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1.
Acta Diabetol ; 56(8): 923-929, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30955127

RESUMO

AIMS: To assess the validity of the 13C-glucose breath test (13C-GBT) to identify insulin resistance (IR) in non-diabetic individuals, using hyperinsulinemic-euglycemic clamps as gold standard. This validity was compared with that of other IR surrogates. METHODOLOGY: Non-diabetic adults were studied in a cross-sectional design. In a first appointment, oral glucose tolerance tests were conducted simultaneously with 13C-GBTs. Oral 75 g glucose dissolved in 150 ml water, followed by 1.5 mg/Kg body weight U-13C-glucose dissolved in 50 ml water, was administered. Breath and blood samples were collected at baseline and at 30-min intervals. The percentages of glucose-oxidized dose at given periods were calculated. Clamps were conducted a week later. A clamp-derived M value ≤ 6.0 mg/kg*min was used as cut-off. ROC curves were constructed for 13C-GBT, fasting insulin, HOMA, and ISI-composite. RESULTS: Thirty-eight subjects completed the study protocol. The correlation coefficient between the 13C-GBT derived glucose-oxidized dose at 180 min and M values was 0.524 (p = 0.001). The optimal value to identify IR with the 13C-GBT was 4.23% (AUC 0.81; 95CI 0.66, 0.96; accuracy 0.82, 95CI 0.66, 0.92). The 13C-GBT sensitivity (0.88) was higher than HOMA and fasting insulin sensitivities (0.83 and 0.75 respectively), while their specificities were comparable (0.71, 0.71, and 0.79, respectively). The sensitivity of ISI-C was higher (0.92) than that of the 13C-GBT, but its specificity was poor (0.36). The accuracy of the 13C-GBT was superior to that of the other studied surrogates. CONCLUSIONS: The 13C-GBT is a valid and accurate method to detect IR in non-diabetic adults. Therefore, it is potentially useful in clinical and community settings.

2.
Rev Alerg Mex ; 65(3): 205-218, 2018 Jul-Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-30176207

RESUMO

Bayesian statistics is based on subjective probability. It works with evidence updating considering the knowledge acquired prior to an investigation, plus the evidence obtained thereof. Results' interpretation requires for the hypotheses to be tested to be specified and their a priori probability to be estimated before the study. Study evidence is measured with the Bayes factor (compatibility ratio of the data under the proposed hypotheses). The conjunction of hypotheses a priori probabilities with the Bayes factor allows calculating the a posteriori probability of each one of them. The hypothesis with the highest degree of certainty at its update is the one that is accepted for decision making. In this review, three examples of hypothesis to be tested are shown: difference of means, correlation and association.

3.
Gac Med Mex ; 154(4): 520-526, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30250314

RESUMO

La mortalidad por cáncer en niños mexicanos no ha disminuido a los niveles informados en países desarrollados. Una explicación frecuentemente declarada es el alto porcentaje (57.3 %) de pacientes diagnosticados en estadios avanzados (III/IV), atribuible a errores en la sospecha o en la metodología empleada, consideración dudosa si se toma en cuenta que el tiempo de diagnóstico y la proporción de estadios avanzados en México son semejantes a los de países desarrollados. En la mayoría de los niños con cáncer, los días transcurridos desde el primer síntoma a momento del diagnóstico oncológico no correlacionan con el estadio clínico y tampoco con la probabilidad de supervivencia. El éxito en la supervivencia depende en gran medida del tratamiento integral (específico y de la atención a las complicaciones). Esta visión obliga a estrategias dirigidas principalmente a invertir más recursos en opciones terapéuticas eficaces y eficientes, capacitación oncológica integral del equipo de salud (médicos, enfermeras, técnicos), tecnologías diagnósticas, fomento a la colaboración interinstitucional e internacional y apoyo socioeconómico a las familias durante el proceso terapéutico.Cancer mortality in Mexican children has not decreased to the levels reported in developed countries. A commonly proposed explanation is the high percentage (53.7%) of patients diagnosed at advanced stages (III/IV), which is attributed to erroneous assumptions or mistakes in the diagnostic approach ­a questionable consideration taking into account that both time to diagnosis and the proportion of advanced stage cases in Mexico are similar to those in developed countries. In most cancer cases in children, the number of days elapsed from the moment of the first symptom to the cancer diagnosis is not correlated with clinical stage, and neither with the probability of survival. Survival success largely depends on comprehensive treatment (specific and for the care of complications). This view calls for strategies mainly aimed at spending more resources on efficacious and efficient therapeutic strategies, comprehensive oncology training of healthcare personnel (physicians, nurses and technicians), diagnostic technologies, promotion of interinstitutional and international collaboration and socioeconomic support to families during the therapeutic process.

