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Background: End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes, Mexico, is one of the highest worldwide, particularly in adults between 20 and 40 years of age. Our aim was to screen adolescents for chronic kidney disease (CKD) to identify risk factors and histologically characterize adolescents with persistent albuminuria. Methods: This was a cross-sectional, observational and comparative study of adolescents in whom serum creatinine and the albumin:creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥30 mg/g) or a low glomerular filtration rate (GFR) (≤75 mL/min/1.73 m2) were re-evaluated and a renal ultrasound (US) was obtained. A kidney biopsy was performed in patients with persistent albuminuria. Results: A total of 513 students were included; 19 had persistent albuminuria and 494 were controls. The prevalence of persistent albuminuria was 3.7% [95% confidence interval (CI) 2.1-5.3]. Only one patient had a decreased GFR. None of the patients with persistent albuminuria had anatomical abnormalities of the urinary tract by renal US. Patients with persistent albuminuria had a decreased total renal volume compared with the control group (150 versus 195 mL/m2; P < 0.01). Eighteen kidney biopsies were performed; 72% had glomerulomegaly and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy, including partial fusion (100%), microvillous degeneration (80%) and increased organelles (60%). Risk factors for persistent albuminuria were: homestead proximity to maize crops, the use of pesticides at the father's workplace, a family history of CKD and blood pressure abnormalities. The body mass index and breastfeeding were protective factors. Conclusions: The prevalence of persistent albuminuria in adolescents in Aguascalientes is high and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of persistent albuminuria patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in this setting.
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BACKGROUND: Given the high contribution of stroke to the global burden of disease, there is a need for good-quality information on Web platforms such as Wikipedia. AIMS: This study aimed to describe the quality of the Wikipedia articles on stroke written in different languages. METHODS: We studied the world's 30 most spoken languages. With the DISCERN score, we evaluated the quality of the information within the Wikipedia articles. Three investigators assessed each of the texts translated to English. We also registered the word count, the number of references, and if the text referred to the emergency status of stroke, cues to suspect a stroke, and allusions to endovascular treatment. RESULTS: There is a Wikipedia article for stroke in 23 out of the 30 languages. The mean DISCERN score was 35 29.9 ± 9.2. Overall quality ranged from 3/5 in 26.1% to 1/5 in 17.4%. Word count had a mean of 36 3,145.8 ± 3,048.9 words, and the texts included a mean of 43.1 ± 57.3 references; 69.6% of the articles referred to stroke as a medical emergency, 52.2% included awareness symptoms, and 34.8% included endovascular management among the stroke treatments. Three pages included steroids as part of the stroke treatment. The DISCERN score was not correlated with the number of speakers, but it was positively correlated with the number of references (r = 0.90, p < 0.001) and the number of words (r = 0.78, p < 0.001) in the articles. CONCLUSION: The analyzed Wikipedia articles do not contain relevant and up-to-date information to the general population. Further, the content varies widely across the different languages and is missing for some of them. The missing versions disproportionally affect millions of potential information seekers in undeveloped countries.
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Idioma , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapiaRESUMO
PURPOSE: To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasilar dolichoectasia (VBD) with and without acute stroke. METHODS: Case-control study. From an outpatient clinic, we recruited 14 controls and 19 patients with VBD. We also recruited 33 patients with stroke from two emergency departments, 14 without VBD (S/-VBD) and 19 with VBD (S/ + VBD). All the patients underwent serum MMP-2 and MMP-9 measurements and a non-contrast CT scan. Two investigators assessed the intracranial vertebral arteries (VA) and the basilar artery (BA) at the mid-pons. Diagnosis of VBD was made if the BA diameter was ≥ 4.5 mm. RESULTS: The mean age of the 66 patients studied was 57.6 + 16.0 years, 41% female. In the 33 patients with stroke, the median NIHSS was 8 (range 15); there were no differences in the NIHSS scores between both groups with stroke. Median MMP-2 levels were lower in the S/-VBD when compared to controls. Median MMP-9 serum levels were higher in both groups with VBD when compared to controls and the S/-VDB group. Both groups with stroke exhibited higher MMP-9 serum levels than controls but were not statistically different from those found in patients with VBD. Serum levels of MMP-9 were significantly correlated with the diameters of the BA (r = 0.344, p = 0.01) and the left VA (r = 0.305, p = 0.05). CONCLUSION: This study found that high serum levels of MMP-9 are associated with VBD independently of stroke and correlated with the degree of VBD.
