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OBJECTIVES: This study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico. DESIGN: We conducted a multimethod non-randomised pilot study. We used a pre-test/post-test design for quantitative assessment of the intervention's effect on patients' supportive care needs and quality of life. We conducted in-depth interviews (IDIs) with participants and healthcare workers to explore the intervention's benefits and barriers and understand its feasibility. PARTICIPANTS: 50 women aged 20-75 diagnosed with stage I-III breast cancer were enrolled within 2 weeks of starting neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy. We excluded illiterate women and those with visual impairment, cognitive disability or severe depression. IDIs were conducted with 18 participants and 10 healthcare providers. SETTING: Oncology services in three public hospitals of the Mexican Social Security Institute. INTERVENTION: The ePRO intervention consisted of a responsive web application for weekly symptom reporting combined with proactive follow-up by nurses guided by predefined clinical algorithms for 6 weeks. RESULTS: 50 women were enrolled out of 66 eligible patients approached (75.8%). All 50 completed the 4-week follow-up assessment (100% retention). Completion of the symptom registry declined from 100% in week 1 to 66% in week 6. Participants experienced decreases in supportive care needs and increased quality of life. The ePRO application was rated highly usable. Participants and health professionals both perceived intervention benefits. Drawbacks included poor fit for women receiving radiotherapy and challenges using the application for women with low digital literacy or experiencing severe symptoms. CONCLUSIONS: This pilot study provided evidence of the high usability and potential efficacy of a web-based ePRO intervention. We revised recruitment during the pilot to include multiple facilities, and we will further revise for the randomised trial to address barriers to successful ePRO implementation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT05925257.
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Neoplasias da Mama , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Humanos , Feminino , Neoplasias da Mama/terapia , Projetos Piloto , Pessoa de Meia-Idade , México , Adulto , Idoso , Adulto Jovem , Intervenção Baseada em Internet , Estudos de ViabilidadeRESUMO
AIM: To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic. METHODS: We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models. RESULTS: The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time. CONCLUSIONS: After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.
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COVID-19 , Previdência Social , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , México/epidemiologia , Política de Saúde , Pandemias , SARS-CoV-2 , Serviços de Saúde , Atenção à SaúdeRESUMO
INTRODUCTION: Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS: We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION: The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: NCT05925257.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Qualidade de Vida , México , Seguimentos , Atenção à Saúde , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.
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Background: Recovery of health services disrupted by the COVID-19 pandemic represents a significant challenge in low- and middle-income countries. In April 2021, the Mexican Institute of Social Security (IMSS), which provides health care to 68.5 million people, launched the National Strategy for Health Services Recovery (Recovery policy). The study objective was to evaluate whether the Recovery policy addressed COVID-related declines in maternal, child health, and non-communicable diseases (NCDs) services. Methods: We analysed the data of 35 IMSS delegations from January 2019 to November 2021 on contraceptive visits, antenatal care consultations, deliveries, caesarean sections, sick children's consultations, child vaccination, breast and cervical cancer screening, diabetes and hypertension consultations, and control. We focused on the period before (April 2020 - March 2021) and during (April 2021 - November 2021) the Recovery policy and used an interrupted time series design and Poisson Generalized Estimating Equation models to estimate the association of this policy with service use and outcomes and change in their trends. Results: Despite the third wave of the pandemic in 2021, service utilization increased in the Recovery period, reaching (at minimum) 49% of pre-pandemic levels for sick children's consultations and (at maximum) 106% of pre-pandemic levels for breast cancer screenings. Evidence for the Recovery policy role was mixed: the policy was associated with increased facility deliveries (IRR = 1.15, 95%CI = 1.11-1.19) with a growing trend over time (IRR = 1.04, 95%CI = 1.03-1.05); antenatal care and child health services saw strong level effects but decrease over time. Additionally, the Recovery policy was associated with diabetes and hypertension control. Services recovery varied across delegations. Conclusions: Health service utilization and NCDs control demonstrated important gains in 2021, but evidence suggests the policy had inconsistent effects across services and decreasing impact over time. Further efforts to strengthen essential health services and ensure consistent recovery across delegations are warranted.
Assuntos
COVID-19 , Diabetes Mellitus , Hipertensão , Neoplasias do Colo do Útero , COVID-19/epidemiologia , Criança , Detecção Precoce de Câncer , Feminino , Humanos , Análise de Séries Temporais Interrompida , México/epidemiologia , Pandemias/prevenção & controle , Políticas , Gravidez , Cuidado Pré-NatalRESUMO
Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations.
Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal.
Assuntos
Cuidado Pós-Natal , Cuidado Pré-Natal , Estudos Transversais , Feminino , Humanos , Período Pós-Parto , Gravidez , Apoio SocialRESUMO
Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal
Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Cuidado Pós-Natal , Fatores Socioeconômicos , Fatores Sociais , Atenção Primária à Saúde , Estudos Transversais , Saúde da Mulher , MéxicoRESUMO
Abstract Objective: To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. Materials and methods: We used a mixed-methods approach: 1) Joinpoint analysis of hospitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. Results: AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortality rates. The survey included 527 hospitals (2nd level =471; 3rd level =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). Conclusions: There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to diagnose and manage AMI and reduce AMI mortality effectively.
Resumen Objetivo: Analizar las tendencias de admisiones y mortalidad hospitalaria por infarto agudo al miocardio (IAM) y evaluar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo. Material y métodos. Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS. Resultados: Las hospitalizaciones por IAM están aumentando entre hombres y pacientes >60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%). Conclusiones: Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.
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Feminino , Humanos , Masculino , Atenção à Saúde/estatística & dados numéricos , Infarto do Miocárdio , Estudos Transversais , Mortalidade Hospitalar , Competência Clínica , Hospitalização , México/epidemiologia , Infarto do Miocárdio/terapia , Infarto do Miocárdio/epidemiologiaRESUMO
OBJECTIVE: To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. MATERIALS AND METHODS: We used a mixed-methods approach: 1) Joinpoint analysis of hos-pitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. RESULTS: AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortal-ity rates. The survey included 527 hospitals (2nd level =471; 3rdlevel =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). CONCLUSIONS: There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to di-agnose and manage AMI and reduce AMI mortality effectively.
OBJETIVO: Analizar las tendencias de admisiones y mortali-dad hospitalaria por infarto agudo al miocardio (IAM) y eva-luar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo. MATERIAL Y MÉTODOS: Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS. RESULTADOS: Las hospitalizaciones por IAM están aumentando entre hombres y pacientes >60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%). CONCLUSIONES: Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Infarto do Miocárdio , Competência Clínica , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , México/epidemiologia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapiaRESUMO
BACKGROUND: Leishmania and other trypanosomatid parasites possess atypical mechanisms of gene expression, including the maturation of mRNAs by trans-splicing and the involvement of RNA Polymerase III in transcription of all snRNA molecules. Since snRNAs are essential for trans-splicing, we are interested in the study of the sequences that direct their expression. Here we report the characterization of L. major U2 snRNA promoter region. RESULTS: All species of Leishmania possess a single U2 snRNA gene that contains a divergently-oriented tRNA-Ala gene in the upstream region. Between these two genes we found a tRNA-like sequence that possesses conserved boxes A and B. Primer extension and RT-qPCR analyses with RNA from transiently-transfected cells showed that transcription of L. major U2 snRNA is almost abolished when boxes A and B from the tRNA-like are deleted or mutated. The levels of the U2 snRNA were also highly affected when base substitutions were introduced into box B from the tRNA-Ala gene and the first nucleotides of the U2 snRNA gene itself. We also demonstrate that the tRNA-like is transcribed, generating a main transcript of around 109 bases. As pseudouridines in snRNAs are required for splicing in other organisms, we searched for this modified nucleotide in the L. major U2 snRNA. Our results show the presence of six pseudouridines in the U2 snRNA, including one in the Sm site that has not been reported in other organisms. CONCLUSIONS: Four different regions control the transcription of the U2 snRNA gene in L. major: boxes A and B from the neighbor tRNA-like, box B from the upstream tRNA-Ala gene and the first nucleotides of the U2 snRNA. Thus, the promoter region of L. major U2 snRNA is different from any other promoter reported for snRNAs. Pseudouridines could play important roles in L. major U2 snRNA, since they were found in functionally important regions, including the branch point recognition region and the Sm binding site.