4.
Rev. sanid. mil ; 72(3/4): 240-245, may.-ago. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1004495

RESUMO

Resumen Introducción El esguince de tobillo es una patología frecuente y uno de los principales motivos de incapacidad laboral, a pesar de ello, no se cuenta con un tratamiento estandarizado y existe controversia con respecto a la inmovilización o una movilización temprana. Objetivo Determinar el mejor tratamiento para los esguinces de tobillo grado II, ofreciendo un resultado satisfactorio con periodos de incapacidad más cortos. Material y métodos Ensayo clínico-aleatorizado, ciego simple de enero a junio de 2016. Dos grupos: inmovilización y vendaje funcional. Se interrogó dolor inicial y al término del tratamiento con escala de EVA, ambos grupos con mismo manejo analgésico, antiinflamatorio y rehabilitación, se evaluó funcionalidad al mes del inicio del padecimiento con escala de Karlsson. Resultados Todos los pacientes con dolor inicial arriba de 70 (de moderado a severo), sin diferencia en media entre grupos (férula 86.3 ± 9.6 contra vendaje de 86.1 ± 8.5; p = 0.95), ambos con disminución del dolor; el grupo con vendaje obtuvo niveles más bajos (férula media 55.2 ± 15.5 contra vendaje 40.3 ± 12.8, p ≤ 0.001). Grupo con férula 24 (88.9%) al final calificaron su dolor como moderado y tres (11.1%) como leve contra el grupo con vendaje, de los cuales, 17 (73.1%) tuvieron dolor moderado y siete (26.9%) leve (p = 0.15). Conclusión El vendaje funcional es una excelente opción de manejo para esguince de tobillo grado II, ofrece buenos resultados con periodos de incapacidad y costos más reducidos.


Abstract Background The grade II ankle sprain it is one of the most frequent pathologies in the musculoskeletal system and one of the principal motives of laboral inability. Despite the fact this pathology is one of the most common reasons for ER visiting there is not a standard treatment for it, and exist controversy about the immobilization vs. an early mobilization. Objective Determine the best treatment for grade II ankle sprains, offering a satisfactory result with a minor time of labor inability. Material and methods Single-blind randomized controlled clinical trial with two groups immobilization versus functional bandage, both groups with VAS evaluation at the beginning and at the end of treatment, same AINES management and rehabilitation, 30 days after the injury we evaluate the functional outcome with Karlsson score. Results At the beginning all patients report pain over 70 (moderate-severe) without difference in the average of both groups (immobilization 86.3 ± 9.6 versus functional bandage treatment of 86.1 ± 8.5; p = 0.95). Both groups present less pain at the end of the treatment, the bandage group present lower values, (Immobilization average 55.2 ± 15.5 versus functional bandage treatment 40.3 ± 12.8, p ≤ 0.001). In the immobilization group 24 (88.9%) at the end of the treatment had moderate pain and 3 (11.1%) light pain against the functional treatment group where 17 (73.1%) had moderate pain and 7 (26.9%) light (p = 0.15). Conclusion Functional bandage is an excellent treatment option for grade II ankle sprain, offering good results with a lower time of inability and cost.

5.
Stud Health Technol Inform ; 250: 24-25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29857358

RESUMO

The use of a venoclysis in hospitalized pediatric patients is a necessity, a procedure perceived by children as painful, so that distraction techniques have been suggested to attenuate this suffering. Evaluating the implementation of a distraction method with an uncontrolled trial with pre and post maneuver evaluation without control group.


Assuntos
Atenção , Manejo da Dor , Flebotomia/efeitos adversos , Criança , Humanos , Dor , Medição da Dor , Percepção
6.
Rev Alerg Mex ; 64(4): 477-486, 2017 Oct-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-29249109

RESUMO

The validity of a study depends on its proper planning, execution and analysis. If these are sufficiently correct, the decision to apply the recommendations issued depends on the expected clinical effect. This effect may have random variations, hence the need to use statistical inference. For years the p-value has been used to determine this statistical significance and the confidence intervals to measure the magnitude of the effect. In this review we present a proposal of how to interpret the 95 % confidence intervals (CI 95 %) as estimators of the expected effect variability based on considering the threshold or value of clinical significance and the null value of the difference or rejection of statistical significance. Thus, an association or effect where the CI 95 % includes the null value (no effect or difference) is interpreted as inconclusive; one between the null value and the clinical threshold (without including them) as possibly inconsequential; one that does not include the null value but the clinical threshold as yet not conclusive and one beyond the clinical threshold as conclusive.

