of RA diagnosis might affect cellular immunity and therefore the TST response.

[Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico]. / Diferencias en la utilización de métodos de planificación familiar por mujeres adolescentes en Monterrey, Mexico, segújn el modelo de educación sanitaria utilizado.

BACKGROUND: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies. METHODS: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated. RESULTS: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1). CONCLUSIONS: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.

Diferencias en la utilización de métodos de planificación familiar por mujeres adolescentes en Monterrey, México, según el modelo de educación utilizado / Differences in the Use of Family Planning Methods by Adolescent Females According to the Education

Fundamento: El objetivo fue comparar la utilización de métodosde planificación familiar durante el puerperio inmediato y dosaños después del parto en las mujeres adolescentes que habían seguidodos programas diferentes de intervención durante su embarazo.Métodos: Se diseñó un estudio cuasiexperimental. Se seleccionóa 62 adolescentes embarazadas que se integraron en dos grupos deintervención, el modelo PRECEDE y el de Creencias en Salud(MCS). Se aplicaron pruebas estadísticas no paramétricas y se estimaronintervalos de confianza de 95%.Resultados: El promedio de conocimiento inicial en el grupoMCS fue de 69,12 puntos (IC95% 63,27-74,97) y al final 89,71 puntos(IC95% 86,24- 93,17), mientras que el inicial del grupo PRECEDEfue de 49,39 puntos (IC 95% 42,24- 56,54) y al final de 75,25puntos (IC 95% 71,12- 79,38). En el puerperio inmediato el 93% (IC95% 83,5-100) de las adolescentes del grupo PRECEDE aceptaron eluso de un método de planificación familiar, similar al empleado porel grupo MCS, de 94,2 (IC 95% 86,3-100). En cuanto a la continuidaden el uso del método, es decir dos años después, el efecto de laestrategia PRECEDE fue superior al del MCS, 92% (IC 95% 82-100) y 72% (IC 95% 56,9-87,1) respectivamente.Conclusiones: Se encontró diferencia entre modelos en lo concernientea la utilización de métodos de planificación familiar a los 2años. Se propone el programa PRECEDE como estrategia educativapara prevenir un segundo embarazo en mujeres adolescentes

Background: The objective was to compare the use of familyplanning methods during the immediate postpartum period and twoyears following childbirth among the adolescent females who hadfollowed two different intervention programs during their pregnancies.Methods: A quasi-experimental study was designed. A total of62 pregnant adolescents were selected to comprised two interventiongroups, the PRECEDE model and the Health Belief model (MCS)groups. Non-parametric statistical tests were employed and 95%confidence intervals estimated.Results: The average starting knowledge in the MCS groups was69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI86.24- 93.17), while the starting knowledge for the PRECEDE groupwas 49.39 points (95% CI 42.24- 56.54) and ending 75.25 points(95% CI 71.12- 79.38). IN the immediate postpartum, 93% (95% CI83.5-100) of the adolescents in the PRECED group accepted the useof a family planning method similar to that employed by the MCSgroup, of 94.2 (95% CI 86.3-100). As regards the continued use ofthe method, that is, two years later, the PRECEDE strategy had a greatereffect that the MCS strategy, respectively 92% (95% CI 82-100)and 72% (95% CI 56.9-87.1).Conclusions: A difference was found to exist between models asregards the use of family planning methods 2 years following childbirth.The PRECEDE program is proposed as the education strategyfor preventing a second pregnancy among adolescent females

[Preventive practices of the residents over 25 years of age in Monterrey and its metropolitan area (Mexico)]. / Prácticas preventivas de los habitantes mayores de 25 años en Monterrey y su zona metropolitana (México).