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Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Metaloproteinase 2 da Matriz , Metaloproteinase 9 da Matriz , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagemRESUMO
BACKGROUND: Chronic kidney disease (CKD) is one of the pathologies with the greatest impact on the public health system. Over the last few decades, the relevance of CKD in Mexico has increased, with associated overwhelming costs for care of renal disease. There are no reliable CKD statistics in Mexico. METHODOLOGY: In June 2018, the government of Aguascalientes called on all Health Institutions to create a state registry of treated end-stage renal disease (ESRD). In the same system, a renal biopsy result registry included all the native kidney biopsies obtained in the state of Aguascalientes since 2012. We herein describe the prevalence, incidence and characteristics of the patients included in the CKD and renal biopsy registry in the state of Aguascalientes. RESULTS: As of April 2020, the state has documented 2827 patients on renal replacement therapy (RRT), 1877 on dialysis and 950 that have been transplanted. The prevalence of patients on dialysis is 1326 per million population (p.m.p.), and if transplanted individuals are included, it is 1997 p.m.p. The incidence of treated ESRD in 2019 was 336 p.m.p. (n = 474) in individuals with an average age of 45.6 years (standard deviation ±18), and in a higher proportion of men (61%). There is a bimodal distribution of the age at which RRT was initiated. The first and the most significant peaks are between the ages of 20 and 40 years and are usually the result of CKD of unknown cause (73%). The second peak is between 50 and 70 years of age, and CKD is usually the result of diabetes mellitus and systemic arterial hypertension (59.6%). Since January 2012, 423 biopsies have been recorded. The patient's ages were between 20 and 30 years (n = 112), and the most frequent diagnosis was focal segmental glomerulosclerosis (FSGS) (54%). CONCLUSIONS: The prevalence of treated ESRD in the state of Aguascalientes is high. The disease mostly afflicts young people between 20 and 40 years of age, and there is a clear male predominance. In this age group, the main clinical diagnosis is CKD of unknown origin, and the most frequent biopsy diagnosis was FSGS.
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BACKGROUND: Evidence suggests that continuing medical education improves the clinical competence of general practitioners and the quality of health care services. Thus, we evaluated the relative impact of two educational strategies, critical reading (CR) and problem based learning (PBL), on the clinical competence of general practitioners in a healthcare system characterized by excessive workload and fragmentation into small primary healthcare centers. METHODS: Clinical competence was evaluated in general practitioners assigned to three groups based on the educational interventions used: 1) critical reading intervention; 2) problem based learning intervention; and 3) no intervention (control group, which continued clinical practice as normal). The effect on the clinical competence of general practitioners was evaluated in three dimensions: the cognitive dimension, via a self-administered questionnaire; the habitual behavioral dimension, via information from patient's medical records; and the affective dimension, through interviews with patients. A paired Student´s t-test was used to evaluate the changes in the mean clinical competence scores before and after the intervention, and a 3 x 2 ANOVA was used to analyze groups, times and their interaction. RESULTS: Nine general practitioners participated in the critical reading workshop, nine in the problem-based learning workshop, and ten were assigned to the control group. The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05). Significant improvements in all three dimensions (cognitive, 45.67 vs 54.89; habitual behavioral, 53.78 vs 82.33; affective, 4.16 vs 4.76) were only observed in the problem-based learning group after the intervention (p > 0.017). CONCLUSIONS: While no differences in post-intervention scores were observed between groups, we conclude that problem-based learning can be effective, particularly in a small-group context. Indeed, problem-based learning was the only strategy to induce a significant difference between pre- and post- intervention scores for all three CC dimensions.
