Survival in a pediatric patient with cerebral aspergillosis: A case report.

Aspergillosis is an infrequent infection in the Central Nervous System with a mortality rate higher than 95 %. Early diagnosis is challenging and crucial. In this report, we present the case of a six-year-old female with an intense headache accompanied by left hemiparesis, gaze deviation, horizontal nystagmus, and vomiting of mucous content on five occasions. After several approaches, a cerebrospinal fluid PCR resulted positive for Aspergillus spp., and then management started with amphotericin B at 2.6 mg/kg/day and was managed to have voriconazole. She survived, and two years after her first hospital admission, she suffered from cerebral aspergillosis sequelae. An area of improvement is the coordination between the request and delivery of studies outside the institution. In this case, the patient´s mother did not report the analysis results on time, delaying the diagnosis.

Insuficiencia cardíaca crónica problema de salud pública y la gestión sanitaria en hospital general, Nicaragua / Chronic heart failure public health problem and health management in general hospital, Nicaragua / Problema de saúde pública de insuficiência cardíaca crônica e gestão de saúde em hospital geral, Nicarágua

El sistema de atención de salud en Nicaragua se basa en el Programa de Enfermedades Crónicas No Transmisibles, demuestra beneficio clínico en personas de alto riesgo, pero en el caso de los pacientes con insuficiencia cardiaca severa (ICC) no se llegan a reducir los ingresos, reingresos hospitalarios y mortalidad. Objetivo. Proponer un modelo de gestión de atención integral dirigido a pacientes con ICC de un hospital general en Nicaragua. Materiales y métodos. Fue un estudio observacional prospectivo, la muestra fue de 289 pacientes con ICC, seleccionados de manera probabilística aleatoria simple; aceptaron participar bajo su consentimiento. La propuesta de gestión consistió evaluar durante un año descriptores demográficos y clínicos, indicadores de calidad, predictores primordiales de calidad de vida, eficiencia educativa. Para la recolección de datos se aplicaron las encuestas Escala Europea de Autocuidado (EEAC) y el Kansas City Cardiomyopathy Questionnaire (KCCQ). Resultados. La suma total de EEAC basal fue de 49.1 y el control 19.1 puntos, representando un bajo autocuidado en los pacientes. El sumario general del KCCQ basal fue de 86.84 y el control 30.84 puntos, representando resultados estadísticamente significativos, al 5% de la prueba de Wilcoxon, para todas las dimensiones del cuestionario asociado a la calidad de vida. Conclusiones. La gestión sanitaria en pacientes con ICC, basado en una atención integral, hospital y atención primaria, con seguimiento a través de visitas en los hogares, educación-autocuidado reducen los ingresos, reingresos y visitas a área de urgencias durante el primer el año de diagnósticos con el seguimiento por consulta externa a las comorbilidades.

The health care system in Nicaragua is based on the Chronic Non-Communicable Diseases Program, which shows clinical benefit in high-risk individuals, but in the case of patients with severe heart failure (CHF), hospital admissions, hospital readmissions and mortality are not reduced. Objective. To propose a comprehensive care management model for CHF patients in a general hospital in Nicaragua. Materials and methods. This was a prospective observational study, the sample consisted of 289 patients with CHF, selected in a simple randomized probabilistic manner; they agreed to participate with their consent. The management proposal consisted of evaluating during one year demographic and clinical descriptors, quality indicators, primary predictors of quality of life, and educational efficiency. The European Self-Care Scale (ESCS) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were used for data collection. Results. The total sum of baseline EEAC was 49.1 and control 19.1 points, representing low self-care in patients. The overall sum of the baseline KCCQ was 86.84 and the control 30.84 points, representing statistically significant results, at 5% Wilcoxon test, for all dimensions of the questionnaire associated with quality of life. Conclusions. Health management in patients with CHF, based on integrated care, hospital and primary care, with follow-up through home visits, education-self-care, reduces admissions, readmissions and visits to the emergency department during the first year of diagnosis with outpatient follow-up for comorbidities.