BACKGROUND: Chronic and degenerative disorders are the leading causes of morbidity-mortality in Mexico, as a result of which the Health Sector has implemented preventive and suitable detection measures. The use of the health services is a dynamic behavior on the part of the population. In order for people to use these preventive measures, the barriers to accessing these services must be lessened. Hence, the objective of this study was that of ascertaining the use of the services for the detection of diabetes mellitus, high blood pressure, cervical-uterine and breast cancer and tetanus and diphtheria toxoide vaccinations. METHODS: The sample size was that of 254 individuals age 25 and over living in Monterrey or in the greater Monterrey metropolitan area. Those having employed preventive measures during the year immediately prior to the study were taken into account with regard to the use of preventive measures. The analysis consisted of descriptive statistics and bivariate analysis. RESULTS: Over 60% of the population was female, the average age being 42.3 + 14 years of age, three fourths of the population being on the social security rolls. A total 37% mentioned having undergone the diabetes test, and 44.5 the test for high blood pressure, while 31.1% had been vaccinated with the tetanus and diphtheria toxoide. Regarding specifically female checkups, 34.3% of all females had undergone the corresponding cervical-uterine cancer test, 29.5% having been screened for breast cancer. No relationship was found to exist between the use of measures and family histories and the perception of the importance of the checks. CONCLUSIONS: The use of preventive measures fall below some international standards. Individuals exposed to the risk must be sought in order to fittingly detect any chronic disorder.

[Impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance]. / Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2.

OBJECTIVE: To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance. DESIGN: A case-control study. Case = diabetic hospitalized by a disease related condition. Control = diabetic without hospitalization during the last 12 months. SETTING: Urban primary care centers. PARTICIPANTS: Cases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135). Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%). MEASUREMENTS: A primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care. RESULTS: The following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5-174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002-1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96-0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2-5,0) (pseudo R2=0,279; P<0,001). CONCLUSIONS: Primary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations.

[Health needs of the diabetic user of primary care]. / Necesidades en salud del diabético usuario del primer nivel de atención.

OBJECTIVE: To determine the extent and importance of unmet health needs of type 2 diabetic patients seen at primary care services. MATERIAL AND METHODS: A cross-sectional study was conducted in 1999, among rural and urban patients of the Mexican Institute of Social Security, in Nuevo Leon, Mexico. The study population consisted of 256 subjects selected at random, diagnosed with type-II diabetes for at least two years. Data were obtained by interview and complemented with medical charts and provider interviews. Five health areas and four health determinants were evaluated, through Mexican Official Standards and American Diabetes Association standards of medical care for diabetic patients. Analysis consisted of descriptive statistics and estimation of z scores. RESULTS: Health needs were met in 49% of cases. A lower mean of health need satisfaction was found in rural regions as compared to urban regions (36.8% vs. 53.3%, p < .01). Nutrition was the most affected health area (z score = -6), followed by the physical exercise (z score = -1), the metabolic health area (z score = +1), the non-smoking health area (z score = +2), the prevention and early detection of complications health area (z score = +2), and the cognitive health area (z score = +3). The health determinant with the highest requirement corresponded to utilization (z score = -5), followed by resource availability (z score = -4), perceived health need (z score = +4), and access barriers (z score = +6). CONCLUSIONS: Health need measurement allows evaluating the effectiveness of existing interventions, in addition to identifying areas with higher unmet health needs. These findings facilitate analysis and decision-making to devise specific health policies and actions directed at improving the quality of care for diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Folic acid levels, homocysteine and polymorphism of methylenetetrahydrofolate reductase enzyme (MTHFR) in patients with pre-eclampsia and eclampsia]. / Niveles de ácido fólico, homocisteína y polimorfismo de la enzima metilentetrahidrofolatorreductasa (MTHFR) en pacientes con preeclampsia severa y eclampsia.

UNLABELLED: Preeclampsia and eclampsia are the primary causes of maternal mortality. In the state of Nuevo León, from 1990 to 1998, these conditions represented 44.1% of maternal deaths. The presence of thrombogenic substances (homocysteine, C protein, and anticardiolipin antibodies) in the mother's blood has been related to this problem. The C677T polymorphism of the enzyme methylene tetrahydrofolate reductase (MTHFR) favors the increase of homocysteine levels, while folic acid (FA) supplementation decreases its levels. OBJECTIVE: To establish the role of FA in the physiopathology of preeclampsia in our environment. KIND OF STUDY: Longitudinal, prospective and comparative. CASES: Women with severe preeclampsia and/or eclampsia (n-13). CONTROLS: Women in the third trimester of a normal pregnancy (n + 15). 20 mL Blood samples were taken during the first 24 hours of puerperium, and their AF, homocysteine and MTHFR polymorphism were measured. The t Student test and the Exact Fisher test were used to compare between both groups. RESULTS: The values obtained for homocysteine were (x + SD): CASES: 9.85 micromoles/L + 2.88, and controls: 7.61 micromoles/L + 1.32 (p < 0.04). The frequency (%) of the genetic polymorphism for MTHFR was: positive homozygotes (T/T): 38.46 vs. 20, heterozygotes (C/T): 38.46 vs. 26.6, negative homozygotes (C/C): 23 vs 53, for cases and controls, respectively. CONCLUSIONS: According to our study, the frequency of the homozygote state (T/T) of MTHFR and increased blood levels of homocysteine is greater in women suffering from preeclampsia.

