The association between maternal and foetal factors with birth weight discordance in twins from Yucatan, Mexico.

Birth weight discordance (BWD) is not an uncommon event in twin pregnancies and can be associated with maternal and newborn characteristics. We aimed to analyse the association between maternal sociodemographic and newborn characteristics with BWD in twin infants born in Yucatan, Mexico, during 2008-2017 (n = 2091 pairs). BWD was calculated as the percentage of birth weight of the heavier twin. We defined three categories of BWD: concordant twins: <15%, mild-discordant: 15-24%, and severe discordant: ≥25%. A multinomial logistic regression model was used to analyse the association between maternal sociodemographic and newborn characteristics with BWD. Seventy-four percent (n = 1547) of twin pairs were classified as concordant, 17% (n = 356) met the criteria for mild-discordance and 9% (n = 188) for severe discordance. The odds for mild-discordance were significantly lower for mothers with medium level of education and in the highest quartile of total twin birth weight (TBW). Opposite-sex twin pairs showed increased odds for mild-discordance compared with same-sex pairs. The odds for severe discordance increased as mothers were in older age groups and decreased as TBW increased. Our rates of BWD are similar to those reported in populations from wealthier countries and maternal age and education, infants' sex, and TBW are associated with BWD.

The influence of maternal height on offspring's birth weight in Merida, Mexico.

OBJECTIVES: To analyze the influence of maternal height (MH) on offspring's birth weight (BW) in infants born from January 2016 to May 2017, in Merida, Mexico. METHODS: A total of 3462 singletons born at term in a public hospital were analyzed. Data extracted from hospital records were MH; number of previous births; and infant's sex, BW, and gestational length. MH was divided into 4 categories at quartile points: Q1:129-147, Q2:148-151, Q3:152-155, and Q4:156-180 cm. BW data were transformed to z-score values using the WHO Child Growth Standard. The association between MH and infants' BW was analyzed through a multiple regression model in which gestational length, infant's sex, maternal age, ethnicity, and number of previous birth were included as covariates. RESULTS: Mean values of MH and infants' BW were 151.43 cm (SD = 6.32) and 3172 g (SD = 401) (corresponding to -0.29 SD in BW z-score), respectively. The regression model showed that the shortest quartile of MH was associated with -0.43 (95% CI -0.35 -0.51) SD in infants' BW compared with the highest quartile. The second and third shortest quartiles of MH were associated with -0.24 (95% CI -0.16 -0.32) and -0.17 (95% CI -0.09 -0.25) SD of infants BW, respectively. CONCLUSIONS: MH remains an important factor for infant BW even in the presence of other determinants. The influence of MH on infants' BW in this population is similar to that found in other populations in low-, middle-, and high-income countries.

Association between overweight and obesity with school performance in secondary students in Merida, Mexico. / Asociación entre el sobrepeso y la obesidad con el rendimiento académico en estudiantes de secundaria de la ciudad de Mérida, México

Background: Some studies have found a negative relationship between obesity and school performance in scholars. However, this topic has not been studied in depth in Mexico. The aim of this study was to analyze the association between overweight and obesity with school performance in secondary school students from Merida. Methods: Weight and height were measured, and body mass index was calculated in a sample of 566 secondary students in Merida. Nutritional status was classified in normal weight (-2-<+1 standard deviation [SD]), overweight (+1-<2 SD) and obesity (> + 2 SD) according to the World Health Organization criteria. The scores in language, mathematics and sciences were used as indicators of school performance. Good performance was considered when the scores were ≥8 points, and poor performance when scores were <8 points. Logistic regression models were used to analyse the association between the variables. Results: The 44% of the sample met the criteria for overweight and obesity. After adjusting for school grade, type of school, number of absences, and Mayan surnames, we found that girls classified as obese had a significant risk of a poor performance in mathematics (odds ratio [OR]: 3.07; 95% confidence interval [CI]: 1.39-6.80) and language (OR: 2.55; 95% CI: 1.14-5.71) compared with those with healthy weight. Conclusions: Our results suggest that obesity represents a risk of having a lower school performance in girls but not in boys.