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Leishmania major/genética , Regiões Promotoras Genéticas , RNA Nuclear Pequeno/biossíntese , RNA de Transferência de Alanina/genética , Transcrição Gênica , Análise Mutacional de DNA , Pseudouridina/análise , RNA Nuclear Pequeno/químicaRESUMO
Introducción: la histoplasmosis es una micosis que fue descrita por primera vez en Panamá, producida por la especie Histoplasma capsulatum, un hongo dimórfico endémico de los valles fluviales de América, el cual produce infección sobretodo en personas con deficiencias en la inmunidad celular, particularmente el virus de la inmunodeficiencia humana. Las guías internacionales definen la primera línea de tratamiento contra la histoplasmosis con anfotericina B liposomal hasta que la condición clínica mejore, y entonces traslaparlo a itraconazol oral por al menos 12 meses. Objetivo: determinar las características de la población con histoplasmosis en el Hospital San Juan de Dios, y valorar los resultados del uso combinado de anfotericina B deoxicolato y fluconazol como tratamiento alternativo de anfotericina liposomal e itraconazol. Materiales y métodos: se realizó un estudio retrospectivo con los casos positivos por histoplasmosis entre el año 2008 y el 2012 atendidos en el Hospital San Juan de Dios, obtenidos con datos del laboratorio y de la Clínica de HIV-SIDA del hospital. Se encontraron 36 casos pero debido a problemas técnicos de archivo solo se tuvo acceso a 15 expedientes. Este trabajo contó con el aval del Comité Local de Bioética y su análisis estadístico fue realizado en Excel 2007 con la estimación de las frecuencias absolutas y relativas de las variables de interés. Resultados: se presenta un reporte de 15 casos con el diagnóstico de histoplasmosis hecho por cultivo u observación directa en muestras de médula ósea, y solo uno por biopsia. El 60% eran hombres, el promedio de edad fue cerca de los 35 años, 86,7% tenían virus de la inmunodeficiencia humana con una media de linfocitos CD4 de 60 celulas/mm³. Los 15 pacientes tuvieron histoplasmosis diseminada aguda progresiva como forma de presentación clínica y dos además tuvieron compromiso intestinal. Solo dos pacientes tuvieron una recaída de la histoplasmosis y ambos ...
Background: histoplasmosis is a fungic infectious disease described for the first time in Panama by the specie Histoplasma capsulatum, a dimorphic fungus endemic from the fluvial valleys from America, the disease is developed in very few persons mostly in those with deficience in their celular inmunity particularly with HIV. The International Guidelines define the first line of therapy against histoplasmosis with Liposomal Amphotericin B therapy until the clinical condition improve, and then switched to itraconazole for at least 12 months. Objetive: to know the characteristics of the patients with histoplasmosis at Hospital San Juan de Dios and to state the value of the combined use of amphotericin B deoxycholate and fluconazole as alternative therapy to liposomal amphotericin and itraconazole. Methods: It was made a retrospective study with histoplasmosis positive cases in 2008 to 2012 attended in the Hospital San Juan de Dios, obtained from laboratory and HIV local group files. It was founded 36 cases, and for archive technical reasons we only had access to review 15 clinical records. This study had the local bioethical and research commission approval. The statistical analysis was made in Excell 2007 through the estimation of absolute and relative frecuencies of the variables of interest. Results: this is the case of 15 patients with the diagnosis of histoplasmosis made by culture and direct observation in bone marrow samples, and only one by biopsy. A 60% were male, the average age of the infection onset nearby 35 years old, 86,7% corresponded to HIV patients among which the mean of lymphocites CD4 was 60 cells/mm³. The 15 patients have acute progressive disseminated histoplasmosis as clinical presentation, and two also have intestinal involve. Only two patients had a histoplasmosis relapse and both with HAART desertion associated. Conclusions: it was founded the combination of Amphotericin B deoxycholate, fluconazole and ...
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Humanos , Masculino , Feminino , Doenças Transmissíveis , HIV , Histoplasmose , Síndrome da Imunodeficiência Adquirida , Diagnóstico , Fungos , Histoplasma , Infecções , Laboratórios , MicosesRESUMO
The Scolytinae insects are commonly known as bark or ambrosial beetles because of their feeding habits. Among them, some species restrict their reproductive activity to a host plant or a small number of them, whereas others are highly polyphagous. In order to evaluate the population dynamics of Scolytinae species, populations of Xyleborus ferrugineus and X. affinis in ecosystems from Tabasco, Mexico were studied. The study was carried out from November 2010-July 2011, February 2010-January 2011 and 2007. The trapping methods used were alcohol traps, light traps and direct capture on their host plants. A total of 688 specimens of X. ferrugineus and 3 911 specimens of X. affinis were collected. The population dynamics of X. ferrugineus showed low size population in the studied ecosystems, without any marked seasonality. The highest population sizes were recorded both in dry season (March-May) and rainy season (September-December). Unlike the populations of X. ferrugineus, those of X. affinis were more abundant and showed the highest peaks during the rainy seasons (except in May at the Botanical Garden “José Narciso Rovisora”). Alcohol and light traps can be complementary methods for monitoring the populations of these types of insects. They occur most of the year and theirs population dynamics depends on food resources availability as well as environmental factors such as temperature and humidity. Judging by the observed abundance it is suggested that X. affinis has been adapted and exploited resources in a better way than X. ferrugineus in those ecosystems. Correlations between abundance and climatic factors had both positive and negative values. The results reflect the behavior of populations. However, a detail assessment of the biological and abiotic factors that influence the fluctuations of these insects is required.
