Family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income.

BACKGROUND: Type 2 diabetes has economic implications involving family income and out-of-pocket spending. OBJECTIVE: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. MATERIAL AND METHODS: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. RESULTS: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. CONCLUSION: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.

ANTECEDENTES: La diabetes tipo 2 tiene implicaciones económicas en el ingreso familiar y el gasto de bolsillo. OBJETIVO: Determinar el gasto de bolsillo familiar en la atención de la diabetes mellitus tipo 2 y el porcentaje que representa en el ingreso familiar. MATERIAL Y MÉTODOS: Estudio de gasto de bolsillo de las familias con pacientes con diabetes tipo 2 atendidos en el primer nivel de atención. El gasto de bolsillo familiar incluyó gasto en traslado, alimentos-bebidas y medicamentos externos. El ingreso familiar correspondió al total de ingresos económicos aportados por los miembros de la familia. El porcentaje del gasto de bolsillo con relación al ingreso familiar se identificó con la relación entre estas dos variables. El análisis estadístico incluyó promedios y porcentajes. RESULTADOS: El gasto de bolsillo familiar anual en transporte fue de $2621.24, en alimentos y bebidas fue de $1075.67 y en medicamentos externos fue de $722.08. El gasto familiar de bolsillo total anual fue de $4418.89 y correspondió a 4.73 % del ingreso familiar. CONCLUSIÓN: El gasto de bolsillo en las familias con un paciente con diabetes mellitus tipo 2 fue de $4418.89 y representó 4.73 % del ingreso familiar.

Increased TNF-α production in response to IL-6 in patients with systemic inflammation without infection.

Acute systemic inflammation can lead to life-threatening organ dysfunction. In patients with sepsis, systemic inflammation is triggered in response to infection, but in other patients, a systemic inflammatory response syndrome (SIRS) is triggered by non-infectious events. IL-6 is a major mediator of inflammation, including systemic inflammatory responses. In homeostatic conditions, when IL-6 engages its membrane-bound receptor on myeloid cells, it promotes pro-inflammatory cytokine production, phagocytosis, and cell migration. However, under non-physiologic conditions, such as SIRS and sepsis, leucocyte dysfunction could modify the response of these cells to IL-6. So, our aim was to evaluate the response to IL-6 of monocytes from patients diagnosed with SIRS or sepsis. We observed that monocytes from patients with SIRS, but not from patients with sepsis, produced significantly more TNF-α than monocytes from healthy volunteers, after stimulation with IL-6. Monocytes from SIRS patients had a significantly increased baseline phosphorylation of the p65 subunit of NF-κB, with no differences in STAT3 phosphorylation or SOCS3 levels, compared with monocytes from septic patients, and this increased phosphorylation was maintained during the IL-6 activation. We found no significant differences in the expression levels of the membrane-bound IL-6 receptor, or the serum levels of IL-6, soluble IL-6 receptor, or soluble gp130, between patients with SIRS and patients with sepsis. Our results suggest that, during systemic inflammation in the absence of infection, IL-6 promotes TNF-α production by activating NF-κB, and not the canonical STAT3 pathway.

Maternal Perinatal Telemonitoring in the Context of the Coronavirus Disease 2019 Pandemic in a Tertiary Health Center in Peru.

OBJECTIVE: This study aimed to describe the characteristics of a telemonitoring program that was rapidly implemented in our institution as a response to the coronavirus disease 2019 (COVID-19) pandemic, as well as the maternal and perinatal outcomes of women who attended this program. STUDY: DESIGN: Retrospective study of patients via phone-call telemonitoring during the peak period of the COVID-19 pandemic (May 2020-August 2020). Maternal and perinatal outcomes were collected and described. Health providers' satisfaction with the telemonitoring program was assessed via an email survey. RESULTS: Twenty-three (69.7%) health providers answered the survey. The mean age was 64.5 years, 91.3% were OB/GYN (obstetrician-gynecologist) doctors, and 95% agreed that telemonitoring is an adequate method to provide health care when in-person visits are difficult. The 78.7% of scheduled telemonitoring consultations were finally completed. We performed 2,181 telemonitoring consultations for 616 pregnant women and 544 telemonitoring consultations for puerperal women. Other medical specialties offering telemonitoring included gynecology, reproductive health, family planning, cardiology, endocrinology, and following up with patients with reactive serology to severe respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of the population attending our telemonitoring program were categorized as the lowest strata, i.e., III and IV, according to the Human Development Index, and approximately 42% were deemed as high-risk pregnant women. Additionally, we reported the perinatal outcomes of 424 (63%) pregnant women, the most relevant finding being that approximately 53% of them had cesarean sections. CONCLUSION: Telemonitoring is an adequate method of continuing the provision of prenatal care when in-person visits are difficult in situations such as the COVID-19 pandemic. Telemonitoring is feasible even in institutions with no or little experience in telemedicine. The perinatal outcomes in women with telemonitoring seem to be similar to that in the general population. KEY POINTS: · Telemonitoring for prenatal care is feasible even in low-income countries and in a critical scenario.. · OB/GYN doctors agreed with that telemonitoring is an adequate method to provide prenatal care.. · Maternal and perinatal outcomes are similar in women attending a telemonitoring program..

