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RESUMEN Introducción: Desde el inicio de la pandemia, México fue de los países que presentó tasas de mortalidad más altas por COVID 19. Objetivo: Determinar si la diabetes mellitus tipo 2, la hipertensión arterial y la obesidad incrementan la tasa de mortalidad en pacientes con diagnóstico de COVID-19 que requirieron hospitalización en México. Métodos: Revisión sistemática en Pubmed MeSH, Web of Science, Lilas, Scielo y Google Scholar con los términos MeSH "COVID-19", "SARS-COV2", "Coronavirus", y "México" durante los años 2020 y 2021, incluyendo artículos en inglés y español. Para el proceso de selección de artículos, dos revisores seleccionaron los estudios mientras que otros dos revisores adicionales participaron en el análisis de dichos estudios. Resultados: Se incluyeron 73 estudios realizados en México del 2020 al 2021 con información obtenida a través de las bases de datos del Sistema Nacional de Vigilancia Epidemiológica de México. Se incluyeron pacientes con un promedio de edad de 52,9 años ±13,27, el 64% de los pacientes incluidos fueron mujeres, se reportó una tasa de mortalidad de 6.76% (Min-Max 0.77-73.73%). El 71% de los estudios (52), no reportaron la mortalidad específica relacionada con las comorbilidades. La patología más prevalente fue la obesidad con un 24.23% (Min-Max 11.50-71.00%), seguida de la hipertensión arterial con un 22.23% (Min-Max 2.0-53.96%) y finalmente la diabetes mellitus tipo 2 con un 18.10% (Min-Max 1.83-40.00%). Conclusión: La comorbilidad más común entre los pacientes hospitalizados por COVID 19 en México fue la obesidad, seguida de la diabetes mellitus tipo 2 y por último la hipertensión.

ABSTRACT Introduction: Since the start of the pandemic, Mexico was one of the countries with the highest mortality rates from COVID 19. Objective: To determine if type 2 diabetes mellitus, arterial hypertension, and obesity increase mortality in patients diagnosed with COVID-19 who required hospitalization in Mexico. Methods: Systematic review in Pubmed MeSH, Web of Science, Lilas, Scielo, and Google Scholar with the terms MeSH COVID-19, SARS-COV2, Coronavirus, and Mexico for the years 2020 and 2021, in English or Spanish. Two reviewers selected the studies, two additional reviewers participated in the analysis of the studies. Results: Seventy three studies carried out in Mexico from 2020 to 2021 were included with information obtained from the databases of the National Epidemiological Surveillance System of Mexico. With an average age of 52.9 ± 13.27 years, 64% of the included patients were women, in general, a mortality rate of 16.76% (Min-Max 0.77-73.73%) was reported. 71% of the studies (52) did not report specific mortality related to comorbidities the most prevalent pathology was obesity with 24.23% (Min-Max 11.50-71.00%), followed by arterial hypertension 22.23% (Min-Max 2.0-53.96%) and finally Diabetes mellitus with 18.10% (Min-Max 1.83-40.00%). Conclusion: The most common comorbidity among patients hospitalized for COVID in Mexico was obesity, followed by type 2 diabetes mellitus and hypertension.

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Introducción: El síndrome metabólico se ha asociado con cambios en parámetros hematológicos (glóbulos rojos, plaquetas y leucocitos); se pueden utilizar para identificar sujetos en riesgo de fenotipos metabólicamente no saludables (MUP). Se investigó si estos parámetros hematológicos sirven como biomarcadores para distinguir el fenotipo metabólicamente sano (MHP) del MUP en niños y adolescentes. Métodos: Estudio transversal, 292 niños y adolescentes. El diagnóstico de MUP fue según consenso. Se utilizó ANOVA unidireccional en las comparaciones, regresión logística múltiple para determinar si el sexo, el grupo etario, el estado nutricional, la pubertad, los parámetros hematológicos y la resistencia a la insulina se asociaron con MUP. Resultados: Edad media 11 años (DE: 2,61). Los valores de RDW fueron significativamente más bajos en los niños en el grupo de peso normal metabólicamente insalubre (MUNW) en comparación con los niños con obesidad metabólicamente no saludable (MUO) (12,33 ± 0,90 vs. 13,67 ± 0,52; p = 0,01) y en la obesidad metabólicamente saludable (MHO) en comparación con el grupo MUO (13,15 ± 0,53 vs. 13,67 ± 0,52; p = 0,04). En adolescentes, la relación plaquetas/linfocitos fue mayor en el grupo MHNW (con un valor medio de 152,60 (DE 62,97) vs 111,16 (DE 44,12) para el grupo MHO. Al ajustar por edad, estado nutricional y pubertad, los índices hematológicos no se asociaron con MUP. Conclusión: Los parámetros hematológicos no están asociados independientemente con el MUP, y es poco probable que representen biomarcadores confiables para la detección del MUP en la población pediátrica.

