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OBJECTIVE: To update prior studies on the impact of Covid-19 on suicide in Mexico. MATERIALS AND METHODS: We used interrupted time-series analysis to model the national trend in monthly suicides before Covid-19 (January 1, 2010, to March 31, 2020), comparing the expected number of suicides with the observed number for the remainder of the period (April 1, 2020, to December 31, 2021). RESULTS: We observed a 5% increase in suicides, driven by suicides among the younger females ages <44 years and among older males ages 45+. CONCLUSION: Since in Mexico the impact of Covid-19 on suicide depended on sex and age, tailored public health strategies may be needed to confront the problem.

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Objectives: Prior research has indicated that no increase in suicides occurred immediately following the declaration of the COVID-19 emergency in Mexico City. Here we examine longer-term overall suicide trends and trends according to basic demographic groups. Methods: We used interrupted time-series analysis to model trends in monthly suicides before COVID-19 (January 1, 2010 to March 31, 2020), comparing the expected number of suicides both overall and according to age and sex with the observed number of suicides for the remainder of 2020 (April 1, 2020 to December 31, 2020). Results: There was an overall increase in suicides during the first 9 months of the pandemic, with a rate ratio of 2.07 (1.86-2.31). The increase began in the early months of the pandemic and remained stable and high after June 2020. Men and women, younger people (< 45) and older people (≥ 45) were affected. The increase was especially high among older women (RR = 3.33; 2.04-5.15). Conclusions: The increase in suicides in Mexico City is worrying and highlights the need to strengthen economic development, mental health, and well-being programs. Suicides among older women should be closely monitored. There is an urgent need to expand primary health care services to include robust suicide prevention and treatment options.

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Abstract Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

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Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

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Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5%) cases in the transversal incision group, and in 7 (12.2%) patients of the group of traditional incisions in J or U, without statistical differences ( p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

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Introduction The submental flap provides an alternative technique in orofacial reconstruction, especially in situations in which free flaps are not available, or the patients are unfit. Objective To demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. Methods A total of 14 patients with oral cavity cancers, who underwent submental flap reconstruction from January 2016 to January 2018, were included in the study. Results There were 11 male and 3 female patients with a mean age of 66.7 ± 14 (Min: 52/Max: 91) years old. The most common primary tumor site was the mobile tongue in 12 (85.7%) patients. All of the patients underwent ipsilateral selective neck dissection after the flap was harvested. Flap partial necrosis was observed in one patient, and total necrosis in another one. The mean follow-up was of one year. Nonlocal or regional recurrences were observed. Conclusion Submental island flap represents a good option in oral cavity reconstruction in a restricted setting or in patients considered not fit for free flap reconstruction. Preoperative selection of clinically neck node-negative patients is essential due to the potential risk of occult metastasis.

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Abstract Introduction The submental flap provides an alternative technique in orofacial reconstruction, especially in situations in which free flaps are not available, or the patients are unfit. Objective To demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. Methods A total of 14 patients with oral cavity cancers, who underwent submental flap reconstruction from January 2016 to January 2018, were included in the study. Results There were 11 male and 3 female patients with a mean age of 66.7 ± 14 (Min: 52/Max: 91) years old. The most common primary tumor site was the mobile tongue in 12 (85.7 %) patients. All of the patients underwent ipsilateral selective neck dissection after the flap was harvested. Flap partial necrosis was observed in one patient, and total necrosis in another one. The mean follow-up was of one year. Nonlocal or regional recurrences were observed. Conclusion Submental island flap represents a good option in oral cavity reconstruction in a restricted setting or in patients considered not fit for free flap reconstruction. Preoperative selection of clinically neck node-negative patients is essential due to the potential risk of occult metastasis.

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Abstract Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5 %) cases in the transversal incision group, and in 7 (12.2 %) patients of the group of traditional incisions in J or U, without statistical differences (p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

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BACKGROUND: A new diagnosis of anxious depression (AD), characterized by both depressive and anxious symptoms at case level, has been proposed for the classification of mental disorders for primary care for ICD-11 (ICD-11 PHC). The ICD-11 PHC proposes a duration requirement for anxiety symptoms of 2 weeks, in line with the requirement for depressive symptoms. This study examined diagnostic assignment under ICD-11 PHC as compared to the previous classification, the ICD-10 PHC, and the relationship of anxiety duration to disability and suicidal ideation. METHODS: Primary care physicians in five countries referred patients based on either perceived psychological distress or distressing somatic symptoms to a research assistant who administered a computer-guided diagnostic interview. Complete data were obtained for 2279 participants. RESULTS: Under ICD-11 PHC 47.7% participants received a diagnosis of AD and had greater disability than other diagnostic groups. Under ICD-10 PHC, in addition to meeting requirements for depressive episode, most of these patients met requirements for either generalized anxiety disorder (41.5%) or mixed anxiety and depressive disorder (45.4%). One third of individuals diagnosed with AD had anxiety durations between 2 weeks and 3 months and presented as much disability and suicidal ideation as individuals with longer anxiety durations. LIMITATIONS: The study was not designed to establish prevalence of these conditions. CONCLUSION: The proposed ICD-11 PHC encourages early identification and management of significant anxiety symptoms in primary care, particularly when these co-occur with depression. This study provides support for the clinical relevance of these symptoms and the importance of early identification.

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BACKGROUND: A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC. METHOD: Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach. RESULTS: A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948]. CONCLUSIONS: These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.

