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Background: In Mexico and the world, breast cancer is the cancer type with the highest incidence and mortality for women. Its incidence has increased due to a higher life expectancy and a higher exposure to risk factors. Screening is done by mammography using the BIRADS (Breast Imaging Reporting and Data System) system, the standard for mammography screening report which classifies lesions assigning recommendations for patient follow-up. The system goes from 0 (not conclusive) to 6 (demonstrated malignancy), being of interest for this study the BIRADS 0 category. Objective: To describe patients classified as BIRADS 0 by mammography and their reclassification in a first-level hospital during 2021. Material and methods: Retrospective, descriptive, cross-sectional, observational study. Women over 40 years with a BIRADS 0 result were studied. The following databases were used: Institutional Cancer Registry, Family Medicine Information System, Electronic Clinical File, and the mammography and patient list from preventive medicine. Results: Reclassification by ultrasound (US) was achieved in 100% of patients, in all of the BIRADS US categories. In 3.8% of BIRADS 0 patients, ductal adenocarcinoma was found and confirmed by histological testing. Conclusion: All of the reassessed lesions with US were adequately reclassified.

Introducción: en México y el mundo, el cáncer de mama causa la mayor mortalidad por cáncer en mujeres. Su incidencia ha incrementado por una mayor esperanza de vida y exposición a factores de riesgo. El tamizaje de esta enfermedad se hace mediante mastografía, y para la estratificación de las lesiones se utiliza el sistema BIRADS (Breast Imaging Reporting and Data System), que estandariza el informe, categoriza las lesiones según el grado de sospecha y asigna recomendaciones a seguir. Dicho sistema va desde 0 (no concluyente) hasta 6 (lesión con malignidad demostrada) y es de interés para este estudio la categoría 0. Objetivo: describir la reclasificación de pacientes con reporte BIRADS 0 por mastografía durante 2021 en una unidad de primer nivel de atención. Material y métodos: estudio retrospectivo, descriptivo, transversal, observacional. Se estudiaron mujeres mayores de 40 años con resultado BIRADS 0. Se utilizaron las siguientes bases de datos: Registro Institucional de Cáncer, Sistema de Información de Medicina Familiar, Expediente Clínico Electrónico y lista nominal de mastografías y censo de pacientes sospechosos de medicina preventiva. Resultados: la reclasificación con ultrasonido (US) se logró en el 100% de pacientes, en todas las categorías de BIRADS US. En el 3.8% se confirmó carcinoma ductal por histología en las pacientes inicialmente categorizadas como BIRADS 0. Conclusiones: la totalidad de lesiones reevaluadas con US fueron reclasificadas satisfactoriamente.

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Background: Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods: Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results: Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion: Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.

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Background: The control of diabetes mellitus is multifactorial, the different therapeutic options make it necessary to compare the effectiveness with previous therapeutic schemes. Objective: Analize the indicators of control of diabetes mellitus after incorporating liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin. Methods: Observational, analytical, longitudinal study. Glucose, glycosylated hemoglobin, and blood pressure were compared after the inclusion of new cues in patients with diabetes mellitus; in addition to the control indicators reported in the unit in october, november, and december 2000, with those of 2021 in the same months. A descriptive analysis was performed, T for related samples and McNemar, a value of < .05 was considered significant, a confidence level of 95%, with the IBM-SPSS 24 software. Results: 352 files were analyzed, 59% women, aged 26 to 88 years, and the percentage of control decreased after the change of scheme (38.4% vs 35.8%) without a statistical difference (p .503). There was no statistical difference between the levels of glucose, glycated hemoglobin, weight, and blood pressure before and six months after the change. In the unit, the regimen glycemic control indicator improved in October, November, and December 2020 compared to the same months in 2021, it increased (from 17.2, 18.7, and 16.3, to 41.6, 47.2, and 46.5%). Blood pressure control went from 64.5, 66.7, and 67 to 82.4, 85.1, and 83.1%. Conclusions: The control indicators in the unit improved, however, the patients who used the new keys did not show any difference.