Los Scolytinae son insectos comúnmente conocidos como coleópteros descortezadores o ambrosiales debido a su forma de alimentarse. Existen especies que restringen su actividad reproductiva a una planta huésped o a un número reducido de ellas, otras son altamente polífagas. Se estudiaron las poblaciones de Scolytinae con el objetivo de conocer la fluctuación poblacional de X. ferrugineus y X. affinis en ecosistemas de Tabasco, México durante noviembre 2010-julio 2011, febrero 2010-enero 2011 y 2007. Los métodos de captura utilizados fueron trampa de alcohol, trampa de luz y captura directa sobre sus plantas huésped. Se recolectaron 688 especímenes de X. ferrugineus y 3 911 de X. affinis. La fluctuación poblacional de X. ferrugineus mostró de manera general poblaciones bajas en los ecosistemas estudiados sin alguna estacionalidad marcada, registrándose los máximos picos poblacionales tanto en época seca (marzo-mayo) como lluviosa (septiembre-diciembre). A diferencia de las poblaciones de X. affinis que fueron más abundantes y mostraron en la mayoría de los sitios (excepto en el Jardín Botánico José Narciso Rovirosa que se presentó en mayo) picos poblacionales en época lluviosa. Las trampas de alcohol y de luz son métodos de recolecta que pueden ser complementarios para el monitoreo de las poblaciones de estos insectos, los cuales se encuentran presentes durante la mayor parte del año y su fluctuación poblacional es dependiente de los recursos alimenticios y sobre todo de factores ambientales como la temperatura y humedad. Se sugiere que X. affinis se ha adaptado y explotado los recursos de mejor manera que X. ferrugineus en estos ecosistemas, a juzgar por la abundancia observada. Las correlaciones entre la abundancia y los factores climáticos presentaron valores positivos y negativos. Los resultados reflejan el comportamiento de las poblaciones, sin embargo, hace falta evaluar de manera detallada algunos factores biológicos y abióticos que influyen en las fluctuaciones de éstos insectos.
Assuntos
Animais , Besouros/fisiologia , Ecossistema , Besouros/classificação , México , Densidade Demográfica , Dinâmica Populacional , Estações do AnoRESUMO
The Scolytinae insects are commonly known as bark or ambrosial beetles because of their feeding habits. Among them, some species restrict their reproductive activity to a host plant or a small number of them, whereas others are highly polyphagous. In order to evaluate the population dynamics of Scolytinae species, populations of Xyleborusferrugineus and X. affinis in ecosystems from Tabasco, Mexico were studied. The study was carried out from November 2010-July 2011, February 2010-January 2011 and 2007. The trapping methods used were alcohol traps, light traps and direct capture on their host plants. A total of 688 specimens ofX ferrugineus and 3 911 specimens of X. affinis were collected. The population dynamics of X. ferrugineus showed low size population in the studied ecosystems, without any marked seasonality. The highest population sizes were recorded both in dry season (March-May) and rainy season (September-December). Unlike the populations of X. ferrugineus, those of X. affinis were more abundant and showed the highest peaks during the rainy seasons (except in May at the Botanical Garden "José Narciso Rovisora"). Alcohol and light traps can be complementary methods for monitoring the populations of these types of insects. They occur most of the year and theirs population dynamics depends on food resources availability as well as environmental factors such as temperature and humidity. Judging by the observed abundance it is suggested that X. affinis has been adapted and exploited resources in a better way than X. ferrugineus in those ecosystems. Correlations between abundance and climatic factors had both positive and negative values. The results reflect the behavior of populations. However, a detail assessment of the biological and abiotic factors that influence the fluctuations of these insects is required.
