Factors associated with nosocomial surgical-site infections for craniotomy in Mexico City hospitals.

BACKGROUND: Nosocomial surgical-site infection (NSSI) after craniotomy is responsible for an increase in deaths and/or disabilities that affect quality of life. It is necessary to identify factors to be included in an index for their control. The aim of this study was to a) identify intrinsic and extrinsic factors associated with NSSI after craniotomy and b) obtain the infection risk attributed to both intrinsic and extrinsic factors as well as to compare their predictive capability with the NNISS (National Nosocomial Infection Surveillance System) index. METHODS: A case-control study was conducted during a 2-year period in patients who underwent craniotomy in hospitals affiliated with the Instituto Mexicano del Seguro Social. Patients were selected according to the Centers for Disease Control and Prevention criteria for NSSI. RESULTS: During the study period 737 craniotomies were performed, 41 of which presented with NSSI. Intrinsic factors associated with NSSI were the presence of chronic diseases (OR = 2.18) and craniotomy due to nontraumatic causes (OR = 1.87), whereas extrinsic factors were procedures performed during the late shift (OR = 2.6) and another surgery at the same surgical site (OR = 5.2). These factors comprised the index with intrinsic and extrinsic factors. Extrinsic factors were 1.7 times higher than intrinsic factors, in addition to having a larger area under the ROC curve (0.731). The risk obtained with the NNISS index for patients who had one factor was 1.5, whereas that for patients who had two or three factors was 4.7. CONCLUSIONS: In the studied population, patients who underwent a craniotomy with extrinsic factors showed a higher association with NSSI.

Factores asociados a infecciones nosocomiales en sitio quirúrgico para craneotomía / Factors associated with nosocomial surgical-site infections for craniotomy in Mexico City hospitals

Introducción: La infección nosocomial en sitio quirúrgico (INSQ) en craneotomía puede ocasionar la muerte o discapacidad que modifica la calidad de vida, por lo que se requiere encontrar factores que puedan ser utilizados para incluir en los índices de control. Por ello es necesario identificar factores asociados a esta infección y obtener el riesgo de infección atribuible y comparar su capacidad predictiva con el índice del NNISS (Sistema de Vigilancia Nacional de Infecciones Nosocomiales de Estados Unidos). Material y métodos: Se realizó un estudio de casos y controles durante dos años, en pacientes con craneotomía en hospitales del Instituto Mexicano del Seguro Social. Los pacientes cumplieron los criterios de los Centros de Control de Enfermedades de Atlanta para INSQ. Resultados: Se practicaron 737 craneotomías durante el estudio, 41 pacientes presentaron INSQ. Factores intrínsecos asociados: presencia de enfermedades crónicas (OR = 2.18) y craneotomía debida a causas no traumáticas (OR = 1.87); factores extrínsecos: turno vespertino (OR = 2.6) y la práctica de otra cirugía en el mismo sitio quirúrgico (OR = 5.2). Estos factores conformaron los índices de factores intrínsecos y extrínsecos. Con factores extrínseco se presentó 1.7 veces más riesgo en comparación con los factores intrínsecos, así como mayor área bajo la curva ROC (0.731). El riesgo con el índice NNISS con un factor fue de 1.5 y con dos a tres factores, de 4.7. Conclusiones: En esta población en estudio, los pacientes sometidos a una craneotomía tuvieron mayor asociación a INSQ con los factores extrínsecos.

BACKGROUND: Nosocomial surgical-site infection (NSSI) after craniotomy is responsible for an increase in deaths and/or disabilities that affect quality of life. It is necessary to identify factors to be included in an index for their control. The aim of this study was to a) identify intrinsic and extrinsic factors associated with NSSI after craniotomy and b) obtain the infection risk attributed to both intrinsic and extrinsic factors as well as to compare their predictive capability with the NNISS (National Nosocomial Infection Surveillance System) index. METHODS: A case-control study was conducted during a 2-year period in patients who underwent craniotomy in hospitals affiliated with the Instituto Mexicano del Seguro Social. Patients were selected according to the Centers for Disease Control and Prevention criteria for NSSI. RESULTS: During the study period 737 craniotomies were performed, 41 of which presented with NSSI. Intrinsic factors associated with NSSI were the presence of chronic diseases (OR = 2.18) and craniotomy due to nontraumatic causes (OR = 1.87), whereas extrinsic factors were procedures performed during the late shift (OR = 2.6) and another surgery at the same surgical site (OR = 5.2). These factors comprised the index with intrinsic and extrinsic factors. Extrinsic factors were 1.7 times higher than intrinsic factors, in addition to having a larger area under the ROC curve (0.731). The risk obtained with the NNISS index for patients who had one factor was 1.5, whereas that for patients who had two or three factors was 4.7. CONCLUSIONS: In the studied population, patients who underwent a craniotomy with extrinsic factors showed a higher association with NSSI.