Introducción: Diversos estudios señalan una relación negativa entre la obesidad y el rendimiento académico en la población infantil. Sin embargo, este tema ha sido poco estudiado en México. El objetivo de este estudio fue analizar la asociación entre el sobrepeso y la obesidad con el rendimiento académico en estudiantes de secundaria de Mérida. Métodos: Se midió el peso y la talla y se calculó el índice de masa corporal (IMC) en una muestra de 566 alumnos de ambos sexos de escuelas secundarias públicas de Mérida. Se clasificó el estado nutricional de los adolescentes en peso normal (-2 - < +1 desviaciones estándar [DE]), sobrepeso (+1 - < 2 DE) y obesidad (> +2 DE) de acuerdo con los valores de referencia de la Organización Mundial de la Salud (OMS). Se utilizó el promedio de calificaciones obtenidas en las asignaturas de lenguaje, matemáticas y ciencias como un indicador del rendimiento académico. Se consideró desempeño mayor cuando el promedio fue > 8 puntos y menor cuando fue < 8 puntos. El análisis de asociación entre las variables se realizó mediante modelos de regresión logística. Resultados: La prevalencia conjunta de sobrepeso y obesidad fue del 44%. Al ajustar para el grado escolar, el tipo de escuela, el número de ausencias y la procedencia maya del apellido, las adolescentes con obesidad tuvieron un riesgo significativo de tener desempeño menor en matemáticas (razón de momios [RM]: 3.07; IC 95%: 1.39-6.80) y lenguaje (RM: 2.55; IC 95%: 1.14-5.71) al compararlas con aquellas con peso saludable. Conclusiones: Los resultados sugieren que la obesidad es un factor de riesgo para tener un menor rendimiento académico en las adolescentes de entre 12 y 15 años, pero no entre los adolescentes de la misma edad.

Asociación entre el sobrepeso y la obesidad con el rendimiento académico en estudiantes de secundaria de la ciudad de Mérida, México / Association between overweight and obesity with school performance in secondary students in Merida, Mexico

Resumen Introducción: Diversos estudios señalan una relación negativa entre la obesidad y el rendimiento académico en la población infantil. Sin embargo, este tema ha sido poco estudiado en México. El objetivo de este estudio fue analizar la asociación entre el sobrepeso y la obesidad con el rendimiento académico en estudiantes de secundaria de Mérida. Métodos: Se midió el peso y la talla y se calculó el índice de masa corporal (IMC) en una muestra de 566 alumnos de ambos sexos de escuelas secundarias públicas de Mérida. Se clasificó el estado nutricional de los adolescentes en peso normal (-2 - < +1 desviaciones estándar [DE]), sobrepeso (+1 - < 2 DE) y obesidad (> +2 DE) de acuerdo con los valores de referencia de la Organización Mundial de la Salud (OMS). Se utilizó el promedio de calificaciones obtenidas en las asignaturas de lenguaje, matemáticas y ciencias como un indicador del rendimiento académico. Se consideró desempeño mayor cuando el promedio fue > 8 puntos y menor cuando fue < 8 puntos. El análisis de asociación entre las variables se realizó mediante modelos de regresión logística. Resultados: La prevalencia conjunta de sobrepeso y obesidad fue del 44%. Al ajustar para el grado escolar, el tipo de escuela, el número de ausencias y la procedencia maya del apellido, las adolescentes con obesidad tuvieron un riesgo significativo de tener desempeño menor en matemáticas (razón de momios [RM]: 3.07; IC 95%: 1.39-6.80) y lenguaje (RM: 2.55; IC 95%: 1.14-5.71) al compararlas con aquellas con peso saludable. Conclusiones: Los resultados sugieren que la obesidad es un factor de riesgo para tener un menor rendimiento académico en las adolescentes de entre 12 y 15 años, pero no entre los adolescentes de la misma edad.

