Patterns of allergen sensitization in patients with asthma in Yaqui Valley, Mexico.

INTRODUCTION: People who live in highly allergenic regions have a greater risk of being sensitized; therefore, these areas have a higher prevalence of mono and polysensitized patients. The aim of the present study was to investigate the allergen sensitization profiles in patients with asthma in an agricultural zone in Mexico. METHODS: An analytical cross-sectional study was conducted in a secondary care hospital in Obregon City, Mexico. The allergen sensitization pattern profiles were analyzed through a skin prick test (SPT) in 294 patients. Data was collected before SPT: asthma control was classified according to the Global Initiative for Asthma Criteria, nutritional status was assessed with the Body Mass Index (BMI) using Quetelet's index (BMI = weight/height2), and comorbidities, asthma, and smoking habits were collected from the patients' medical records. RESULTS: In this study, in a group of adults with asthma, the prevalence of sensitization was 77%. The most frequent categories of aeroallergens were in indoors, in zones with weeds and abundant trees. A low proportion of monosensitized patients (2%) was observed. House dust mites were the most common allergens. CONCLUSIONS: Our study describes the sensitization pattern among asthma patients. This study will help identify the panel of most common allergens in this region of Mexico, and aid in selection of specific treatment through immunotherapy.

Arsenic methylation capacity is associated with breast cancer in northern Mexico.

Exposure to environmental contaminants, dietary factors and lifestyles may explain worldwide different breast cancer (BC) incidence. Inorganic arsenic (iAs) in the drinking water is a concern in many regions, such as northern Mexico. Studies in several countries have associated the proportion of urinary monomethylarsenic (%MMA) with increased risks for many As-related diseases, including cancer. To investigate the potential relationships between the risk of BC and the capacity to methylate iAs, a hospital-based case-control study (1016 cases/1028 controls) was performed in northern Mexico. Women were directly interviewed about their reproductive histories. The profile of As metabolites in urine was determined by HPLC-ICP-MS and methylation capacity was assessed by metabolite percentages and indexes. Total urinary As, excluding arsenobetaine (TAs-AsB), ranged from 0.26 to 303.29µg/L. Most women (86%) had TAs-AsB levels below As biological exposure index (35µg/L). Women with higher %MMA and/or primary methylation index (PMI) had an increased BC risk (%MMA ORQ5vs.Q1=2.63; 95%CI 1.89,3.66; p for trend <0.001; PMI ORQ5vs.Q1=1.90; 95%CI 1.39,2.59, p for trend <0.001). In contrast, women with higher proportion of urinary dimethylarsenic (%DMA) and/or secondary methylation index (SMI) had a reduced BC risk (%DMA ORQ5vs.Q1=0.63; 95%CI 0.45,0.87, p for trend 0.006; SMI ORQ5vsQ1=0.42, 95%CI 0.31,0.59, p for trend <0.001). Neither %iAs nor total methylation index was associated to BC risk. Inter-individual variations in iAs metabolism may play a role in BC carcinogenesis. Women with higher capacity to methylate iAs to MMA and/or a lower capacity to further methylate MMA to DMA were at higher BC risk.

[Cohesion and family adaptability in women with epilepsy: cross-sectional study]. / Cohesión y adaptabilidad familiar en mujeres con epilepsia: estudio transversal analítico.

