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Objective: To evaluate the time of ureteral ejection of intravenous sodium fluorescein in the assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy (TLH). Material and Methods: Fifty-four women undergoing TLH were studied in a public teaching hospital in Culiacan, Sinaloa, Mexico. They underwent cystoscopic evaluation of ureteral patency after intravenous administration of 100 mg of sodium fluorescein. The present study analyzed the time elapsed in minutes from the intravenous administration of fluorescein to the outflow of stained urine by one or both ureteral meatus, the degree of urine staining, and the impact of body mass index (BMI) (BMI; normal, overweight, and obesity) on ejection time. Results: The overall average time elapsed to visualize the ejection of fluorescein through at least one ureteral meatus was 7.5 minutes [95% confidence interval (CI): 6.3-8.7]. There were no significant differences in the time of ureteral ejection of fluorescein taking BMI into account (p=0.579), with a mean time for normal BMI of 8.1 minutes (95% CI: 5.1-11.2), for overweight of 7.0 minutes (95% CI: 5.5-8.5), and for obesity of 7.8 minutes (95% CI: 5.3-10.3). Conclusion: Intravenously administered 10% sodium fluorescein dye is rapidly eliminated and strongly stains urine, which makes it useful for identifying ureteral patency during cystoscopy after TLH. Fluorescein excretion is not affected by patient BMI.

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Resumen OBJETIVO: Comparar la frecuencia de dehiscencia de la cúpula vaginal en pacientes tratadas con y sin estrógenos equinos conjugados por vía vaginal antes de la histerectomía total laparoscópica. MATERIALES Y MÉTODOS: Ensayo clínico controlado, comparativo, ciego simple, efectuado en pacientes atendidas entre enero de 2013 y agosto de 2016 en el Hospital Civil de Culiacán con indicación de histerectomía total laparoscópica por enfermedad benigna. Criterios de inclusión: haber recibido durante tres semanas previas al procedimiento estrógenos equinos conjugados por vía vaginal (grupo de estudio) o crema lubricante vaginal como placebo (grupo control). Criterios de exclusión: pacientes con diabetes mellitus tratadas con esteroides y antecedente de un evento tromboembólico reciente. Se evaluó la frecuencia de dehiscencia de la cúpula vaginal a los 7 y 30 días posteriores a la cirugía. Se utilizó la prueba t de Student para comparar medias y la χ2 para la comparación de proporciones, con cálculo de riesgo relativo para evaluar el riesgo de dehiscencia de la cúpula vaginal. RESULTADOS: Se estudiaron 236 pacientes con edad promedio, en ambos grupos, de 47.1 y 47.7 años, respectivamente (p > .05). Los antecedentes ginecoobstétricos y las indicaciones para histerectomía fueron similares en ambos grupos (p = .340). La incidencia total de dehiscencia de la cúpula vaginal fue de 4.6% (n = 11/236) con frecuencia de 6.8% (n = 8/118) en las pacientes del grupo tratado con lubricante vaginal y de 2.5% (n = 3/118) en el grupo tratado con estrógenos equinos conjugados por vía vaginal, sin diferencias entre ambos grupos (p = .123; RR=.359; IC95%: .093-1.387). CONCLUSIONES: El riesgo de dehiscencia de la cúpula vaginal fue similar entre el grupo que recibió lubricante y el de estrógenos tópicos vaginales, pero con una tendencia menor en la frecuencia de dehiscencia de la cúpula vaginal en el grupo tratado con estrógenos tópicos.

Abstract OBJECTIVE: To compare the frequency of vaginal cuff dehiscence in patients managed with and without conjugated equine estrogens vaginally prior to total laparoscopic hysterectomy (TLH). MATERIALS AND METHODS: In a single-blind controlled clinical trial, 236 patients with indications for laparoscopic total hysterectomy for benign pathology at the Hospital Civil de Culiacán and who agreed to participate in the study were randomly assigned to receive vaginally conjugated equine estrogens (study group) or vaginal lubricating cream as a placebo (control group) for 3 weeks prior to the procedure. Patients with diabetes mellitus, treated with steroids and history of a recent thromboembolic event were excluded. The frequency of vaginal cuff dehiscence was evaluated at 7 and 30 days after surgery. The student's t-test was used to compare means and the Chi-square test was used to compare proportions, with relative risk (RR) calculation to evaluate the risk of vaginal cuff dehiscence. RESULTS: We studied 236 patients with average age, in both groups, 47.1 and 47.7 years, respectively (p > .05). The mean age of the patients was similar between the groups (47.1 vs 47.7 years, p>.05). The gynecological-obstetric history and indications for hysterectomy were similar between both groups (p = .340). The incidence of vaginal cuff dehiscence was 2.5% (n = 3) in the group treated with conjugated equine estrogens vaginally and 6.8% (n = 8) in the patients of thse group treated with vaginal lubricant (p= .123; RM= .359; IC95%: .093-1.387). CONCLUSIONS: The risk of presenting vaginal cuff dehiscence was similar between the group of lubricant and topical vaginal estrogens, but with a lower tendency in the frequency of vaginal cuff dehiscence in the group of topical estrogens.