Abstract Background: Some studies have found a negative relationship between obesity and school performance in scholars. However, this topic has not been studied in depth in Mexico. The aim of this study was to analyze the association between overweight and obesity with school performance in secondary school students from Merida. Methods: Weight and height were measured, and body mass index was calculated in a sample of 566 secondary students in Merida. Nutritional status was classified in normal weight (−2-<+1 standard deviation [SD]), overweight (+1-<2 SD) and obesity (> + 2 SD) according to the World Health Organization criteria. The scores in language, mathematics and sciences were used as indicators of school performance. Good performance was considered when the scores were ≥8 points, and poor performance when scores were <8 points. Logistic regression models were used to analyse the association between the variables. Results: The 44% of the sample met the criteria for overweight and obesity. After adjusting for school grade, type of school, number of absences, and Mayan surnames, we found that girls classified as obese had a significant risk of a poor performance in mathematics (odds ratio [OR]: 3.07; 95% confidence interval [CI]: 1.39-6.80) and language (OR: 2.55; 95% CI: 1.14-5.71) compared with those with healthy weight. Conclusions: Our results suggest that obesity represents a risk of having a lower school performance in girls but not in boys.

Epidemiologic profile and clinical course of four confirmed rickettsiosis cases in Southern Mexico during 2016.

Domestic animals can carry ticks or fleas, which constitute common vectors of rickettsial infections. The contact with them should be considered as suggestive of rickettsial infections in symptomatic patients. Misdiagnosis might occur in regions where other vector-borne diseases are endemic. Anamnesis is essential for an accurate clinical diagnosis.

Síndrome de Eisenmenger en una paciente embarazada de 21 años / Eisenmenger syndrome in 21-year pregnant patient

Resumen ANTECEDENTES El síndrome de Eisenmenger es la cardiopatía congénita con mayor riesgo de mortalidad de las embarazadas. CASO CLÍNICO: Paciente primigesta de 21 años, con síndrome de Eisenmenger e insuficiencia cardiaca grado III NYHA e hipertensión arterial sistémica. El embarazo se interrumpió mediante cesárea a las 30 semanas, con recién nacido vivo de 1000 g, Apgar 3-7, 32 semanas de gestación por Capurro. Seis días después de la cesárea la paciente falleció debido a choque cardiogénico. El neonato falleció de insuficiencia respiratoria el décimo segundo día de vida extrauterina. CONCLUSIONES El caso aquí descrito permite reflexionar acerca de las oportunidades de mejora en la atención de las pacientes con síndrome de Eisenmenger. En el primer nivel de atención es importante centrarse en la educación y consejería específicas que permitan comprender a la paciente y su pareja los riesgos implícitos de su afección, pues la alternativa más segura hubiera sido evitar el embarazo. En el segundo nivel de atención ha de favorecerse siempre la práctica basada en evidencia y correcta coordinación en los equipos de salud que, en este caso particular, hubiera permitido que la paciente desde la semana 14 hubiera sido referida para atención altamente especializada que hubiese podido incrementar las probabilidades de supervivencia de ella y el neonato.

Abstract BACKGROUND Eisenmenger syndrome is congenital heart disease with a higher risk of mortality for pregnant women. CLINICAL CASE 21-years women with Eisenmenger syndrome, whose pregnancy was accompanied by class III NYHA heart failure and systemic arterial hypertension. Pregnancy was interrupted at 30 weeks by caesarean section. Six days after the caesarean section, the patient died due to cardiogenic shock. CONCLUSIONS The case described here allows us to reflect on the opportunities for improvement in the care of patients with Eisenmenger syndrome. At the first level of care, it is important to focus on specific education and counseling that allows the patient and her partner to understand the implicit risks of their condition, since the safest alternative would have been to avoid pregnancy. At the second level of care, the practice based on evidence and correct coordination in the health teams should always be favored, which in this particular case would have allowed the patient, since week 14, to have been referred for highly specialized care could increase the chances of survival of her and the neonate.

Fatal cardiopulmonary decompression sickness in an untrained fisherman diver in Yucatán, Mexico: a clinical case report.