OBJECTIVE: To test the hypothesis that women with epilepsy come from families with poor cohesion and adaptability to the disease, compared with healthy women. DESIGN: Cross-sectional study. SETTING: A retrospective study was done on 263 women from a neurology outpatient department and a family medicine unit from the Mexican Social Security Institute in Sonora (Mexico) between 2010 and 2011. PARTICIPANTS: Were 82 women with epilepsy (cases), and 181 healthy women (control group). Age and area of residence was utilized to pair the sample (1:2,2). MEASUREMENTS: Univariate analysis was performed for socio-demographic variables, family type, socio-economic status, level of cohesion and family adaptability based on FACES III. A logistic regression analysis was performed for those variables that were associated with functionality of family in women with and without epilepsy. RESULTS: A family dysfunction were found in 22% of epileptic women (OR = 2.91 [2.17, 3.89], p=.0001). Univariate analysis suggested the presence of epilepsy and of family dysfunction associated with age, disease more than 15 years of evolution, and family type (rural, urban and traditional). The logistic regression model confirmed an association only for presence of epilepsy (OR = 7.30 [4.00, 13.33], p=.0001). CONCLUSION: The study answers the hypothesis that women with epilepsy live in families with greater psychosocial impairment, manifested by deficiencies in cohesion and adaptability to the disease, compared with healthy women.

[Reasons for abandonment of hormone replacement therapy with tibolone in menopausal women]. / Motivos de abandono de la terapia hormonal de reemplazo con tibolona en mujeres con menopausia.

BACKGROUND: Hormone replacement therapy (HRT) with tibolone used in the management of menopause has low rates of acceptance and compliance in the first year. Few studies analyze the reasons for abandoning the use of tibolone. OBJECTIVE: To analyze the reasons for abandoned tibolone hormone replacement therapy in postmenopausal women and the effects of the drug through the years in the treatment. MATERIAL AND METHODS: In a cross-sectional study, were included 261 menopausal women between 40 and 60 year old who attended their disease control at the Gynaecological Endocrinology serving in the National Medical Center Northwest in Obregon City, Sonora, Mexico during 2010-2011. The variables studied included: age, type of menopause, time of use of HRT with tibolone, abandonment reason, development of hypertension, dyslipidemia, hypothyroidism and diabetes mellitus. RESULTS: A total of 21 women discontinued treatment (8.60%, 95% CI -3 to 19), p=0.0001. The reasons for abandonment included, 42.9% gynecological reasons (23.8% breast disease, 14.3% and 4.8% cervical condition ovarian pathology, p=0.0001). Liver disease and vascular occurred in 28.6%, p=0.050. CONCLUSION: The women studied have adequate adherence to treatment with tibolone (>90%). We don't show an increased risk of cardiovascular or metabolic disease in women studied. Further studies are needed to explore the long-term clinical course, therapeutic response and complications in menopausal patients who use HRT with tibolone.

[Follow-up of the patient with pacemakers: Interrogation and basic programming]. / Seguimiento del paciente con marcapasos: interrogatorio y programación básica.

Permanent pacemakers are a frequently used therapeutic modality. Its use has had a great impact on the morbidity and mortality and quality of life of patients with heart rhythm disturbances, with an exponential increase observed in recent decades. The use of this strategy presents different phases, in which follow-up throughout the useful life of the device is a fundamental and determinant pillar of the efficacy and safety of this therapeutic modality. This review seeks to provide a clear and structured update of the fundamental aspects to consider in the follow-up of all patients with pacemakers. The follow-up of the patient with a pacemaker must follow a complete, systematic and periodic protocol, evaluating aspects and parameters related to the patient and the pacemaker, in order to ensure the proper and safe operation of the device adapted to the person.

Los marcapasos permanentes son una modalidad terapéutica de uso frecuente. Su empleo ha tenido un gran impacto en la morbimortalidad y calidad de vida de los pacientes con alteraciones del ritmo cardiaco, observándose en las últimas décadas un incremento exponencial. El empleo de esta estrategia presenta diferentes fases, que inician con la indicación de la estimulación, la selección del sistema de marcapaso apropiado, el procedimiento de implantación, la programación inicial y el seguimiento posterior, en la cual el seguimiento a lo largo de la vida útil del dispositivo es un pilar fundamental y determinante de la eficacia y seguridad de esta modalidad terapéutica. La presente revisión busca proporcionar una actualización clara y estructurada de los aspectos fundamentales a considerar en el seguimiento de todo paciente portador de marcapasos. El seguimiento del paciente con marcapasos debe seguir un protocolo completo, sistemático y periódico, evaluando aspectos y parámetros relacionado con el paciente y el marcapaso, con la finalidad de garantizar un funcionamiento adecuado y seguro del dispositivo adaptado a la persona.