7.
Rev Alerg Mex ; 64(2): 220-227, 2017 Apr-Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-28658730

RESUMO

Sample size refers to the number of participants to be included in a research study. If the calculation is carried out properly, not only conclusions will be established with statistical support and the potential risks to the subjects included in the investigation will be limited, but also the study can be properly planned to optimize economic and time costs. Calculation of sample size requires information that must be supported by the research protocol. This information includes that the objectives (descriptive study or a study to establish differences between groups) and hypotheses are well elaborated (with magnitude and direction), the scale of measurement of the outcome variable(s) must be defined, and type I error and type II error appropriately identified. This review describes how to specify the requirements needed for sample size calculation, including examples in clinical research designs.

8.
Arch Med Res ; 48(7): 599-608, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29506764

RESUMO

BACKGROUND: The brain-derived neurotrophic factor (BDNF) rs6265 (G196A; Val66Met) single nucleotide polymorphism has been associated with BMI and obesity in distinct populations, both adult and pediatric, with contradictory results involving either Val or Met as the risk variant. AIM OF THE STUDY: To determine the association between the BDNF Val66Met polymorphism and BMI in Mexican children and adolescents. METHODS: BDNF Val66Met genotyping by restriction fragment length polymorphism and nutritional status characterized by their BMI-for-age z-scores (BAZ) from pediatric volunteers (n = 498) were analyzed by Fisher's exact test association analysis. Standardized residuals (R) were used to determine which genotype/allele had the major influence on the significant Fisher's exact test statistic. Odds ratios were analyzed to measure the association between genotype and normal weight (≥-2 SD < + 1 SD) and overweight (≥ + 1 SD, including obesity, Ow + Ob) status with 95% confidence intervals to estimate the precision of the effect as well as 95% credible intervals to obtain the most probable estimate. RESULTS: Comparisons between GG (Val/Val), GA (Val/Met) and AA (Met/Met) genotypes or Met homozygotes vs. Val carriers (combination of GG and GA genotypes) showed significant differences (p = 0.034 and p = 0.037, respectively) between normal weight and the combined overweight and obese pediatric subjects. Our data showed that children/adolescents homozygous for the A allele have increased risk of overweight compared to the Val carriers (Bayes OR = 4.2, 95% CI**[1.09-33.1]). CONCLUSION: This is the first study showing the significant association between the BDNF rs6265 AA (Met/Met) genotype and overweight/obesity in Mexican pediatric population.

9.
Rev Alerg Mex ; 63(4): 397-407, 2016 Oct-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-27795220

RESUMO

Descriptive statistics is the branch of statistics that gives recommendations on how to summarize clearly and simply research data in tables, figures, charts, or graphs. Before performing a descriptive analysis it is paramount to summarize its goal or goals, and to identify the measurement scales of the different variables recorded in the study. Tables or charts aim to provide timely information on the results of an investigation. The graphs show trends and can be histograms, pie charts, "box and whiskers" plots, line graphs, or scatter plots. Images serve as examples to reinforce concepts or facts. The choice of a chart, graph, or image must be based on the study objectives. Usually it is not recommended to use more than seven in an article, also depending on its length.

10.
Salud Publica Mex ; 58(2): 162-70, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27557374

RESUMO

OBJECTIVE: To identify the cancer incidence and mortality in Mexican Social Security Institute beneficiary (MSSI-B) children during 1996-2013. MATERIALS AND METHODS: Both cancer cases (n=4 728) and deaths (n=2 378) were analyzed in MSSI-B children who were registered in five states of the Mexican Republic. The incidence and mortality trends and the incidences (rate x 1 000 000 children / year) of the type of cancer, age, sex, and place of residence were obtained. RESULTS: For both indicators (incidence and mortality), there was a downward trend for the period of 1996-2001 and a stable trend for 2002-2013. This occurred in the overall mortality and incidence trends of the Estado de México and Chiapas and in the leukemia and the acute lymphoid subgroups. The annual overall incidence was 128 cases per 1 000 000 children. Leukemia, lymphomas, and central nervous system tumors were the principal cancer groups. CONCLUSIONS: Cancer mortality for the period of 2002-2013 did not diminish. Interinstitutional and/or international research should be designed to improve the care of these children.