[Chronic degenerative conditions as risk factors for lethal COVID-19Doenças crônicas degenerativas como fator de risco para letalidade por COVID-19]. / Enfermedades crónicas degenerativas como factor de riesgo de letalidad por COVID-19 en México.

Objective: To determine the relative risk of a lethal outcome associated with chronic degenerative conditions in patients with COVID-19. Methods: A cohort study was conducted using electronic medical records belonging to patients who tested positive for COVID-19 on RT-PCR while receiving care as outpatients or inpatients in a social security system facility between March 2020 and March 2021. Two study groups were formed. The exposed group was divided into four subgroups, each of which was diagnosed with one and only one chronic condition (diabetes, hypertension, obesity, or chronic kidney disease); the unexposed group was obtained from the medical records of patients without comorbidities. A total of 1 114 medical records were examined using simple random sampling. Once the minimum sample size was reached, the relative risk was calculated for each chronic condition. Combinations of two, three, and four conditions were created, and each of them was included in the analysis. Results: In the absence of a chronic degenerative condition, the prevalence of a lethal outcome from COVID-19 is 3.8%; in the presence of type 2 diabetes mellitus, 15.8%; in the presence of arterial hypertension, 15.6%; and in the presence of obesity, 15.0%. For diabetes and hypertension combined, the prevalence of a lethal outcome is 54.1%; for diabetes and obesity combined, 36.8%, and for obesity and hypertension combined, 28.1%. Conclusion: In patients with COVID-19, the relative risk of a lethal outcome is 4.17 for those with diabetes, 4.13 for those with hypertension, and 3.96 for those with obesity. For two chronic conditions combined, the relative risk doubles or triples. The relative risk of a lethal outcome is 14.27 for diabetes plus hypertension; 9.73 for diabetes plus obesity, and 7.43 for obesity plus hypertension. Chronic conditions do not present alone; they generally occur together, hence the significance of the relative risks for lethal outcomes presented in this paper.

Objetivo: Determinar o risco de letalidade conferido por doenças crônicas degenerativas em pacientes com COVID-19. Métodos: Foi realizado um estudo de coorte em prontuários eletrônicos de pacientes com RT-PCR positivo para COVID-19 em atendimento ambulatorial ou hospitalar em uma instituição de previdência social, no período de março de 2020 a março de 2021. Foram constituídos dois grupos de estudo. O grupo exposto foi dividido em quatro subgrupos, cada um com diagnóstico único e exclusivo de uma doença crônica (diabetes, hipertensão, obesidade ou doença renal crônica). O grupo não exposto foi constituído por prontuários de pacientes sem comorbidades. Foram revisados 1.114 prontuários no total, utilizando técnica de amostragem aleatória simples. Uma vez obtido o tamanho mínimo da amostra, foi calculado o risco relativo para cada doença crônica. Foram realizadas combinações de 2, 3 e 4, tendo sido feita a análise com cada uma delas. Resultados: Na ausência de doença crônica degenerativa, a prevalência de letalidade na COVID-19 é de 3,8%; na presença de diabetes mellitus tipo 2, a letalidade é de 15,8%; na presença de hipertensão arterial, 15,6%; e na presença de obesidade, 15%. Quando tanto diabetes como hipertensão estão presentes, a letalidade é de 54,1%; com diabetes e obesidade, 36,8%; e obesidade com hipertensão, 28,1%. Conclusões: Em pacientes com COVID-19, o risco relativo de letalidade é de 4,17 naqueles com diabetes; 4,13 naqueles com hipertensão; e 3,96 naqueles com obesidade. Quando duas doenças crônicas são combinadas, o risco relativo dobra ou triplica. Para diabetes e hipertensão, o risco relativo de letalidade é 14,27; para diabetes e obesidade, 9,73; e para obesidade e hipertensão, 7,43. As doenças crônicas não ocorrem sozinhas (geralmente estão associadas), e nessa perspectiva os riscos relativos de letalidade apresentados neste artigo tornam-se relevantes.

