Caracterización clínica y etiológica de una muestra de niños y adultos con disfagia atendida en dos centros asistenciales en Medellín (Colombia). Estudio retrospectivo

Introducción: la disfagia es un trastorno frecuente a lo largo del ciclo vital, que posee diferentes etiologías en relación con su tipo clínico en orofaríngea o esofágica. Objetivo: caracterización clínica y etiológica de una muestra con disfagia atendida en dos centros asistenciales de salud en la ciudad de Medellín (Colombia), mostrando la etiología y el tipo clínico de disfagia según los grupos de edad. Métodos: estudio observacional, descriptivo y retrospectivo, mediante la revisión y análisis de historias y registros clínicos de pacientes con diagnóstico de disfagia, atendidos entre el 2012 al 2018 en un hospital universitario y un centro de fonoaudiología en deglución. Resultados: muestra de 527 pacientes. Distribuidos en menores de 18 años 45,4 % (239/527); 18 a 59: 20,1 % (106/527) y mayores de 60: 34,5 % (182/527). Tipo clínico, etiología y condición de salud más frecuente en toda la muestra: disfagia orofaríngea, etiología funcional y enfermedades neurológicas. Enfermedades más frecuentes causantes de la disfagia en menores de 18 años fueron los trastornos del desarrollo infantil; grupo 18 a 59 años, los tumores/cáncer y en mayores de 60 años, los procesos neurodegenerativos. Conclusión: la disfagia orofaríngea por etiología funcional es frecuente en todo el ciclo vital y, al parecer, las enfermedades neurológicas explican en gran parte su fisiopatología. En adultos mayores se asocia con trastornos neurodegenerativos y en menores de 60 años (incluyendo los niños) la etiología es diversa. Sus causas y características clínicas deben ser tenidas en cuenta para procesos de promoción, diagnóstico, tratamiento y rehabilitación.

Summary Introduction: Dysphagia is a frequent disorder throughout the life cycle, which has different etiologies in relation to its clinical type in oropharyngeal or esophageal. Objective: Clinical and etiological characterization of a sample with dysphagia attended in two health care centers in the city of Medellín (Colombia), showing the etiology and clinical type of dysphagia according to age groups. Methods: Observational, descriptive, and retrospective study, through the review and analysis of and clinical records of patients with a diagnosis of dysphagia, treated between 2012 and 2018 in a university hospital and a speech therapy center in swallowing. Results: Sample of 527 patients. Distributed in those under 18 years 45.4% (239/527); 18 to 59: 20.1% (106/527) and over 60: 34.5% (182/527). Clinical type, etiology, and most frequent health condition in the entire sample: oropharyngeal dysphagia, functional etiology, and neurological diseases. The most frequent conditions causing dysphagia in children under 18 years of age were childhood development disorders; group 18 to 59 years, cancer and, in those over 60 years of age, neurodegenerative processes. Conclusion: Oropharyngeal dysphagia due to functional etiology is common throughout the life cycle, and neurological diseases seem to largely explain its pathophysiology. In older adults it is associated with neurodegenerative disorders, and in those under 60 years of age (including children) the etiology is diverse. Its causes and clinical characteristics must be considered for promotion, diagnosis, treatment, and rehabilitation processes.

Síndrome de Boerhaave: manejo diagnóstico y terapéutico en el Hospital Regional de Talca / Boerhaave Syndrome: diagnostic and therapeutic management at the Hospital Regional de Talca

Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.

Acreditación de servicios y calidad de la atención a neonatos en hospitales mexicanos / Accreditation of services and quality of care for newborns in mexican hospitals

Resumen: Objetivo: Comparar la calidad de atención a neonatos con sepsis neonatal, hipoxia intrauterina, prematuridad y asfixia perinatal en hospitales acreditados (HA) y no acreditados (HNA). Material y métodos: Se evaluaron 28 hospitales de la Secretaría de Salud en 11 estados de México; la evaluación incluyó infraestructura, equipamiento e insumos, procesos de gestión de calidad e indicadores de calidad clínica. Se utilizó LQAS y se estimó el cumplimiento promedio de criterios e indicadores en HA y HNA. Resultados: Hubo diferencias significativas en favor de HA en equipamiento e insumos y no significativas en existencia y funcionamiento de los comités hospitalarios. No hubo diferencias consistentes ni significativas en cumplimiento de indicadores clínicos entre los HA y HNA. Conclusiones: La acreditación para la atención de neonatos con los diagnósticos seleccionados no se asocia a diferencias en la calidad de la atención.