O sistema de saúde da Nicarágua baseia-se no Programa de Doenças Crônicas Não Transmissíveis, que demonstra benefícios clínicos em indivíduos de alto risco, mas, no caso de pacientes com insuficiência cardíaca grave (ICC), não consegue reduzir as internações, readmissões hospitalares e mortalidade. Objetivo. Propor um modelo abrangente de gestão de cuidados para pacientes com ICC em um hospital geral na Nicarágua. Materiais e métodos. Este foi um estudo observacional prospectivo, a amostra consistiu em 289 pacientes com ICC, selecionados de forma probabilística aleatória simples; eles concordaram em participar com seu consentimento. A proposta de gerenciamento consistiu na avaliação de descritores demográficos e clínicos, indicadores de qualidade, preditores primários de qualidade de vida e eficiência educacional durante um ano. A Escala Europeia de Autocuidado (ESCS) e o Questionário de Cardiomiopatia de Kansas City (KCCQ) foram usados para a coleta de dados. Resultados. A soma total da EEAC da linha de base foi de 49,1 e a do controle, 19,1 pontos, representando baixo autocuidado nos pacientes. A soma total do KCCQ basal foi de 86,84 e o controle de 30,84 pontos, representando resultados estatisticamente significativos, a 5% no teste de Wilcoxon, para todas as dimensões do questionário associadas à qualidade de vida. Conclusões. O gerenciamento da saúde em pacientes com ICC, baseado em cuidados integrados, hospitalares e primários, com acompanhamento por meio de visitas domiciliares, educação e autocuidado, reduz as internações, readmissões e visitas ao departamento de emergência durante o primeiro ano de diagnóstico com acompanhamento ambulatorial das comorbidades.

Universal prenatal screening: a initiative from Guanajuato, Mexico to improve equity in perinatal healthcare.

The prenatal approach from a preventive perspective is necessary to reduce perinatal complications. A perinatal care model with a holistic and horizontal approach is required. Mexico is currently considered an emerging market economy with inequality and an economic gap that impacts the accessibility and distribution of healthcare services. Guanajuato is one of the 32 states of Mexico and represents 1.6% of the country's surface. Strategies during the prenatal approach allow prediction, diagnosis, and anticipation of the principal causes of morbidity and mortality. Combining data from maternal characteristics and history with findings of biophysical and biochemical tests at 11 to 13 weeks of gestation can define the patient-specific risk for a large spectrum of complications that include miscarriage and fetal death, preterm delivery, preeclampsia, congenital disorders, and fetal growth abnormalities. We aim to describe the care model designed and implemented in the State Center for Timely Prenatal Screening of the Maternal and Child Hospital of Leon, Guanajuato, Mexico. Previous research showed there is a lack of information for low and middle-income countries regarding how to integrate prenatal screening strategies in the absence of resources to perform cell-free fetal DNA or biochemical serum markers in countries with emergent economies. This care model is carried out through horizontal processes where the screening is provided by trained and certified general practitioners who identify the population at risk in a timely manner for specialized care, and could help guide other Mexican states, and other countries with emergent economies with limited financial, professional, and infrastructural resources to improve prenatal care with a sense of equity, equality, and social inclusion as well as the timely evaluation of specialized perinatal care of high-risk patients.

Paediatric fibrosarcoma treatment.

Introduction: Soft tissue sarcomas make up 7%-15% of childhood solid tumours. The aetiology of this disease is unknown. It is a fast-growing, painless tumour; histologically similar to adult fibrosarcoma, but having a lesser risk of metastasis and a better prognosis. The treatment is aimed towards localised intervention; complete surgical resection is the appropriate treatment as long as it can be performed. Case report: An 11 years old female was referred for resection of a soft tissue tumour on the right elbow with significant peripheral vascularisation. Tumour resection was scheduled, with the placement of a partial thickness skin graft, and a piece was sent to pathology; a histological type consistent with paediatric fibrosarcoma was obtained with margins less than 1 mm from the lesion. Therefore, the patient was referred to the paediatric oncology unit. Further studies with positron emission tomography were requested, in which no evidence of macroscopic anatomy-metabolic tumour activity was found. Subsequently, treatment was started by paediatric oncology with 2 sessions of chemotherapy and 20 sessions of radiotherapy with sufficient progress; finally, assessment by plastic and reconstructive surgery was performed and an adequate quality of graft was observed, without the need for any other intervention by their service. Conclusion: The involvement of the vascular surgeon in performing the tumour resection permitted the preservation of the best circulation to the extremity, thereby, avoiding amputation. The difficult decision made by the reconstructive surgeon to place a partial thickness graft over the surgical site, and to start radiotherapy/chemotherapy by paediatric oncology, were key to the success in achieving the patient's satisfactory progress.

COVID-19-Associated Case Fatality Rate in Subjects Under 18 Years Old in Mexico, up to December 31, 2020.

