RESUMEN

OBJECTIVES: Exercise has been scarcely studied in patients with cirrhosis, and prior evidence showed hepatic venous pressure gradient (HVPG) to be increased in response to exercise. The aim of this study was to investigate the effects of a supervised physical exercise program (PEP) in patients with cirrhosis. METHODS: In an open-label, pilot clinical trial, patients with cirrhosis were randomized to PEP (cycloergometry/kinesiotherapy plus nutritional therapy, n=14) or control (nutritional therapy, n=15); for 14 weeks. Primary outcomes were: the effect of PEP in HVPG, and quality of life (chronic liver disease questionnaire, CLDQ). As secondary outcomes we investigated changes in physical fitness (cardiopulmonary exercise testing), nutritional status (phase angle-bioelectrical impedance), ammonia levels, and safety. RESULTS: Twenty-two patients completed the study (11 each). HVPG decreased in subjects allocated to PEP (-2.5 mm Hg (interquartile range: -5.25 to 2); P=0.05), and increased in controls (4 mm Hg (0-5); P=0.039), with a significant between-groups difference (P=0.009). No major changes were noted in CLDQ in both groups. There was significant improvement in ventilatory efficiency (VE/VCO2) in PEP group (-1.9 (-3.12 to -0.1); P=0.033), but not in controls (-0.4 (-5.7 to 1.4); P=0.467). Phase angle improvement and a less-pronounced exercise-induced hyperammonemia were noted only in PEP group. No episodes of variceal bleeding or hepatic encephalopathy were observed. CONCLUSIONS: A supervised PEP in patients with cirrhosis decreases the HVPG and improves nutritional status with no changes in quality of life. Further studies evaluating physical training in cirrhosis are eagerly awaited in order to better define the benefits of sustained exercise. ClinicalTrials.gov:NCT00517738.

RESUMEN

OBJECTIVE: The molecular and epidemiologic effect of human papillomavirus (HPV) coinfections in the risk of developing cervical cancer is yet unclear. The aim of this study was to determine the frequency HPV coinfections at different stages of cervical lesions in the development of cervical cancer and the impact of HPV specific type interactions on high-grade squamous intraepithelial lesions (HSIL) and invasive cervical cancer (ICC) risk. METHODS: HPV testing was performed in 931 cervical samples diagnosed as: negative for intraepithelial lesion or malignancy (NILM); low-grade squamous intraepithelial lesion (LSIL); HSIL; and ICC. For HPV detection and typing two sets of primers from the L1 region were used in the polymerase chain reaction method (PCR) (MY09/MY11/HMB01 and L1C1/L1C2.1/L1C2.2) and HPV type was determined by PCR product sequence. To look for multiple HPV infections, the E6 nested multiplex PCR method was performed in all DNA samples. Odds ratios were calculated as indexes of the strength of the association between the sample category (LSIL/NILM or ICC/HSIL) and the presence of a given viral combination. RESULTS: In HPV positive samples, coinfections are as common in ICC/HSIL as in LSIL/NILM (47.12% and 40.17%, respectively). There is an increased risk to ICC/HSIL when multiple high-risk HPV types are present. The coinfection of HPV68 with HPV16 increases the risk of ICC/HSIL (OR=14.54, P=0.012, after multivariate adjustment), related to the presence of HPV16 or HPV68 alone. CONCLUSIONS: These results sustain that specific HPV coinfections confer an increased risk to develop ICC/HSIL.

Asunto(s)

Coinfección/epidemiología , Infecciones por Papillomavirus/complicaciones , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Papillomavirus Humano 16 , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/patología , Medición de Riesgo , Neoplasias del Cuello Uterino/patología , Adulto Joven , Displasia del Cuello del Útero/patología

RESUMEN

INTRODUCTION: Treatment of aortic coarctation with hypoplastic aortic arch is still a surgical challenge. The aortic arch advancement surgery has shown less re-coarctation frequency. OBJECTIVE: To determine the re-coarctation frequency in patients who underwent aortic arch advancement technique for aortic coarctation with hypoplastic aortic arch and analyze the results. MATERIAL AND METHODS: Retrospective and observational study of 38 patients who underwent aortic arch advancement in a third level Institution from 2002 to 2010. RESULTS: Twenty four males and 14 females all with aortic arch Z index diameter of < or = -2 were found. The median age was 2.6 months and the median weight was 3.8 kg. Twelve patients (31.5%) did not show post operative complications. Eighteen (47%) had only one complication; one patient (2.6%) had 2 complications and 2 (5.2%) had 3 complications. After a follow up of 3.7 years the frequency of re-coarctation was O%. DISCUSSION: With the previously mentioned technique the recoarctation frequency on medium and long term basis was 0%. From the anatomical and functional point of view, we believe this technique offers the best possible results.