Utilisation of collagenolytic enzymes from sierra fish (Scomberomorus sierra) and jumbo squid (Dosidicus gigas) viscera to generate bioactive collagen hydrolysates from jumbo squid muscle.

Crude extracts of collagenases from jumbo squid (Dosidicus gigas) hepatopancreas and sierra fish (Scomberomorus sierra) viscera were used to hydrolyse squid muscle collagen into peptides with inhibitory capacity over angiotensin I-converting enzyme (ACE) and ABTS free radicals [2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulphonic acid)], as a measure of their antihypertensive potential and antioxidant activity, respectively. Proteins from 20 to 200 kDa were found in both enzyme extracts; however, in comparison to the jumbo squid extract (JSE), the extraction yield and specific activity of the enzymatic sierra fish extract (SFE) were ≈ 40% greater, suggesting the presence of enzymes with different collagenolytic activity. Moreover, the utilised collagen was obtained with a yield of 0.98 ± 0.09 g/100 g muscle from jumbo squid arms, which after an incubation with JSE and SFE generated peptides with different biological activity. However, the collagen hydrolysates from the enzymatic SFE contained a higher proportion of low-molecular-weight peptides than that obtained from JSE (15.2 and 7.9% of < 3 kDa peptides, respectively). Finally, the antioxidant potential and ACE-inhibitory activity were increased after hydrolysis, being the SFE the one that showed a greater increase of both biological activities (82.28% of ACE inhibition and 64% of ABTS inhibition).

Acutely altered mental status as the main clinical presentation of multiple strokes in critically ill patients with COVID-19.

BACKGROUND AND AIMS: Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes. METHODS: Clinical presentation and diagnostic work-up of the patients. RESULTS: Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes. CONCLUSION: Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.

Partial Characterization of a Low-Molecular-Mass Fraction with Cryoprotectant Activity from Jumbo Squid (Dosidicus gigas) Mantle Muscle.

Freezing conditions affect fish muscle protein functionality due to its denaturation/aggregation. However, jumbo squid (Dosidicus gigas) muscle protein functionality remains stable even after freezing, probably due to the presence of low-molecular-mass compounds (LMMC) as cryoprotectants. Thus, water-soluble LMMC (<1 kDa) fraction obtained from jumbo squid muscle was evaluated by Fourier transform infrared spectrometry. From its spectra, total carbohydrates, free monosaccharides, free amino acids and ammonium chloride were determined. Cryoprotectant capacity and protein cryostability conferred by LMMC were investigated by differential scanning calorimetry. Fraction partial characterization showed that the main components are free amino acids (18.84 mg/g), carbohydrates (67.1 µg/mg) such as monosaccharides (51.1 µg/mg of glucose, fucose and arabinose in total) and ammonium chloride (220.4 µg/mg). Arginine, sarcosine and taurine were the main amino acids in the fraction. LMMC, at the mass fraction present in jumbo squid muscle, lowered the water freezing point to -1.2 °C, inhibiting recrystallization at 0.66 °C. Significant myofibrillar protein stabilization by LMMC was observed after a freeze-thaw cycle compared to control (muscle after extraction of LMMC), proving the effectiveness on jumbo squid protein muscle cryo- stability. Osmolytes in LMMC fraction inhibited protein denaturation/aggregation and ice recrystallization, maintaining the muscle structure stable under freezing conditions. LMMC conferred protein cryostability even at the very low mass fraction in the muscle.

Effect of temperature on the actomyosin-paramyosin structure from giant squid mantle (Dosidicus gigas).