Increment of D-dimer Associated with Immune Thrombotic Thrombocytopenia in ChAdOx1 nCoV-19 Vaccinated Individuals.

AIM OF THE STUDY: Development of thrombocytopenia and thrombosis after administration of the ChAdox1 nCoV-19 (AstraZeneca-Oxford) vaccine has recently been described. This new condition is called vaccine-induced immune thrombotic thrombocytopenia (VITT). Our objective was to summarize case reports on VITT with/without D-dimer increments in AstraZeneca-Oxford vaccinated individuals. DATA SOURCES: MEDLINE, PubMed, and Scopus databases were searched. STUDY SELECTION: Case series, case reports, letters to the editor; and abstracts of AstraZeneca-Oxford vaccinated patients with a clinical profile of thrombocytopenia (platelet count <150X10 3 /dL) and D-dimer determination, with or without thrombosis, and/or bleeding, and/or antibodies against platelet factor 4 (aPF4), were included. DATA EXTRACTION: Baseline risk factors, symptoms, physical signs; laboratory results, imaging findings, treatment; and outcome in patients with VITT reported in case series, were examined. DATA SYNTHESIS: Patients who developed VITT were more likely to be young women (ages 21 to 77) given the AstraZeneca-Oxford vaccine 5-14 days prior to presentation. Patients' signs, symptoms, and imaging findings were consistent with cerebral venous sinus thrombosis, or deep veins, lung, and other sites. Laboratory findings showed thrombocytopenia, low fibrinogen, and elevated D-dimer levels, while aPF4 was positive in most assays performed. Treatment was non-heparin anticoagulants, IV immunoglobulin, and steroids, as recommended by medical guidelines. CONCLUSIONS: Vaccine-induced immune thrombotic thrombocytopenia is a rare complication with high morbidity, related to administration of the AstraZeneca-Oxford vaccine. Clinicians should prepare for early identification of patients with suspicious symptoms, and prompt treatment initiated to avoid catastrophic events. D-dimer determination is useful for surveillance of cases with suspected VITT.

Reporte de caso: hipoglucemia grave como manifestación tardía de síndrome de Sheehan.

BACKGROUND: Sheehan's syndrome is a hypopituitarism secondary to necrosis of the pituitary gland caused by massive postpartum bleeding. The presentation is frequently amenorrhea and agalactia; hypoglycemia as a solitary presentation is uncommon. CASE REPORT: 68-year-old female with a history of postpartum hemorrhage 35 years ago. She had two episodes of hypoglycemia. During her hospital stay, panhypopituitarism was detected and the empty sella was confirmed by magnetic resonance imaging. CONCLUSIONS: It is recommended that medical personnel suspect Sheehan´s syndrome in any woman with nonspecific hypoglycemia and no history of chronic degenerative disease.

ANTECEDENTES: El síndrome de Sheehan es un hipopituitarismo secundario a necrosis de la glándula hipófisis causado por una hemorragia posparto. La presentación frecuentemente es como amenorrea y agalactia; la hipoglucemia como presentación solitaria es infrecuente. CASO CLÍNICO: Mujer de 68 años con antecedente de hemorragia posparto hace 35 años. Cursó con dos episodios de hipoglucemia. Durante su hospitalización se detecta panhipopituitarismo y se corrobora por resonancia magnética la silla turca vacía. CONCLUSIONES: Es recomendable que el personal médico sospeche un síndrome de Sheehan ante cualquier mujer con hipoglucemia inespecífica y sin antecedente de enfermedad crónica degenerativa.

[Ebstein's anomaly with ventricular preexcitation in an adult patient]. / Anomalía de Ebstein con preexcitación ventricular en un paciente adulto.