Assuntos
Besouros/fisiologia , Ecossistema , Animais , Besouros/classificação , México , Densidade Demográfica , Dinâmica Populacional , Estações do AnoRESUMO
UNLABELLED: The objective of this study was to determine high risk human papillomavirus infection (HPV-RH) and factors with cervical intraepithelial neoplasia appears (CIN). MATERIAL AND METHOD: From October 1998 to January 2000, a case-control study, was made; women with benefit package from Mexican Institute of Social Security. The cases were of the colposcopic clinic of the department of the Hospital Obstetrics and Gynecology Luis Castelazo Ayala, women histologically diagnosed with colposcopy and CIN cervical biopsy, and controls patients with negative cervical uterine cytologic study of the Preventive Medicine Department, Unit of Familiar Medicine No. 8, of Mexico City. Trained personnel obtained information about socioeconomic and reproductive factors did the interview. A cytobrush was used to take the cervical sample for HPV-RH to determine HPV-RH utilizing Hybrid Capture II test. Both bivariate analysis and logistic regression analysis were used for the adjustment of variables. RESULTS: We analyzed 102 cases and 192 controls, 79% (44/56) of the cases with CIN I and 89% (37/42) of CIN II-III as 21% of controls, respectively, were positive for HPV-RH. Global risk for HPV-RH association to CIN was OR = 40.6 (95% CI, = 17-96.8). Women age was determinative for HPV-RH association to CIN. We observed a high correlation between HPV positive magnitude and CIN degree. CONCLUSIONS: Frequency of RH-HPV in controls and CIN I is higher than other reports in the literature. HPV was identified as the most important agent associated with this neoplasia, other factors involved and age is an important modifier in HPV-RH and CIN.
Assuntos
Carcinoma in Situ/virologia , Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções Tumorais por Vírus/complicações , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The objective of this study was to determine high risk human papillomavirus infection (HPV-RH) and factors with cervical intraepithelial neoplasia appears (CIN). MATERIAL AND METHOD: From October 1998 to January 2000, a case-control study, was made; women with benefit package from Mexican Institute of Social Security. The cases were of the colposcopic clinic of the department of the Hospital Obstetrics and Gynecology Luis Castelazo Ayala, women histologically diagnosed with colposcopy and CIN cervical biopsy, and controls patients with negative cervical uterine cytologic study of the Preventive Medicine Department, Unit of Familiar Medicine No. 8, of Mexico City. Trained personnel obtained information about socioeconomic and reproductive factors did the interview. A cytobrush was used to take the cervical sample for HPV-RH to determine HPV-RH utilizing Hybrid Capture II test. Both bivariate analysis and logistic regression analysis were used for the adjustment of variables. RESULTS: We analyzed 102 cases and 192 controls, 79 (44/56) of the cases with CIN I and 89 (37/42) of CIN II-III as 21 of controls, respectively, were positive for HPV-RH. Global risk for HPV-RH association to CIN was OR = 40.6 (95 CI, = 17-96.8). Women age was determinative for HPV-RH association to CIN. We observed a high correlation between HPV positive magnitude and CIN degree. CONCLUSIONS: Frequency of RH-HPV in controls and CIN I is higher than other reports in the literature. HPV was identified as the most important agent associated with this neoplasia, other factors involved and age is an important modifier in HPV-RH and CIN.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma in Situ , Infecções por Papillomavirus/complicações , Infecções Tumorais por Vírus/complicações , Papillomaviridae , Estudos de Casos e Controles , Fatores de RiscoRESUMO
Un problema clínico frecuente es la diferenciación entre los soplos sistólicos expulsivos y regurgitantes. La inhalación de nitrito de amilo para este propósito es útil pues aumenta la intensidad de los primeros y disminuye la de los segundos. Debido a la dificultad de conseguir este farmáco, se ensayó el sioproterenol inhalado en diecisiete pacientes con soplos expulsivos y en dieciocho con soplos regurgitantes. El isoproternol se administró a las dosis de 480 a 640 mcg, según la edad y corpulencia. Las modificaciones de los soplos y de la frecuencia cardiaca se expresaron como porciento del cambio con respecto a las valores basales. La frecuencia cardíaca aumentó en ambos grupos. La amplitud de los soplos expulsivos aumentó de inmediato, llegando a un máximo a los 45", en tanto que la de los regurgitantes disminuyó de inmediato y al máximo a los 15". Se concluye que el isoproterenol inhalado, con efecto parecidos a los del nitrito de amilo, puede substituír a éste en la diferenciación clínica y fonocardiográfica de los soplos expulsivos y regurgitantes