BACKGROUND: The secondary structure of a protein determines its functional properties, such as its gelling capacity. The α-helix and ß-sheet comprise its main structures. Myofibrillar proteins from jumbo squid are composed mainly of the actomyosin-paramyosin complex; this complex contains a high percentage of α-helix, because actin, paramyosin, and myosin constitute 30%, 100%, and 55% of the α-helix, respectively. It is important to elucidate the role of the secondary structures in the gelation of giant squid proteins as they form gel. The role of the secondary structures in the gelation of giant squid proteins is therefore very important. For this reason, the objective of this work was to evaluate the effect of temperature on the structural behavior of actomyosin-paramyosin isolate (API) from Dosidicus gigas. RESULTS: The unfolding of the API system, which is composed of the actomyosin-paramyosin complex, was clarified by studying surface hydrophobicity and viscosity. Three characteristic peaks were found, associated with myosin, paramyosin, and actin. Infrared and circular dichroism corroborated the view that API undergoes major structural changes, because it proceeds from mostly an α-helix structure to 100% ß-sheet. CONCLUSION: The structural rearrangement favors gelation by cross-linking, generating new protein-protein and water-protein interactions, which create a more stable structure compared to mantle proteins (MP). Likewise, the presence of sarcoplasmic and stromal proteins in D. gigas muscle prevents the unfolding of myofibrillar proteins, favoring gelation by agglomeration, decreasing the ability to trap water and thus its gelling capacity. © 2019 Society of Chemical Industry.

IMPACT Score for Traumatic Brain Injury: Validation of the Prognostic Tool in a Spanish Cohort.

BACKGROUND: The aim of this work was to validate the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) model in a Spanish cohort of patients with moderate-severe TBI (traumatic brain injury). SETTING: Two level I neurotrauma centers. PARTICIPANTS: Patients admitted to these hospitals between 2011 and 2014 with a diagnosis of TBI and a Glasgow Coma Scale score of 12 or less. DESIGN: Prospective observational study. MAIN MEASURES: We collected prospectively the clinical variables included in the IMPACT models. Outcome evaluation was prospectively done at 6-month follow-up according to the Glasgow Outcome Scale. RESULTS: A total of 290 patients were included in the study. Forty-seven patients (16.2%) died within 6 months post-TBI, and 74 patients (25.5%) had an unfavorable outcome. The Hosmer-Lemeshow test revealed that there was no difference between observed and predicted outcomes; hence, the 3 models displayed adequate calibration for predicting 6-month mortality or unfavorable outcome. The receiver operating characteristic curve indicated that the 3 models (Core, Extended, and Lab) could accurately discriminate between favorable and unfavorable outcomes, as well as between survival and mortality (P < .001). CONCLUSION: The IMPACT model validates prediction of 6-month outcomes in a Spanish population of moderate-severe TBI. IMPACT Lab model is the one that presents a higher discriminative capacity. These results encourage the implementation of the IMPACT model as a prognostic tool in the management of patients with TBI.

Emerging adults not in education, employment or training (NEET): socio-demographic characteristics, mental health and reasons for being NEET.

BACKGROUND: A growing group of emerging adults in many countries around the globe are not incorporated into the education system or the labor market; these have received the label "NEET: not in education, employment nor training". We describe the mental health and socio-demographic characteristics of emerging adults who are NEET from Mexico City (differentiating between NEET who are homemakers and NEET who are not) compared to their peers who are studying, working or both, in a city in which education and employment opportunities for youth are limited. A secondary objective, because of the often inconsistent inclusion criteria or definitions of NEET, was to evaluate the heterogeneity amongst NEET emerging adults in terms of their perceived reasons for being NEET and to evaluate whether different reasons for being NEET are associated with different mental health characteristics. METHODS: The participants were 1071 emerging adults aged 19 to 26; they were interviewed in person by an interviewer in their homes as part of a follow-up study of the Mexican Adolescent Mental Health Survey. The Composite International Diagnostic Interview (WMH-CIDI) assessed psychiatric disorders, substance use and abuse, suicidal behavior and socio-demographic characteristics. RESULTS: Of the total sample, 15.3% were NEET homemakers, 8.6% NEET non-homemakers, 41.6% worked only, 20.9% studied only and 13.5% worked and studied. Of those who were NEET, 12.6% were NEET by choice. NEET non-homemakers had overall greater odds of substance use, substance use disorders and some suicidal behaviors in comparison with all their peers, whereas NEET homemakers had reduced odds. Those who were NEET because they didn't know what to do with their life had greater odds of mood, behavioral, and substance disorders, use of all substances and of suicide behaviors compared to those who were NEET by choice. CONCLUSIONS: Non-homemaker NEET who lack life goals require targeted mental health intervention. The demographic reality of emerging adults not in education or employment and the varying reasons they give for being NEET are not consistent with how NEET is often conceptualized in terms of a societal problem.