Assuntos
Neoplasias/epidemiologia , Previdência Social/estatística & dados numéricos , Academias e Institutos/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Classificação Internacional de Doenças , Masculino , México/epidemiologia , Morbidade/tendências , Mortalidade/tendências , Neoplasias/mortalidade , Estudos Prospectivos , Sistema de Registros
11.
Rev Med Inst Mex Seguro Soc ; 54(3): 318-26, 2016 May-Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-27100977

RESUMO

OBJECTIVE: Suck dysfunction in breastfeeding infants has an impact on their appropriate nutrition. The objective was to build and validate one clinical nutritional sucking scale in the components of sucking, swallowing, and respiration. METHODS: The scale was carried out in two phases: face-validity and psychometric validity. The first was done by expert consensus. For the second phase, 179 infants (153 healthy newborn and 26 infant less than 6 month of age) and 86 infants with high risk for abnormal sucking were evaluated with the new scale. Three observers evaluated all patients during their feeding. With an initial scale of 10 items we calculated the inter-observer concordance and the internal consistence. With an analysis of the mail components and a discrimination index we reduced to pertinent items. Each component of the scale was compared with clinical variables. RESULTS: We reached a 7 items scale, which showed high reliability (Cronbach's alpha of 0.77 and inter-observer concordance of 0.98. The suck component correlated positively with the ingested volume (Ro = 0.61), the swallow component with the peripheral oxygen saturation (Ro = 0.24), and the breath component with the respiratory frequency (Ro = 0.50). With this scale, we can establish different patterns of sucking abnormalities related with history of neurological abnormalities, hemodynamic alteration and immaturity. CONCLUSIONS: In this study the clinical nutritional scale showed to be reliable and valid for its use in sucking problems classification. More studies are required to evaluate its application for oral stimulation therapies.


Assuntos
Aleitamento Materno , Indicadores Básicos de Saúde , Comportamento de Sucção/fisiologia , Deglutição/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Psicometria , Reprodutibilidade dos Testes , Respiração
12.
Salud pública Méx ; 58(2): 162-170, Mar.-Apr. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-793003

RESUMO

Abstract Objective: To identify the cancer incidence and mortality in Mexican Social Security Institute beneficiary (MSSI-B) children during 1996-2013. Materials and methods: Both cancer cases (n=4 728) and deaths (n=2 378) were analyzed in MSSI-B children who were registered in five states of the Mexican Republic. The incidence and mortality trends and the incidences (rate x 1 000 000 children / year) of the type of cancer, age, sex, and place of residence were obtained. Results: For both indicators (incidence and mortality), there was a downward trend for the period of 1996-2001 and a stable trend for 2002-2013. This occurred in the overall mortality and incidence trends of the Estado de México and Chiapas and in the leukemia and the acute lymphoid subgroups. The annual overall incidence was 128 cases per 1 000 000 children. Leukemia, lymphomas, and central nervous system tumors were the principal cancer groups. Conclusions: Cancer mortality for the period of 2002-2013 did not diminish. Interinstitutional and/or international research should be designed to improve the care of these children.


Resumen Objetivo: Mostrar la incidencia y mortalidad por cáncer en niños derechohabientes del Instituto Mexicano del Seguro Social (DH-IMSS) (periodo 1996-2013). Material y métodos: Se analizaron los casos (n=4 728) y las muertes (n=2 378) por cáncer en niños DH-IMSS registrados en cinco estados de la República mexicana. Se obtuvo la tendencia de la incidencia y mortalidad y la incidencia por tipo de cáncer, edad, sexo y lugar de residencia. Resultados: Para ambos indicadores (incidencia y mortalidad) hubo tendencia a la disminución para el periodo 1996-2001 y estabilidad para 2002-2013; esto sucedió para la tendencia global, para el Estado de México y Chiapas, para las leucemias y para el subgrupo de las linfoide agudas. La incidencia global fue de 128 x 1 000 000 niños/año; las leucemias, tumores del sistema nervioso central y linfomas fueron los principales grupos de cáncer. Conclusiones: La mortalidad por cáncer para el periodo 2002-2013 no ha disminuido; deben diseñarse investigaciones interinstitucionales e internacionales para mejorar la atención médica de estos niños.