Background: The emergence of the SARS-CoV-2 and the COVID-19 have become a global health crisis. The infection has been present in all the social sectors. Subjects under 18 years are one of them. The objective was to analyze the case fatality ratio of COVID-19 cases in the Mexican population under 18 years of age registered in the National Epidemiological Surveillance System from March 2020 to December 31, 2020. Material and Methods: The design is cross-sectional, quantitative, and analytical. All the suspected cases of respiratory viral disease, with a real-time polymerase chain reaction (RT-PCR) test result, aged from 0 to 17 years, were included. Descriptive statistics are presented for all the variables. Epidemiological curves were designed. The chi-squared test and its P-values were obtained to show the relationship between comorbidities and death. The case fatality ratio was computed for each comorbidity, sex, and age group. Multivariable logistic regression models were fitted to study the effect between comorbidities with the fatality of cases, adjusting for sex and age group as potential confounders. The alpha value was fixed to 0.05 to assess significance. Results: The number of records for this study was 167,856. Among them, 48,505 were from SARS-CoV-2-positive patients (28.90%), and 119,351 (71.10%) were negative. Of those who died, males (55.29%) (P < 0.05) and those under 2 years of age (50.35%) (P < 0.05) predominated. Unlike in older populations, from the comorbidities considered risk factors for death by COVID-19, only immunosuppression showed a statistically significant effect on the fatality of cases after adjustment by the other related variables. Sex and age group were not confounders for the models in those under 18 years old. Pneumonia, being younger than 5 years, and immunosuppression are related to death. Conclusion: The case fatality ratio in those under 18 years old is low. Special attention must be paid to those children under 5 years. The development of pneumonia is a warning indicator while treating them. On the other hand, having an open database of cases allows the researchers to analyze the impact of COVID-19 in different population sectors, which has clear benefits for public health.

Including unpublished surveys in reviews on Chagas disease in Mexico.

A consequence of the late awareness of Chagas disease in North America is that many early studies were never published in peer-reviewed journals and are not easily accessible for inclusion in systematic reviews. We reviewed data from the state of Guanajuato, Mexico, as an illustration. Three population-based surveys have been performed between 1991 and 2002 and were never fully published. Systematic reviews should recognize this publication bias.

Cancer prevention programmes in Mexico: are we doing enough?

Cancer has increased in all the countries of the world and Mexico is no exception. The recognised risk factors for the main types of cancer are reviewed and searched through the Mexican government web pages and cancer prevention programmes to tackle the risk factors in the population. The Mexican government, a member of the World Health Organization, shows that the main approach is an early diagnosis rather than prevention, forgetting that an ounce of prevention is better than a pound of cure. Effective public programmes should be promoted to reduce preventable risk factors in the population (smoking, nutrition, obesity, diet, environmental toxicity, sedentary lifestyle) and control the non-preventable factors (genetics) if we really want to control the incidence of different types of cancer.

Clinical Data, Comorbidities, and Mortality of COVID-19 in the State of Guanajuato, Mexico until May 20, 2020.

Introduction: In December 2019, cases of pneumonia of unknown cause arose in Wuhan, China. The causative agent was subsequently identified as 2019-nCoV and later called SARS-CoV-2. In Mexico, since January 2020 when the first cases were reported, the spread of the infection has occurred throughout the country. The state of Guanajuato, which is located in the center of the country, has taken isolation measures and closed public places in March 2020. The objective of this study was to analyze the evolution, symptoms, co-morbidities and deaths due to confirmed cases of COVID-19. Methods: An ecological study was designed from the database of confirmed cases of COVID-19 in the state of Guanajuato. Odds ratios and 95% confidence intervals were calculated for symptoms and co-morbidities in deaths of confirmed cases. Logistic regression models were generated adjusting for age group and gender. Results: Among the 838 confirmed cases in the state, cases with dyspnea and cyanosis showed more significant effect on death. Age group and gender had little involvement as confounders. For practically all comorbidities (including diabetes, hypertension, cardiovascular disease, chronic kidney disease, and immunosuppression), there was a significant effect (odds ratio greater than 2) on mortality from COVID-19. Age group showed a confounding effect on comorbidities and death, but not gender. Conclusions: The confirmed cases had more than twice the possibility of having comorbidities, compared with those who did not die.

Evaluation of micronuclei in oral mucosa of individuals exposed to ionizing radiation: a pilot study from Celaya, México.