Incidencia de infección nosocomial en sitio quirúrgico (índice del NNIS y características clínicas y bioquímicas prequirúrgicas de pacientes sometidos por primera vez a derivación ventrículo-peritoneal) / Incidence of nosocomial surgical-site infections. Application of National Nosocomial Infections Surveillance System (NNIS) index and description of clinical and biochemical features from patients undergoing first-time ventriculoperitoneal shunt

Objetivo: Determinar la incidencia de infección nosocomial en sitio quirúrgico, aplicar el índice del NNIS y describir las características prequirúrgicas clínicas y bioquímicas de los pacientes sometidos a derivación ventrículo-peritoneal por primera vez. Material y métodos: Se realizó un estudio de cohorte durante un año. Se incluyeron pacientes mayores de 18 años sometidos a derivación ventrículo-peritoneal. El seguimiento se efectuó durante 30 días. El diagnóstico de infección se realizó de acuerdo con los criterios establecidos por los Centros de Control de Enfermedades en Atlanta. Se elaboró un cuestionario para identificar los factores contenidos en el índice del NNIS, así como las características clínicas y bioquímicas prequirúrgicas. Resultados: La incidencia anual de infección nosocomial en sitio quirúrgico fue de 12.3 % (9/73). En cuanto al número de factores de acuerdo al NNIS, 55 % de los pacientes no presentó ningún factor; 38 %, uno; 7 %, dos; ningún paciente, tres. ASA: RR = 2.0, IC 95 % = 0.4-11.4. Tipo de herida: RR = 5.1, IC 95 % = 0.5-48.9. Tiempo quirúrgico: RR = 0.6, IC 95 % = 0.1- 4.2. No se observaron diferencias en la frecuencia de enfermedades concomitantes. Conclusiones: Aun cuando las características clínicas y bioquímicas de los pacientes sometidos a derivación ventrículo-peritoneal de primera vez se encontraban dentro de los parámetros normales y no se identificaron factores del NNIS asociados, hubo infección en el sitio quirúrgico en 12.3 % de los pacientes, lo cual sugiere que existen factores que pueden influir en el desarrollo de infección diferentes a los contendidos en el NNIS.

OBJECTIVE: We undertook this study to determine the incidence of nosocomial surgical-site infections, apply the National Nosocomial Infections Surveillance (NNIS) index, and describe the clinical and biochemical characteristics of patients prior to a first-time ventriculoperitoneal shunt (VPS). METHODS: We conducted a cohort study for 1 year with patients aged 18 years or older who underwent VPS. Patients were followed up for 30 days to identify the presence of an infection. Infection diagnosis was made according to the criteria established by the Centers for Disease Control (Atlanta, GA). A questionnaire was developed to obtain the data regarding the factors contained in the NNIS and the clinical and biochemical characteristics prior to surgery. RESULTS: The annual incidence of nosocomial surgical-site infections was 12.3% (9/73). Distribution of factors according to the NNIS index was as follows: 55% without any factor, 38% with one factor, 7% with two factors, and no patients with three factors. ASA RR = 2.0, 95% CI 0.4-11.4, wound type RR = 5.1, 95% CI 0.5-48.9 and surgical time RR = 0.6, 95% CI 0.1-4.2. No differences were found in the frequency of concomitant diseases. CONCLUSIONS: Even though the clinical and biochemical characteristics of patients who underwent first-time VPS were normal and no associated NNIS factors were identified, 12.3% of the patients developed a nosocomial surgical-site infection. These results suggest the existence of factors other than those contained in the NNIS, which are possibly extrinsic to the individual and may influence the development of infections.

Uso de dexametasona y salbutamol nebulizados en bronquiolitis aguda: estudio clínico comparativo / Comparative clinical study of dexamethasone vs. nebulized salbutamol in acute bronchiolitis

Objetivo: Evaluar la eficacia de salbutamol y dexametasona nebulizados comparados con salbutamol solo en pacientes con bronquiolitis aguda. Material y métodos: Estudio clínico controlado, aleatorizado, en pacientes de 1 a 18 meses de edad con diagnóstico de bronquiolitis aguda y evolución menor de tres días. Se asignaron dos grupos: 1) salbutamol (n = 24) o 2) salbutamol más dexametasona (n = 25) administrado por micronebulizaciones cada cuatro horas por 24 horas. Se midieron las frecuencias cardiaca y respiratoria, la gravedad del cuadro mediante el Respiratory Distress Assigment Index, el Silvermann-Andersen, saturación de O2 y tiempo de desaparición de la dificultad respiratoria y frecuencia de altas en 24 horas. Resultados: No se encontraron diferencias significativas entre los grupos de estudio, excepto en la frecuencia de altas hospitalarias en las primeras 24 horas, 75 vs 96 % p < 0.04 respectivamente. Conclusiones: La aplicación de salbutamol más dexametasona es más rápida para controlar la dificultad respiratoria en niños con bronquiolitis aguda en comparación con la aplicación de salbutamol solo.