INTRODUCTION: In Yucatán, Mexico, during the sea cucumber season fishermen dive intensely to obtain good catches but are often at risk of decompression sickness (DCS). We present a single case fatality. OBJECTIVE: We analyzed the clinical course, medical assessment and recompression treatment plan of an untrained fisherman. CASE REPORT: A 35-year-old male ascended rapidly using compressed-air diving. Before reaching the coast, he reported dizziness, shortness of breath, and pain in the abdomen and legs. Three hours later, when symptoms worsened, he went to the hospital. He was admitted with increased osteotendinous reflexes and cutis marmorata in the abdomen. The patient was diagnosed with carbon monoxide (CO) poisoning and Type I DCS, receiving the U.S. Navy Treatment Table 5 (USN TT5). Before completing his treatment at depth, he developed myocardial infarction and died. The death certificate indicated Type I DCS, thrombotic pulmonary embolism and cardiac arrest. DISCUSSION: Upon reviewing his medical records, we uncovered no evidence to support the diagnosis of CO poisoning and thrombotic pulmonary embolism. The clinical presentation seems to be compatible with a serious decompression insult, not a Type I hit. Based on the information gathered, it seems likely that the patient died as a result of cardiopulmonary DCS. This case report suggests a need to provide fishermen divers in this region with formal dive training. There also seems to be a need to improve medical education for physicians who work at hyperbaric programs, and to ensure that sufficient and qualified staff is present to supervise patients inside the chambers.

Perfil clinicoepidemiológico de la infección por Chikungunya en casos hospitalarios atendidos en 2015 en Mérida, México / Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, Mexico / Perfil clínico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México

Objetivos. Describir el perfil epidemiológico y analizar las manifestaciones clínicas por grupo de edad de los casos de chikungunya atendidos en 2015 en un hospital general de Mérida, México. Métodos. Estudio observacional en el cual se describen los casos de Chikungunya registrados por el Departamento de Vigilancia Epidemiológica entre julio y diciembre de 2015 y análisis de las manifestaciones clínicas por grupo de edad. La asociación entre los signos y síntomas y el ingreso hospitalario se analizó mediante un modelo de regresión logística. Resultados. En total se atendieron 830 casos diagnosticados de Chikungunya. La media de edad fue 27,4 ± 17,05 años y la razón de sexos, 1:1,4. Los casos procedieron en su mayoría del medio urbano (n = 592, 87%) y, en particular, de la ciudad capital. En 723 (90%) casos se notificó haber tenido contacto con el vector artrópodo en el peridomicilio. Las alteraciones musculares y articulares fueron más frecuentes en los grupos de mayor edad, mientras que el exantema lo fue entre los más jóvenes. Las manifestaciones de gravedad neurológicas y no neurológicas no tuvieron predominio por edad. Conclusiones. Los casos de Chikungunya atendidos fueron mayormente cuadros benignos autolimitados, mientras que las manifestaciones neurológicas como letargia, vómitos persistentes, hemorragia, fotofobia y cefalea intensa fueron predictores de la gravedad y su identificación oportuna en los menores de un año de edad fue posible mediante la vigilancia estrecha.

Objectives. Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital. Methods. An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission. Results. A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. Conclusions. Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

Objetivos. Descrever o perfil epidemiológico e analisar as manifestações clínicas por faixa etária dos casos de chikungunya atendidos em 2015 em um hospital geral de Mérida, México. Métodos. Estudo observacional em que são descritos os casos de chikungunya registrados pelo departamento de vigilância epidemiológica entre julho e dezembro de 2015 e é feita uma análise das manifestações clínicas por faixa etária. A associação entre os sinais e sintomas e a admissão hospitalar foi analisada em um modelo de regressão logística. Resultados. Ao todo, foram atendidos 830 casos diagnosticados de chikungunya. A idade média foi 27,4 ± 17,05 anos e a proporção entre os sexos foi de 1:1,4. Os casos foram procedentes na sua maioria da zona urbana (n = 592, 87%) e, em particular, da capital. Em 723 casos (90%) foi notificado o contato peridomiciliar com o vetor artrópode. Manifestações musculares e articulares foram mais frequentes nas faixas etárias avançadas, enquanto que o exantema foi mais comum em jovens. As manifestações neurológicas e não neurológicas graves não apresentaram predomínio por idade. Conclusões. Os casos de chikungunya atendidos foram na sua maioria quadros benignos autolimitados, enquanto que as manifestações neurológicas como letargia, vômitos persistentes, hemorragia, fotofobia e cefaleia intensa foram preditivas da gravidade da doença e a identificação oportuna em crianças menores de 1 ano foi possível com a vigilância rigorosa.