Introduction: Metabolic syndrome has been associated with changes in several hematological parameters, such as red blood cells, platelets, and leucocytes. Therefore, hematologic parameters can be used to identify the subjects at risk of metabolically unhealthy phenotypes (MUP). The current study investigated if hematological parameters can serve as biomarkers to distinguish metabolically healthy phenotype (MHP) from MUP in children and adolescents. Methods: Two hundred ninety-two children and adolescents were enrolled in this cross-sectional study. The MUP was diagnosed using consensus-based criteria. Group comparisons were performed using one-way ANOVA. Multiple logistic regression analysis was used to determine if sex, age group, nutritional status, puberty, hematological parameters, and insulin resistance were associated with MUP. Results: The subject's age mean was 11 years (SD: 2.61). RDW values were significantly lower in children in the metabolically unhealthy normal weight (MUNW) group compared to children with metabolically unhealthy obesity (MUO) group (12.33 ± 0.90 vs. 13.67 ± 0.52; p = 0.01) and in metabolically healthy obesity (MHO) compared to MUO group (13.15 ± 0.53 vs. 13.67 ± 0.52; p = 0.04). In adolescents, the platelet-to-lymphocyte ratio was higher in the MHNW group, with a mean value of 152.60 (SD 62.97) compared to 111.16 (SD 44.12) for the MHO group. However, after adjusting for age, nutritional status, and puberty, hematological indices were not associated with MUP. Conclusions: The study demonstrates that hematologic parameters are not independently associated with the MUP, and it is unlikely that they represent reliable biomarkers for screening for the MUP in the pediatric population.

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Rheumatoid Arthritis (RA) is an autoimmune disease characterized by loss of immune tolerance and chronic inflammation. It is pathogenesis complex and includes interaction between genetic and environmental factors. Current evidence supports the hypothesis that gut dysbiosis may play the role of environmental triggers of arthritis in animals and humans. Progress in the understanding of the gut microbiome and RA. has been remarkable in the last decade. In vitro and in vivo experiments revealed that gut dysbiosis could shape the immune system and cause persistent immune inflammatory responses. Furthermore, gut dysbiosis could induce alterations in intestinal permeability, which have been found to predate arthritis onset. In contrast, metabolites derived from the intestinal microbiota have an immunomodulatory and anti-inflammatory effect. However, the precise underlying mechanisms by which gut dysbiosis induces the development of arthritis remain elusive. This review aimed to highlight the mechanisms by which gut dysbiosis could contribute to the pathogenesis of RA. The overall data showed that gut dysbiosis could contribute to RA pathogenesis by multiple pathways, including alterations in gut barrier function, molecular mimicry, gut dysbiosis influences the activation and the differentiation of innate and acquired immune cells, cross-talk between gut microbiota-derived metabolites and immune cells, and alterations in the microenvironment. The relative weight of each of these mechanisms in RA pathogenesis remains uncertain. Recent studies showed a substantial role for gut microbiota-derived metabolites pathway, especially butyrate, in the RA pathogenesis.

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Objective: Identify risk factors for severe outcome in Mexican patients with COVID-19 in the population of Quintana Roo. Material and methods: Study of 5,916 who met the criteria for suspected cases of COVID-19, 2,531 confirmed by qrTPCR-Sars-CoV-2 tests, of which 1,486 were positive, among which they were classified as hospitalized (severe COVID-19) and outpatients. Multivariate logistic regression analysis was performed to explore the factors associated with the severity of COVID-19 and death as clinical outcomes. The basic reproduction number (R0) was calculated Statistical analysis) Endorsement of the ethics committee 2301. Results: SARS-CoV-2 positive patients presented a high prevalence of hypertension 29.1%, diabetes 23.5%, obesity 24%, and 48.5% have at least one chronic disease. There is a high risk of severity for COVID-19 in patients with diabetes OR=3.14, hypertension OR=1.88, obesity OR=1.68, kidney disease OR=3.2, older than 65 years OR=13.6 and men OR=1.7. These factors also increase the risk of death up to 7.7 times. The maximum R0 during the epidemic was 2.4. Conclusion: Liver and kidney disease, diabetes, hypertension, and obesity are significantly associated with severe COVID-19 and death.