Abstract: Objective: To compare the quality of care for neonates with neonatal sepsis, intrauterine hypoxia, prematurity and perinatal asphyxia in accredited hospitals (HA) and unaccredited (HNA). Materials and methods: 28 hospitals of the Ministry of Health were evaluated in 11 states in Mexico; the evaluation included infrastructure, equipment and supplies, quality management processes, and clinical quality indicators. LQAS was used, and average fulfillment of criteria and indicators in AH and NAH was estimated. Results: There were significant differences in favor of HA in equipment and supplies and, not significant, in the existence and functioning of hospital committees. There were no consistent or significant differences in compliance with clinical indicators between the AH y NAH. Conclusions: Accreditation for the care of newborns with the selected diagnoses is not associated with differences in the quality of care.

Sedentarismo laboral en distintos contextos ocupacionales en México: prevalencia y factores asociados / Sedentary work in different occupational contexts in Mexico: prevalence and associated factors

Resumen: Objetivo: Analizar la prevalencia de sedentarismo laboral en diferentes contextos ocupacionales y estimar los factores asociados de acuerdo con el sector de actividad económica. Material y métodos: Análisis secundario de datos de la Encuesta Nacional de Ocupación y Empleo (ENOE); se identificó la ocupación y se clasificó en cuatro categorías. La variable dependiente fue el sedentarismo laboral; las variables independientes fueron sexo, edad, escolaridad, ingreso, zona de residencia urbana del trabajador, formalidad laboral y región socioeconómica. Los factores asociados se estimaron mediante regresión logística múltiple por sector de actividad económica. Resultados: La mayor prevalencia del sedentarismo laboral se encontró en el sector de servicios (43%, IC95%: 42.3-43.6). Los factores asociados fueron nivel de estudios superior, mayores ingresos, ser mujer y trabajar en el sector formal. Conclusiones: La prevalencia de sedentarismo laboral es alta en sectores productivos estratégicos, por lo que es necesario considerar los factores de riesgo identificados en este trabajo para establecer estrategias de mitigación.

Abstract: Objective: To analyze the prevalence of sedentary work in different occupational contexts and to estimate the associated factors to economic activity sector. Materials and methods: Secondary analysis of the Occupation and Employment National Survey (ENOE, in Spanish) was conducted. Occupation was classified into four categories. Sedentary work was the dependent variable; the independent variables were sex, age, education, income, inhabitant of urban area, work formality and socioeconomic region. The associated factors were estimated using multiple logistic regression by economic activity sector. Results: The highest prevalence of sedentary work was found in services sector (43%, 95%CI= 42.3-43.6). The associated factors were college degree, higher income, being a woman and working in the formal sector. Conclusions: Sedentary work has a high prevalence in strategic productive sectors. It is necessary to consider the risk factors identified here to establish mitigation strategies.

Barreras y facilitadores en la implementación de guías de práctica clínica en México: perspectiva del personal de salud / Barriers and facilitators in the implementation of clinical practice guidelines in Mexico: perspective of health workers

Resumen: Objetivo: Identificar barreras, facilitadores y propuestas de mejora en la implementación de Guías de Práctica Clínica (GPC) desde la perspectiva de los profesionales de la salud. Material y métodos: Estudio cualitativo a través de 85 entrevistas semiestructuradas a responsables de implementación, difusión y aplicación, y del personal operativo en centros de atención primaria y hospitales en siete estados de México. El contenido fue codificado y analizado con ATLAS.ti 7.0. Resultados: Las principales barreras encontradas fueron la no actualización de las GPC y baja alineación con otras normas, e imposibilidad de implementarlas debido a la sobrecarga de trabajo y los recursos limitados. Conclusiones: El esfuerzo por implementar GPC parece haber sido errático e insuficiente, y la evaluación de su utilización inexistente. Se propone crear estrategias integradas y contextualizadas que resulten ser más efectivas y eficientes para la implementación exitosa de GPC.