OBJECTIVE: Asess the efficacy of nebulized salbutamol and dexamethasone compared with nebulized salbutamol, in patients with bronchiolitis. MATERIAL AND METHODS: A blinded clinical trial was performed with 49 patients between 1-18 months diagnosed with bronchiolitis with three days or less of disease evolution. Participant's parents signed an informed consent and patients did not receive prior medication. Patients were randomly assigned to two groups: nebulized salbutamol or salbutamol plus dexamethasone, which they received every four hours during twenty-four hours. We measured heart and respiratory rate; respiratory distress index, oxygen saturation, and Silverman Andersen scores. RESULTS: No significant differences were found between groups for treatment response; but the frequency of hospital release at 24 hrs was significant among groups; 75 vs 96 % respectively (p = 0.04). CONCLUSIONS: The administration of salbutamol plus dexamethasone is more effective in the control of respiratory distress in children with bronchiolitis compared with the use of salbutamol alone.

[Elaboration and validation of an index for preeclampsia diagnosis]. / Elaboración y validación de un indice para el diagnóstico de preeclampsia.

OBJECTIVE: To build a consistent and valid preeclampsia diagnosis index (IDP) for its Spanish acronyms. PATIENTS AND METHOD: The study was done in a Gyneco-Obstetrics Hospital and a Family Medicine Unit from March 2000 to February 2001. Fifty items were chosen from the literature, with a design to validate diagnostic tests, which were assessed by family doctors and gyneco-obstetricians in regard to their appearance and content validity. Concurrent criterion validity. Golden standard: Two gyneco-obstetricians diagnosed pre-eclampsia (hypertension and proteinuria). Simultaneously a family doctor (in an independent and blinded way) questioned, examined and recorded laboratory data of 219 preeclamptic patients and 251 non preeclamptic patients. RESULTS: Preeclampsia diagnosis index is an additive index with 21 clinical and paraclinical parameters weighted according to their individual diagnostic capacity. It has two parts: The first one with 82% (95%CI 80-84) sensitivity; 93% (95%CI 91-95) specificity; the second one with 86% (95%CI 83-89) sensitivity; 75% (95%CI 65-85) specificity. CONCLUSIONS: Preeclampsia diagnosis index is easily applied and has immediate results, which makes easier the physician's decisions.

[Depression prevalence and risk factors found in women attended by a family physician]. / Prevalencia de depresión y factores de riesgo en mujeres atendidas en medicina familiar.

OBJECTIVES: Determine the prevalence of depressive symptoms in adult woman who was attended by family physician, to explore risk factors for depression and estimate how often depression is registered as a diagnosis by the family physician. MATERIALS AND METHODS: We did a prospective, analytic, and transversal study with simple randomized sampling at a Mexico City Family Medicine Clinic from March to December 2004. The size of the study was 384 patients. It includes women from 20 to 59 years of age. We excluded women without a clinical file for at least 1 year of reliable information. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Family Apgar Scale were applied. RESULTS: The survey included a total of 400 patients with the following characteristics: average age, 39 +/- 11 years; married, 74%; homemakers, 68%, and women with education level of high school or less were 79%. Prevalence of depressive symptoms was 52% (95% confidence interval [95% CI], 47-57). In women between 20 and 39 years of age, there was an association between depression and family dysfunction; the average number of healthcare appointments for the year prior to the study was significantly higher in patients 40 years old or more. CONCLUSIONS: There is a high prevalence of depressive symptoms in adult women, and depression diagnosis is frequently omitted. Depression-associated factors differ according to chronological age. In young women, family dysfunction is the main risk factor.

Incidence of leukemias in children from El Salvador and Mexico City between 1996 and 2000: population-based data.