Objetivo: identificar factores de riesgo para desenlace a COVID-19 grave en pacientes mexicanos con de COVID-19 en población en Quintana Roo. Material y métodos: estudio de 5,916 quienes cumplieron criterios de casos sospechosos de COVID-19, 2,531 confirmados por pruebas qrTPCR-Sars-CoV-2 de los cuales 1,486 fueron positivos entre los cuales se clasifico en hosptializados (COVID-19 grave) y ambulatorios. Se realizó análisis de regresión logística multivariada para explorar los factores asociados con la gravedad de COVID-19 y defunción como desenlaces clínicos. Se calculó el número básico de reproducción (R0) Análisis estadístico) Aval del comité de ética 2301. Resultados: pacientes positivos a SARS-CoV-2 presentaron alta prevalencia de hipertensión 29.1%, diabetes 23.5%, obesidad 24%, y 48.5% tiene al menos una enfermedad crónica. Existe alto riesgo de severidad para COVID-19 en pacientes con diabetes OR=3.14; hipertensión OR=1.88, obesidad OR=1.68, enfermedad renal OR=3.2, mayores de 65 años OR=13.6 y hombres OR=1.7. Estos factores también incrementan el riesgo de defunción hasta 7.7 veces. El R0 máximo durante la epidemia fue de 2.4. Conclusión: la enfermedad hepática, renal, diabetes, hipertensión y obesidad se asocian significativamente a COVID-19 severo y defunción.

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PURPOSE OF REVIEW: This Review evaluates the available information on the modification of the microbiota by diet, prebiotics, probiotics, or drugs and its association with the severity of arthritis in animals and humans and highlights how this modulation could have therapeutic applications in RA. RECENT FINDINGS: The gut microbiota and microbiota-derived metabolites play a role in developing rheumatoid arthritis (RA) in animals and humans, making the intestinal microbiota an exciting novel approach to suppress autoimmunity. Studies in animal models of RA show that it is possible to modify the intestinal microbiota with drugs, natural products, diet, probiotics, and prebiotics. Furthermore, these changes showed beneficial effects on symptom relief in animal models of RA and that these effects were associated with modulation of the immune response. Therapies that modify the gut microbiota would significantly impact the preclinical stage of arthritis, based on the fact that dysbiosis occurs before clinical arthritis. The effects of interventions to modulate the microbiota could not reverse arthritis. Furthermore, the therapies modulating therapies in controlling symptoms were limited once arthritis developed. The results obtained in the study of acarbose, probiotics, and prebiotics suggest that these interventions may decrease the disease's incidence rather than treat or cure it.

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This research explores if a social marketing intervention model based on social representations theory and the health belief model can generate changes regarding treatment adherence and improve patient self-efficacy. As a pilot, a test-retest field quasi-experiment was designed to evaluate the intervention model with type 1 diabetes (T1DM) patients of families with 8- to 17-year-old children. The intervention model was designed to clarify misconceptions, increase awareness of the benefits of following doctors' treatments and improve patients' self-efficacy. In-depth interviews were carried out to gain a richer understanding of the intervention's effect. The pilot intervention generated a favourable change in shared misconceptions, individual health beliefs, glycaemic control and declared treatment adherence. This paper contributes to the social marketing literature and public health by providing early support for the theoretical assumptions regarding the role of shared misconceptions in physiological and behavioural outcomes for patients with T1DM. Contrary to previous studies, instead of only focusing on individual beliefs, this study incorporates shared beliefs between patients and caregivers, generating more comprehensive behavioural change.