Elaboración de un artículo de reporte de caso clínico o de revisión, en la materia de metodología de la investigación en medicina / Elaboration of a case report or review paper in the course of methodology for research in medicine

Introducción. La formación en redacción y metodología de la investigación es importante en la formación médica. En el plan de estudios de la licenciatura en medicina de la universidad marista de Mérida, Yucatán, México, se imparte la materia de metodología de la investigación en el sexto semestre y actualmente involucra la generación de competencias para la comunicación escrita. En el presente artículo, presentamos los resultados obtenidos en el programa académico de la materia, en la cual los alumnos desarrollaron un borrador de artículo académico y posteriormente elaboraron un artículo, para lo cual optaron por un reporte de caso clínico o un artículo de revisión. Métodos. Este es un estudio descriptivo, observacional mediante encuesta a los alumnos. Adicionalmente se analiza los productos académicos derivados del curso que fueron sometidos para su publicación seis meses después de iniciado el curso y las experiencias y percepciones expresadas por los alumnos. Resultados. De una generación de 60 alumnos, 19 (32%) optaron por un manuscrito de reporte de caso clínico y 41 (68%) eligieron un tema de revisión. Un artículo derivado de la materia ha sido publicado, dos de revisión y tres de caso clínico se encuentran ahora bajo revisión. Conclusiones. Los alumnos de pregrado fueron capaces de desarrollar manuscritos de revisión y de reportes de caso clínico de calidad y eligieron el tipo de artículo tomando en cuenta el acceso a los datos, el tiempo requerido y la estructura del manuscrito.

Introduction: In medical education, it is important to train students in scientific writing and research methods, relevant for progress of health sciences. The curriculum for the undergraduate program of medical education at the Marista University of Merida, Yucatan, Mexico, includes the subject of research methodology in the sixth semester, and currently involves the generation of skills for written communication. In this article, we present the results obtained in the academic program of the research methods course, in which the students develop a draft of an academic article and subsequently an original article consisting of a clinical case report or a review article. Methods: Descriptive, observational study obtained from a survey applied to the students. Additionally, we discuss on the academic products derived from the course that were submitted for publication, six months after the commencement of the course; we also discuss the experiences and perceptions expressed by the students. Results: From 60 students, 19 (32%) opted for writing a clinical case report and 41 (68%) for a review paper. To this day one article derived from the material has been published, and two review papers and three clinical cases are currently under peer review. Conclusions: Undergraduate students were able to develop review manuscripts and clinical case reports of quality and to choose them taking into account access to the data, the time required and the structure of the manuscript.

[Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, MexicoPerfil clÍnico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México]. / Perfil clinicoepidemiológico de la infección por Chikungunya en casos hospitalarios atendidos en 2015 en Mérida, México.

OBJECTIVES: Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital. METHODS: An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission. RESULTS: A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. CONCLUSIONS: Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

OBJETIVOS: Descrever o perfil epidemiológico e analisar as manifestações clínicas por faixa etária dos casos de chikungunya atendidos em 2015 em um hospital geral de Mérida, México. MÉTODOS: Estudo observacional em que são descritos os casos de chikungunya registrados pelo departamento de vigilância epidemiológica entre julho e dezembro de 2015 e é feita uma análise das manifestações clínicas por faixa etária. A associação entre os sinais e sintomas e a admissão hospitalar foi analisada em um modelo de regressão logística. RESULTADOS: Ao todo, foram atendidos 830 casos diagnosticados de chikungunya. A idade média foi 27,4 ± 17,05 anos e a proporção entre os sexos foi de 1:1,4. Os casos foram procedentes na sua maioria da zona urbana (n = 592, 87%) e, em particular, da capital. Em 723 casos (90%) foi notificado o contato peridomiciliar com o vetor artrópode. Manifestações musculares e articulares foram mais frequentes nas faixas etárias avançadas, enquanto que o exantema foi mais comum em jovens. As manifestações neurológicas e não neurológicas graves não apresentaram predomínio por idade. CONCLUSÕES: Os casos de chikungunya atendidos foram na sua maioria quadros benignos autolimitados, enquanto que as manifestações neurológicas como letargia, vômitos persistentes, hemorragia, fotofobia e cefaleia intensa foram preditivas da gravidade da doença e a identificação oportuna em crianças menores de 1 ano foi possível com a vigilância rigorosa.