Background: Ebstein's anomaly is a rare complex congenital heart disease, first described in 1866 by physician Wilhelm Ebstein, characterized by anatomical and functional malformations of the tricuspid valve and the right ventricle because of inadequate delaminization of the tricuspid valve tissue. By presenting a clinical case and reviewing the literature, we analyzed the approach of an adult patient with Ebstein anomaly with ventricular preexcitation. Clinical case: We describe the case of a 34-year-old male patient, with a clinical history of palpitations and dyspnea, and his paraclinics documented Ebstein type B anomaly associated with patent foramen oval and paroxysmal supraventricular tachycardia, Successful radiofrequency ablation was performed and tricuspid valvuloplasty was proposed. Conclusion: It is concluded that Ebstein's anomaly is complex with clinical, morphological and physiopathological heterogeneous spectrum. Manifested from severe symptomatic forms in the neonatal period to asymptomatic or minimally symptomatic ones detected incidentally. Its diagnosis is based on clinical suspicion and confirmed by echocardiography or imaging studies. The therapeutic strategy may be based on medical management in its mild asymptomatic forms up to surgical interventions that include tricuspid valvuloplasty, palliative surgery, valve replacement or cardiac transplantation.

Introducción: la anomalía de Ebstein es una cardiopatía congénita compleja infrecuente, descrita por primera vez en 1866 por el médico Wilhelm Ebstein, caracterizada por malformaciones anatómicas y funcionales de la válvula tricúspide y del ventrículo derecho a consecuencia de una inadecuada deslaminización del tejido valvular tricuspídeo. Mediante la presentación de caso clínico y revisión de la literatura analizamos el abordaje de un paciente adulto con anomalía de Ebstein con preexcitación ventricular. Caso clínico: describimos el caso de un paciente masculino de 34 años, con historial clínico de palpitaciones y disnea, en sus paraclínicos se documentó anomalía de Ebstein tipo B asociado a foramen oval permeable y taquicardia paroxística supraventricular, como tratamiento se realizó ablación por radiofrecuencia exitosa y proponiéndose valvuloplastia tricuspídea. Conclusión: la anomalía de Ebstein es compleja de espectro clínico, morfológico y fisiopatológico heterogéneo, manifestada desde formas graves sintomáticas en el periodo neonatal hasta asintomáticas o mininamente sintomáticas detectadas de forma incidental. Su diagnóstico parte de la sospecha clínica confirmándose a partir de ecocardiografía o estudios de imagen. La estrategia terapéutica puede estar basada en manejo médico en sus formas leves asintomáticas hasta intervenciones quirúrgicas que incluyen valvulo-plastia tricuspídea, cirugía paliativa, reemplazo valvular o trasplante cardiaco.

Phospholipase and proteinase activities of Candida isolates from denture wearers.

The aim of the present study was to characterise phospholipase and proteinase activities of oral Candida isolates from 100 denture wearers and to study the relationship of these activities with denture stomatitis. Of 100 patients studied, 44 suffered from denture stomatitis. Specimens were collected by swabbing the denture and underlying mucosa. Isolates were previously identified by conventional mycological and genotypic methods. The phospholipase and proteinase activities were evaluated by agar plate methods. A total of 152 isolates were recovered from denture and underlying mucosa, including 101 Candida albicans, 18 Candida tropicalis, 14 Candida glabrata, 11 Candida guilliermondii, four Candida parapsilosis, two Saccharomyces cerevisiae and one isolate each of Candida dubliniensis and Candida krusei. Most C. albicans (97%) showed phospholipase activity; furthermore, the unique C. dubliniensis isolate showed a moderate phospholipase activity. The isolation of C. albicans (chi-square test, P = 0.0016) and phospholipase production by Candida spp. (chi-square test, P = 0.0213) was found to be significantly associated with denture stomatitis. Proteinase production was observed in <30% of isolates, and it was not related to the presence of denture stomatitis (P = 0.7675). Candida albicans isolates may produce both virulence factors, although the proteinase production was only observed in <30% of the isolates. Phospholipase production was exclusive of C. albicans and C. dubliniensis.