Tolerability profiles of rofecoxib (Vioxx) and Arthrotec. A comparison of six weeks treatment in patients with osteoarthritis.

OBJECTIVE: To compare the incidence of selected spontaneously reported adverse events (AEs) in patients with osteoarthritis (OA) treated with rofecoxib (VIOXX, 12.5 mg qd) or Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid). METHODS: Double-blind, parallel-group, 6-week study of patients aged > or = 40 years with a clinical diagnosis of OA treated with rofecoxib or Arthrotec. Primary endpoint: self-reported diarrhea; secondary endpoints: abdominal pain, discontinuations due to AEs, GI AEs and NSAID-type GI AEs (ie., acid reflux, dyspepsia, epigastric discomfort, heartburn, nausea, vomiting). RESULTS: Among 483 patients (80.3% females, mean age 62.1), the rofecoxib group vs the Arthrotec group respectively reported diarrhea 6.2% vs 16.2% (p<0.001); drug-related diarrhea 3.7% vs 16.2% (p<0.001); one or more clinical AEs 52.9% vs 73.0% (p<0.001); GI AEs 28.9% vs 48.5% (p<0.001); NSAID-type GI AEs 18.6% vs 29.9% (p=0.004); discontinuations due to abdominal pain 0.4% vs 3.7% (p<0.05); and discontinuations due to any AE 4.1% vs 9.1% (p=0.029). No significant differences were observed in efficacy. CONCLUSION: Rofecoxib 12.5 mg qd has improved GI tolerability and similar efficacy compared to Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid).

[Nutritional risk in patients with pulmonary tuberculosis: the patient's or the health services' problem?]. / Riesgo nutricional en pacientes con tuberculosis pulmonar: cuestión del paciente o de los servicios de salud?

OBJECTIVE: To determine nutritional risk factors in a population of patients with pulmonary tuberculosis (PT). MATERIAL AND METHODS: During 1997, one-hundred and eighty-five patients with PT were chosen at random from two health institutions in Monterrey, Nuevo León, México. Variables analyzed were: anthropometric measures, socioeconomic status, utilization of the nutrition clinic, access to foodstuffs, adverse reactions to drugs, and disease attributable to malnutrition. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression, in addition to prevalence ratios and 95% confidence intervals. RESULTS: The mean age was 42.4 +/- 19.9 years. The mean body mass index was 19.8 +/- 3.2; 57% of patients presented malnutrition; 26% of them were referred to the nutrition clinic, 24.3% of whom actually attended it. Multivariate analysis showed that adverse reactions of tuberculosis drugs were risk factors for malnutrition, independent of age, gender, education, occupation, year of diagnosis and access to foodstuffs, disease attributable, and utilization of the nutrition clinic. (chi 2 = 10.58; p = 0.051, R2 = 0.42). CONCLUSIONS: Nutritional risk in patients with pulmonary tuberculosis is both a patient and a health services issue. The high prevalence of malnutrition, the low utilization rate of nutritional services, and the effect of adverse reactions to therapeutic drugs, justify the need to focus attention on this particular group of patients.

[Assessment of accessibility to health services facilities]. / Evaluación de la accesibilidad en los servicios de salud.

OBJECTIVE: To assess health care access integrating the availability of resources, medical institution and the patient point of view. SETTING: Nuevo León, México. MEASUREMENTS AND MAIN RESULTS: A random sample of patients were interviewed about their perceptions on different barriers, which also were assessed for the institution utilizing the corresponding indicator. Availability of resources were also measured for every primary and secondary medical care unit of the greatest Mexican health care system in Nuevo León. It was observed a 70% access; 70% for primary care and 73% for secondary care. Availability of human resources was an important factor but barriers as observed by the institution were the most important (waiting time and traveling cost). Barriers were rated different by the institution and the patient. CONCLUSIONS: The combination of institutional barriers, patient barriers and resources for assessing health care access is discussed.