Perfil clinicoepidemiológico de la infección por Chikungunya en casos hospitalarios atendidos en 2015 en Mérida, México / Perfil clínico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México / Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, Mexico

RESUMEN Objetivos Describir el perfil epidemiológico y analizar las manifestaciones clínicas por grupo de edad de los casos de chikungunya atendidos en 2015 en un hospital general de Mérida, México. Métodos Estudio observacional en el cual se describen los casos de Chikungunya registrados por el Departamento de Vigilancia Epidemiológica entre julio y diciembre de 2015 y análisis de las manifestaciones clínicas por grupo de edad. La asociación entre los signos y síntomas y el ingreso hospitalario se analizó mediante un modelo de regresión logística. Resultados En total se atendieron 830 casos diagnosticados de Chikungunya. La media de edad fue 27,4 ± 17,05 años y la razón de sexos, 1:1,4. Los casos procedieron en su mayoría del medio urbano (n = 592, 87%) y, en particular, de la ciudad capital. En 723 (90%) casos se notificó haber tenido contacto con el vector artrópodo en el peridomicilio. Las alteraciones musculares y articulares fueron más frecuentes en los grupos de mayor edad, mientras que el exantema lo fue entre los más jóvenes. Las manifestaciones de gravedad neurológicas y no neurológicas no tuvieron predominio por edad. Conclusiones Los casos de Chikungunya atendidos fueron mayormente cuadros benignos autolimitados, mientras que las manifestaciones neurológicas como letargia, vómitos persistentes, hemorragia, fotofobia y cefalea intensa fueron predictores de la gravedad y su identificación oportuna en los menores de un año de edad fue posible mediante la vigilancia estrecha.

RESUMO Objetivos Descrever o perfil epidemiológico e analisar as manifestações clínicas por faixa etária dos casos de chikungunya atendidos em 2015 em um hospital geral de Mérida, México. Métodos Estudo observacional em que são descritos os casos de chikungunya registrados pelo departamento de vigilância epidemiológica entre julho e dezembro de 2015 e é feita uma análise das manifestações clínicas por faixa etária. A associação entre os sinais e sintomas e a admissão hospitalar foi analisada em um modelo de regressão logística. Resultados Ao todo, foram atendidos 830 casos diagnosticados de chikungunya. A idade média foi 27,4 ± 17,05 anos e a proporção entre os sexos foi de 1:1,4. Os casos foram procedentes na sua maioria da zona urbana (n = 592, 87%) e, em particular, da capital. Em 723 casos (90%) foi notificado o contato peridomiciliar com o vetor artrópode. Manifestações musculares e articulares foram mais frequentes nas faixas etárias avançadas, enquanto que o exantema foi mais comum em jovens. As manifestações neurológicas e não neurológicas graves não apresentaram predomínio por idade. Conclusões Os casos de chikungunya atendidos foram na sua maioria quadros benignos autolimitados, enquanto que as manifestações neurológicas como letargia, vômitos persistentes, hemorragia, fotofobia e cefaleia intensa foram preditivas da gravidade da doença e a identificação oportuna em crianças menores de 1 ano foi possível com a vigilância rigorosa.