Evaluation of Antioxidant Capacity, Protective Effect on Human Erythrocytes and Phenolic Compound Identification in Two Varieties of Plum Fruit (Spondias spp.) by UPLC-MS.

Plum edible part was used to obtained extracts by during a 4 h maceration process using three different solvents (ethanol, methanol and water) for the determination of total phenols and flavonoids, antioxidant capacity by (2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH) and hemolysis inhibition in human blood assays. Subsequently, phenolic compounds were identified using ultra-performance liquid chromatography (UPLC-MS). The results indicated that the ethanolic extract of plum fruit being a good source of phenolic (12⁻18 mg GAE/g FW) and flavonoids (2.3⁻2.5 mg QE/g FW) content in both varieties of plum. Also, the fruits proved a good source of antioxidants as measured by DPPH and ABTS; likewise, plum aqueous extracts showed the highest protective effect on human erythrocytes with 74.34 and 64.62% for yellow and red plum, respectively. A total of 23 bioactive compounds were identified by UPLC-MS, including gallic acid, rutin, resorcinol, chlorogenic acid, catechin, and ellagic acid, and the antioxidant capacity can be attributed to these species. The edible part of plum contains compounds of biological interest, suggesting that this fruit has antioxidant potential that can be exploited for various technologies.

Physicochemical characterization of actomyosin-paramyosin from giant squid mantle (Dosidicus gigas).

BACKGROUND: The giant squid (Dosidicus gigas) has been proposed as raw material to obtain myofibrillar protein concentrates. However, it has been observed that colloidal systems formed from squid proteins have limited stability. Therefore, the isolation and characterization of the actomyosin-paramyosin isolated (API) complex were performed, because they are the main proteins to which functionality has been attributed. RESULTS: Densitogram analysis revealed 45% of actin, 38% of myosin and 17% of paramyosin. The amino acid profile indicates a higher proportion of acidic amino acids, which gives a higher negative charge; this was supported by the zeta potential. Total sulfhydryl (TSH) content was lower compared with proteins of other aquatic species. CONCLUSION: The higher percentage of actin in relation to myosin, the presence of paramyosin, as well as the low content of sulfhydryl groups, could comprise the main causes of the low technological functional property of proteins from D. gigas mantle. © 2017 Society of Chemical Industry.

Sulfur-Containing Aristoloxazines and Other Constituents of the Roots of Aristolochia orbicularis.

Six new compounds, aristoloxazine A (1), aristoloxazine B (2), 7-methoxytaliscanine (3), humul-7-en-1,4,11-triol (4), 8-hydroxy-ß-logipinene (5), and 1ß-hydroxy-4(14)-eudesmene (6), corresponding to two sulfur-containing aristoloxazines (1 and 2), an aristolactam (3), and three sesquiterpenes (4-6) were isolated, along with 26 known compounds, from the roots of Aristolochia orbicularis. The structures of the new compounds were established based on their spectroscopic and spectrometric data and in the case of aristoloxazine A (1) by single-crystal X-ray crystallography. This is the first report of sulfur-containing aristoloxazines from a natural source. Furthermore, aristoloxazine A (1) was found to possess potent in vitro antimicrobial activity against all resistant Staphylococcus aureus and several fungal strains in which it was evaluated.

NEET adolescents grown up: eight-year longitudinal follow-up of education, employment and mental health from adolescence to early adulthood in Mexico City.