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Introducción. El sangrado de tubo digestivo alto de origen variceal tiene una mortalidad alta. El cociente número de plaquetas/diámetro mayor del bazo puede ser un parámetro no invasivo útil para predecir el sangrado por várices esofágicas en pacientes cirróticos. Objetivo: Determinar la sensibilidad y especificidad del cociente número de plaquetas/diámetro mayor del bazo, para el diagnóstico de várices esofágicas con riesgo de sangrado en pacientes con insuficiencia hepática. Material Y Métodos: Estudio de proceso, realizado en un hospital de segundo nivel de atención médica, en pacientes con insuficiencia hepática a quienes se les realizó ultrasonido, citometría hemática, pruebas de función hepática y endoscopia. Se valoró sensibilidad y especificidad del cociente plaquetas/bazo para el diagnóstico de várices esofágicas con riesgo de sangrado. Resultados: Fueron 70 pacientes: 28 mujeres, 42 hombres; causa principal de insuficiencia hepática en hombres fue etilismo en 31 pacientes, virus de la hepatitis C en 20 mujeres. El cociente bazo-plaquetas tiene una sensibilidad de 90%, especificidad 83%, falsos positivos 16%, falsos negativos 9%, valor predictivo positivo 94%, valor predictivo negativo 75 %, prevalencia del 74% y una certeza diagnóstica del 88% para diagnosticar várices esofágicas con riesgo de sangrado. Conclusión: El cociente plaquetas/bazo es un estudio útil y no invasivo para diagnosticar várices esofágicas con riesgo de sangrado, en hospitales donde no se cuenta con endoscopía.

Introduction: Upper gastrointestinal bleeding of variceal origin has a high mortality. The platelet count/spleen major diameter ratio may be a useful noninvasive parameter to predict esophageal variceal bleeding in cirrhotic patients. Objective: to determine the sensitivity and specificity of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices with risk of bleeding in patients with hepatic insufficiency. Material and Methods: Process study, performed in a Second Level Medical Facility, in patients with liver failure who underwent ultrasound, blood cytometry, liver function tests and endoscopy. Sensitivity and specificity of the platelet/spleen ratio were assessed in patients with esophageal variceal and bleeding risk. Results: There were 70 patients: 28 women, 42 men; main cause of liver failure in men was ethylism in 31 patients and hepatitis C virus in 20 women. The spleen-platelet ratio has a sensitivity of 90%, specificity 83%, false positives 16%, false negatives 9%, positive predictive value 94%, negative predictive value 75%, prevalence of 74% and diagnostic accuracy of 88% to diagnose esophageal varices with risk of bleeding. Conclusion: Platelet/spleen ratio is a useful, non-invasive study to diagnose esophageal varices with bleeding risk, in hospitals where endoscopy is not available.

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To evaluate the validity, reliability, and responsiveness to change of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS) Spanish version questionnaire. This study was based on a questionnaire validation design. A cross-sectional survey of 199 patients with knee osteoarthritis (KOA) and ten healthy controls was studied to evaluate the validity and reliability of KOOS-12. One hundred and sixteen patients were assessed for test-retest reliability, and 38 patients were included for a responsiveness assessment. Structural validity was assessed by the confirmatory factor analysis (CFA). Item response theory-based methods were used to determine the performance of the items. Internal consistency reliability was appropriate for all scales (Cronbach's alpha = 0.85-0.94). The intra-class correlation coefficient of KOOS-12 scales ranged from 0.60 to 0.71. The CFA and generalized partial credit model showed that KOOS-12 scales presented a good overall model fit. No differential item functioning was found. Convergent validity was demonstrated by strong correlations (Spearman's rho ≥ 0.70) with KOOS, International Knee Documentation Committee subjective knee evaluation form (IKDC), and Knee Intermittent and Constant Osteoarthritis Pain (ICOAP). Known-groups validity showed that KOOS-12 well discriminated subgroups of patients (radiographic severity and nutritional status). Standardized response means for KOOS-12 scales were ≥ 0.75. Changes in KOOS-12 scales had a moderate to strong correlation (Pearson's r ≥ 0.40) with the changes in the KOOS, ICOAP, and IKDC scales. The KOOS-12 Spanish version is a valid, reliable, and responsiveness to change questionnaire to measure patients' opinions about their knee and associated problems in Mexican subjects with KOA. Key Points • KOOS-12 is a short self-reported measure that assesses patient's opinions about the difficulties they experience due to problems with their knee and also covers aspects of pain, functional limitations, and knee-related quality of life. • The Spanish version of KOOS-12 questionnaire is a valid instrument for measuring the patients' opinions about their knee and associated problems, and is both reliable and responsiveness to change.