Asunto(s)

Aorta Torácica/anomalías , Aorta Torácica/cirugía , Coartación Aórtica/complicaciones , Coartación Aórtica/cirugía , Femenino , Humanos , Lactante , Masculino , Recurrencia , Estudios Retrospectivos , Procedimientos Quirúrgicos Vasculares/métodos

RESUMEN

OBJECTIVE: The aim of this study was to determine the frequency and genotype distribution of single and multiple human papillomavirus (HPV) infections in head and neck squamous cell carcinomas (HNSCCs) in a Mexican population and to assess their associations with smoking and drinking habits and clinicopathologic characteristics. STUDY DESIGN: A cross-sectional study was performed on a sample of patients diagnosed with HNSCCs. Tumor DNA was amplified using polymerase chain reaction with HPV consensus and multiplex primers. The associations among HPV status, survival, and clinical characteristics were analyzed. RESULTS: Sixteen of the 43 HNSCCs were HPV positive. HPV16 was the most prevalent type, with single infections present in 5 cases, whereas another 5 cases were combined with HPV56 infection. There was a significant association between HPV infection and oropharyngeal cancers. HPV positivity was associated with overall survival at a nearly significant P level of 0.06. CONCLUSIONS: Our data support the importance of HPV infection in oropharyngeal cancer, with a trend toward higher survival in HPV-positive cases.

Asunto(s)

Alphapapillomavirus/clasificación , Carcinoma de Células Escamosas/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Infecciones por Papillomavirus/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , Alphapapillomavirus/genética , Carcinoma de Células Escamosas/virología , Estudios de Cohortes , Estudios Transversales , Supervivencia sin Enfermedad , Electroforesis en Gel de Agar , Femenino , Estudios de Seguimiento , Genotipo , Neoplasias de Cabeza y Cuello/virología , Papillomavirus Humano 16/aislamiento & purificación , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/virología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/epidemiología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/virología , Reacción en Cadena de la Polimerasa , Prevalencia , Fumar/epidemiología , Tasa de Supervivencia

RESUMEN

Mexico has the second biggest prevalence in the world of obese adults (30%). We conducted a survey to determine knowledge concerning obesity co-morbidities. Three groups were surveyed with a questionnaire divided into three sections: demographic characteristics; knowledge and awareness in relation to obesity being a disease; causes of obesity and the health risks it represents; weight auto-perception and the subject's personal experiences regarding weight. In all groups we found high knowledge regarding that obesity is a disease and the causes of its development, as well as that it greatly increases the risk of presenting type 2 diabetes, high blood pressure and knee osteoarthritis. However, in all groups, there was a gap in knowledge regarding the risk obesity poses for the development of breast and colon cancer. Aggressive health promotion campaigns concerning obesity, which have been implemented recently in Mexico, must emphasize cancer as a potential outcome for obese patients.

Asunto(s)

Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/fisiopatología , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/etiología , Neoplasias/etiología , Obesidad/complicaciones , Osteoartritis de la Rodilla/etiología , Adolescente , Adulto , Actitud Frente a la Salud , Concienciación , Estudios de Casos y Controles , Comorbilidad , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/psicología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Promoción de la Salud , Humanos , Hipertensión/epidemiología , Hipertensión/psicología , Masculino , México/epidemiología , Neoplasias/epidemiología , Neoplasias/psicología , Obesidad/psicología , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/psicología , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven

Asunto(s)

Academias e Institutos/historia , Historia de la Medicina , Ciencias de la Nutrición/historia , Historia del Siglo XX , Medicina , México

RESUMEN

INTRODUCTION: Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water. OBJECTIVES: To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B). MATERIAL AND METHODS: One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed. RESULTS: Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group. CONCLUSIONS: The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.