BACKGROUND: There are very few studies that report the incidence of acute leukemias in children in Latin America. This work assesses the incidence of acute leukemias, between 1996 and 2000, in children from 0-14 years old who were attended at the Mexican Social Security Institute in Mexico City and in children from 0-11 years old in El Salvador. DESIGN: Population-based data. Hospitals: In San Salvador, El Salvador, Hospital Nacional de Niños "Benjamin Bloom", the only center in El Salvador which attends all children, younger than 12 years, with oncologic disease. The Pediatric Hospital and the General Hospital of the Mexican Social Security Institute in Mexico City, the only centers in Mexico City which attend all those children with acute leukemia who have a right to this service. DIAGNOSIS: All patients were diagnosed by bone marrow smear and were divided into acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and unspecified leukemias (UL). The annual incidence rate (AIR) and average annual incidence rate (AAIR) were calculated per million children. Cases were stratified by age and assigned to one of four age strata: 1) <1 year; 2) 1-4 years; 3) 5-9 years, or 4) 10-14 or 10-11 years, for Mexico City and El Salvador, respectively. RESULTS: The number of cases was 375 and 238 in El Salvador and Mexico City, respectively. AAIRs in Mexico City were 44.9, 10.6, 2.5, 0.5, and 58.4 per million children for ALL, AML, CML, UL, and total leukemias, respectively. The AAIRs in El Salvador could not be calculated because the fourth age stratum in El Salvador included children only from 0-11 years old. The incidence rates for the Salvadorian group of 0-11 year olds were 34.2, 7.1, 0.6, 0.2, and 43.2 per million children for ALL, AML, CML, UL, and total leukemias, respectively. CONCLUSION: Reported AIRs for each age group in El Salvador were similar to those from other American countries. The AAIR of ALL in Mexico City is one of the highest reported for North America.

Frequency of cancer in children residing in Mexico City and treated in the hospitals of the Instituto Mexicano del Seguro Social (1996-2001).

BACKGROUND: The objective of this article is to present the frequency of cancer in Mexican children who were treated in the hospitals of the Instituto Mexicano del Seguro Social in Mexico City (IMSS-MC) in the period 1996-2001. METHODS: The Registry of Cancer in Children, started in 1996 in the IMSS-MC, is an on-going, prospective register. The data from 1996 through 2001 were analyzed and the different types of cancer were grouped according to the International Classification for Cancer in Children (ICCC). From this analysis, the general and specific frequencies by age and by sex were obtained for the different groups of neoplasms. Also, the frequency of the stage of the disease that had been diagnosed in cases of children with solid tumors was obtained. RESULTS: A total of 1,702 new cases of children with cancer were registered, with the male/female ratio at 1.1/1. Leukemias had the highest frequency with 784 cases (46.1%) and, of these, acute lymphoblastic leukemias were the most prevalent with 614 cases (78.3%). Thereafter, in descending order of frequency, were tumors of the central nervous system (CNST) with 197 cases (11.6%), lymphomas with 194 cases (11.4%), germinal cell tumors with 110 cases (6.5%), and bone tumors with 97 cases (5.7%). The highest frequency of cancer was found in the group of one to four year-olds that had 627 cases (36.8%). In all the age groups, leukemias were the most frequent. In the present work, the frequency of Hodgkin's disease (~4%) was found to be lower than that (~10%) in previous studies and the frequency of tumors of the sympathetic nervous system was low (2.3%). Of those cases of solid tumors for which the stage of the disease had been determined, 66.9% were diagnosed as being Stage III or IV. CONCLUSIONS: The principal cancers in the children treated in the IMSS-MC were leukemias, CNST, and lymphomas, consistent with those reported by developed countries. A 2.5-fold reduction in the frequency of Hodgkin's disease was found. Of the children, the stage of whose disease had been determined, two thirds were diagnosed as having advanced stages of the disease.

[Clinical significance of the laboratory determinations in preeclamptic patients]. / Significado clínico de los resultados de laboratorio en las pacientes preeclámpticas.

OBJECTIVE: To determine the clinical significance and optimal cutting points of laboratory tests more frequently used in patients with pre-eclampsia of recent diagnosis. MATERIALS AND METHODS: We made an analytic cross-sectional study for evaluation of diagnostic test. Non probabilistic sampling. Sample size 400 patients. We used the American College of Obstetricians and Gynecologists criteria as gold standard. Laboratory personnel was blinded to the clinical classification of the patients. RESULTS: We studied 192 patients without pre-eclampsia, 63 with mild and 153 with severe pre-eclampsia. Hematocrits, prothrombin time, partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase and bilirubins did not show significative differences among groups. Platelets counting showed low sensitivity. Lactic dehydrogenase showed 71% sensitivity (65-85 CI95%), specificity 74% (68-80 CI95%) positive likelihood ratio 2.7 and negative 0.4. Uric acid showed sensitivity of 75% (69-81 CI95%) specificity 79% (73-85 CI95%) positive likelihood ratio of 3.5 and negative of 0.3. Seric creatinine with sensitivity of 81% (76-86 CI95%) specificity of 60% (53-67 CI95%) positive likelihood ratio of 2 and negative of 0.3. CONCLUSIONS: Seric uric acid, seric creatinine and lactic dehydrogenase are useful for diagnosis and severity classification of pre-eclampsia. Platelets counting is not useful for diagnosis but is useful for severity classification. In patients with thrombocytopenia prothrombin time is useful for severity classification.