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Competência Clínica , Países em Desenvolvimento , Educação Médica Continuada/métodos , Medicina Geral/educação , Aprendizagem Baseada em Problemas/métodos , Leitura , Currículo , Atenção à Saúde , Humanos , México , Modelos Educacionais , Atenção Primária à Saúde , Melhoria de Qualidade , Carga de TrabalhoRESUMO
BACKGROUND: Most valid methods to measure treatment adherence require time and resources, and they are not easily applied in highly demanding Primary Health Care Clinics (PHCC). The objective of this study was to determine sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities of two novel questionnaires as proxy measurements of treatment adherence in Type-2 diabetic patients. METHODS: Two questionnaires were developed by a group of experts to identify the patient's medical prescription knowledge (knowledge) and their attitudes toward treatment adherence (attitudes) as proxy measurements of adherence. The questionnaires were completed by patients receiving care in PHCC pertaining to the Mexican Institute of Social Security in Aguascalientes (Mexico). Pill count was used as gold standard. Participants were selected randomly, and their oral hypoglycemic prescriptions were studied. The main outcome measures for each questionnaire were sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities, all as an independent questionnaire test and in a serial analysis. RESULTS: Adherence prevalence was 27.0% using pill count. Knowledge questionnaire showed the highest sensitivity (68.1%) and negative predictive value (82.2%), the lowest negative likelihood ratio (0.58) and post-test probability for a negative result (0.16). Serial analysis showed the highest specificity (77.4%) and positive predictive value (40.1%) as well as the highest positive likelihood ratio (1.8) and post-test probability for a positive result (0.39). CONCLUSION: Medical Prescription Knowledge questionnaire showed the best performance as proxy measurement to identify non-adherence in type 2 diabetic patients regarding negative predictive value, negative likelihood ratio, and post-test probability for a negative result. However, Medical Prescription Knowledge questionnaire performance may change in contexts with higher adherence prevalence. Therefore, more research is needed before using this method in other contexts.
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Diabetes Mellitus Tipo 2/terapia , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Fatores Etários , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/diagnóstico , Dieta para Diabéticos , Feminino , Seguimentos , Humanos , Hipoglicemiantes/administração & dosagem , Estilo de Vida , Funções Verossimilhança , Masculino , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND: Despite certain contradictions, an association has been identified between adherence to drug treatment and the quality of life in patients with type 2 diabetes. The contradictions observed emphasize the importance of using different methods to measure treatment adherence, or the association of psychological precursors of adherence with quality of life. For this reason, we have used an indirect method to measure adherence (pill count), as well as two adherence behaviour precursors (attitude and knowledge), to assess the association between adherence and the quality of life in type 2 diabetes patients. METHODS: A cross-sectional comparative study on a random sample of 238 type 2 diabetic patients was carried out over one year in four family medicine units of the Mexican Institute of Social Security (IMSS) in Aguascalientes, Mexico. Treatment adherence was measured using the indirect method of pill count to assess adherence behaviour, obtaining information at two home visits. In the first we recorded the medicine prescribed and in the second, we counted the medicine remaining to determine the proportion of the medicine taken. We also assessed two adherence behaviour precursors: the patients' knowledge regarding their medical prescription measured through a structured questionnaire; and attitudes to treatment adherence using a Likert scale. Quality of life was measured through the WHOQOL-100 (the WHO Quality of Life questionnaire). Information concerning both knowledge and attitude was obtained through interviews with the patients. A multiple linear regression model was constructed to establish the relationship between each quality of life domain and the variables related to adherence, controlling for covariates. RESULTS: There was no association between quality of life and treatment adherence behaviour. However, the combination of strong knowledge and a positive attitude was associated with five of the six quality of life domains. CONCLUSION: The results suggest that it is important to explore psychological precursors of treatment adherence behaviour in type 2 diabetic patients. Indeed, we consider that it will be useful to carry out interventions that change negative attitudes towards treatment adherence and that promote medical prescription knowledge, which may help to improve the quality of life of such patients.