Asunto(s)

Antiinfecciosos Locales/farmacología , Clorhexidina/análogos & derivados , Comportamiento del Consumidor , Etanol/farmacología , Cirugía General , Desinfección de las Manos/métodos , Mano/microbiología , Auxiliares de Cirugía/psicología , Grupo de Atención al Paciente , Médicos/psicología , Infección de la Herida Quirúrgica/prevención & control , Antiinfecciosos Locales/efectos adversos , Bacterias/aislamiento & purificación , Clorhexidina/efectos adversos , Clorhexidina/economía , Clorhexidina/farmacología , Ahorro de Costo , Dermatitis Profesional/epidemiología , Dermatitis Profesional/etiología , Dermatitis Profesional/prevención & control , Equipos y Suministros de Hospitales/economía , Etanol/efectos adversos , Etanol/economía , Femenino , Hongos/aislamiento & purificación , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/epidemiología , Dermatosis de la Mano/prevención & control , Humanos , Ictiosis/inducido químicamente , Ictiosis/epidemiología , Ictiosis/prevención & control , Masculino , Auxiliares de Cirugía/estadística & datos numéricos , Médicos/estadística & datos numéricos , Estudios Prospectivos , Agua

RESUMEN

OBJECTIVE: Several intratype variants of HPV16 and 18 have been identified. These variants are associated with populations from different geographic regions, and show a differential distribution among the severity of the cervical lesion, most likely due to different pathogenic potential. The objective of this study was to investigate the variant distribution of HPV16 and 18 in a Mexican population and its association with the severity of the cervical lesion and the histological lineage of cervical cancer. METHODS: HPV types 16 and 18 detection was performed in 412 samples of preinvasive and invasive specimens from patients attending a Primary Health-Care Center, an Early Cervical Lesion Clinic, or a Cancer Center. Distribution of HPV variants was correlated with the cytological findings and tumor cell types using contingency tables. Statistical difference was tested with the Fisher's Exact Test or its Fisher-Freeman-Halton extension for RXC tables. Alpha value was set at the P < 0.05. RESULTS: Among the 277 women included in this study without cancer, 63.5% (176 cases) had a normal cytology; from the remaining 101 women, 53.5% were LSIL (54 cases), and 46.5% HSIL (47 cases). From a total of 135 invasive carcinomas, 78.5% were squamous (106 cases); 6.6% adenocarcinoma (9 cases); 9.6% adenosquamous (ADSC) (13 cases); and 5.1% were undifferentiated carcinoma (7 cases). HPV16 E and AA-a were evenly distributed among preinvasive and invasive lesions. However, the isolate AA-c was exclusively found in cervical cancer. HPV18 Var-1(E) was almost exclusively found in invasive lesions, while the HPV18 Var-2(Af) predominated in normal or preinvasive lesions. In invasive cancer, this variant was found only in squamous tumors. CONCLUSIONS: The differential distribution of HPV16 and 18 variants in cervical lesions we found further supports experimental data on the different pathogenic potential of HPV16 and 18 variants for cervical cancer development.

Asunto(s)

Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 18/aislamiento & purificación , Infecciones por Papillomavirus/virología , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/virología , Cuello del Útero/virología , Femenino , Humanos , México/epidemiología , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/patología

RESUMEN

Background. Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary and pancreatic diseases. Objective. To know the complication rate of ERCP in the elderly. Patients and methods. Patient files who underwent ERCP were reviewed and were divided into two groups: aged 65 and older (group 1) and less than 65 years (group 2). Sociodemographic variables, prophylactic antibiotic use, indications for ERCP and outcomes were assessed. Results. Mean age in group 1 was 72.9 years and 41.7 years in group 2. Group 1 had more comorbidity (p < 0.001). The most frequent indication for the procedure was obstructive jaundice in both groups (63% versus 44%; p = 0.002). Malignancy was more frequent as a cause of biliary obstruction in group 1 (45% versus 21%; p < 0.001). ERCP was performed once in 76% in group 1 and 93% in group 2 (p = 0.001). Prophylactic antibiotics were used more frequently in group 1 (84% versus 60%; p < 0.001). There were no differences between groups regarding infectious complications (p = 0.700). There was no difference in mortality rates between groups. Conclusion. ERCP is a safe procedure in elderly patients. The elderly frequently have more comorbidity. Nevertheless, the complication and mortality rates did not differ in this study. It is noteworthy that elderly patients received prophylactic antibiotics more frequently than younger patients but infectious complications were not different. The patients should not be excluded from ERCP based on their age.