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OBJECTIVES: To determine the prevalence of the Metabolically Healthy Obesity (MHO), and Metabolically Obese Normal-Weight (MONW) phenotypes in a sample of children and adolescents. To evaluate which clinical and laboratory variables are related to the MONW and MHO phenotypes. METHODS: A cross-sectional study was carried out in children and adolescents aged 6-18 years old, presumably healthy. Somatometry, glucose, insulin, triglycerides, HDL-cholesterol, LDL-cholesterol, HOMA-IR, triglycerides/HDL ratio, triglycerides and glucose index, and leptin/adiponectin, were determined. RESULTS: Data from 620 children and adolescents were included (50.65% were males); the median age was 11 years. The prevalence of the MONW phenotype was 22.85% (95%CI 16.85%-29.79%), and the MHO phenotype 27.61% (95%CI 22.60%-33.06%). The variables that significantly explained the possibility of presenting the MONW and MHO phenotype were triglycerides/HDL ratio, and product of triglycerides and glucose. Insulin and HOMA-IR were significantly associated with the MHO phenotype but not with the MONW phenotype. CONCLUSIONS: Prevalence of metabolically healthy obese phenotype is lower in the Mexican population compared to European studies; thus, future studies should determine if this difference relies upon genetic profile or lifestyle. The indices to assess the action of insulin based on lipids can help identify children and adolescents with the MHO and MONW phenotypes.

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ABSTRACT Objective To determine the incidence of primary malignant bone tumors of the spine in a High Specialty Orthopedics and Traumatology Medical Unit. Methods Review study. The study included patients receiving benefits from the Mexican Social Security Institute of all ages and both sexes with malignant spinal bone tumors during the period from 2010 to 2017. The descriptive statistics used were central tendency measures and dispersion in the SPSS v. 22 program from IBM. The results are presented in tables and figures. Results There were 107 patients, 56 (52.34%) men, 51 (47.66%) women with a mean age of 59.75 + 10.76 years (minimum 35, maximum 88). There were 46,840 hospital discharges during the period, for an annual average of 5,855 and a monthly average of 487.91. Of the 107 study cases, 78 (72.89%) were in the lumbosacral, 15 (14.01%) in the cervical, and 14 (13.08%) in the thoracic region. The incidence for the period was 1.9/1000 discharges, 1.38in 2010 increasing to 2.32 in 2017. Conclusions The behavior of primary malignant spinal tumors has increased its presentation from 2010 to 2017 . Level of evidence III; Non-analytical, descriptive study.

RESUMO Objetivo Conhecer a incidência de tumores ósseos malignos primários da coluna vertebral em uma unidade médica de alta especialidade médica em Ortopedia e Traumatologia. Métodos Estudo de revisão. O período do estudo incluiu os anos de 2010 a 2017 incluindo pacientes com tumores ósseos malignos da coluna vertebral, de todas as idades e ambos os sexos e usuários do IMSS (Instituto Mexicano de Seguridade Social). Foram utilizadas medidas estatísticas descritivas de tendência central e de dispersão no programa SPSS v. 22 IBM. Os resultados são apresentados em tabelas e gráficos. Resultados O estudo incluiu 107 pacientes, 56 (52,34%) homens e 51 mulheres (47,66%); idade média 59,75 + 10,76 anos (mínima 35, máxima 88). As altas hospitalares durante o período foram 46840, média anual de 5855 e média mensal de 487,91; dos tumores malignos 78 (72,89%) foram na região lombossacra, 15 (14,01%) na região cervical e 14 (13,08%) na região torácica. A incidência do período foi de 1,9/1000 altas, 1,38 em 2010, aumentando para 2,32 em 2017. Conclusões O comportamento dos tumores malignos primários da coluna vertebral tem aumentado desde 2010 a 2017. Nível de evidência III; Estudo analítico-descritivo.

RESUMEN Objetivo Conocer la incidencia de tumores óseos malignos primarios de columna vertebral en una Unidad Médica de Alta Especialidad en Ortopedia y Traumatología. Métodos Estudio de revisión. El período de estudio comprendió los años 2010 a 2017, incluyendo a pacientes con tumores óseos malignos de columna vertebral, de todas las edades y ambos sexos, y usuarios del IMSS (Instituto Mexicano del Seguro Social). Fueron utilizadas medidas estadísticas descriptivas de tendencia central y de dispersión en el programa SPSS v. 22 de IBM. Los resultados son presentados en tablas y gráficos. Resultados El estudio incluyó a 107 pacientes, 56 hombres (52,34%), y 51 mujeres (47,66%); edad promedio 59,75 + 10,76 años (mínima 35, máxima 88). Las altas hospitalarias durante el período fueron 46840, promedio anual de 5855 y promedio mensual de 487,91; de los tumores malignos, 78 (72,89%) casos en la región lumbosacra, 15 (14,01%) en la región cervical y 14 (13,08 %) en la región torácica. La incidencia del período fue 1,9/1000 altas, 1,38 en 2010, aumentando para 2,32 en 2017. Conclusiones El comportamiento de los tumores malignos primarios de columna vertebral ha aumentado desde 2010 a 2017. Nivel de evidencia III; Estudio analítico-descriptivo.