[Dermatological reactions secondary to the use of personal protective equipment]. / Reacciones dermatológicas secundarias al uso de equipo de protección personal.

BACKGROUND: During the COVID-19 pandemic, healthcare professionals use personal protective equipment (PPE) on a constant basis and for extended periods, leading to adverse dermatological reactions, a situation little known and studied despite its relevance. OBJECTIVE: To determine the risk factors associated with the development of adverse dermatological reactions in health workers using PPE during the COVID-19 pandemic. MATERIAL AND METHODS: An observational, cross-sectional, analytical study conducted through an online survey that evaluated the association between dermatological reactions and the use of PPE through a descriptive and inferential statistical analysis. RESULTS: There was a sample of 171 healthcare professionals. It was reported a high prevalence of adverse reactions (59%) and the most affected sites were the facial region and hands. The use of PPE > 6 hours, a history of dermatological disease, female gender, use of plastic overalls and the use of a respirator were documented as risk factors. CONCLUSIONS: Being an infectious disease, COVID-19 forces healthcare professionals to use accessories as a form of personal protection, implying potential health risks; for this, effective preventive strategies and treatment are required.

INTRODUCCIÓN: durante la pandemia por COVID-19, los trabajadores de la salud utilizan equipos de protección personal (EPP) de forma constante y por periodos prolongados, lo cual propicia reacciones adversas dermatológicas, situación poco conocida y estudiada a pesar de su relevancia. OBJETIVO: determinar los factores de riesgo asociados al desarrollo de reacciones adversas dermatológicas en trabajadores de la salud que utilizan EPP durante la pandemia por COVID-19. MATERIAL Y MÉTODOS: estudio observacional, transversal, analítico, realizado mediante una encuesta en línea, que evaluó la asociación entre reacciones dermatológicas y el uso de EPP a partir de un análisis estadístico descriptivo e inferencial. RESULTADOS: se recabó una muestra de 171 trabajadores de la salud. Se reportó una alta prevalencia de reacciones adversas (59%) y los sitios más afectados fueron la región facial y las manos. El uso de EPP > 6 horas, el antecedente de enfermedad dermatológica, el género femenino, el uso de overol de plástico y el uso de respirador se documentaron como factores de riesgo. CONCLUSIONES: al ser una enfermedad infectocontagiosa, la COVID-19 condiciona que los trabajadores de salud utilicen aditamentos para su protección personal, lo cual implica potenciales riesgos para la salud; por tanto, se requieren estrategias preventivas y tratamientos eficaces.

In vitro activity of voriconazole against Mexican oral yeast isolates.

Oral candidiasis is the most prevalent complication in HIV-infected and AIDS patients. Topical antifungal treatment is useful for the initial episodes of oral candidiasis, but most patients suffer more than one episode and fluconazole or itraconazole can help in the management, and voriconazole may represent a useful alternative agent for the treatment of recalcitrant oral and oesophageal candidiasis. The aim of this research was to study the in vitro activity of voriconazole and fluconazole against Mexican oral isolates of clinically relevant yeast. The in vitro susceptibility of 187 oral yeast isolates from HIV-infected and healthy Mexicans was determined for fluconazole and voriconazole by the M44-A disc diffusion method. At 24 h, fluconazole was active against 179 of 187 isolates (95.7 %). Moreover, a 100% susceptibility to voriconazole was observed. Voriconazole and fluconazole are highly active in vitro against oral yeast isolates. This study provides baseline data on susceptibilities to both antifungal agents in Mexico.

Simultaneous oral antral fistula closure and sinus floor augmentation to facilitate dental implant placement or orthodontics.

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

Understanding SARS-CoV-2: an analysis of the current pandemic. / Para entender el SARS-CoV-2: un análisis de la pandemia actual.