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Introducción. La colangiopancreatografia retrógrada endoscópica (CPRE) es un procedimiento ampliamente utilizado para el diagnóstico y tratamiento de las enfermedades biliares y pancreáticas. Objetivo. Conocer la frecuencia de complicaciones de la CPRE en los adultos mayores. Pacientes y métodos. Se revisaron los expedientes clínicos de pacientes que se sometieron a CPRE y se dividieron en dos grupos: de 65 años o mayores (grupo 1) y menores de 65 años (grupo 2). Se documentaron variables sociodemográficas, uso de antibióticos profilácticos, indicación de la CPRE y evolución. Resultados. El promedio de edad fue de 72.9 años en el grupo 1 y 41.7 años en el grupo 2. El grupo 1 presentó mayor frecuencia de comorbilidad (p < 0.001). La indicación más frecuente para la realización del procedimiento en ambos grupos fue la ictericia obstructiva (63 vs. 44%; p = 0.002). El cáncer fue más frecuente causa de obstrucción en el grupo 1 (45 vs. 21%; p < 0.001). La CPRE se realizó una vez en 76% del grupo 1 y en 93% en el grupo 2 (p = 0.001). Los antibióticos profilácticos se utilizaron con mayor frecuencia en el grupo 1 (84 vs. 60%; p < 0.001). Sí bien, no hubo diferencias en relación con la frecuencia de complicaciones infecciosas (p = 0.700). No hubo diferencias en mortalidad entre los dos grupos. Conclusión. La CPRE es un procedimiento seguro para los adultos mayores. Los adultos mayores frecuentemente presentan mayor comorbílídad. Sin embargo, la frecuencia de complicaciones y mortalidad no fue diferente en este estudio. Es importante señalar que los adultos mayores recibieron con mayor frecuencia antibióticos profilácticos que los pacientes de menor edad, pero la frecuencia de complicaciones infecciosas no fue diferente. No debe excluirse a los pacientes de la CPRE por su edad.

Asunto(s)

Adulto , Anciano , Femenino , Humanos , Masculino , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Distribución por Edad , Prevalencia

RESUMEN

Objective. To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. Method. A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconómica! level. Results. We interviewed 173 patients, most women (73%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. Conclusions. Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.

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Objetivo. Determinar la relación de algunos factores clínicos y psicosociales con la percepción global de la calidad de vida de pacientes con diabetes. Material y métodos. Se realizó un escrutinio transversal, de pacientes con diabetes en una clínica de medicina familiar del Seguro Social. La calidad de vida se evaluó con una escala global verbal. Se evaluaron las siguientes variables clínicas: tipo de diabetes, tiempo de evolución, tipo de tratamiento, enfermedades asociadas, complicaciones y el control metabólico. Las variables psicosociales estudiadas fueron: el conocimiento de la enfermedad, el apego al tratamiento, las formas de contender con la enfermedad, el impacto emocional producido por la misma y el apoyo social. Los pacientes fueron entrevistados con instrumentos previamente validados. Se determinó la hemoglobina glucosilada. Resultados. Fueron entrevistados 173 pacientes (73% mujeres), con un promedio de edad de 50.5 años para las mujeres y 51.5 para los hombres. La mayoría (95%) tenía diabetes tipo 2. Se determinó la relación entre las variables estudiadas y la calidad de vida. En el análisis bivariado se encontró que las mujeres tenían significativamente una menor calidad de vida (62.8 vs. 69.5). De los factores sociales, el nivel socioeconómico, el apoyo social y tener una pareja, correlacionaron positivamente con la calidad de vida. De los factores psicológicos, las formas de contención (evitación y resignación), el rechazo a la enfermedad y el impacto emocional correlacionaron negativamente con la calidad de vida. De las variables clínicas, sólo el tiempo de evolución tuvo una correlación discreta (r = - 0.14). En el análisis multivariado, siete variables psicosociales explicaron 30% de la varianza en la calidad de vida. Conclusiones. Nuestros resultados indican que aparentemente los factores clínicos influyen poco sobre la calidad de vida. Consideramos que la calidad de vida, medida de forma global, subjetiva, depende en un gran porcentaje de la forma en la que los pacientes viven la enfermedad más que de las características de la misma.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus/psicología , Calidad de Vida , Estudios Transversales