13.
Rev Med Inst Mex Seguro Soc ; 54(2): 142-5, 2016 Mar-Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-26960039

RESUMO

BACKGROUND: In a retrospective study, we evaluated; frequency, clinical presentation and treatment of lymphocele in pediatric patients with kidney transplant. METHODS: Between January 2004 and January 2009, we had 242 kidney transplantations, 197 from living donors and 45 from cadaveric donors. The technique was the usual, and the implants of the ureteres were by the technique Ricard modified. The treatment of lymphocele was by percutaneous punction and laparoscopic intraperitoneal drainage. RESULTS: We diagnosed lymphocele in seven patients (2.9 % with an IC95 %: 0.6- 5.2 %) one female and six males. All patients went trough percutaneous drainage. Six patients presented lymphocele recurrence at 48 to 72 hours after the drainage. Surgical laparoscopic intraperitoneal drainage was performed with success. CONCLUSIONS: Our frequency of lymphocele is the same reported in other studies (6-18 %). The treatment by laparoscopic intraperitoneal window seems to be the most appropriate in pediatric patients.


Assuntos
Drenagem/métodos , Transplante de Rim , Laparoscopia , Linfocele/cirurgia , Complicações Pós-Operatórias/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Linfocele/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
14.
Rev Med Inst Mex Seguro Soc ; 54(1): 64-9, 2016 Jan-Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-26820201

RESUMO

BACKGROUND: Diabetes is a serious health problem for pediatrics. In pediatric patients control depends on correct insulin administration. The most usual is subcutaneous administration according to the glycemic control. The aim was to analyze the indications for continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1DM) children and adolescents. METHODS: It was carried out a descriptive study in patients from 1 to 16 years with T1DM who underwent CSII therapy. The main cause to use this therapy was analyzed, and also if that cause was different regarding age, sex and disease progression. RESULTS: 61 patients underwent CSII therapy. The median age at the beginning of treatment was 9 years old; 43 patients (71.6 %) had more than one year of diagnosis. The main reasons to use CSII were: 42.6 % had to improve their quality of life, 34.4 % had to reduce the high glycemic variability, 13.1 % had to control severe recurrent hypoglycemia, and 9.8 % had to control their HbA1c. For children under 6 years of age (n = 14) the more frequent indication were recurrent hypoglycemia and to improve their quality of life; children from 6 to 12 years of age (n = 27) had to improve their quality of life, and in children over 12 years CSII was indicated for high glycemic variability and severe recurrent hypoglycemia. There was no different indication related between sexes. CONCLUSION: Improve their quality of life and reach a better glycemic control were the main reasons to start CSII in our patients.


Assuntos
Tomada de Decisão Clínica , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Bombas de Infusão Implantáveis , Insulina/uso terapêutico , Masculino , Fatores Sexuais , Resultado do Tratamento
15.
Arch Med Res ; 47(7): 550-556, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-28262197

RESUMO

BACKGROUND AND AIMS: When pregnancy occurs in obese women, two opposite mechanisms for iron homeostasis concur: increased need for available iron to support erythropoiesis and decreased iron mobilization from diets and stores due to obesity-related inflammation linked to overexpressed hepcidin. Few studies have examined the role of hepcidin on maternal iron homeostasis in the context of obese pregnancy. The aim of the study was to evaluate the combined effect of maternal obesity and pregnancy on hepcidin and maternal iron status while accounting for inflammation and iron supplementation. METHODS: We conducted a secondary analysis of a cohort of pregnant women recruited from a referral obstetric hospital in Mexico City. Circulating biomarkers of iron status (hepcidin, ferritin [SF], transferrin receptor [sTfR], erythropoietin [EPO]), and inflammation (C-reactive protein [CRP], tumor necrosis factor-[TNF]α, and interleukin-[IL]6) were determined monthly throughout pregnancy. Repeated measures ANOVA and logistic regression models were used for statistics. RESULTS: Twenty-three obese (Ob) and 25 lean (Lc) women were studied. SF and hepcidin declined, and EPO and sTfR increased throughout pregnancy in both groups. sTfR increased more in Ob than in Lc (p = 0.024). The smallest hepcidin decline occurred in iron-supplemented Ob women compared to non-supplemented Lc women (p = 0.022). The risk for iron deficiency at the end of pregnancy was higher for Ob than for Lc (OR = 4.45, 95% CI = 2.07-9.58) after adjusting for iron supplementation and hepcidin concentration. CONCLUSION: Pre-gestational obesity increases the risk of maternal iron deficiency despite iron supplementation. Overexpressed hepcidin appears to be a potential mechanism.