In late December 2019, a group of patients with "atypical pneumonia" of viral etiology was reported in Wuhan, China. We now know that coronavirus disease 2019 (COVID-19) is caused by the new coronavirus SARS-CoV-2 that produces an acute disease with respiratory predilection and high contagiousness, whose origin is the result of natural selection between species. The World Health Organization declared this event as a public health emergency of global concern. The clinical presentation is diverse, from asymptomatic or mildly self-limiting upper respiratory tract disease to the development of severe and progressive interstitial pneumonia with the development of multiple organ failure and death. To date there is no specific treatment. Epidemiological measures of social distancing, hand washing and the use of personal protective equipment reduce the spread of this virus in the population. The aim of this review was to describe the existing information about SARS-CoV-2 and the COVID-19 pandemic, which allows health personnel to better understand the origin, epidemiology, clinical evolution, diagnosis, and current experimental treatments for this new disease. Therefore, it was carried out an evaluation of the bibliographic information with the terms coronavirus, COVID-19, and SARS-CoV-2 in the specialized databases in English and Spanish.

A fines de diciembre de 2019, se informó en Wuhan (China) sobre un grupo de pacientes con "neumonía atípica" de etiología viral. Ahora sabemos que la enfermedad por coronavirus 2019 (COVID-19) es provocada por el nuevo coronavirus SARS-CoV-2, que produce una enfermedad aguda con predilección respiratoria y de elevada contagiosidad, cuyo origen es resultado de una selección natural entre especies. La Organización Mundial de la Salud declaró este evento como una emergencia de salud pública de interés global. La presentación clínica es diversa y se manifiesta en personas asintomáticas o con enfermedad leve autolimitada del tracto respiratorio superior hasta aquellas que desarrollan una neumonía intersticial progresiva y grave, con evolución a insuficiencia multiorgánica y muerte. No se cuenta a la fecha con tratamiento específico. Las medidas epidemiológicas de distanciamiento social, lavado de manos y uso de equipo de protección personal disminuyen la diseminación de este virus entre la población. Esta revisión tuvo la finalidad de hacer una descripción de la información existente acerca del SARS-CoV-2 y la pandemia de COVID-19 que permita al personal de salud comprender mejor el origen, la epidemiología, el cuadro clínico, el diagnóstico y los tratamientos experimentales actuales para esta nueva enfermedad, para lo cual se realizó una evaluación de la información bibliográfica con los términos coronavirus, COVID-19 y SARS-CoV-2 en las bases de datos especializadas en idioma inglés y español.

[Feminizing genitoplasty in adrenal congenital hyperplasia: one or two surgical steps?]. / Genitoplastia feminizante en hiperplasia suprarrenal congénita; una o dos etapas quirúrgicas?

SUMMARY OBJECTIVES: The best time to perform a genitoplasty in a Congenital Adrenal Hyperplasia (CAH) girl is an issue that has been discussed extensively. The purpose of this study is to find criteria that may help in the decision. METHODS: Charts of all patients with diagnosis of CAH with 21 Hydroxylase deficit who underwent genitoplasty in our institution were reviewed (Jan 1996-Dec 2006). Demographic data, surgery performed and outcomes were analyzed. RESULTS: In the 10 year-period, 25 patients fit the inclusion criteria; 22 had complete data. All patients were classified based on Prader's criteria; Prader 2 (n=3), Pra der 3 (n=13) and Prader 4 (n=6). Mean age at first surgery was 13.5 months (range 2-89 m). In Prader 2 patients, a reduction clitoroplasty with a "cut back" vaginoplasty was performed with no complications. All patients in the Prader 3 group underwent a reduction clitoroplasty. A vaginoplasty was done in 9/13; 5/9 at the same surgery session (4 stenotic) and the other 4 in a 2nd stage with good results; vaginoplasty is still pending for the other 4 girls. In the Prader 4 group, a vaginoplasty pull-through was performed in 4/6 using the posterior sagital approach; one at the reduction clitoroplasty stage which ended stenotic and need dilatations, and the other 3 in a 2nd surgery with a good outcome. The other 2/6 girls are awaiting a vaginoplasty. 22/22 had acceptable results after a mean follow-up of 63 months (range 12-144). CONCLUSIONS: Congenital Adrenal Hyperplasia (CAH) shows different approaches may be used for different degrees of virilization. For less severe cases (Prader 3) a cut-back may be the surgery of choice for vaginoplasty, while in the more complex cases a flap with pull-through or a posterior sagital procedure could be useful. Based on this series, we recommend performing vaginoplasty in a 2nd stage surgery, avoiding complications and further procedures such as di lactations.