Abstract: Objective: To identify barriers, facilitators and proposals for improvement in the implementation of CPG from the perspective of health professionals. Materials and methods: Qualitative study through 85 semi-structured interviews with those responsible for the implementation, dissemination and application activities, and of the operational personnel in primary care centers and hospitals in seven states of Mexico. The content was coded and analyzed with ATLAS.ti 7.0. Results: The main barriers found were the failure to update the CPGs and low alignment with other standards, and the impossibility of implementing them due to work overload and limited resources. Conclusions: The effort to implement CPG seems to have been erratic and insufficient, and the evaluation of its use non-existent. It is proposed to create integrated and contextualized strategies that prove to be more effective and efficient for the successful implementation of the CPG.

Carencias y variabilidad en la calidad de la atención a neonatos hospitalizados en México. Estudio transversal en 28 hospitales públicos / Deficiencies and variability in the quality of care for hospitalized neonates in Mexico. Cross-sectional study in 28 public hospitals

Resumen: Objetivo: Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Material y métodos: Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccionados al azar del Subsistema Automatizado de Egresos Hospitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según muestreo estratificado no proporcional. Resultados: Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la identificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones: La calidad de la atención a neonatos en hospitales es heterogénea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Abstract: Objective: To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods: Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as "standard compliance"/"non-compliance" by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results: No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is <50% on all other indicators. Conclusions: The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.

Extraction, separation, and evaluation of antioxidant effect of the different fractions of polyphenols from cocoa beans / Extracción, separación y evaluación del efecto antioxidante de las diferentes fracciones de polifenoles de los granos de cacao / Extração, Separação e Avaliação do Efeito Antioxidante das Diferentes Frações de Polifenóis de Grãos de Cacau

Abstract Polyphenol Extracts (PE) hold antioxidant properties, which might be related to positive effects on human health. It has been stated that PE, obtained from cocoa beans, contain fractions of flavan-3-ols with different degrees of polymerization (DP). However, it is unknown which of the fractions or their mixture drives the best antioxidant activity. This paper reports the study conducted to elucidate the role of each fraction (with different DP) on Antioxidant Capacity (AC). First, the process of extraction and separation of polyphenols' fractions in cocoa beans was executed; afterward, AC was determined for each fraction individually and their combinations (monomers, dimers and oligomers). Solid-liquid extraction was made by using a 50% (v/v) ethanol solution and a mass:solvent ratio of 1:120 in an ultrasound bath. PE were separated into monomers, dimers, and oligomers by HPLC using a semipreparative column. The results obtained show that PE contain 95.35, 7.45, and 21.75 mg EE (epicatechin equivalents) / g ds of monomers, dimers, and oligomers, respectively. Finally, the AC of each fraction was evaluated using a complete cubic model mix design. According to the results, the best AC was obtained for dimers. However, when monomers, dimers and oligomers were mixed, an antagonistic effect on AC was observed.

Resumen Los extractos polifenólicos (PE) tienen propiedades antioxidantes positivas para la salud humana. Se conoce que los PE obtenidos del cacao contienen fracciones de flavan-3-ols con diferentes grados de polimerización (DP). Sin embargo, se desconoce qué fracción o mezcla de ellos posee mayor capacidad antioxidante. Este trabajo se realizó con el fin de evaluar la capacidad antioxidante (AC) de cada fracción polifenólica (con diferentes DP) extraída del cacao. Primero, se realizó un proceso de extracción y separación de las fracciones de polifenoles en los granos de cacao. Luego, se determinó la AC para cada fracción individual y combinada (monómeros, dímeros y oligómeros). La extracción sólido-líquido se realizó utilizando una solución de etanol en agua al 50 % (v/v) y una relación masa:solvente de 1:120 en un baño de ultrasonido. El extracto PE se separó en monómeros, dímeros y oligómeros por HPLC usando una columna semipreparativa. Los resultados obtenidos muestran que el extracto PE contiene 95,35, 7,45 y 21,75 mg EE (equivalentes de epicatequina) / g ds de monómeros, dímeros y oligómeros, respectivamente. Finalmente, se evaluó la CA de cada fracción utilizando un diseño de mezcla de modelo cúbico completo. Según los resultados, se obtuvo una mayor AC para dímeros; sin embargo, se observó un efecto antagonista de la AC cuando se mezclan monómeros, dímeros y oligómeros.