The emotional response of families to children with leukemia at the lower socio-economic level in central Mexico: a preliminary report.

Little research has been done in developing countries on the emotional impact experienced by families who have a child diagnosed with leukemia. This preliminary study looked at parents in Mexico who had to cope with their child's leukemia in the face of meager financial and social resources. The 51 children in the study were under 15 years and being treated for leukemia in hospitals affiliated with the Mexican Social Security Institute (IMSS) where their parents were interviewed using a questionnaire to ascertain their emotional responses to the illness. The data are analyzed and reported in five domains: perceived illness; psychological impact; coping strategies; family relationships; socio-economic impact. A strengthening of family bonds was found the most common response (82.4%). The second most common responses were concern for the expenses incurred by the illness and the time dedicated to caring for the sick child (both 78.4%). It is especially important to assess families with meager social and financial resources as to their emotional responses to life-threatening illness because these limitations impose greater burdens and make coping more difficult. Psychosocial interventions are key to ensuring adequate treatment of the child in these circumstances.

Intestinal anti-spasmodic effect of a phytodrug of Psidium guajava folia in the treatment of acute diarrheic disease.

Ancestral medicinal use of guava (Psidium guajava L. Fam. Myrtaceae) is today supported by numerous biomedical studies concerning the properties of leaf extracts. However, insufficient clinical studies are reported on the use of this plant resource in the treatment of gastrointestinal ailments. The present work reports a randomized, double-blinded, clinical study performed to evaluate the safety and efficacy of a phytodrug (QG-5) developed from guava leaves, standardized in its content of quercetin and orally administered to a group of adult patients with acute diarrheic disease. Capsules containing 500 mg of the product were administered to 50 patients every 8 h during 3 days. Results obtained showed that the used guava product decreased the duration of abdominal pain in these patients.

Epidemiological characteristics of retinoblastoma in children attending the Mexican Social Security Institute in Mexico City, 1990-94.

The object of this study is to present descriptive epidemiological characteristics of retinoblastoma (Rb) in children aged 0-14 years, seen at the Mexican Social Security Institute hospitals in Mexico City (MC) from 1990 to 1994. This is a retrospective, observational hospital survey. Clinical records of 52 Rb cases were reviewed; 39 were patients who did not reside in MC (non-residents), and 13 were MC residents. The study period was 1990-94. The male/female ratio (M/F) was 1.6. Average annual incidence (AAI) was estimated by age and sex (rates per 1000000). Annual average percentage change (AAPC) in incidence rates was estimated in children from 0 to 14 years. The AAI for MC residents was 3.2; the highest rate being for those <1 year olds (rate of 20.8); AAPC was 6.9% [95% CI -27.5, 57.4]; the highest incidence was for the south-eastern region of MC residents (rate of 5.9); 13 cases (25%) were diagnosed at stage III or IV, and 11 cases (21.2%) were bilateral. Incidence of Rb is similar to that in developed countries and shows no increasing trend. Patients from communities outside MC are more frequently diagnosed at stages III and IV.

Clinical and social factors that affect the time to diagnosis of Mexican children with cancer.

BACKGROUND: There are few studies on the factors that influence the time to diagnosis (TD) in childhood cancer. The object of the present study was to determine the influence of some clinical and social factors associated to TD in children with cancer seen at Mexico City (MC) hospitals. PROCEDURE: A retrospective study was performed. A total of 4,940 clinical records of children with cancer were reviewed. Cases of cancer were grouped, according to the International Classification of Childhood Cancer. The median (med) TD was calculated for each group (type) of cancer. The association between delayed TD (longer than 1 month) and type, age at diagnosis, parental educational level, medical institution, and place of residence was analyzed, for which the odds ratio (OR) and 95% confidence intervals (CI) were obtained. RESULTS: Leukemias had the shortest TD (med = 1 month), while Hodgkin disease (HD) and retinoblastoma had the longest TD (med = 5 months). The highest risk for delayed TD was in children with HD (OR = 7.0; 95% CI 5.3-9.3), in the 10-14 age group (OR = 1.8; 95% CI 1.4-2.3), with low maternal educational level (OR = 1.5; 95% CI 1.2-2.1), in the population with no access to social security (OR = 1.3; 95% CI 1.1-1.4), and whose place of residence is far from MC (OR = 1.5; 95% CI 1.2-2.1). CONCLUSIONS: In Mexican children with cancer, age at diagnosis, and societal characteristics are important factors affecting timely diagnosis.