RESUMEN

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary and pancreatic diseases. OBJECTIVE: To know the complication rate of ERCP in the elderly. PATIENTS AND METHODS: Patient files who underwent ERCP were reviewed and were divided into two groups: aged 65 and older (group 1) and less than 65 years (group 2). Socio-demographic variables, prophylactic antibiotic use, indications for ERCP and outcomes were assessed. RESULTS: Mean age in group 1 was 72.9 years and 41.7 years in group 2. Group 1 had more comorbidity (p < 0.001). The most frequent indication for the procedure was obstructive jaundice in both groups (63% versus 44%; p = 0.002). Malignancy was more frequent as a cause of biliary obstruction in group 1 (45% versus 21%; p < 0.001). ERCP was performed once in 76% in group 1 and 93% in group 2 (p = 0.001). Prophylactic antibiotics were used more frequently in group 1 (84% versus 60%; p < 0.001). There were no differences between groups regarding infectious complications (p = 0.700). There was no difference in mortality rates between groups. CONCLUSION: ERCP is a safe procedure in elderly patients. The elderly frequently have more comorbidity. Nevertheless, the complication and mortality rates did not differ in this study. It is noteworthy that elderly patients received prophylactic antibiotics more frequently than younger patients but infectious complications were not different. The patients should not be excluded from ERCP based on their age.

Asunto(s)

Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Adulto , Distribución por Edad , Anciano , Femenino , Humanos , Masculino , Prevalencia

RESUMEN

OBJECTIVE: To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. METHOD: A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconomical level. RESULTS: We interviewed 173 patients, most women (739%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. CONCLUSIONS: Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.

Asunto(s)

Diabetes Mellitus/psicología , Calidad de Vida , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

It has been reported that Vitamin D receptor polymorphisms are associated with osteoporosis, particularly those demonstrated by the BsmI and FokI restriction enzymes. Herein we report the results of a case-control study performed in postmenopausal Mexican women. We studied 65 osteoporotic women (< or = -2.5 SD bone mineral density [BMD] of young normal females) and 57 controls (over 90% > or = -1.5 SD BMD of young normal females. Restriction enzymes BsmI and FokI were used to identify polymorphisms. Odds ratios and their 95% confidence intervals were calculated, and analysis was performed controlling for age as a covariate. The BsmI genotypes revealed a higher frequency of the bb genotype in cases than in controls, contradicting much of the literature that suggests this genotype protects females against osteoporosis. Regarding the FokI genotypes, we were unable to confirm that the FF genotype has a protective effect against osteoporosis. The inconsistencies found in the literature and the results obtained in the present work suggest to us that other genetic and nongenetic factors are involved in the occurrence of osteoporosis, confounding the results of the possible association of osteoporosis and VDR polymorphisms.

Asunto(s)

Osteoporosis Posmenopáusica/genética , Polimorfismo Genético , Receptores de Calcitriol/genética , Anciano , Estudios de Casos y Controles , Desoxirribonucleasas de Localización Especificada Tipo II/genética , Femenino , Genotipo , Humanos , México/epidemiología , Persona de Mediana Edad , Osteoporosis Posmenopáusica/epidemiología