[Transcutaneous electrical nervous stimulation in the prognosis of Bell's palsy]. / Estimulación nerviosa eléctrica transcutánea para el pronóstico de parálisis de Bell.

BACKGROUND: The peripheral face palsy (PFP) is the commonest acute cranial neuropathy. The PFP has a showy clinical pattern which contrasts with a favorable course. Our objective was to determine the sensitivity and specificity for the nervous excitability test (NET) with transcutaneous electrical nerve stimulation (TENS) and the time required to obtain face symmetry. METHODS: An analytical cross-sectional study was made in 22 patients with PFP. The goal was the time (days) to obtain face symmetry. The sensitivity and specificity was carried out. RESULTS: A sensitivity and specificity of the NET was of 100 %. The correlation corrected by sex and age between both variables was 0.89. The average in days of recovery was smaller in those with a positive NET (p < 0.05) test. CONCLUSIONS: The test of nervous excitability for PFP with TENS is safe and simple to use in primary care and urgencies services.

[The cross-sectional area of the median nerve by sonography in the diagnosis of carpal tunnel syndrome]. / Determinación ultrasonográfica del área de corte transversal del nervio mediano en síndrome del túnel carpiano.

OBJECTIVE: To measure the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) level by sonography (S) in a Mexican population. METHODS: A comparative cross-sectional design study with a nonprobabilistic sampling with 50 women and 50 men in good health were submitted for measuring MNCSA at the level of the CT. Other variables like sex; side and degree of daily hand activity were also studied. The analysis was made by descriptive statistics, and Mann-Whitney U or Kruskal-Wallis tests. RESULTS: The mean MNCSA was 0.063 +/- 0.015 cm(2), in women; in men it was 0.072 +/- 0.018 cm(2); the difference was significant (p < 0.004). The median MNCSA among women was 0.062 cm(2) in the right side and 0.060 cm(2) in the left (90th percentile for both hands of 0.084 cm(2)); in men, it was of 0.070 cm(2) in the right hand and of 0.069 cm(2) in the left (90th percentile for both hands of 0.097 cm(2)). The difference between women and men was significant in each side, but not between right and left hands (p = 0.21). There was no correlation between age and MNCSA on either side, or with hand activity. CONCLUSIONS: A MNCSA value of 0.1 cm(2) for men and 0.09 cm(2) for women is proposed as a standard parameter for the Mexican population.

Prevalence and antifungal susceptibility profiles of Candida glabrata, Candida parapsilosis and their close-related species in oral candidiasis.