Objectives Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital. Methods An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission. Results A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. Conclusions Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

La retroalimentación constructiva en el desarrollo de habilidades comunicativas escritas e investigativas en dos generaciones de alumnos de medicina en Yucatán, México / Constructive feedback in the development of written and research communicational skills in two generations of medical students in Yucatan, Mexico

Antecedentes. La generación de competencias para la investigación en medicina es fundamental para que los médicos apliquen lashabilidades científicas en su quehacer diario; los programas académicos que incluyen la formación de habilidades investigativasrequieren a su vez habilidades para la comunicación escrita en los alumnos. La retroalimentación constructiva es un medio comúnmenteempleado en medicina, por el cual el docente acompaña al alumno, dándole a conocer sus fortalezas, debilidades y oportunidadespara un mejor desempeño, mientras asegura una evaluación justa. A pesar de ello, su aplicación más difundida es en la práctica clínicay no en el aprendizaje de la redacción y comunicación científica. Objetivo. Evaluar el impacto de la retroalimentación constructiva enel desempeño de los estudiantes en sus propuestas de protocolos clínicos y epidemiológicos considerando aspectos de redacción ymetodológicos. Diseño. Estudio analítico, prospectivo. Lugar. Universidad Marista de Mérida, Yucatán, México. Participantes. Alumnosregulares que cursaron la materia Métodos Clínicos y Epidemiológicos de la carrera de Médico Cirujano durante los ciclos escolares2014-2015 y 2015-2016. Intervención. Se evaluaron los puntajes obtenidos en el protocolo de investigación antes y después de laretroalimentación constructiva. Resultados. La media de la puntuación inicial de los protocolos fue 8,3 ± 0,8 y la media posterior a laretroalimentación constructiva fue 9,4 ± 0,9; el incremento de las puntuaciones en promedio fue de 1,1 ± 0,1 con un valor de t=7,70p=0,000. Las habilidades para la comunicación escrita que mejoraron los alumnos fueron fundamentalmente: 1. El manejo del tema,2. La organización del texto, 3. Empleo del lenguaje escrito, redacción, y 4. Fuentes de información; los alumnos presentan todaslas ideas no propias en su escrito con las citas a la fuente de donde fueron extraídas...

Background: Research and written communication skills are essential in undergraduate medical education, because medical doctors are often involved in research, and written communication is part of a medical doctor's everyday routine. Academic medical programs that include training in clinical or epidemiological research require written communication aptitudes. Constructive feedback is a review technique commonly employed in medical education that involves the professor's close surveillance of the student’s performance and a clear communication to respectfully explain to students their strengths, weaknesses and opportunities of improvement, while ensuring a fair evaluation. Even though constructive feedback is common in clinical practice, it is rarely used in undergraduate medical training in scientific writing. Objective: To evaluate the impact of constructive feedback on the academic performance of students in their clinical or epidemiological research protocol proposals, involving written and methodological aspects. Design: Analytical, prospective study. Setting: Universidad Marista de M‚rida, Yucat n, M‚xico. Participants: Students in their fourth year of medical education. Intervention: The quantitative evaluations obtained in the research protocol proposals before and after the constructive feedback were compared in 103 students in their fourth year of medical education who were attending the Clinical and Epidemiological Research Methods course during 2014-2015 and 2015-2016 school years. Results: The mean of the initial score was 8.3 ñ 0.8, and the mean post constructive feedback was 9.4 ñ 0.9; the average score increase was 1.1 ñ0.10 with t=7.70 value, p=0.000. Students improved the following communication skills: 1. Theme presentation and review, 2. Organization of a scientific manuscript, 3. Use of written language, and 4. Use of information sources...

Maternal maya ancestry and birth weight in Yucatan, Mexico.

OBJECTIVES: The purpose of this study was to analyze the association between maternal Maya ancestry and the birth weight of infants born in Yucatan, Mexico, during 2013. METHODS: A total of 30,435 singletons born at term (≥37 weeks) in Yucatan during 2013 were analyzed. Birth weights, gestational ages, and maternal socioeconomic data were provided by the Ministry of Health of Yucatan. Maternal Maya ancestry was defined by the presence of Maya surnames in: (1) non-Maya surnames (NM-NM), (2) one Maya surname (NM-M), and (3) two Maya surnames (M-M). Biological and socioeconomic parameters were compared between the categories of ancestry through one-way analysis of variance (ANOVA) and a multiple regression model was used to analyze the association between ancestry and infants' birth weight controlling for influence of covariates. RESULTS: Mean birth weight was 3,114 g (SD = 406) (NM-NM: 3,150 g [SD = 404], NM-M: 3,106 g [SD = 402], M-M: 3,088 g [SD = 408]). With the biological and socioeconomic variables statistically adjusted for, the presence of one and two maternal Maya surnames was associated with decreases in birth weight of 42 g and 63 g, respectively. None of the interactions between ancestry and other predictors was statistically significant. CONCLUSIONS: The lower mean birth weights of Maya infants are consistent with studies reporting poor growth and nutritional status of Maya children from Yucatan. Historically adverse socioeconomic conditions experienced by the Maya population are probably linked to the relatively lower birth weights of their infants. Am. J. Hum. Biol. 28:436-439, 2016. © 2015 Wiley Periodicals, Inc.