Resumo Os extratos de polifenóis (PE) possuem propriedades antioxidantes, que podem estar relacionadas a efeitos positivos para a saúde humana. Foi afirmado que o PE, obtido a partir de grãos de cacau, contém frações de flavan-3-ols com diferentes graus de polimerização (DP). No entanto, não se sabe qual fração ou mistura deles impulsiona a melhor atividade antioxidante. Este artigo relata os achados de um estudo realizado com o objetivo de elucidar o papel de cada fração (com DP diferente) na capacidade antioxidante (AC). Inicialmente, o processo de extração e separação de frações de polifenóis 'em grãos de cacau é descrito. Posteriormente, é determinada a AC para cada fração isolada e combinada (monômeros, dímeros e oligômeros). A extração sólido-líquido foi realizada utilizando uma solução de etanol a 50% (v/v) e uma razão massa: solvente de 1: 120 em um banho de ultrassom. O PE foi separado em monômeros, dímeros e oligômeros por HPLC usando uma coluna semi-preparativa. Os resultados obtidos mostram que o PE contém 95,35, 7,45 e 21,75 mg EE (equivalentes de epicatequina) / g ds de monômeros, dímeros e oligômeros, respectivamente. Finalmente, o efeito de cada fração na AC foi avaliado usando um modelo de mistura cúbica completo. De acordo com os resultados, a melhor AC foi obtida para os dímeros; no entanto, um efeito antagônico na AC foi observado quando monômeros, dímeros e oligômeros foram misturados.

Calidad de la atención en diabetes tipo 2, avances y retos de 2012 a 2018-19 para el sistema de salud de México / Quality of care in type 2 diabetes, progress and challenges from 2012 to 2018-19 for the Mexican health system

Resumen: Objetivo: Estimar cambios en la calidad del proceso de atención y su asociación con control glucémico en adultos con diabetes tipo 2. Material y métodos: Análisis del cambio en el cumplimiento de 14 indicadores del proceso de atención en 9 038 adultos con diabetes tipo 2 y del control glucémico en una submuestra. Se estimaron promedios, cambios ponderados y asociaciones crudas y ajustadas utilizando ponderaciones estadísticas para datos combinados (Ensanut 2012 y Ensanut 2018-19). Resultados: De 2012 a 2018-19, el control glucémico se duplicó. Mejoró la detección temprana de complicaciones y aumentó el uso de insulina, pero disminuyó la identificación y tratamiento de factores de riesgo cardiovascular. La calidad global de la atención se asoció con el control glucémico óptimo. Conclusiones: Existen áreas de oportunidad para la mejora de la calidad en la atención que ameritan estrategias integrales y monitorización continua.

Abstract: Objective: To estimate changes in the quality of process of care and its association with glycaemic control in adults with type 2 diabetes. Materials and methods: Changes in compliance of 14 process of care indicators for 9 038 adults with type 2 diabetes and glycaemic control in a subsample were estimated. Averages, weighted changes and associations without or controlling for other factors were estimated using statistical weights for the combined data (Ensanut 2012 and Ensanut 2018-19). Results: From 2012 to 2018-19, glycaemic control doubled. Early detection of complications and increased insuline use improved, but identification and treatment of cardiovascular risk factors decreased. The overall quality of care was associated with optimal glycaemic control. Conclusions: There are areas of opportunity for improvement of quality of care, that deserve comprehensive strategies and continuous monitoring.

La condición indígena en los servicios de salud: comparación de la calidad en la atención 2012-2018 para la población en pobreza / Indigenous condition in health services: comparison of quality of care 2012-2018 for poor population

Resumen: Objetivo: Comparar la percepción de la calidad de atención ambulatoria de servicios de salud en 2012 y 2018, por condición indígena y no indígena. Material y métodos. Con información de dos encuestas poblacionales (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 y Ensanut 100k) se analizó la calidad de atención con indicadores de estructura, proceso, resultado en salud y satisfacción. Resultados: Entre 2012 y 2018 aumentó la utilización de servicios privados, disminuyó la buena opinión sobre las condiciones del lugar y la percepción de tiempo de espera corto para utilizadores no indígenas. Para servicios públicos se mantuvo alto el surtimiento de medicamentos, disminuyó la realización de estudios de laboratorio y gabinete en la unidad de atención y la explicación del tratamiento farmacológico principalmente en no indígenas. La percepción de mejoría y la satisfacción fue buena. Conclusión: Es prioritario un modelo de atención ambulatoria acorde con las necesidades y expectativas de la población más vulnerable y, principalmente, indígena.