RESUMEN

Exposure to urban airborne particulate matter (PM) is associated with adverse health effects. We previously reported that the cytotoxic and proinflammatory effects of Mexico City PM10 (less than or equal to 10 micro m mean aerodynamic diameter) are determined by transition metals and endotoxins associated with these particles. However, PM2.5 (less than or equal to 2.5 micro m mean aerodynamic diameter) could be more important as a human health risk because this smaller PM has the potential to reach the distal lung after inhalation. In this study, we compared the cytotoxic and proinflammatory effects of Mexico City PM10 with those of PM2.5 using the murine monocytic J774A.1 cell line in vitro. PMs were collected from the northern zone or the southeastern zone of Mexico City. Elemental composition and bacterial endotoxin on PMs were measured. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) production by J774A.1 cells was measured in the presence or absence of recombinant endotoxin-neutralizing protein (rENP). Both northern and southeastern PMs contained endotoxin and a variety of transition metals. Southeastern PM10 contained the highest endotoxin levels, 2-fold higher than that in northern PM10. Northern and southeastern PM2.5 contained the lowest endotoxin levels. Accordingly, southeastern PM10 was the most potent in causing secretion of the proinflammatory cytokines TNF-alpha and IL-6. All PM2.5 and PM10 samples caused cytotoxicity, but northern PMs were the most toxic. Cytokine secretion induced by southeastern PM10 was reduced 50-75% by rENP. These results indicate major differences in PM10 and PM2.5. PM2.5 induces cytotoxicity in vitro through an endotoxin-independent mechanism that is likely mediated by transition metals. In contrast, PM10 with relatively high levels of endotoxin induces proinflammatory cytokine release via an endotoxin-dependent mechanism.

Asunto(s)

Contaminantes Atmosféricos/toxicidad , Supervivencia Celular/efectos de los fármacos , Inflamación/inducido químicamente , Animales , Apoptosis/efectos de los fármacos , Línea Celular , Humanos , Mediadores de Inflamación/metabolismo , Interleucina-6/biosíntesis , México , Ratones , Tamaño de la Partícula , Factor de Necrosis Tumoral alfa/biosíntesis

RESUMEN

Se presenta la distribución de la concentración sérica de las transaminasas ALAT y ASAT en una población de 155 donadores altruistas despúés de haber excluído a 28 sujetos en base a un cuestionario de selección. Las enzimas se midieron, con equipos comerciales de reactivos, en suero obtenido de una muestra de sangre colectada al final de la donación de 500 mL de sangre. La mayoría de los sujetos (52% para ALAT y 79% para ASAT) mostró niveles superiores al límite normal máximo propuesto por el fabricante de los equipos de reactivos. Además, el 19% mostró una ALAT arriba de 45 U/L, la cual es una prevalencia significativamente mayor que la de 2 a 6% vista en donadores de otros países. Estos datos abren una interrogante interesante ya que nuestros hallazgos no parecen obedecer a un puro problema metodológico

Asunto(s)

Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Donantes de Sangre , Transaminasas/sangre

RESUMEN

Se ha propuesto que los pacientes sometidos a colecistectomía desarrollan con mayor frecuencia carcinoma colorectal, sin embargo, dicha correlación ha mostrado considerables variaciones en las diferentes series en cuanto a edad, sexo, localización de la neoplasia e incluso ha sido negada por algunos autores. El propósito del presente trabajo consiste en evaluar dicha asociación. Para ello se revisaron los expedientes de 200 pacientes con carcinoma de colon y 200 pacientes tomados como controles, investigándose la frecuencia del antecedente de colecistectomía, apendicectomía y hemorroidectomia. No se encontraron diferencias significativas en la frecuencia de colecistectomía ni hemorroidectomía en ambos grupos y la frecuencia de apendicectomía fue discretamente mayor en el grupo de pacientes del sexo masculino con tumores localizados en el colon ascendente. Se concluye que la colecistectomía probablemente no constituye un factor de riesgo para el desarrollo del carcinoma de colon

Asunto(s)

Humanos , Masculino , Femenino , Colecistectomía/efectos adversos , Neoplasias del Colon/etiología , Neoplasias del Recto/etiología , Riesgo

RESUMEN

A pesar de que la telerradiografía de tórax (RxT) constituye el estudio radiológico rutinario realizado con mayor frecuencia, existen muy pocas investigaciones acerca de su utilidad real. El presente estudio se diseñó con la finalidad de explorar su utilidad en la detección de patología no sospechada en una muestra de pacientes atendidos en nuestra Institución. Se concluyeron 200 pacientes a quienes se les practicó RxT dividiéndose en 2 grupos dependiendo si el estudio había sido solicitado por sospecha clínica de anormalidad torácica o únicamente en base a su admisión al hospital. 184 de los estudios evaluados fueron realizados en forma rutinaria de los cuales 156 (85%) fueron normales y 28 anormales; solo una de las anormalidades encontradas fue considerada de relevancia clínica. 16 estudios fueron solicitados por sospecha de patología torácica, encontrándose adecuada correlación clínico-radiológica en la mitad de ellos. La edad promedio de los pacientes son estudios rutmarios anormales y la de aquellos a quienes les fue solicitado el estudio con orientación diagnóstica fue significativamente mayor que la de los pacientes que tuvieron estudios rutinarios normales. Mediante este estudio se demostró que la probabilidad de detectar alteraciones relevantes en la RxT sin sospecha clínica previa es baja (aproximadamente 5 en 1000 estudios rutinarios y difícilmente superaría una frecuencia de 3%)