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Approximately 40 genotypes of the human papillomavirus (HPV) have been identified in cervical mucosa. In particular, HPV-16 and HPV-18 have been associated with cervical neoplasia. Squamous intraepithelial lesions (SILs) are precursors of cervical cancer. This study aimed to identify the HPV by genotype in SILs using a linear array genotyping test in a population in Mexico. We performed a cross-sectional study of 129 female patients with or without SILs, as determined by colposcopy, who completed a risk factor questionnaire. Cervical swab samples were obtained and genotyped using a Linear Array HPV Genotyping assay. Forty-nine (37.98%) samples were positive for HPV, and 24 genotypes were identified among these samples. The most common genotype was HPV-16. Twelve genotypes were found in both high- and low-grade SILs (HPV-6, 16, 31, 39, 51, 52, 53, 58, 59, 61, 67, and 84), of which seven were high-risk SILs (HPV-16, 31, 39, 51, 52, 58, and 59). Among the populations studied, the most frequent genotype was HPV-16, multiple infections were found, and four patients without injury tested positive for HPV.

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BACKGROUND: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. METHODS: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. RESULTS: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. CONCLUSIONS: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

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Abstract Background: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. Methods: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. Results: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. Conclusions: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

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Obesity is a metabolic disease characterized by low-grade inflammation and accompanied by dyslipidemia and up-regulation of other bioactive molecules, creating a predisposition to endothelial dysfunction and metabolic syndrome. We studied the association between gut microbiota diversity and endothelial dysfunction (EDF) markers in obese Mexican children and adolescents. We examined clinical data including metabolic factors and EDF markers in blood samples. Gut bacterial diversity was characterized by high-throughput sequencing of V3-16S rDNA libraries. Triglycerides, insulin, homeostasis model assessment-insulin resistant (HOMA-IR), leptin, C-reactive protein (CRP), and EDF marker intercellular adhesion molecule 1 (ICAM-1) were significantly higher in obese children and adolescents. Multivariate analysis showed statistically significant positive associations between vascular cell adhesion molecule 1 (VCAM-1) and Veillonellaceae, and between ICAM-1 and Ruminococcus in obese children. In obese adolescents, there was a statistically significant positive association between total cholesterol and Ruminococcus, and between ICAM-1 and Bacteroides. LEfSe analysis showed that the genus Lactobacillus and family Coriobacteriaceae were enriched in children, and genera Collinsella and Prevotella were enriched in obese adolescents. Obese children and adolescents had higher levels of insulin resistance and metabolic syndrome. These results suggest that obese Mexican children and adolescents had increased levels of CRP and a reduction of adiponectin, which causes higher expression of EDF markers, affecting endothelial function and associating with changes in the gut microbiota.

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Objetivo: Determinar la Relación de la saturación central venosa de oxígeno (ScvO2) >_70% con la mortalidad, en el choque séptico en pacientes que ingresan al servicio de terapia intensiva pediátrica del HGR 36, Puebla. Métodos: Estudio, descriptivo, longitudinal, observacional. Se identificaron todos los pacientes de un mes a 14 años de edad que ingresaron a unidad de terapia intensiva con el diagnóstico de choque séptico. Se corroboró la colocación de un catéter venoso central para la medición de la ScvO2 a su ingreso y las 6 horas. Calificamos con el Indice Pediátrico de Mortalidad (PIM2) para medir el riesgo de mortalidad en cada paciente. Se realizó estadística descriptiva. Resultados: Fueron 15 pacientes, 8 (53.3%) femeninos y 7 (46.7%) masculinos. El PIM2 obtuvo un promedio de 7.42 % al ingreso, y a las 6 horas fue de 13.4%. El promedio de la saturación venosa central de oxígeno al ingreso de los pacientes a la terapia intensiva pediátrica fue de 56% y a las 6 horas el promedio alcanzó 71%. Ningún paciente falleció durante la reanimación cardiiopulmonar desde su ingreso. Conclusión: En base a los resultados anteriores podemos concluir, que no hay una correlación entre la ScvO2 >_ 70% y la mortalidad en los pacientes pediátricos con choque séptico