INTRODUCTION: Occupational exposure to ionizing radiation can potentially lead to adverse health effects, including cancer and genetic defects. Genetic damage caused by radiation can be detected if micronuclei are observed. The objective of this pilot study was to detect the presence of micronuclei in cells of the oral mucosa in inidividuals occupationally exposed to ionizing radiation. METHODS: We implemented a pilot case-control study in which we compared oral mucosa micronuclei in 30 medical and nursing personnel in radiology centers in Celaya, Mexico, with 30 volunteers not exposed to ionizing radiation recruited from a public University. The oral mucosa was brushed and the amount of micronuclei was quantified. Chi-square test or t-test for two proportions were used to compared ionizing radiation and genetic damage between exposed and non-exposed groups. RESULTS: The exposed group had an average of 5.37 ± 3.49 micronuclei and the non-exposed had 0.37 ± 0.61 (P<0.01). In the exposed group, 90% of participants exhibited genetic damage compared to 6.67% in the unexposed group (P<0.05). CONCLUSION: In this pilot study, medical and nursing staff from radiology centers presented with higher genetic damage compared to control group. Further studies are needed to identify the prevalence of genetic damage due to occupational radiation exposure in Mexico.

Screening Procedure for Hemihypertrophy: Preliminary Results of International Multicenter Prospective Study.

INTRODUCTION: Isolated or congenital hemihypertrophy is a rare disorder characterized by asymmetric overgrowth of one side of the body. This article describes the protocol and preliminary results of a lateral body asymmetry (hemihypertrophy) screening procedure performed in healthy adolescents in a multicenter study. The reported incidence of hemihypertrophy varies between different publications and standardized protocols are needed to improve research in this area. METHODS: Our screening program is taking place in Australia, Israel, Mexico, Ukraine and USA. Procedure includes two steps: (1) "three measurements - three questions" screening, or assessment of face, palms, and shins; (2) in-depth assessment of selected cases in order to exclude localized, lesional, and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of isolated hemihypertrophy. This step includes measurements of various anatomical regions and a detailed questionnaire. RESULTS: At this stage, the screening procedure is completed and the selected participants are advised to refer to medical institutions for further clinical and genetic follow up to exclude possible tumors and other accompanying disorders. CONCLUSION: We present an easy-to-use selection tool to identify children with suspected IH, which results in the selection of the risk group that may benefit from referral to a pediatrician and a clinical geneticist.

Representación social de la diabetes tipo 2 en mujeres bajo la teoría del núcleo central / Social Representation of the Diabetes Type 2 in Women according to the Central Core / Theory Representação social da diabete tipo 2 em mulheres sob a teoria do núcleo central

Introducción: La diabetes como enfermedad crónica es un evento catastrófico que origina comportamientos negativos hacia la adherencia terapéutica, lo que hace necesario usar teorías cognoscitivas y sociales para reorientar los cuidados de enfermería. Objetivo: Dar respuesta a las preguntas orientadoras de la investigación: ¿cuál es la representación social que la mujer tiene sobre la diabetes tipo 2? ¿Qué elementos integran el núcleo central y los sistemas periféricos de la representación social? Método: Revisión integrativa utilizando como guía el método prisma, de artículos cuyos descriptores primarios fueran "representaciones sociales", "diabetes tipo 2" y "mujeres" y secundarios "pacientes con diabetes tipo 2". La búsqueda se realizó en bases de datos informatizadas: Web of Science, Medline, PubMed, SciELO, LILACS, Bireme y CUIDEN. Resultados: Los hallazgos señalan que el fenómeno de la diabetes dio origen a una representación social irreversible. Este sistema de informaciones, actitudes y creencias se organizan y estructuran alrededor del padecimiento, alimentación, ejercicio y medicación, lo que dificulta la identidad social y, probablemente, la adherencia terapéutica a la enfermedad. Conclusión: El identificar la estructura de la representación social y elementos que integran el núcleo central les permite a los profesionales de la salud planear intervenciones que favorezcan la identidad social y la adherencia terapéutica de las mujeres en la diabetes tipo 2.