The cost of diabetes mellitus and its impact on health spending in Mexico.

BACKGROUND: The objective of this study was to determine the cost of diabetes mellitus, its impact on health spending in Mexico, and its percentage of the gross domestic product (GDP). METHODS: There was a four-stage approach: identification of the epidemiology of the use of health services; estimate of treatment cost; determination of the diabetic population, and calculation of the percentage of health spending. RESULTS: The average annual cost per diabetic patient was $708 U.S. dollars (USD), the total annual cost of diabetics was $2,618,000 USD, the percentage of health spending was 15.48%, and the percentage of the GDP was 0.79%. CONCLUSIONS: It is necessary to seek strategies that allow for a more efficient use of resources designated for type 2 diabetes treatment.

[Work-related anxiety among nursing personnel]. / Ansiedad laboral en personal de enfermería.

OBJECTIVE: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors. MATERIAL AND METHODS: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random. RESULTS: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively). CONCLUSIONS: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.

[Costs of maternal-infant care in an institutionalized health care system]. / Costo de la atención materno infantil en un sistema de salud institucionalizado.

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

[Quality of the Early Cervical Cancer Detection Program in the State of Nuevo León]. / Calidad del Programa de Detección Oportuna de Cáncer Cervicouterino en el estado de Nuevo León.

OBJECTIVE: To determine the quality of the Early Cervical Cancer Detection Program in the state of Nuevo León. MATERIAL AND METHODS: A random selection of 4791 cytologic reports were analyzed, emitted by the State Ministry of Health, the University Hospital and the Mexican Institute for Social Security early cervical cancer detection modules. Pap tests of women with hysterectomy, current pregnancy, menopause or positive result were excluded. Quality was measured with previously defined standards. Analysis included, besides univariate statistics, tests of significance for proportions and means. RESULTS: The quality of the program was fairly satisfactory at the level of the State. The quality of the sampling procedure was low; 39.9% of the tests contained endocervical cells. Quality of coverage was low; 15.6% were women 25+years with first time Pap test. Quality of opportunity was high; 8.5 +/- 7 weekdays between the date of the pap smear and the interpretation date. CONCLUSIONS: Strategies are needed to increase the impact of the state program, such as improving the sampling procedure and the coverage quality levels.

[Cost at the first level of care]. / Costo en el primer nivel de atención.

OBJECTIVE: To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. MATERIAL AND METHODS: The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. RESULTS: A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. CONCLUSIONS: Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.

[Antigens of the human immunodeficiency virus in serum of high risk people in the city of Monterrey]. / Antígenos del virus de inmunodeficiencia humana en el suero de personas del grupo de alto riesgo de la ciudad de Monterrey.

One hundred forty human sera distributed in 2 groups were analyzed. In group I, 50 serum samples from healthy individuals that did not belong to the high-risk acquired immune deficiency syndrome (AIDS) population were included. In group II, there were 90 individuals, most of whom were apparently healthy but were at high risk of getting AIDS through their life styles or by transfusion. Of the 90 persons, 5 had a clinical picture of AIDS. All sera were analyzed by the enzyme - linked immunosorbent assay (ELISA) for the anti VIH antibodies. The positive cases were confirmed by the Western blot assay. In all samples the presence of the human immune deficiency virus antigens was sought. The results showed that the 50 healthy individuals (control group) were negative for both HIV antigens and antibodies. Of the 90 sera for the high-risk group, 50 were negative for antibodies, and 2 of them (4%) were positive for HIV antigens. Forty sera were positive for anti HIV antibody and among them, 5 patients were diagnosed as AIDS, and showed positive for antigen and antibody. The other 35 patients were all positive for HIV antibody and in 8 of them HIV antigen was also present.

A multi-systemic disease (lupus-like) preceding bronchioloalveolar carcinoma.

A patient with a multi-systemic disease (lupus-like) that preceded the onset of a bronchioloalveolar carcinoma is described, and a brief review of the literature is presented. We suggest that this tumor be listed among the neoplasms responsible for multi-systemic diseases with lupus-like characteristics.