The purpose is to examine the socio-demographic and mental health outcomes in early adulthood of those who as adolescents were not in education, employment or training, termed NEET, compared to their counterparts who studied, worked, or both. One thousand and seventy-one youth residing in Mexico City participated in a representative, prospective, longitudinal 8-year two-Wave cohort study. At Wave I the participants were aged 12-17 and at Wave II aged 19 and 26. The Composite International Diagnostic Interview assessed psychiatric disorders, substance use and abuse, suicidal behavior, interpersonal relationships, employment and education. The main finding of this study is that being NEET in adolescence was associated with several socio-demographic and mental health outcomes in early adulthood, above and beyond baseline socioeconomic disadvantage and mental health compared to their peers, particularly their peers who studied only or studied and worked. NEET youth were not that different from their peers who worked exclusively highlighting the protective value of keeping youth in school. The strongest differences between NEET youth and all their peer groups were their increased risks of incident suicidal behaviors. Social policies are needed for creating more educational opportunities, greater support for retention of students, and programs to facilitate the transition from school to the labor market considering cultural attitudes towards life trajectory expectations.

Chemical constitution and effect of extracts of tomato plants byproducts on the enteric viral surrogates.

Byproducts of tomato are known to include phenolic compounds but have not been studied in depth. In this study, the phenolic compositions of (stem, leaf, root, and whole plant) of two tomato cultivars, Pitenza and Floradade, were analyzed by HPLC-DAD. In parallel, the antiviral effects of crude extracts on viral surrogates, the bacteriophages MS2 and Av-05 were evaluated. The leaf extracts from the two varieties showed the highest concentration of phenolic compounds. The compounds identified were gallic acid, chlorogenic acid, ferulic acid, cafeic acid, rutin, and quercetin, and they represented 3174.3 and 1057.9 mg/100 g dried weight of the Pitenza and Floradade cultivars, respectively. MS2 and Av-05 titers at 5 mg/mL were reduced by 3.47 and 5.78 log10 PFU/mL and 3.78 and 4.93 log10 PFU/mL by Pitenza and Floradade cultivar leaf extract, respectively. These results show that tomato extracts are natural sources of bioactive substances with antiviral activity.

[Health status of the elderly in primary health care practices using an integral geriatric assessment]. / Estado de salud en el adulto mayor en atención primaria a partir de una valoración geriátrica integral.

OBJECTIVE: To determine the health status of patients 60 years of age or over in Primary Health Care practices using an integral geriatric assessment. DESIGN: Descriptive cross-sectional study. LOCATION: Five primary care units, Instituto Mexicano del Seguro Social; México. PARTICIPANTS: Elderly patient aged 60 years of age or over, who were seen in primary health care practices. Previously signed informed consent was given, with exclusion criteria being non-completion of the integral geriatric assessment. A technical sample of conglomerates and quota was used. MAIN MEASUREMENTS: Medical dimension variables: visual, hearing (Hearing Handicap Inventory for the Elderly), urinary incontinence (Consultation in Incontinence Questionnaire), nutritional condition (Mini Nutritional Assessment), personal clinical history, polypharmacy; mental impairment (Mini Mental State Examination), depression (Yesavaje); functional: basic (Katz) and instrumental (Lawton and Brody) activities of daily living, mobility (Up and go) and social (Social sources scale). The analysis included percentages and confidence intervals. RESULTS: In the medical dimensions; 42.3% with visual impairment, 27.7% hearing, 68.3% urinary incontinence, 37.0% malnutrition, and 54.7% polypharmacy. In the mental dimension: 4.0% severe mental impairment, and 11% depression: functional dimension: 2.0% total dependence of activities of daily living; 14.3% instrumental activities impairment; 29.0% mobility impairment, and 48.0% had moderately deteriorated social resources. CONCLUSION: The health status of the elderly seen in primary health care practices is characterized by independent patients with different levels of alterations in the medical dimensions, low levels in mental alteration, and moderately deteriorated social resources.

[Natural history of breast cancer diagnostic procedures]. / Historia natural del proceso diagnóstico del cáncer de mama.

OBJECTIVE: To build a model that explains the natural history of breast cancer diagnostic procedures. METHODS: Descriptive cross-sectional study of 245 women between 40 and 69 years of age, selected by simple random sampling, who underwent a mammography and met the requirements of the breast cancer diagnostic procedure. Diagnosis was made by biopsy. For the diagnostic procedure, an estimate was made of the percentage of patients seen by each service, the total number of patients per service, and the total number of consultations in each service, with 95% confidence intervals. RESULTS: Of the patients who initiated the breast cancer diagnostic procedure in preventive medicine services, 20% underwent a mammography; 23.7% were seen in family medicine services and of these patients, 70.9% were referred to a breast clinic, where 7.3% underwent a harpoon biopsy. The prevalence of breast cancer confirmed by biopsy was 0.48% (95%CI: 0.0-1.3). Per 1 000 patients who initiated the procedure, 47.4 were seen in family medicine services and 33.6 in a breast clinic, and open biopsies were performed on 2.4. Per 1 000 patients who initiated the procedure, there were 211.4 consultations in radiology services, 51.6 in family medicine services, and 54.6 in a breast clinic. CONCLUSIONS: The model described here may be useful in planning and evaluation activities.