Asunto(s)

Niño , Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Radiografía Torácica , Pruebas Diagnósticas de Rutina

Asunto(s)

Adulto , Humanos , Masculino , Hemorragia Gastrointestinal/etiología , Hemangioma Cavernoso/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasia Endocrina Múltiple/diagnóstico , Anomalías Múltiples , Gastritis Hipertrófica/complicaciones , Discapacidad Intelectual/complicaciones , Síndrome de Marfan/diagnóstico , Neoplasias Hipofisarias/diagnóstico , Neoplasias de la Tiroides/diagnóstico

RESUMEN

Se presentan los resultados de un estudio a 3 años con el uso de amikacina como aminoglucósido de uso exclusivo en el Instituto Nacional de la Nutrición Salvador Zubirán. En el Período Basal (3 meses) se midió la resistencia de 870 cepas de bacterias gram negativas para amikacina, gentamicina y 233 cepas para tobramicina que en total fue del 3.2%, 17.4% y 11,2% respectivamente. En ese período el consumo proporcional de aminoglucósidios fue de 69% para gentamicina, 30.5% para amikacina y de 0.5% para tobramicina. En el siguiente período, de uso exclusivo de amikacina, se estudió el patrón de sensibilidad de 9,344 cepas de gram negativos a lo largo de 3 años; en este lapso el consumo de amikacina fue del 99.3%de gentamicina del 0.62%, y de tobramicina del 0.08%. Al comparar los dos períodos se muestra que la proporción de cepas resistentes a gentamicina disminuyó al 7.4% (P < 0.0001 mientras que el nivel de resistencia para amikacina no se incrementó significativamente. El análisis de la pediente de la curva que resultó de los porcentajes de cepas resistentes reportados trimestralmente, nuevamente evidenció una significativa disminución de la resistencia a gentamicina (P < 0.005) y globalmente no hubo un aumento de la resistencia a amikacina. Por lo anterior se puede concluir en términos generales que el uso exclusivo de amikacina no se acompaño de un incremento significativo en la aparición de resistencia durante un período de 3 años y, en cambio, la restricción del uso de gentamicina y tobramicina se acompaño de una importante disminución en el nivel de resistencia a estos antibióticos

Asunto(s)

Amicacina/farmacología , Bacterias Gramnegativas/efectos de los fármacos , Farmacorresistencia Microbiana , Gentamicinas/farmacología , Tobramicina/farmacología

RESUMEN

Se investig'ó la capacida de crítica en investigación clínica en dos grupos: 47 residentes de medicina Interna (grupo experimental) y diez integrantes del personal administrativo (grupo control). El instrumento de medición se construyó con cinco trabajo de investigación resumidos, ya publicado o propuestos a consideración editorial, valido previamente a su aplicación que incluía dos aspectos: el juicio apreciativo global (JAG) y el razonamiento analítico (RA). Se encontraron diferencias altamente significativas en los resultados del JAG y el RA, entre el grupo experimental y el control. En ambos grupos se apreció una clara tendenia a sobreestimar la calidad de los trabajos valorados (JAG). En el grupo experimental se observó que el año académico (1§, 2§ ó 3§) no influyó significativamente en los resultados del JAG y el RA. No se encontró correlación significativa entre el JAG y el RA en ninguno de los dos grupos. Tomando como límite inferior a los resultados del grupo control, el desempeño del grupo experimental fue superior en el JAG con respecto al RA. Se concluye la importancia de explorar conductas (aprendizaje) relacionadas con la práctica (la capacidad de crítica en investigación clínica( ya que es la que a fin de cuentas, determina la forma en que se lleva a cabo ese gran conglomerado del saber y del hacer que es la investigación clínica

Asunto(s)

Humanos , Internado y Residencia , Juicio , Investigación