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OBJECTIVE: To determine the prevalence of burnout syndrome components among the medical and nursing staff of the second care level hospitals of the Instituto Mexicano del Seguro Social and Instituto de Seguridad Social al Servicio de los Trabajadores del Estado from Durango, Mexico. MATERIAL AND METHODS: A cross-sectional comparative study was carried out among 73 physicians and 100 nurses randomly selected from both hospitals. The prevalence of burnout syndrome components was established by the Maslash Burnout Inventory, which determines the presence of physical/emotional exhaustion, depersonalization, and labor performance. In addition, sociodemographic and labor information was collected. Prevalence was calculated with a reliability interval of 95% (CI 95%). RESULTS: 73 physicians and 100 nurses enrolled, corresponding to 22.8% and 14.5% of such personnel working in both institutions. Among the IMSS and ISSSTE workers respectively, the prevalence of depersonalization was 43.2% (34.4-52.9) and 14.5% (6.8-25.8), whereas the prevalence of physical/emotional exhaustion was 41.4% (32.7-51.1) and 19.4% (10.4-31.4). Pre-valence of labor performance was higher among the personnel of Instituto Mexicano del Seguro Social: 99.1% (95.1-100) versus 96.8% (88.8-100). Severe depersonalization (p = 0.004), but not emotional exhaustion (p = 0.09) nor labor performance (p = 0.06) was significantly higher among personnel working at the Instituto Mexicano del Seguro Social. CONCLUSIONS: Prevalence of depersonalization and physical/emotional exhaustion was higher among physicians and nurses of the Instituto Mexicano del Seguro Social; nonetheless, their labor performance was high. Our finding suggests that personnel working at the Instituto Mexicano del Seguro Social make a greater effort to maintain the high labor performance that medical care requires.

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Se estudiaron 72 pacientes por el método de ultrasonografía con el objetivo de demostrar su utilidad en el diagnóstico del síndrome de cadera irritable en el niño. Se utilizó un equipo de tiempo real con transductor sectorial de 5 Mhz para comparar ambas caderas. Se halló efusión en 43 pacientes. En los enfermos con sinovitis transitorias predominó sólo la efusión articular; el engrosamiento capsular con alteraciones de la cabeza femoral en la Enfermedad de Perthes y una efusión anecoica con pequeñas imágenes ecogénicas en el caso de artritis séptica. Se consideró la ecografía un método eficaz de elección para realizar diagnóstico diferencial de las enfermedades agrupadas en el síndrome de cadera irritable

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Objetivo. Determinar la correlación que existe entre la presión del manguito en la intubación endotraqueal (PMIE) y las manifestaciones de dolor traqueal postoperatorio.Material y Métodos. Estudio transversal comparativo al que se integraron de manera aleatoria sujetos progra-mados a cirugía electiva que requirieron intubación endotraqueal. Se midió la PMIE antes de su retiro, integrándose dos grupos, uno en el que la PMIE fue igual o menor de 42 mmHg (Grupo A), y otro en el que fue mayor de 42 mmHg (Grupo B). En todos los casos se utilizaron tubos de baja presión y alto volumen. Las presencia de dolor se evaluó 60 minutos y 24 h después de la extubación.Resultados. Se incluyeron 10 sujetos en el grupo A y 30 en el B, sin diferencias en la duración de la intubación 117 ñ 36.9 min versus 133 ñ 64.9 min, p = 0.3, ni en el calibre del tubo utilizado. Sesenta minutos después de la extubación el dolor fue similar en ambos grupos, mientras que 24 h después de la extubación persistió en 10 por ciento de los pacientes del grupo A y 53.3 por ciento del grupo B, p = 0.02. La correlación entre la PMIE y la presencia de dolor a las 24 h fue de 0.76, p = 0.00001.Conclusiones. La elevada PMIE es un factor relacionado con la presencia de dolor traqueal, por lo que deberían implementarse medidas de vigilancia rutinaria y dispositivos para evitar que la presión del manguito exceda el mínimo necesario.

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Para determinar la variación cardiana de la presión arterial en hipertensos de reciente diagnóstico, se analizaron las lecturas de la presión arterial obtenidas durante la vigilia, el sueño y la jornada laboral, en personal del Departamento de Anestesiología del Hospital General de Zona Núm. 1, Instituto Mexicano del Seguro Social en Durango. Se consideró hipertensión arterial sistémica la presencia de 50 por ciento o más de lecturas de presión arterial sistólica = 140 mmHg o de presión arterial diastólica = 90 mmHg en la vigilia; y de presión arterial sistólica = 120 mmHg o presión arterial diastólica ñ 80 mmHg en el sueño. Los patrones circadianos de la presión arterial y de la frecuencia cardiaca en los hipertensos se caracterizan por disminución de las fluctuaciones en el periodo de vigilia, en el que además se observan cifras de presión arterial sistólica y diastólica elevadas en forma sostenida y durante periodos prolongados y ausencia de sincronía entre las elevaciones de la presión arterial y de la frecuencia cardiaca

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Se estudiaron 208 pacientes en puerperio inmediato, seleccionadas en forma aleatoria, a quienes se les practicó oclusión tubaria bilateral voluntaria por la técnica de Pomeroy modificada con abordaje abdominal infraumbilical con anestesia local. El procedimiento se consideró seguro y eficaz. Su aplicación reduce el costo hospitalario y el riesgo operatorio

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