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BACKGROUND: It has been proposed that abnormal modulation of inflammatory response is involved in the physiopathology of idiopathic recurrent spontaneous abortion (iRSA). Factors that may participate in this process include the genetic background such as carrying specific polymorphisms of genes with functional effects. OBJECTIVE: The objective is to study the association between iRSA and the frequency of intron-2 variable number tandem repeat-polymorphisms of interleukin-1 receptor antagonist gene (IL1RN). METHODS: We conducted a case-control study including 108 women with iRSA and 103 controls. Five allelic variants of IL1RN were determined by polymerase chain reaction (PCR) product length analysis. RESULTS: The most frequent IL1RN allele in this population was IL1RN*1, which was present in 78% of cases and 94% of controls, and allele IL1RN*2, in 45 (20.8%) cases and 12 (5.8%) controls. Allele IL1RN*2 was significantly associated with iRSA (odds ratio = 4.28, 95% confidence interval 2.2-8.4; p = 0.000). CONCLUSION: Carrying allele IL1RN*2 had a strong association with iRSA in Mexican women. This polymorphism codifies for a low-function protein, which may allow for increased activity of IL-1 pro-inflammatory axis in iRSA.

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INTRODUCTION: Acute appendicitis is the most common surgical disease in emergency surgery, however, it remains a diagnostic problem and represents a challenge despite the experience and the different clinical and paraclinical diagnostic methods. OBJECTIVE: To evaluate in a comparative way the scale of Alvarado, AIR and RIPASA to determine which one is best as a diagnostic test of acute appendicitis in our population in order to arrive to an accurate diagnosis in the shortest possible time and cost. METHOD: Observational, prospective, transversal and comparative study of 137 patients to whom the scale of Alvarado, AIR and RIPASA was applied, who entered the emergency service of the Civil Hospital of Culiacán (México) with abdominal pain syndrome suggestive of acute appendicitis. RESULTS: The Alvarado scale presented sensitivity 97.2% and specificity of 27.6%. AIR presented sensitivity of 81.9% and specificity of 89.5%. RIPASA showed the same results as Alvarado. All tests showed diagnostic accuracy above 80. CONCLUSIONS: Alvarado and RIPASA presented good sensitivity, however, AIR is more specific, and has better accuracy for the diagnosis of acute appendicitis, making a better screening and thus reducing unnecessary surgeries. Therefore, it is recommended to use more AIR than Alvarado and RIPASA.

INTRODUCCIÓN: La apendicitis aguda es la enfermedad quirúrgica más común en cirugía de urgencia; sin embargo, sigue siendo un problema diagnóstico y representa un reto a pesar de la experiencia y los diferentes métodos de diagnóstico clínicos y paraclínicos. OBJETIVO: Evaluar en forma comparativa las escalas de Alvarado, AIR y RIPASA para determinar cuál es superior como prueba diagnóstica de apendicitis aguda en nuestra población, llegando a un diagnóstico preciso en el menor tiempo y costo posibles. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo de 137 pacientes a quienes se aplicó las escalas de Alvarado, AIR y RIPASA, que ingresaron al servicio de urgencias del Hospital Civil de Culiacán (México) con síndrome doloroso abdominal sugestivo de apendicitis aguda. RESULTADOS: La escala de Alvarado presentó una sensibilidad del 97.2% y una especificidad del 27.6%. AIR tuvo una sensibilidad del 81.9% y una especificidad del 89.5%. RIPASA arrojó los mismos resultados que Alvarado. Todas las pruebas tuvieron una exactitud diagnóstica por arriba del 80. CONCLUSIONES: Alvarado y RIPASA presentaron buena sensibilidad, mientras que AIR es más específica y tiene mayor exactitud diagnóstica de apendicitis aguda, realizando un mejor tamizaje y permitiendo disminuir las cirugías innecesarias, por lo que se recomienda usar más AIR que Alvarado y RIPASA.

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Resumen Objetivo: Evaluar el patrón menstrual y la reserva ovárica mediante la determinación de FSH y conteo de folículos antrales en pacientes con salpingectomía y oclusión tubárica bilateral como métodos de esterilización definitiva. Material y métodos: Estudio prospectivo, longitudinal, comparativo, experimental, con asignación al azar, ciego simple, al que se incluyeron pacientes con deseos de esterilización definitiva como método anticonceptivo. Las pacientes se asignaron al azar a dos grupos, el primero con oclusión tubárica bilateral y el segundo con salpingectomía. A los seis meses posprocedimiento se evaluaron en forma ciega el patrón menstrual y la determinación sérica de hormona folículo estimulante (FSH) y el recuento de folículos antrales por ultrasonido transvaginal como marcadores de reserva ovárica. El análisis estadístico se llevó a cabo con t de Student para muestras independientes (comparación entre los grupos) y dependientes (comparación intragrupo) para comparación de medias y la prueba x2 para comparación de proporciones. Resultados: Se estudiaron 60 pacientes, 31 con oclusión tubárica bilateral y 29 con salpingectomía. Se registraron aumentos significativos en los días de sangrado menstrual con respecto a la basal después de la oclusión tubaria bilateral (p = .002) y salpingectomía (p = .008). No hubo diferencias entre oclusión tubárica bilateral y salpingectomía con respecto al tiempo quirúrgico para llevar a cabo la técnica de esterilización (p = .83), duración del ciclo menstrual (p = .35), duración de los días de sangrado menstrual (p = .40). Tampoco resultaron diferencias en las concentraciones séricas de FSH (p = 0.75) ni en el recuento de folículos antrales (p = .44) entre los grupos. Conclusiones: El patrón menstrual y la reserva ovárica son muy similares en pacientes con oclusión tubárica bilateral o salpingectomía. Ambas técnicas incrementan la duración del sangrado menstrual posterior al procedimiento. La salpingectomía implica un aumento ligero en el tiempo quirúrgico, sin diferencias en la frecuencia de complicaciones.