Objective: To determine the ratio of central venous oxygen saturation (ScvO2) >_ 70% mortality in septic shock patients admitted to pediatric intensive care unit of the HGR 36, Puebla. Methods: A descriptive, longitudinal, observational study. We identified all patients from one month to 14 years of age who were admitted to ICU with a diagnosis of septic shock. It confirmed the placement of a central venous atheter for the measurrement of income and ScvO2 to 6 hours. Qualified with the Pediatric Index of Mortality (PIM2) to measure the risk of death in each patient. We performed descriptive statistics. Results: there were 15 patients,eight (53.3%) female and 7 (46.7%) male. The PIM2 obtained an average of 7.42%. To entry, and 6 hours was 13.4%. The mean central venous oxygen saturation on admission of patients to the pediatric intensive care was 56% and 6 hours on average reached 71%. No patient died during cardiopulmonary resuscitation from your income. Conclusion: Based on previous results we can conclude that there is no coelation between ScvO2 >_70% and mortality in pediatric patients with septic shock

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Introducción La lesión aislada del ligamento cruzado posterior ocasiona inestabilidad y falla del componente rotatorio de la rodilla. El objetivo del trabajo es describir los resultados del tratamiento artroscópico con banda simple operados por técnica de un solo haz con monotúnel y fijación con tornillos interferenciales en pacientes con lesiones aisladas del Ligamento Cruzado Posterior grado III. Materiales & métodos Estudio transversal. Se utilizó el formulario IKDC para evaluar tratamiento de lesiones del Ligamento Cruzado Posterior preoperatoriamente y al año. La estadística empleada fue descriptiva, se utilizaron medidas de tendencia central y dispersión, U de Mann Whitnney-Wilcoxon para comparar medias. Resultados Fueron 5 pacientes, 4(80%) fueron masculinos y 1(20%) femenino, la edad promedio 27.8 años (mínima 20, máxima 33) ± 5.58 años, el lado afectado fue derecho en 3(60%), izquierdo en 2(40%) pacientes, todos presentaron signo de cajón posterior positivo. Los resultados del formulario IKDC prequirúrgico y al año fueron: diferencia de promedios 2.6, suma de rangos negativos 15, suma de rangos positivos 0, z= -2.070, p=0.038, al año ningún paciente presentó signo de cajón posterior positivo. Discusión El tratamiento de lesiones aisladas del LCP grado III con técnica de un solo haz y monotúnel con autoinjerto de isquiotibiales por vía artroscópica ofrece resultados buenos.

Background Isolated lesions of the posterior cruciate ligament cause instability and failure in the rotating component of the knee. The objective of this article is to describe the results of single-row arthroscopic treatment using a single-bundle technique with a single tunnel and fixation with interference screws in patients with isolated lesions of the Posterior Cruciate Ligament, grade III. Methods A cross-sectional study was conducted using the IKDC Test to evaluate, pre-operatively and yearly, the treatment of posterior cruciate ligament injuries. The statistics used were descriptive, as well as measures of central tendency and dispersion, and Mann Whitney U- Wilcoxon tests to compare means. Results The study included 5 patients, 4 (80%) were male and 1 (20%) female, and a mean age 27.8 years (minimum 20, maximum 33) ± 5.58 years). The affected side was right in 3%, left in 2 (40%) patients, and all showed a posterior drawer sign. The results of the pre-operative IKDC test were: difference of means 2.6, sum of negative ranks 15, sum of positive ranks 0, z = -2.070, P=.038; after surgery no patient had a positive posterior drawer sign. Discussion The treatment of isolated grade III lesions of PCL with a single bundle and tunnel technique with an arthroscopic autograft of hamstrings offers good results.

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Librarian and information services focused on supporting research, teaching, and health care are vital for the generation of new knowledge and its application in health care, both by staff and students, helps to improve the quality of medical care. Therefore, in this article we expose an historical and social tour of 50 years of the Instituto Mexicano del Seguro Social's library services in Puebla. From 1964 to 2014 occurred many events in the development of these services in our area, from the creation of a small space in the basement, to the implementation of spaces created deliberately to provide dignified service to all users, which is why this historical sketch is here as an acknowledgement to the first librarians who contributed to the training of specialists in Mexico.