ETHNICITY AND INCOME IMPACT ON BMI AND STATURE OF SCHOOL CHILDREN LIVING IN URBAN SOUTHERN MEXICO.

Obesity affects quality of life and increases the risk of morbidity and mortality. Mexico, a middle-income country, has a high prevalence of overweight and obesity among urban children. Merida is the most populated and growing city in southern Mexico with a mixed Mayan and non-Maya population. Local urbanization and access to industrialized foods have impacted the eating habits and physical activity of children, increasing the risk of overweight and obesity. This study aimed to contribute to the existing literature on the global prevalence of overweight and obesity and examined the association of parental income, ethnicity and nutritional status with body mass index (BMI) and height in primary school children in Merida. The heights and weights of 3243 children aged 6-12 from sixteen randomly selected schools in the city were collected between April and December 2012. Multinomial logistic regression models were used to examine differences in the prevalence of BMI and height categories (based on WHO reference values) by ethnicity and income levels. Of the total students, 1648 (50.9%) were overweight or obese. Stunting was found in 227 children (7%), while 755 (23.3%) were defined as having short stature. Combined stunting and overweight/obesity was found in 301 students (9.3%) and twelve (0.4%) were classified as stunted and of low weight. Having two Mayan surnames was inversely associated with having adequate height (OR=0.69, p<0.05) and the presence of two Maya surnames in children increased the odds of short stature and stunting. Children from lower income families had twice the odds of being stunted and obese. Overweight, obesity and short stature were frequent among the studied children. A significant proportion of Meridan children could face an increased risk of developing cardiovascular disease and its associated negative economic and social outcomes unless healthier habits are adopted. Action is needed to reduce the prevalence of obesity among southern Mexican families of all ethnic groups, particularly those of lower income.

Height Growth and Percentage of Body Fat in Relation to Early Menarche in Girls from Merida, Yucatan, Mexico.

Early menarche (EM) (i.e., age at menarche [AAM] <12 years of age) is related to short height and higher body fatness. In a mixed-longitudinal study done in Merida, Yucatan, height, body mass index (BMI), and percentage of body fat (BF%) were recorded at a one-year interval among 258 postmenarcheal (EM = 94) girls. Anthropometric measurements were recorded of the age cohorts in 2008-09 when participants were 13-17 years of age (baseline), and in the one-year follow-up study (± 6 days) the girls were 14-18 years of age. The BF% was estimated through bioelectrical impedance analysis. Mean AAM was 10.59 years in EM girls and 12.54 years in not early menarche (NEM) girls. Height growth (cm/year) was greater in NEM girls. Mean values of BMI, BF%, and frequencies of stunting (low height-for-age) and excess weight (overweight + obesity) were higher in EM girls than in their NEM age peers.

"You are not fat, you are hermosa": Mexican caregivers share their perceptions about their role supporting their morbidly obese children.

This qualitative study reports the findings from 6 focus groups conducted at a clinic in Southern Mexico with caregivers of morbidly obese children. This study was developed with the purpose of gaining a further understanding of caregivers' perceived role in addressing their children's obesity within the family context and identifying topics that could be considered when providing health care in similar sociocultural environments. We identified that although caregivers acknowledge the role of modifiable factors in obesity prevention and treatment, they held beliefs about determinism in obesity. In addition, diet was the more frequently identified means of reducing the impact of obesity. The importance of role modeling and promoting healthy behaviors in the family context are topics that could be addressed in clinical practice.