Abstract: Objective: To compare the perception of the quality of ambulatory care in users of health services in 2012 and 2018, by indigenous and non-indigenous condition. Materials and methods: With information from two population surveys (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 and Ensanut 100k) the quality of care was analyzed based on indicators of structure, process, health outcome and care satisfaction. Results: Between 2012 and 2018, the use of private health services increased; favorable opinion about the conditions of the site, and perception of short waiting times decreased among non-indigenous people. In public health services, the supply of medicines remained high, the laboratory and Rx tests in the same care unit and pharmacology treatment explanation decreased, particularly among non-indigenous patients. Perception of health improvement and satisfaction of care was adequate. Conclusion: An ambulatory care model aimed to response needs and expectations of the most vulnerable population, mainly the indigenous population, is a priority.

Influence of the Habitat on Marine Macroalgae Toxicity

Macroalgae synthesize molecules that may be toxic to other organisms. These molecules are synthesized as a defense strategy against herbivores. It has been proven that the synthesis process is directed by several physiological, chemical and even spatial-temporal variables. The purpose of this study was to determine whether the complexity of the habitat influences on the expression of marine macroalgae toxicity. Algae of 31 species (39 samples) were collected in localities with different habitat morphology: a coral reef in the Mexican Caribbean, three myxohaline localities in the Yucatán peninsula and six rocky intertidal localities, four of these in the Mexican Pacific and two in the Gulf of Mexico. Results identified 19 strongly toxic species from the reef, followed by algae collected in the rocky intertidal area, and the least number of toxic species in the myxohaline environments. The results support the hypothesis established by several researchers worldwide regarding the complexity of coral reefs, which promotes the synthesis of toxic substances as a defense against herbivores. These substances have been employed as molecules that are useful in the fight against diseases or as synthesis matrices of other compounds with pharmacological potential.

The Effect of High Temperature on the Growth Performance of Hybrid Tilapia Oreochromis niloticus X Oreochromis aureus Juveniles Reared in a Recycling System

Tilapia juveniles live in littoral regions of freshwater ecosystems which have temperatures that may reach critical values for growth, especially in face of the onslaught of climate change. This study analyzes the effect of temperature (25, 30, 35, 40°C) on the growth and survival of hybrid tilapia juveniles in a re-circulating system. Duplicate groups of 30 juveniles were stocked in 200 L tanks in a closed, re-circulating system. Automatic heaters were used to establish the water temperatures, commercial food was supplied at 5% of their weight as daily ration. Fish were weighed and measured at 15-day intervals for a period of 3 months. Water temperature and dissolved oxygen were monitored daily. Ammonia, nitrates and dissolved reactive phosphorus were monitored every third day. Fish responses were estimated through variations in length, weight and inter-circuli space of fish scales. Average initial and final weight and length, Specific growth rate (SGR), Fulton Index (FI), Length-weight relationship and survival were used to assess tilapia growth performance. Weight, length, SGR and FI were significantly affected (P < 0.05) by water temperature. Growth of the fish reared at 30oC was almost one third greater than that at 25°C and one sixth greater than that at 35°C. Except for fish reared at 40°C, the other treatments showed a positive allometric growth, with the better results recorded for the 30 and 35°C treatments. The fish reared at 40°C survived only two weeks while the survival rate of 98, 90 and 88.3% for 25, 30 and 35°C, respectively.

Calidad del sistema de información en salud: análisis comparativo de indicadores reportados, México OCDE 2010-2016 / Quality of the health information system: A comparative analysis of reported indicators, OECD Mexico 2010-2016

Resumen: Objetivo: Analizar cantidad y calidad de la información sobre indicadores de salud reportada por México a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). Material y métodos: Análisis de frecuencia de indicadores reportados, calidad de los datos y comparación de valores reportados en el entorno OCDE. Resultados: Se analizan 191 indicadores. México reportó anualmente (2010-2016) 52.9% de ellos. Nunca reportó 45.5%. La mayor frecuencia de no reportados (84%) es en el grupo "Calidad de la atención". En los reportados, la información es de calidad deficiente en 28.7%. Comparativamente, México ostenta los peores resultados de OCDE en indicadores sobre tamizaje de cáncer, mortalidad infantil e intrahospitalaria por infarto de miocardio y hospitalización por diabetes, entre otros. Conclusiones: México tiene problemas de carencia y calidad de la información reportada y valores frecuentemente desfavorables en el entorno OCDE. Se requiere mejorar el sistema de información incidiendo tanto en cantidad como en calidad de los datos, y su utilización efectiva.