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Diabetes Mellitus Tipo 2/terapia , Cooperação do Paciente , Qualidade de Vida , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Lineares , Masculino , México , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estatísticas não ParamétricasRESUMO
Antecedentes: conocer si la utilización de las salas de operaciones es eficiente, requiere de una evaluación continua de su equipamiento, capacidad del personal involucrado y el nivel de complejidad de las intervenciones quirúrgicas. En los centros hospitalarios institucionales, estas evaluaciones son constantes para llevar un control interno, pero se consideran poco o nada en el Análisis anual de productividad de los quirófanos para la toma de decisiones. Objetivo: identificar el uso subóptimo de las salas de operaciones, y en su caso, proponer solución para un uso más eficiente. Tipo de estudio: prospectivo, observacional, transversal y comparativo. Material y método: se analizaron cuestionarios estructurados con los tiempos quirúrgicos de dos quirófanos en 60 días, en el Servicio de Ginecología y Cirugía General. Se compararon los tiempos reales vs. los tiempos ideales y los niveles de complejidad. Análisis estadístico: se utilizó la prueba Exacta de Fisher. El valor p < 0.05 fue significativo. Resultados: se efectuaron 125 procedimientos quirúrgicos. En el turno matutino (TM) 57.6 por ciento y 42.2 por ciento en el vespertino (TV). A nivel de complejidad III (66.4 por ciento). Fueron electivos 84.8. De la especialidad de Cirugía General 58.4 por ciento y Ginecología 41.6 por ciento. El retraso de ingreso a quirófano de 20.5 minutos del TM contra 4.3 minutos del TV (p < 0.05). El retraso quirúrgico en el TV de 30.32 minutos vs 14.59 en el TM. Hubo retraso en el tiempo posquirúrgico del TV (33.7 minutos p < 0.05). A mayor complejidad del procedimiento mayor retraso en el tiempo operatorio. Conclusiones: el uso eficiente del quirófano depende del cumplimiento de las funciones específicas en los tiempos programados del equipo quirúrgico, la supervisión sistemática, y el nivel de complejidad.
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Eficiência , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Salas CirúrgicasRESUMO
Se realizó un estudio de casos y controles de malformaciones congénitas en 4 hospitales del área metropolitana de Guadalajara. Se estudiaron 75,788 recién nacidos durante el periodo de noviembre de 1988 a junio de 1993, recolectándose la información a través de la exploración física del recién nacido y por entrevista a la madre sobre la condición del producto al nacer, antecedentes patológicos y exposición a factores físicos y químicos. Por cada malformado se seleccionó un control no malformado del mismo sexo, no necesariamente sano, pero del mismo hospital. La prevalencia hospitalaria general de las malformaciones congénitas fue de 22.3 x 1,000 RN; en nacidos vivos fue de 21.4 x 1,000 y de 69.6 x 1,000 en nacidos muertos. Los diagnósticos más importantes de malformaciones mayores por 10,000 RN fueron; defectos del cierre del tubo neural con tasa de 26.5; la anencefalia con tasa de 12.8. Las anomalias cromosómicas tuvieron una tasa de 14.8; la malformación más frecuente fue el Síndrome de Down con tasa de 12.1 , el labio paladar endido 11.1 y la polidactilia con 11.0. Las malformaciones se encontraron asociadas a: edad mayor de 40 años de la madre (RR=2.4; IC=1.5-3.8)~ antecedentes de un malformado previo (RR=4.6; IC=3.6-5.9), metrorragia en el primer trimestre de embarazo (RR=1.4; IC=1.0-1.9) y diabetes en el embarazo (RR=4.7; IC=1.2-20.4)
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Humanos , Recém-Nascido , Anencefalia/diagnóstico , Aberrações Cromossômicas/classificação , Aberrações Cromossômicas/epidemiologia , Fenda Labial/epidemiologia , Encefalocele/epidemiologia , Estatísticas Hospitalares , Luxação Congênita de Quadril/epidemiologia , México/epidemiologiaRESUMO
Con el propósito de identificar la asociación de factores socioeconómicos, ambientales, alimentarios e individuales en la desnutrición aguda del preescolar migrante, se realizó un estudio observacional comparativo transversal, en 511 niños de uno a cinco años de edad en los albergues de la zona cañera de Jalisco. Mediante indicadores antropométricos, clasificados de acuerdo con Waterlow se evaluó el estado de nutrición. La prevalencia de desnutrición fue de 79.0 por 100 preescolares (68.1%adaptados y 21.5%crónico agudizados y 10.4%agudos). Se asociaron a la desnutrición aguda: ingreso familiar menor a un salario mínimo (R.M= 6.32, P= 0.00), menores con patología aguda (R.M. = 3.34, P =0.00) y tener un año de edad (R.M. =2.22, P=0.01). Existieron diferencias significativas en hijos de padres: sin escolaridad (P = 0.04) y ser cortador de caña (P = 0.05). Los hallazgos identifican factores de riesgo en la desnutrición aguda, modificables probablemente mediante estrategias de vigilancia epidemiológica nutricional