[Trends in the incidence of hepatic tumors in childhood]. / Tendencia de la incidencia de los tumores hepáticos en la infancia.

OBJECTIVE: To evaluate the incidence trends of hepatic tumors among children living in Mexico City. MATERIAL AND METHODS: A cross-sectional hospital survey was conducted to yield two databases. The first database contains the registry of all the cases of hepatic tumors occurring during the period 1982-1991, in public hospitals of Mexico City. The second database contains all hepatic tumor cases found between 1996 and 1999 in Hospital de Pediatría del Centro Médico Nacional "Siglo XXI" and in Hospital General del Centro Médico La Raza, both hospitals pertaining to Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). The average annual incidence rates (AAIR) were calculated for each type of hepatic tumor. The rates were standardized with the direct method, using as standard the world population under 15 years of age. The trends were evaluated with the annual incidence rates and the average rate of change assuming a Poisson distribution. RESULTS: The AAIR for hepatoblastoma during the period 1982-1991 was three times higher for men than for women, with a value of 0.6 x 10(6). The group of 1-4 years of age was the most affected. For hepatocarcinomas the AAIR was two-fold for women (0.14) as compared to men. Between 1996-1999 the AAIR for hepatoblastoma was 5.11 in women and 1.85 in men. The age group with the highest rate was women under one year of age. The AAIR for hepatocarcinoma was 0.64 for males and 1.23 for females. The most affected age group was males aged 10 to 14 years. No significant upward or downward trend was found in the incidence of hepatoblastomas. A non-significant change rate of 10% was found for hepatocarcinoma. CONCLUSIONS: No significant trends were observed in the incidence of hepatic tumors in children of Mexico City aged under 15 years, during the periods 1982-1991 and 1996-1999. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Tendencia de la incidencia de los tumores hepáticos en la infancia / Trends in the incidence of hepatic tumors in childhood

OBJECTIVE: To evaluate the incidence trends of hepatic tumors among children living in Mexico City. MATERIAL AND METHODS: A cross-sectional hospital survey was conducted to yield two databases. The first database contains the registry of all the cases of hepatic tumors occurring during the period 1982-1991, in public hospitals of Mexico City. The second database contains all hepatic tumor cases found between 1996 and 1999 in Hospital de PediatrÝa del Centro MÚdico Nacional "Siglo XXI" and in Hospital General del Centro MÚdico La Raza, both hospitals pertaining to Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). The average annual incidence rates (AAIR) were calculated for each type of hepatic tumor. The rates were standardized with the direct method, using as standard the world population under 15 years of age. The trends were evaluated with the annual incidence rates and the average rate of change assuming a Poisson distribution. RESULTS: The AAIR for hepatoblastoma during the period 1982-1991 was three times higher for men than for women, with a value of 0.6 x 10(6). The group of 1-4 years of age was the most affected. For hepatocarcinomas the AAIR was two-fold for women (0.14) as compared to men. Between 1996-1999 the AAIR for hepatoblastoma was 5.11 in women and 1.85 in men. The age group with the highest rate was women under one year of age. The AAIR for hepatocarcinoma was 0.64 for males and 1.23 for females. The most affected age group was males aged 10 to 14 years. No significant upward or downward trend was found in the incidence of hepatoblastomas. A non-significant change rate of 10 was found for hepatocarcinoma. CONCLUSIONS: No significant trends were observed in the incidence of hepatic tumors in children of Mexico City aged under 15 years, during the periods 1982-1991 and 1996-1999. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

El cáncer, un problema de salud que incrementa en el niño: un reto para conocer su epidemiología en los niños mexicanos / Childhoo cancer: an increasing health problem and a challenge to disclose its epidemiology in Mexico