Abstract: Objective: To analyze quantity and quality of the information reported by Mexico to OECD in relation to health indicators. Materials and methods: Analysis of frequency of indicators reporting, data quality, and comparison of reported values in the OECD environment. Results: We analyzed 191 indicators. Mexico reported annually (2010-2016) 52.9% of them. Never reported 45.5%. The highest frequency of not reported (84%) is in the "Quality of care" group. Among the reported, information is of poor quality in 28.7% of them. Comparatively, Mexico holds the worst results in OECD indicators on screening of cancer, child and in-hospital mortality from myocardial infarction, and hospitalization for diabetes, among others. Conclusions: Mexico has problems of lack and quality of reported information, and frequently unfavorable values among OECD countries. The information system needs improvement, in both quantity and quality of data, and its effective utilization.

Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto / Quality care indicators for neonates with selected pathologies: pilot study

Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.

Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.

Localización de lesiones osteomusculares por actividades relacionadas con el ejercicio profesional en el personal de salud: revisión de la literatura / Localization of osteomuscular injuries by activities related to professional exercise in health personnel: review of literature

Introducción: Las lesiones osteomusculares se han convertido en uno de los principales problemas de salud pública y de las aseguradoras de riesgos profesionales, ya que estas afectan la calidad de vida, del trabajador, el ausentismo, la disminución productiva, las incapacidades temporales o permanentes, reubicación del personal aumento de los costos económicos, de los cuidados a la salud, los cambios en las perspectivas y actitudes psicosociales individuales, familiares y sociales. Objetivo: Determinar la prevalencia de lesiones osteomusculares en el personal de salud. Metodología: se realizó una revisión documental de los estudios recientes enfocados en la percepción de alteraciones osteomusculares, tras obtener los artículos en las bases de datos Hinari, Elsevier, Scopus, Pubmed, Ebsco, se seleccionaron los estudios que cumplieron con los criterios de inclusión. Resultados: Se evidencio que el principal síntoma de origen osteomuscular es el dolor, presentado inicialmente en cuello y espalda, el género femenino resultó más vulnerable y en especial el grupo etáreo correspondiente a 41 a 50 años, la principal causa son los movimientos repetitivos. Conclusiones: el personal de salud, en especial enfermería esta frecuentemente expuesto a factores de riesgo para desarrollar patologías osteomusculares, por lo que es indispensable la implementación de estrategias para mantener una adecuada salud ocupacional para la prevención y tratamiento oportuno.

Introduction: Musculoskeletal injuries have become one of the main public health problems and professional risk insurers, since they affect the quality of life, of the worker, absenteeism, productive decline, temporary or permanent disabilities, relocation of staff increased economic costs, health care, changes in perspectives and individual psychosocial attitudes, family and social. Objective: To determine the prevalence of osteomuscular injuries in health personnel Methodology: a documentary review of the recent studies focused on the perception of musculoskeletal alterations was made, after obtaining the articles in the databases Hinari, Elsevier, Scopus, Pubmed, Ebsco, the studies that met the inclusion criteria were selected. Results: It was evidenced that the main symptom of musculoskeletal origin is pain, presented initially in the neck and back, the female gender was more vulnerable and especially the age group corresponding to 41 to 50 years, the main cause are repetitive movements. Conclusions: health personnel, especially nurses, are frequently exposed to risk factors to develop musculoskeletal conditions, so it is essential to implement strategies to maintain adequate occupational health for prevention and timely treatment.