Introduction: As a chronic disease, diabetes is a disastrous event bringing about negative behaviors regarding the treatment adherence, which makes necessary the use of cognitive and social theories in order to redirect the nursing care. Objective: To answer the guiding research questions: What is the social representation that women have about Diabetes Type 2? What elements form the central core and the peripheral systems of the social representation? Method: This is a comprehensive review using the Prism Method as a guide. It includes articles whose primary descriptors are "social representations", "Diabetes Type 2" and "women"; and the secondary descriptor "type 2 diabetes patients". The search was carried out in systematized databases: Web of Science, Medline, PubMed, SciELO, LILACS, Bireme, and CUIDEN. Results: The findings indicate that diabetes phenomenon gave rise to an irreversible social representation. This system of data, attitudes and beliefs is organized and structured around the suffering, feeding, exercise and medication, which makes difficult to ascertain the social identity and, probably, the treatment adherence specific to this disease. Conclusion: To identify the structure of the social representation and elements forming the central core allows the health professionals to plan interventions intended to favor the social identity and treatment adherence among women with diabetes type 2.

Introdução: O diabete como urna doença crónica é um evento catastrófico que origina comportamentos negativos para a adesão terapêutica, o que faz preciso usar teorias cognoscitivas e sociais para reorientar os cuidados de enfermagem. Objetivo: Dar resposta às perguntas norteadoras da pesquisa: qual a representação social que a mulher possue sobre o diabete tipo 2? Quais elementos compõem o núcleo central e os sistemas periféricos da representação social? Método: Revisão integrativa utilizando como guia o método prisma, de artigos cujos descritores primarios foram "representações sociais", "diabete tipo 2" e "mulheres" e secundarios "pacientes com diabete tipo 2". A busca foi realizada em bases de dados informatizadas: Web of Science, Medline, PubMed, SciELO, LILACS, Birerne e CUIDEN. Resultados: Os achados apontam que o fenômeno da diabete deu origem a urna representação social irreversível. Esse sistema de informações, atitudes e crenças é organizado e estruturado em torno do padecimento, alimentação, exercício e medicação, o que dificulta a identidade social e, provavelmente, a adesão terapêutica à doença. Conclusão: Identificar a estrutura da representação social e elementos que integram o núcleo central permite os pro fissionais de a saúde planejarem intervenções favorecendo a identidade social e a adesão terapêutica das mulheres em diabetes tipo 2.

The 11p15.5 chromosomal region: When did the instability occur?

The disturbances of the 11p15.5 chromosomal region are associated with Beckwith-Wiedemann syndrome, Russell-Silver syndrome, Wilms tumor, IMAGe syndrome, and idiopathic hemihyperplasia. The aim of this research was to examine the hypothesis that 11p15.5 initially became unstable in the European population about 200 years ago. The medical literature from 1557 onwards, especially treatises on teratology, body asymmetry, and books of normal and pathologic anatomy, was searched for any mentioning of lateral body asymmetry, macroglossia and other possible visually detectable symptoms associated with the above-mentioned syndromes. The results indicate that lateral body asymmetry was not described before the first half of the 19th century, it was mentioned in the 1820s, and the first description of a true case was published in 1850. All first cases of hemihyperplasia were reported in continental Europe. Historical data suggest that the 11p15.5 chromosomal region became unstable in the first half of the 19th century. Our preliminary hypothesis is that de novo mutation occurred in continental Europe. Additional genetic research is needed to investigate the development of 11p15.5 instability during this period.

Validity and reliability of electroacoustic probe for diagnosis of developmental dysplasia of the hip.

BACKGROUND: Sound transmission is used in the diagnosis of hip dysplasia since the end of the 80's. Aim of this study is to quantify the validity and reliability of electroacoustic probe for the diagnosis of hip dysplasia in neonates. METHODS: Diagnostic study included neonates aged 4-28 days, whose parents signed an informed consent. The probe was used three times for comparative sound transmission and with extension/flexion; hip ultrasound was performed with Graf technique as gold standard. Kappa was determined for intraobserver and interobserver reliability; validity was calculated with sensitivity, specificity, and predictive values. RESULTS: 100 neonates were included. For the comparative sound transmission, 0.80 and 0.81 Kappa were obtained for the intraobserver and interobserver respectively; with extension/flexion, Kappa 0.98 and 0.95 were obtained for the intraobserver and interobserver respectively. With comparative sound transmission, 44.8%, 97.7%, 76.5% and 91.3% for sensitivity, specificity, positive and negative predictive values, respectively; with extension/flexion test, the sensitivity, specificity, positive and negative predictive values: 82.8%, 99.4%, 96.0%, and 97.1%, respectively. CONCLUSION: The electroacoustic probe is moderate valid and reliable for the diagnosis of developmental dysplasia of the hip. TRIAL REGISTRATION: Open Science framework https://osf.io/kpf5s/?view_only=0a9682c6w1c842ad8e1d9a66e8dcf038.