Objetivo: revisar en el ámbito mundial y nacional los datos epidemiológicos más relevantes de la incidencia de cáncer en los niños. Establecer una perspectiva del impacto que han causado en la patología del niño y principalmente en los niños mexicanos. Metodología: se seleccionaron los artículos más relevantes sobre la incidencia de cáncer en los niños publicados en los últimos 15 años, de donde pudiera obtenerse las características de tiempo, lugar y persona. Para la incidencia de cáncer en los niños mexicanos, además, se incluyeron datos de un estudio multicéntrico que se está realizando. Resultados: la incidencia mundial de cáncer en el niño se encuentra entre 100 y 182 x 106. Existen diferentes patrones de presentación, la incidencia es más frecuente en los hombres, en los menores de 5 años, en la raza blanca y al parecer en el medio urbano. Parece que hay una tendencia de la incidencia al incremento. En países desarrollados la mortalidad por cáncer ha disminuido significativamente. En los niños residentes del Distrito Federal derechohabientes del Instituto Mexicano del Seguro Social, al parecer hay tendencia al incremento y comparten características similares con los niños de otros países. La mortalidad por cáncer no tiende a disminuir. Los datos epidemiológicos de cáncer para niños de otros estados son muy escasos. Conclusiones: al parecer existe tendencia al incremento de la incidencia de cáncer en el niño. En México, es necesario diseñar estrategias institucionales o nacionales integrales, tanto para conocer mejor la epidemiología del cáncer en el niño, como para dar un mejor tratamiento a los niños que desarrollan una neoplasia.

Cáncer de cuello uterino: factores sociales, clínicos y reproductivos asociados con lesiones precursoras / Cancer of the uterine cervix social, clinical and reproductive factors associated to precursor lesions

La neoplasia intraepitelial cervical es una lesión preinvasora que precede al cáncer cervicouterino. El objetivo de este estudio fue identificar los factores sociales, clínicos y reproductivos que se relacionan con dicha neoplasia, en una población derechohabiente del Instituto Mexicano del Seguro Social (IMSS), residente de la ciudad de México. Diseño: estudio de casos y controles prolectivo.Lugar de estudio: unidades de atención médica de tercer y primer nivel de atención.Casos: mujeres con diagnóstico histopatológico de primera vez de neoplasia intraepitelial cervical. Controles: Se identificaron dos tipos: comunitario (control 1), mujeres con dos estudios de papanicolaou negativos a displasia, adscritas a unidades de medicina familiar de la misma zona de referencia de los casos; hospitalario (control 2), mujeres con patología ginecológica benigna, negativas a neoplasia intraepitelial o cáncer de cérvix, de la misma unidad de tercer nivel de atención de los casos de referencia.Mediciones: entrevistas a las pacientes por personal capacitado para identificar variables sociales, clínicas y reproductivas. Se llevaron a cabo medidas de frecuencia, comparación de rangos para muestras independientes por U de Mann-Whitney, razones de riesgo y análisis de regresión logística no condicionada, para medir la asociación ajustada por otras variables. Se calcularon intervalos de confianza a 95 por ciento.Resultados: se estudiaron 150 casos, 157 con-troles comunitarios y 99 controles hospitalarios. Los principales factores de riesgo fueron el antecedente de cinco o más partos, la positividad a enfermedades de transmisión sexual, el mayor número de parejas sexuales, el antecedente positivo a cáncer cervicouterino y la edad para el primer control de papanicolaou después de los 40 años.Conclusiones: los factores reproductivos y sexuales definen claramente a población en riesgo para desarrollar neoplasia intraepitelial cervical. Las diferencias observadas entre los dos tipos de controles se deben principalmente a la relación de algunos factores con la patología ginecológica benigna de base, que hacen subestimar dicha asociación.

Incidencia de las leucemias agudas en niños de la ciudad de México, de 1982 a 1991 / Incidence of acute leukemia in children of Mexico city; 1982 to 1991

Objetivo. Medir la tasa de incidencia de las leucemias agudas (LA) en las diferentes delegaciones políticas del Distrito Federal y evaluar si existe una tendencia significativa en dichos padecimientos en tales delegaciones. Material y métodos. Estudio longitudinal descriptivo realizado en seis hospitales de la ciudad de México, los que atienden a cerca de 97.5 por ciento de todos los niños con cáncer de esta ciudad. Los datos se capturaron de 1995 a 1996, y se analizaron en 1999, en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social. Para cada delegación se cal-cularon la tasa de incidencia anual promedio, la tasa es-tandarizada y la razón estandarizada de morbilidad (REM) con intervalos de confianza al 95 por ciento (IC 95 por ciento). La tendencia se evaluó con la tasa de cambio promedio. Re-sultados. Se observó una tendencia al incremento en la incidencia de la leucemia aguda linfoblástica (LAL) en cinco delegaciones: Alvaro Obregón, Cuauhtémoc, Gustavo A. Madero, Izta-calco y Venustiano Carranza. En la leucemia aguda mieloblás-tica (LAM) no se notificaron cambios estadísticamente signi-ficativos en la incidencia en ninguna delegación política. Sólo con LAM se encontró una REM significativa y co-rrespondió a la delegación Alvaro Obregón (REM= 2.91, IC 95 por ciento 1.63 - 4.80). Las REM más altas se encontraron en el sur y suroeste de la ciudad. Conclusiones. Sólo se observó incremento en la incidencia de LAL en cinco delegaciones políticas. La incidencia más alta de LAM se encontró en la delegación Alvaro Obregón.