Assuntos
Ferro/sangue , Obesidade/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Suplementos Nutricionais , Eritropoetina/sangue , Feminino , Ferritinas/sangue , Hepcidinas/metabolismo , Homeostase , Humanos , Ferro/deficiência , Ferro na Dieta , México , Gravidez , Receptores da Transferrina/sangue
16.
Rev Med Inst Mex Seguro Soc ; 53(6): 710-4, 2015 Nov-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-26506488

RESUMO

BACKGROUND: The aim of this study was to determine if the care of child patients on admission, coincides with perception of real urgency on the part of parents with that of the doctor and not because of perceived worry in the family (perceived emergencies). METHODS: All the care given in the emergency department, from January 1st 2009 to December 31st 2010, was analyzed. A real urgency was determined by consensus on the conditions of the child. Sociodemographic of real urgency conditions were compared against those perceived. RESULTS: 8,888 consultations were given, of which 2,024 (22.7 %) met criteria for real urgency. The main causes of real urgency were infectious diseases were followed by accidents and poisoning. Of real emergencies 17 (1 %) eventually required intensive management. Factors associated with real urgency were age, non-infectious disease, occurring between Monday to Friday, during the morning shift and in the winter months. CONCLUSIONS: The frequency of care for real urgency was low compared to that reported in other pediatric centers. Restructuring of pre-consultation services for the implementation of optimal patient classification before going to emergency helps greatly to optimize the use of the emergency department, deriving the patients in true need sooner.


Assuntos
Emergências/psicologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pais/psicologia , Percepção , Adolescente , Criança , Pré-Escolar , Emergências/epidemiologia , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , México
17.
Rev Med Inst Mex Seguro Soc ; 53(4): 400-4, 2015 Jul-Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-26177426

RESUMO

BACKGROUND: The aim of this article is to evaluate the quality of care in intensive care, with international quality indices. METHODS: It was a descriptive study in an intensive care private care in Mexico. 2012 indicators are analyzed in a total of 446 hospital patients. The quality indicators were in line with international recommendations. The severity was determined by the scale SAPS III. RESULTS: Indicator of ventilation associated pneumonia was below the recommended standard (11.7 vs. 12 per thousand), bacteremia related central venous catheter in accepted ranges (5.7 vs. 4 per thousand). The ulcer prophylaxis, prevention of pulmonary embolism and prevention of falls in high compliance proportions (> 90, > 95 % and 0 falls). The rates of unplanned extubation and re-intubation below indicators (< 1 per thousand days intubation and < 12 %). While indicators varied by classification of severity of the condition, the goals were met. Mortality was lower than that estimated by gravity. CONCLUSION: In this therapy the implementation of internationally recommended actions has helped maintain an adequate quality of care. The effort has impacted not only the patients with acute conditions of admission, but also patients with high mortality or Hazard.


Assuntos
Cuidados Críticos/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Privados/normas , Unidades de Terapia Intensiva/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto Jovem
18.
Bol. méd. Hosp. Infant. Méx ; 72(3): 169-173, may.-jun. 2015. tab
Artigo em Espanhol | LILACS-Express | ID: lil-774479

RESUMO

ResumenINTRODUCCIÓN: El objetivo de este estudio fue demostrar si la decisión de realizar una tomografía axial computarizada de cráneo (TACC) en un paciente con traumatismo craneoencefálico (TCE) no severo se encontraba determinada por la presencia o ausencia del médico tratante durante la valoración en el servicio de urgencias.MÉTODOS: Se seleccionaron los expedientes de 92 pacientes de 8 meses a 4 años de edad. Los pacientes acudieron al servicio de urgencias del Hospital Español de México por TCE. Para la valoración inicial se utilizó la escala de coma de Glasgow (ECG). Se consideraron los siguientes criterios: pacientes con o sin realización de TACC, pacientes con médico tratante que acudió a la valoración inicial, pacientes con médico tratante que no acudió a valorar al paciente y pacientes valorados por el médico de guardia.RESULTADOS: Se determinó que al 38% de los pacientes con TCE no severo se les realizó TACC; el 8.6% tuvo alguna alteración; la intensidad de impacto moderada fue mayor en el grupo con TACC. De acuerdo con la ECG se encontró que la mayoría de los niños se localizaron en el puntaje 15 (p = 0.03). En aquellos pacientes sin médico tratante se observó una tendencia mayor a la realización de TACC.CONCLUSIONES: En pacientes pediátricos con TCE no severo sin datos de deterioro neurológico se sugiere una valoración clínica detallada y que genere confianza en los familiares, con la finalidad de evitar la toma de TACC cuando su uso no se encuentra justificado.