Negative studies are helpful to compute the specificity of diagnostic tests: measuring Trypanosoma cruzi seroprevalence in Guanajuato, Mexico.

BACKGROUND: Publishing negative seroprevalence studies not only helps to have more accurate seroprevalence estimates but also allows calculating the specificity of the diagnostic tests used. We performed a population-based Trypanosoma cruzi seroprevalence survey in a community in central Mexico. RESULTS: We surveyed 204 women and children and collected blood by finger prick. We performed rapid tests (Stat-Pak, Chembio, Inc., Medford, New York) and recombinant Chagas ELISA tests v3.0 (Wiener, Rosario, Argentina). All rapid tests and all ELISA tests were negative. CONCLUSION: The rapid test had 100 % of specificity compared to the ELISA.

Do People with Type 2 Diabetes Think They are Unhealthy?: A Cross-Sectional Study in Celaya, Mexico.

BACKGROUND: Type 2 diabetes is a chronic disease that presents a significant burden on health care systems in many countries. With the rise of obesity, the incidence of Type 2 diabetes has also been steadily increasing. A healthy lifestyle and understanding of diabetes management are important factors for delaying the onset of comorbidities associated with Type 2 diabetes. The objective of this study was to evaluate the self-perception of health in individuals with Type 2 diabetes as it relates to BMI status, which has important implications for the implementation of preventive programs. METHODS: A cross-sectional lifestyle survey was implemented in the region of Celaya, Guanajuato, Mexico, targeting 100 participants diagnosed with Type 2 diabetes. Anthropometric measurements and participant characteristics were also obtained. Fisher's exact test was used to determine if the proportions of lifestyles perceptions differed by BMI status. RESULTS: Participants had a mean age of 56.12 ± 10.26, a mean BMI of 29.13 ± 5.48 kg/m2, were mostly married (67.0%), and female (70.0%). None of the normal weight participants perceived themselves as unhealthy. 95% of overweight/obese participants perceived themselves to be healthy, despite a diagnosis of diabetes and being overweight/obese, while only 5% perceived themselves to be unhealthy. However, these differences in the perceptions of health classified by BMI status were not statistically significant (p = 0.42). CONCLUSION: Our findings indicate that overweight and obese persons with Type 2 diabetes in Celaya, Mexico may have misperceptions about their own health, even though these findings were not statistically significant. These preliminary data highlight the importance of implementing prevention and educational programs among those with diabetes, in order to combat health misperceptions and raise awareness about the dangers of diabetes and obesity. Furthermore, more research with larger sample sizes is needed in order to fully understand the effects of perception of health on actual health.

Efecto del apoyo educativo para la adherencia al tratamiento en pacientes con diabetes tipo 2: un estudio experimental / Effect of educational support on treatment adherence in patients with type 2 diabetes: An experimental study

INTRODUCCIÓN: La adherencia al tratamiento farmacológico o no farmacológico de la diabetes tipo 2 es fundamental para retrasar la aparición de complicaciones. OBJETIVO: Medir el efecto del apoyo educativo de enfermería en la adherencia al tratamiento de pacientes con diabetes tipo 2 del Hospital Regional Universitario de Colima, México. MÉTODO: Estudio experimental, aleatorizado. Se incluyeron pacientes diabéticos tipo 2 del Hospital Regional que aceptaron por escrito participar en el estudio (pacientes ambulatorios). Se aplicó intervención educativa de enfermería en sesiones de 3h 2 días a la semana durante 3 meses. La adherencia al tratamiento fue evaluado antes y después de la intervención con el instrumento Escala de adherencia al tratamiento de diabetes mellitus tipo 2(EATDM-III©). Análisis estadístico: Se realizó Z para 2 proporciones y valor de p, razón de riesgos e intervalo de confianza al 95% y fracción atribuible en expuestos. RESULTADOS: El grupo experimental tuvo 32 integrantes, lo mismo que el control. Con posterioridad a la intervención se encontró que en el grupo experimental 16 integrantes (50%) mostraron adherencia al tratamiento, a diferencia del grupo control donde nadie mostró apego al tratamiento, obteniendo Z para 2 proporciones independientes = 4.62, p = 0,0000; razón de riesgos=65; intervalo de confianza al 95% = 3,67 a 1152,38; fracción atribuible en expuestos=98,46%. CONCLUSIÓN: La intervención fue efectiva para que el sujeto se apegara al tratamiento de diabetes tipo 2