Los servicios bibliotecarios y de información enfocados a apoyar la investigación, la docencia y la atención médica son de vital importancia para la generación de nuevos conocimientos y su aplicación en la atención médica por el personal del área de la salud, y los alumnos en proceso de formación, contribuye a mejorar la calidad de la atención médica. Por ello, en el presente artículo exponemos un recorrido histórico y social de 50 años de los servicios bibliotecarios del Instituto Mexicano del Seguro Social en Puebla. De 1964 a 2014 ocurrieron muchos sucesos en el desarrollo de estos servicios en nuestro medio, desde la creación de un espacio pequeño ubicado en el sótano, hasta un espacio establecido ex profeso para otorgar servicio digno a todos los usuarios, por lo que se muestra este bosquejo histórico como reconocimiento a aquellos primeros bibliotecarios que contribuyeron a la formación de especialistas en México.

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Characterization and understanding of gut microbiota has recently increased representing a wide research field, especially in autoimmune diseases. Gut microbiota is the major source of microbes which might exert beneficial as well as pathogenic effects on human health. Intestinal microbiome's role as mediator of inflammation has only recently emerged. Microbiota has been observed to differ in subjects with early rheumatoid arthritis compared to controls, and this finding has commanded this study as a possible autoimmune process. Studies with intestinal microbiota have shown that rheumatoid arthritis is characterized by an expansion and/or decrease of bacterial groups as compared to controls. In this review, we present evidence linking intestinal dysbiosis with the autoimmune mechanisms involved in the development of rheumatoid arthritis.

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RESUMEN Antecedentes: la apendicitis aguda tuberculosa es una enfermedad rara, constituye de 0,001 % a 0,01 % de las formas clínicas de tuberculosis. Se presenta un caso de apendicitis aguda probablemente tuberculosa como causa de abdomen agudo quirúrgico. Caso clínico: hombre de 29 años con cuadro de dolor abdominal leve a moderado que se intensificó y localizó en el hemiabdomen derecho, claudicación, febrícula, vómito, mal estado general, leucocitosis de 11 300/µL y neutrofilia de 91 %. Se hizo apendicectomía, el reporte histopatológico fue de apendicitis aguda y la tinción de Ziehl Neelsen fue positiva. A los tres días regresó a su domicilio y no presentó complicaciones a corto ni a largo plazo. Conclusión: la apendicitis aguda tuberculosa es una entidad rara que puede ocasionar abdomen agudo; los pacientes deben recibir tratamiento medicamentoso para erradicar la causa y tener un seguimiento epidemiológico adecuado.

SUMMARY Background: Acute tuberculous appendicitis is a rare disease. It constitutes from 0.001 % to 0.01 % of the clinical forms of tuberculosis. We present cases of such disease as probably cause for surgical acute abdomen. Case report: Male aged 29 with mild to moderate diffuse abdominal pain, which intensified and localized in the right lower quadrant of the abdomen, fever, vomiting, malaise, leukocytosis (11,300/µL) and 91 % neutrophils. Appendectomy was performed, the histopathological report was acute appendicitis, Ziehl-Neelsen stain was positive. Three days later he returned home and had no short- or long term complications. Conclusion: Acute tuberculous appendicitis is a rare disease that may cause acute abdomen, patients should receive drug treatment to eradicate the cause and have proper epidemiological monitoring.

RESUMO Antecedentes: a apendicite aguda tuberculosa é uma doença rara, constitui de 0,001 % a 0,01 % das formas clínicas de tuberculose. Se apresenta um caso de apendicite aguda tuberculosa como causa de abdome agudo cirúrgico. Caso clínico: homem de 29 anos com quadro de dor abdominal leve a moderado que se intensificou e localizou no hemiabdome direito, claudicação, febrícula, vómito, mal estado em geral, leucocitose de 11 300/µL e neutrofilia de 91 %. Se fez apendicectomia, o relatório histopatológico foi de apendicite aguda e a técnica de Ziehl Neelsen foi positiva. Aos três dias regressou a seu domicílio e não apresentou complicações a curto nem a longo prazo. Conclusão: a apendicite aguda tuberculosa é uma entidade rara que pode ocasionar abdome agudo; os pacientes devem receber tratamento medicamentoso para erradicar a causa e ter um seguimento epidemiológico adequado.

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