Prevalencia de infección en pacientes con catéter venoso central / Prevalence of infection in patients with central venous catheters

Los catéteres venosos centrales se utilizan para asegurar un acceso para la terapia de fluidos, infusión de drogas, nutrición parenteral y para la monitorización de la presión venosa central en pacientes hospitalizados en diferentes servicios. La colonización del catéter es producida por diversos factores como: número de lúmenes, tipo de adaptadores, tiempo de permanencia, soluciones intravenosas suministradas y material de fabricación. Debido a la frecuente necesidad de usar catéteres en los pacientes existe la obligación de conocer la prevalencia de infección del catéter y los posibles factores contribuyentes con el fin de prevenirla. Objetivo: conocer la prevalencia de infección de catéter venoso central en pacientes hospitalizados en diferentes servicios. Metodología: de mayo de 1999 a mayo 2000, se captó una muestra de 839 pacientes que requirieron de catéter venoso central, de los cuales 108 pacientes que presentaron infección, considerando los siguientes criterios: expediente completo, que la infección estuviera referida en el expediente clínico y diagnosticada por un médico de base y con cultivo positivo reportado. Resultados: se estudiaron 108 pacientes hospitalizados con catéter infectado durante el periodo mencionado, encontrándose mayor incidencia en el servicio de UCl (80%), Nefrología(74%) y Hematología (66%). El germen aislado con mayor frecuencia es el estafilococo coagulasa negativo. Conclusión: prevalencia de infección en catéter venoso central del Hospital de Especialidades fue del 12.87%.

The central venous catheters are used in order to assure an effective route for fluid therapy, drug administration, parenteral nutrition and for the measuring of venous central pressure In hospitalized patients among hospital services. Many conditions with the bacterial colonization inside the venous catheters had been related like the quantity of lumens, presence of adaptations, how many time had spent In use, kind of solutions and material of the catheters. Cause the use of venous catheters Is broadly, if s necessary to know the prevalence of septical complications In patients with central venous catheters and the conditions related In order to avoid the Infection. Objective: to know the sepsis prevalence In hospitalized patients with central venous catheters among medical services of the Hospital de Especialidades, CMN 5XXI. Methods: It was made along a year, from may 1999 until may 2000 at the Hospital de Especialidades del CMN, 5XXI. We studied 839 patients that used a central venous catheter. There were identified 108 patients with sepsis at the catheter according with the following judgments: A complete clinical history, a diagnosis of sepsis made bay a clinician and a positive culture. Results: there was a higher incidence at Special Care Unit (UCE) with 80%, nephrology (74%) and Hematology (66%). Staphylococcus was the most frequent bacterial isoled.

Validation of a prognostic index in the critically ill newborn / Validación de un índice pronóstico en el recién nacido en estado crítico

Objetivo. Elaborar y validar un modelo pronóstico para evaluar a los pacientes que ingresan a una Unidad de Cuidados Intensivos Neonatales (UCIN). Diseño. Casos y controles anidado en una cohorte. Lugar. UCIN de dos hospitales de tercer nivel y uno de segundo nivel. Pacientes. El estudio se realizó en dos fases (elaboración y validación del modelo respectivamente). En la primera fase se estudiaron 336 recién nacidos, 112 casos (pacientes fallecidos en la UCIN) y 224 controles (pacientes egresados vivos de la UCIN). En la segunda fase se incluyeron 300 pacientes, 100 casos y 200 controles. Mediciones. A cada uno de los pacientes que ingresaron al estudio se les determinaron los factores perinatales, clínicos, paraclínicos, y de co-morbilidad dentro de las primeras 12 horas de haber ingresado. Las variables que mostraron significancia estadística en el análisis bivariado se llevaron a un modelo de regresión logística. Resultados. Las variables que constituyeron el modelo pronóstico fueron edad gestacional x peso al nacer, paO2/FiO2 x saturación de O2, paro cardiaco, malformaciones congénitas mayores, septicemia y exceso de base. En la cohorte de elaboración la sensibilidad del modelo fue 70 por ciento y la especificidad 91 por ciento. En la cohorte de validación la sensibilidad fue 68 por ciento y la especificidad 92 por ciento, el valor predictivo positivo 80 por ciento, el valor predictivo negativo 85 por ciento y la frecuencia de clasificación correcta 84 por ciento. Conclusiones. El índice pronóstico de mortalidad neonatal desarrollado en este estudio demostró ser útil para la evaluación de la mortalidad hospitalaria en recién nacidos críticamente enfermos que ingresan a una UCIN.