INTRODUCTION: Adherence to pharmacological or non-pharmacological treatment of diabetes type 2 is fundamental in order to delay the onset of complications. OBJECTIVE: To measure the effect of nursing educational support on compliance with treatment in patients with type 2 diabetes attending Regional Hospital Universitario of Colima, Mexico. METHOD: An experimental, randomized study including outpatients with type 2 diabetes attending a Regional Hospital who agreed in writing to participate in the study. Nursing educational intervention sessions of three hours on two days a week for three months were provided. Adherence to treatment was assessed before and after intervention using the Scale for treatment adherence in type 2 diabetes (EATDM-III©). Statistical análisis. We performed two-proportion Z and p; Risk Ratio and confidence interval 95% and attributable fraction exposed. RESULTS: The experimental group had 32 members, the same as the control. After the intervention it was found that 16 members (50%) in the experimental group showed treatment adherence, unlike the control group where no one showed adherence to treatment, obtaining an independent two-proportion Z = 4.62, P = .0000, Risk Ratio = 65; Confidence Interval 95% = 3.67 to 1152.38; exposed attributable fraction = 98.46%. CONCLUSION: The intervention was effective for the adherence of treatment

Correlación de mediciones de temperatura corporal con 3 termómetros: ótico, cutáneo y digital, en niños mexicanos / Comparison of body temperatures in children measured using 3 different thermometers: Tympanic, skin and digital axillary

OBJETIVO: comparar las mediciones de la temperatura corporal con termómetros ótico y cutáneo con termómetro digital axilar. MÉTODO: Los sujetos fueron niños hospitalizados o de consulta externa del Hospital General Celaya, Clínica Hospital ISSSTE y Hospital General de Zona No. 4 del IMSS y de servicio privado pediátrico en Celaya (Guanajuato) desde neonatos de un día de vida hasta adolescentes de 16 años de edad, reclutados durante un mes en cada institución, seleccionado el orden de las instituciones por método aleatorizado simple. Se midió la temperatura corporal con termómetro ótico, termómetro cutáneo y digital axilar. Todas las mediciones se tomaron en 3 ocasiones. RESULTADOS: La muestra estuvo integrada por 554 niños. Entre termómetro ótico y digital axilar, la r de Pearson fue de 0,57 a 0,65, con relación lineal positiva (p < 0,05); entre el cutáneo y el digital axilar, la r de Pearson fue entre 0,47 y 0,52 con relación lineal positiva (p < 0,05). La kappa intraobservador para el termómetro ótico fue de 0,86, e interobservador fue de 0,77, para el termómetro cutáneo fueron 0,82 y 0,67, respectivamente y para el termómetro axilar digital fue de 0,86 para la confiabilidad intraobservador y de 0,78 para la interobservador. CONCLUSIÓN: El termómetro ótico y el digital axilar muestran mejor precisión de la medición de la temperatura corporal que el termómetro cutáneo

OBJECTIVE: To compare body temperature measurements using tympanic, skin and digital axillary thermometers. METHOD: Hospitalized or outpatient children from the General Hospital Celaya, ISSSTE Hospital Clinic and General Hospital No. 4 IMSS, and the pediatric private service in Celaya, Guanajuato, from 1 day of life until 16 years old, were recruited over a one month period, aftertheir parents signed the consent form. The order of each institution was selected by simplerandomization. Body temperatures were measured in triplicate using tympanic, skin and digitalaxillary thermometers. RESULTS: The sample consisted of 554 children. The Pearson r between the tympanic and digitalaxillary thermometers was 0.57 to 0.65, with a positive linear relationship (P<.05); betweenthe skin and the digital axillary thermometers, it was between 0.47 and 0.52 with a positivelinearrelationship (P<.05). The intra-observer Kappa for the tympanic thermometer was 0.86, and for the inter-observer was 0.77; for the skin thermometer it was 0.82 and 0.67, respectively,and for the digital axillary thermometer it was 0.86 for intra-observer reliability and 0.78 forinter -observer reliability. CONCLUSION: Tympanic and axillary thermometers showed better precision in measuring the bodytemperature in children than skin thermometers

[Comparison of body temperatures in children measured using 3 different thermometers: tympanic, skin and digital axillary]. / Correlación de mediciones de temperatura corporal con 3 termómetros: ótico, cutáneo y digital, en niños mexicanos.