Introducción: el control de la diabetes mellitus es multifactorial, las diferentes opciones terapéuticas hacen necesario comparar la efectividad con esquemas terapéuticos previos. Objetivo: analizar los indicadores de control de diabetes mellitus posterior a incorporar liraglutida, sitagliptina/metformina, linagliptina y sitagliptina. Métodos: estudio observacional, analítico, longitudinal. Se compararon glucosa, hemoglobina glucosilada y presión arterial posterior a la inclusión de nuevas claves en pacientes con diabetes mellitus; además de los indicadores de control reportados en la unidad en los meses octubre, noviembre y diciembre 2020, con los del 2021 en los mismos meses. Se realizó un análisis descriptivo, T para muestras relacionadas y McNemar, se consideró un valor de p ≤ 0.05 como significativo, un nivel de confianza de 95%, con el programa informático IBM-SPSS 24. Resultados: se analizaron 352 expedientes, el 59% correspondía a mujeres, con edades de 26 a 88 años, el porcentaje de control disminuyó después del cambio de esquema (38.4% frente a 35.8%) sin diferencia estadística (p = 0.503). No hubo diferencia estadística entre los niveles de glucosa, hemoglobina glucosilada, peso y presión arterial previos y seis meses después del cambio de esquema. En la unidad, el indicador de control de glucemia en los meses de octubre, noviembre y diciembre 2020 comparados con los mismos meses en el 2021 incrementaron (17.2, 18.7 y 16.3, a 41.6, 47.2 y 46.5%). El control de presión arterial pasó del 64.5, 66.7 y 67 a 82.4, 85.1 y 83.1%. Conclusiones: los indicadores de control en la unidad mejoraron, sin embargo los pacientes que utilizaron las nuevas claves no mostraron diferencia.

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BACKGROUND: The Division of Educational Innovation offers open courses training, updating and training courses that promote self-taught learning. It is important to take the user´s perspective into account in the evaluation to improve educational quality. OBJECTIVE: Analyze the perception of family doctors about the online courses of the platform of The Division of Educational Innovation. METHOD: Qualitative study, descriptive. Included family doctors who took at least one online course. Their opinion on online courses was asked and the questionnaire MOOC (Massive Online Open Courses) was applied. An analysis of the content of the open questions was carried out, the questionnaire was evaluated globally and by sections. RESULTS: 19 doctors included, 58% women, the majority have taken the online course for updating and professional and personal interest, the main limitation is the lack of time. Registration restrictions, platform failure, course duration time and disinterest are also mentioned. The quality of the courses was measured as regular by 36.8% and low quality by 26.3%, with adaptation to the user and didactic planning being the lowest scores. CONCLUSIONS: The perception of online courses is good, considering the to be of regular quality, with time being the main limiting factor.

INTRODUCCIÓN: La División de Innovación Educativa ofrece cursos abiertos de formación, actualización y capacitación que favorecen el aprendizaje autodidacta. Es importante tomar en cuenta la perspectiva del usuario en la evaluación para mejorar la calidad educativa. OBJETIVO: Analizar la percepción de los médicos familiares sobre los cursos en línea de la plataforma de la División de Innovación Educativa. MÉTODO: Estudio cualitativo, descriptivo, que incluyó médicos familiares que tomaron como mínimo un curso en línea. Se preguntó su opinión sobre los cursos en línea y se aplicó el cuestionario MOOC (Massive Online Open Courses). Se realizó un análisis de contenido de las preguntas abiertas, y el cuestionario se evaluó de forma global y por dimensiones. RESULTADOS: El estudio incluyó a 19 médicos de los cuales el 58% fueron mujeres. La mayoría tomó los cursos en línea por actualización e interés profesional y personal, y señalan como principal limitación la falta de tiempo. También se mencionan restricciones en el registro, fallas en la plataforma, tiempo de duración del curso y desinterés. La calidad de los cursos fue calificada como regular por el 36.8% y baja por el 26.3%, siendo la adaptación al usuario y la planeación didáctica las puntuaciones más bajas. CONCLUSIÓN: La percepción de los cursos en línea es buena, considerándolos de regular calidad, y el factor tiempo es la principal limitante.

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BACKGROUND: Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients. METHODS AND FINDINGS: Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006-0.060); p-value: 0.0156). CONCLUSIONS: Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.

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The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.

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