AbstractBACKGROUND: The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room.METHODS: Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff.RESULTS: 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p = 0.03). In patients without a physician, a greater trend was demonstrated for performing CT.CONCLUSIONS: Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT.

19.
Ginecol Obstet Mex ; 83(1): 41-7, 2015 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-26016315

RESUMO

BACKGROUND: Leiomyomas are the most common benign tumors of the uterus, frequently associated with abnormal uterine bleeding. Medroxyprogesterone (MP) acetate it is a therapeutic alternative. OBJECTIVE: To determine the efficacy of the medroxyprogesterone for abnormal uterine bleeding associated with leiomyomatosis in perimenopause women. METHODS: An observational, prospective, longitudinal study. We selected 31 patients with uterine myomas and abnormal uterine bleeding. Two years monthly doses of 150 mg of MP were given. If the bleeding did not stop at six months of treatment or increased a hysterectomy was performed. RESULTS: Two (6.4%) patients abandoned the treatment after a first doses; 21 (67.7%) completed the treatment without uterine bleeding (efficacy observed of 72.4%; CI 95% 54.4 to 90.4%, intention to treat efficacy 67.7%, CI 95% 49.6 to 86.8%). Eight (25.8%) patients persisted with uterine bleeding before 6 months of treatment and a hysterectomy was performed. There was no severity secondary effect informed. CONCLUSIONS: Management with medroxyprogesterone may be an effective treatment to control the uterine bleeding associated with myomatosis. Their use could reduce the necessity of some hysterectomies.


Assuntos
Leiomioma/tratamento farmacológico , Acetato de Medroxiprogesterona/uso terapêutico , Perimenopausa , Neoplasias Uterinas/tratamento farmacológico , Antineoplásicos Hormonais/uso terapêutico , Feminino , Humanos , Histerectomia/métodos , Leiomioma/patologia , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Neoplasias Uterinas/patologia
20.
Cancer Causes Control ; 26(6): 849-57, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25779380

RESUMO

PURPOSE: We reviewed the childhood lymphomas epidemiological data for the Mexico City metropolitan area (MCMA). METHODS: Data analysis from children (0-14 years old) diagnosed with lymphoma during the period 1996-2010 was performed at the Mexican Childhood Cancer Registry. Histological subtype was determined according to the International Classification of Childhood Cancer 3 (ICCC-3). Age-adjusted incidence rates were calculated per 1,000,000 children/year by age, gender, and ICCC-3 subtype; trends, by average annual percent change (AAPC). RESULTS: A total of 328 lymphoma cases included in the study had an incidence rate of 11.8, showing a decreasing trend [AAPC: -3.5; CI 95% (-5.9, -1.0)], primarily due to non-Hodgkin lymphomas (NHL) and Hodgkin lymphoma (HL) mixed cellularity subtype. NHL had the major incidence (5.8), with the precursor cell subtype being the most frequent (38.3%). Nodular sclerosis was the most frequent HL subtype. The incidence of Burkitt lymphoma was low (1.3). During the study period, there was an important reduction in the not-otherwise-specified subtype of NHL, which translated into a relative increase in the IIb3 subtype [AAPC: 7.3 (1.2, 13.8)]. Low incidences of NHL and of HL and NHL were found for < 1-year-olds and for 10- to 14-year-olds, respectively. Incidence rates for children in the MCMA, particularly the < 1 and 10-14 age groups, were lower than those for developed countries. The overall male/female ratio was 2.3. CONCLUSIONS: There was a trend toward a reduced incidence, for some lymphoma subtypes, in particular for NOS lymphomas, which may be the result of improvement in diagnostic techniques.


Assuntos
Linfoma/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Linfoma/patologia , Masculino , México/epidemiologia , Sistema de Registros
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