OBJECTIVE: To compare body temperature measurements using tympanic, skin and digital axillary thermometers. METHOD: Hospitalized or outpatient children from the General Hospital Celaya, ISSSTE Hospital Clinic and General Hospital No. 4 IMSS, and the pediatric private service in Celaya, Guanajuato, from 1 day of life until 16 years old, were recruited over a one month period, after their parents signed the consent form. The order of each institution was selected by simple randomization. Body temperatures were measured in triplicate using tympanic, skin and digital axillary thermometers. RESULTS: The sample consisted of 554 children. The Pearson r between the tympanic and digital axillary thermometers was 0.57 to 0.65, with a positive linear relationship (P<.05); between the skin and the digital axillary thermometers, it was between 0.47 and 0.52 with a positive linearrelationship (P<.05). The intra-observer Kappa for the tympanic thermometer was 0.86, and for the inter-observer was 0.77; for the skin thermometer it was 0.82 and 0.67, respectively, and for the digital axillary thermometer it was 0.86 for intra-observer reliability and 0.78 for inter -observer reliability. CONCLUSION: Tympanic and axillary thermometers showed better precision in measuring the body temperature in children than skin thermometers.

Efecto de los factores socioculturales en la capacidad de autocuidado del paciente hospitalizado con diabetes tipo 2 / The Effect of Socio-cultural Factors on the Self-care Capacity of Hospitalized Patients with Type 2 Diabetes / Efeito dos fatores socioculturais na capacidade de autocuidado do paciente hospitalizado com diabete tipo 2

Introducción: la diabetes tipo 2 es considerada como un problema de salud pública por su creciente prevalencia e incidencia. Objetivo: describir el efecto de los factores socioculturales en la capacidad de autocuidado del paciente hospitalizado con diabetes tipo 2 en el Hospital General de Tecomán, Colima, México. Método: estudio transversal, observacional. Se trabajó con 68 pacientes hospitalizados con diabetes tipo 2; se utilizó un instrumento que midió el efecto de los factores socioculturales en la capacidad de autocuidado. El análisis de datos se realizó con Razón de Momios, intervalos de confianza al 95% y fracción atribuible en expuestos. Resultados: los factores socioculturales tuvieron un leve efecto positivo en la capacidad de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) en pacientes hospitalizados con diabetes tipo 2. Conclusiones: los factores socioculturales: experiencias vitales, experiencias laborales, religión, costumbres y tradiciones, prácticas curativas y ritos, señalados en la Teoría General del Déficit de Autocuidado, muestran un efecto positivo sobre la capacidad de autocuidado de las personas con diabetes tipo 2.

Introduction: Type 2 diabetes is considered a public health problem because of its increasing prevalence and incidence. Objective: The purpose of this research is to describe the effect of socio-cultural factors on the self-care capacity of patients with type 2 diabetes who are hospitalized at the Tecomán General Hospital in Colima, Mexico. Method: This is a cross-sectional, observational study of 68 hospitalized patients with type 2 diabetes. An instrument to measure the effect of socio-cultural factors on the capacity for self-care was used. Data analysis was conducted with the odds ratio method, confidence intervals at 95% and attributable fraction in exposures. Results: Socio-cultural factors had a slight positive effect on the capacity for self-care among hospitalized patients with type 2 diabetes (RM = 1.10, 95% CI, 0.26 to 4.74). Conclusions: The socio-cultural factors outlined in the General Self-care Deficit Theory; namely, life experiences, work experiences, religion, customs and traditions, healing practices and rituals, were shown to have a positive effect on the self-care capacity of people with type 2 diabetes.

Introdução: a diabete tipo 2 é considerada um problema de saúde pública por sua crescente prevalência e incidência. Objetivo: descrever o efeito dos fatores socioculturais na capacidade de autocuidado do paciente hospitalizado com diabete tipo 2 no Hospital General de Tecomán, Colima, México. Método: estudo transversal, observacional. Trabalhou-se com 68 pacientes hospitalizados com diabete tipo 2; utilizou-se um instrumento que mediu o efeito dos fatores socioculturais na capacidade de autocuidado. A análise de dados foi realizada com Razão de Chances, intervalos de confiança de 95% e fração atribuível em expostos. Resultados: os fatores socioculturais tiveram um leve efeito positivo na capacidade de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) em pacientes hospitalizados com diabete tipo 2. Conclusões: os fatores socioculturais, como experiências vitais, experiências laborais, religião, costumes e tradições, práticas curativas e rituais, indicados na Teoria Geral do Déficit de Autocuidado, mostram um efeito positivo sobre a capacidade de autocuidado das pessoas com diabete tipo 2.