OBJECTIVE: To evaluate the importance of Candida glabrata, Candida parapsilosis and their close-related species, Candida bracarensis, Candida nivariensis, Candida metapsilosis and Candida orthopsilosis in patients with oral candidiasis and, to determine the in vitro activities of antifungal drugs currently used for the treatment. METHODS: One hundred fourteen isolates of C. glabrata and 97 of C. parapsilosis, previously identified by conventional mycological methods, were analysed by molecular techniques. In vitro antifungal susceptibility to fluconazole, itraconazole, miconazole, and nystatin was evaluated by CLSI M44-A2 disk diffusion test, and by CLSI M27-A3 microdilution for fluconazole. RESULTS: All C. glabrata isolates were identified as C. glabrata sensu stricto, 93 out of 97 C. parapsilosis isolates as C. parapsilosis sensu stricto, three as C. orthopsilosis and one as C. metapsilosis. Candida glabrata was mainly isolated in mixed cultures but C. parapsilosis complex was more frequent in pure culture. Candida metapsilosis and C. orthopsilosis were isolated as pure culture and both species were susceptible to all antifungal agents tested. Most C. glabrata isolates were susceptible to miconazole and nystatin, but resistant to fluconazole and itraconazole. Azole cross resistance was also observed. Candida parapsilosis isolates were susceptible to fluconazole although azole cross resistance to miconazole and itraconazole was observed. CONCLUSION: This study highlights the importance of accurate identification and antifungal susceptibility testing of oral Candida isolates in order to have an in-depth understanding of the role of C. glabrata and C. parapsilosis in oral candidiasis.

[Environmental noise levels in 2 intensive care units in a tertiary care centre]. / Nivel de ruido ambiental en 2 unidades de cuidados críticos de un centro de tercer nivel de atención.

INTRODUCTION: The World Health Organisation (WHO) has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise levels in 2 different intensive care units at a tertiary care centre. METHODS: Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level. RESULTS: The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points. CONCLUSIONS: Noise levels measured in intensive care wards exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of environmental noise.

Monitorización hemodinámica integrada: clínica, gasométrica y ecocardiográfica / Integrated hemodynamic monitoring: clinical, gasometric and echocardiographic / Monitorização hemodinâmica integrada: clínica, gasométrica e ecocardiográfica

Introducción: la monitorización hemodinámica constituye un conjunto de técnicas y parámetros que permiten valo rar si la función cardiovascular es la adecuada para mantener la perfusión y la oxigenación tisular que permita sa tisfacer las demandas metabólicas del organismo, valorar el estado y el comportamiento del sistema cardiovascular, orientando sobre la mejor estrategia terapéutica. La presente revisión busca proporcionar una descripción general e integrada de las diferentes técnicas de monitorización, así como aspectos fisiológicos relevantes para su entendi miento y empleo terapéutico. La monitorización hemodinámica acompañada de un adecuado conocimiento de la fisiología cardiovascular permite determinar el estado del sistema cardiovascular, la condición hemodinámica del paciente y la estrategia terapéutica requerida. Su interpretación debe partir de la integración y la correlación de diversos parámetros hemodinámicos.

Introduction: hemodynamic monitoring is a set of techniques and parameters that allow evaluating whether cardio vascular function is adequate to maintain tissue perfusion and oxygenation to satisfy metabolic demands of the or ganism, assess the condition and behavior of the cardiovascular system, providing guidance on the best therapeutic strategy. This review seeks to provide a general and integrated description of the different monitoring techniques, as well as physiological aspects relevant to their understanding and therapeutic use. Hemodynamic monitoring accompanied by an adequate knowledge of cardiovascular physiology allows to determine the state of the cardiovascular system, hemodynamic condition of the patient and therapeutic strategy required, its interpretation must start from the integration and correlation of different hemodynamic parameters.

Introdução: a monitorização hemodinâmica constitui um conjunto de técnicas e parâmetros que permitem avaliar se a função cardiovascular é adequada para manter a perfusão e oxigenação tecidual que permite satisfazer as exi gências metabólicas do organismo, avaliar o estado e comportamento do sistema cardiovascular, orientando sobre a melhor estratégia terapêutica. Esta revisão procura fornecer uma descrição geral e integrada das diferentes técnicas de monitorização, bem como aspectos fisiológicos relevantes para a sua compreensão e utilização terapêutica. A monitorização hemodinâmica acompanhada de um conhecimento adequado da fisiologia cardiovascular permite determinar o estado do sistema cardiovascular, a condição hemodinâmica do doente e a estratégia terapêutica neces sária, a sua interpretação deve partir da integração e correlação de vários parâmetros hemodinâmicos.