Abstract Objective: To evaluate the menstrual pattern and ovarian reserve in patients undergoing salpingectomy and bilateral tubal occlusion as definitive sterilization methods. Material and methods: A prospective, longitudinal, comparative, experimental, randomized, single blind study was carried out in patients with a desire for definitive sterilization as a contraceptive method. Patients were randomly assigned to perform bilateral tubal occlusion or salpingectomy. Six months after the procedure in each patient, the menstrual pattern and the serum determination of follicle stimulating hormone (FSH) and the antral follicle count were evaluated by transvaginal ultrasound as markers of ovarian reserve. The statistical analysis was carried out using the student's t-test for independent samples (comparison between groups) and dependent samples (intra-group comparison) for comparison of means and the x2 test for comparison of proportions. Results: Sixty patients were studied, 31 with bilateral tubal occlusion and 29 with salpingectomy. Significant increases were observed in the days of menstrual bleeding with respect to the baseline after bilateral tubal occlusion (p = .002) and salpingectomy (p = .008). No differences were observed between bilateral tubal occlusion and salpingectomy with respect to the surgical time to carry out the sterilization technique (p = .83), menstrual cycle duration (p = .35), duration of the days of menstrual bleeding (p = .40). No differences were observed in the serum levels of FSH (p = .75) nor in the antral follicle count (p = .44) between the groups. Conclusions: The menstrual pattern and the ovarian reserve are very similar in patients who undergo bilateral tubal occlusion and salpingectomy, although the two techniques increase the duration of menstrual bleeding after the procedure.

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BACKGROUND: Evidence shows the negative impact of irritable bowel syndrome on the quality of life of patients who suffer from the condition as compared to the general population. OBJECTIVE: The objective of this study was to determine the health-related quality of life in adults with irritable bowel syndrome who are receiving treatment at a specialist hospital. MATERIAL AND METHODS: The study had a cross-sectional prospective design. The study included consecutive patients diagnosed with irritable bowel syndrome under the Rome III criteria and attending outpatient appointments. The SF-36 questionnaire was applied in its standard Spanish version and the results were compared with population reference scores in Mexico. Statistical analysis was performed with the Student's t test, analysis of variance and the Chi-squared test, considering a significance of 0.05%. RESULTS: One hundred and fifty-four patients were included in the study, 137 (89%) women and 17 (11%) men, with an average age of 52.8 (SD 12.6). The constipation, diarrhea and mixed subtypes comprised 85 (55.2%), 27 (17.5%) and 42 (27.3%) patients, respectively. The quality of life of patients with irritable bowel syndrome vs the population reference scores in Mexico were 50 vs 79 for the physical health sub-scale and 59.1 vs 76.7 for the mental health sub-scale, respectively (p = 0.000). No significant difference was found in quality of life among the irritable bowel syndrome subtypes (p > 0.05). CONCLUSIONS: Health-related quality of life is lower in patients with irritable bowel syndrome in a population in the North East of Mexico compared to the data taken from a population reference study undertaken in the same country, enabling an inference in the female population and a cautious one from the results found in the small male sample studied. There was no significant difference found in the quality of life according to the clinical subtype of irritable bowel syndrome.

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INTRODUCTION: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. MATERIAL AND METHODS: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. Forthe statistical analysis, we used Student´s t-test and Chi-square, 95 % confidence intervals and significance 0.05 %. RESULTS: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal anti-inflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. CONCLUSIONS: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries.

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OBJECTIVE: To evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH). METHODS: In a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain. RESULTS: The mean duration of surgical procedure (P<0.001) and operative bleeding (P=0.002) were lower for patients with normal BMI compared with the other 2 groups. The rate of conversion to laparotomy was similar among the 3 groups. Overall, the frequency of complications was 6.2% (n=13/209); the frequency of complications by study group was 2.6%, 4.8%, and 14% for the normal BMI, overweight and obesity groups, respectively (P<0.05). Major complications were more frequent among patients with obesity (P=0.010). CONCLUSION: The duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30).

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BACKGROUND: The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman. OBJECTIVE: To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery. PATIENTS AND METHODS: We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome. RESULTS: The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p = 0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR = 2.9, 95% CI 1.2-7.6, p = 0.036). There were no differences in perinatal outcomes between the groups. CONCLUSIONS: Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.

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