The "Little-Old-Lady's Hernia", Obturator Hernia: A Case Report and Literature Review.

Obturator hernias, though rare, are clinically significant abdominal hernias, predominantly affecting elderly, thin women, with an estimated prevalence of less than 1%. The primary treatment involves surgical intervention to reduce and repair the defect, either through laparotomy or laparoscopy, with bowel resection needed in up to 75% of patients. Here, we present the case of an 83-year-old woman presenting with abdominal pain and a history of constipation. An abdominal computed tomography scan demonstrated a left obturator hernia with small bowel obstruction. Successful reduction of the hernia was achieved, albeit requiring intestinal resection via an open surgical approach. Subsequently, the patient achieved complete recovery.

[Association between family functionality and mild cognitive impairment in the family with the elderly]. / Asociación entre funcionalidad familiar y deterioro cognitivo leve en la familia con adulto mayor.

AIM: To determine the association between family functionality and mild cognitive impairment in the family with the elderly. METHODOLOGY: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test. RESULTS: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000). CONCLUSION: There is an association between family functionality and mild cognitive impairment.

[Anorectal melanoma: Clinical case]. / Melanoma anorrectal: un caso clínico.

Background: Anorectal melanoma (AM) is a rare and aggressive type of tumor, with varied and inconclusive scientific information. Its preoperative diagnosis is challenging due to its rarity and similarity to other anorectal conditions. It represents only 1.3% of melanomas and affects more women than men. Approximately 20-30% of AM cases are amelanotic, complicating endoscopic detection and leading to misdiagnoses. AM is often confused with hemorrhoids, polyps, and rectal cancer in two thirds of patients due to similar symptoms. The causes and risk factors of AM are not well understood, but they are suspected to differ from cutaneous and ocular melanomas. Diagnosis is performed through biopsy and immunohistochemical staining. Colonoscopy helps to characterize the lesions, and histological examination is crucial for definitive diagnosis. Clinical case: 50-year-old woman with rectal bleeding and proctalgia. AM was diagnosed through colonoscopy, and transanal resection with hemorrhoidectomy was performed. Conclusions: Management of AM is complicated by the lack of randomized trials. Resection surgery is the standard treatment, but there is no established protocol. Wide local excision may be an option for limited cases. Further research is needed to improve the management and treatment of AM. Early detection and complete surgical removal are crucial for enhancing survival in these patients.

Introducción: el melanoma anorrectal (MA) es un tipo raro y agresivo de tumor, cuya información científica es variada y poco concluyente. Su diagnóstico preoperatorio es un desafío debido a su rareza y a su similitud con otras afecciones anorrectales. Representa solo el 1.3% de los melanomas y afecta más a mujeres que a hombres. Aproximadamente el 20-30% de los casos de MA son amelanóticos, lo que complica su detección endoscópica y conduce a diagnósticos erróneos. El MA se confunde con hemorroides, pólipos y cáncer de recto en dos tercios de los pacientes debido a síntomas similares. Las causas y factores de riesgo del MA aún no se conocen bien, pero se sospecha que son diferentes de los melanomas cutáneos y oculares. El diagnóstico se realiza mediante biopsia y tinción inmunohistoquímica. La colonoscopía permite caracterizar las lesiones y el examen histológico es crucial para el diagnóstico definitivo. Caso clínico: mujer de 50 años con rectorragia y proctalgia. Se diagnosticó MA mediante colonoscopía y se realizó una resección transanal con hemorroidectomía. Conclusiones: el manejo del MA es complicado por la falta de ensayos aleatorizados. La cirugía de resección es el tratamiento habitual, pero no hay un protocolo establecido. La escisión local amplia puede ser una opción para casos limitados. Se necesita más investigación para mejorar el manejo y tratamiento del MA. La detección temprana y la extirpación quirúrgica completa son cruciales para mejorar la supervivencia en estos pacientes.