Evaluación de dos fórmulas de yogur enriquecido con harina de Acheta domesticus y harina de Brosimum alicastrum Swartz como alimentos complementarios / Evaluation of two formulas of yogurt enriched with Acheta domesticus flour and Brosimum alicastrum flour, as complementary foods

La prevalencia de desnutrición en niños en Guatemala es constante y se ha mantenido alta por años. Tomando en cuenta esta problemática se planteó un modelo de alimentación complementaria a base de yogur enriquecido con harinas de alto valor proteico en niños de edad preescolar en el suroccidente de Guatemala. Los tratamientos evaluados fueron yogur con harina de Acheta domesticus (grillo), yogur con harina de Brosimum alicastrum Swartz (ramón) y un grupo control. Se evaluó el peso, talla y velocidad de crecimiento durante cuatro meses brindando 125 mL de yogur cinco días por semana. La ganancia media (desviación estándar) de peso en kg fue de 3.21 (1.84), 2.22 (1.14) y 1.67 (0.64) para A. domesticus, B. alicastrum y grupo control, respectivamente. Mostrando la mezcla de yogur con harina de A. domesticus diferencia significativa frente al control (p < .05), por el contrario, no se encontró diferencia significativa (p > .05) cuando se comparó con yogur con harina de B. alicastrum. Para el incremento en talla en cm los resultados fueron 4.61 (1.13), 4.25 (1.54) y 3.07 (1.84) para A. domesticus, B. alicastrum y grupo control, respectivamente, mostrando ambas diferencias significativas frente al control (p < .05). Se determinaron los costos por dosis los cuales fueron US$0.56 (A. domesticus) y US$0.36 (B. alicastrum). Se concluye que el yogur con harina de A. domesticus fue el que presentó mejor respuesta en las variables de estudio.

The prevalence data on malnutrition of children in Guatemala are constant. Taking into account this problem, a yogurt-based supplementary feeding model was proposed, enriched with high-protein flours in pre-school children in southwestern Guatemala. The treatments evaluated were yogurt with Acheta domesticus flour (cricket), yogurt with Brosimum alicastrum Swartz flour (ramon) and control group. The weight, height and growth rate were evaluated during four months providing 125 mL of yogurt five days per week. The weight gain in kg was 3.21 (1.84), 2.22 (1.14) and 1.67 (0.64) for A. domesticus, B. alicastrum and control group respectively, showing significant difference (p < .05). The costs per dose were determined, which were US $ 0.56 (A. domesticus) and US $ 0.36 (B. alicastrum). The study concludes that yogurt with A. domesticus flour was the one that presented the best response in the study variables.

pMEX01, a 70kb Plasmid Isolated From Escherichia Coli That Confers Resistance to Multiple ß-Lactam Antibiotics

Abstract Multidrug-resistant microorganisms are of great concern to public health. Genetic mobile elements, such as plasmids, are among the most relevant mechanisms by which bacteria achieve this resistance. We obtained an Escherichia coli strain CM6, isolated from cattle presenting severe diarrheic symptoms in the State of Querétaro, Mexico. It was found to contain a 70 kb plasmid (pMEX01) with a high similarity to the pHK01-like plasmids that were previously identified and described in Hong Kong. Analysis of the pMEX01 sequence revealed the presence of a blaCTX-M-14 gene, which is responsible for conferring resistance to multiple β-lactam antibiotics. Several genes putatively involved in the conjugative transfer were also identified on the plasmid. The strain CM6 is of high epidemiological concern because it not only displays resistance to multiple β-lactam antibiotics but also to other kinds of antibiotics.

Macroalgae as Soil Conditioners or Growth Promoters of Pisum sativum (L)

Mexico has long littorals that receive great amounts of marine algae that are wasted despite being potentially useful as growth promoters without the inconveniences of agrochemicals. Some macroalgae have been used with excellent results as soil conditioners and fertilisers in agriculture. In this study nine macroalgae from the coasts of Veracruz (Gulf of Mexico) and one from Guerrero (Mexican Pacific), Mexico, were tested. They were added to the soil in the form of fragments and of silage in liquid around Pisum sativum plants. A two-way random design with four replicas was followed. Two controls, hormones and water, were also used. Growth was recorded every third day. Results showed that four algae promoted growth (p<0.05) Ulva fasciata (ensiling treatment) and Ulva lactuca (ensiling treatment) and Gracilaria caudata (fragment treatment) and Palisada perforata (fragment treatment), compared with the hormones and water controls. The activity of Ulva fasciata and Palisada perforata is recorded for the first time. Since the control plants treated with hormones grew much less than those treated with the four algae, we conclude that the release of all algae compounds was responsible for the growth, and not the hormone mimetics.

Anaerobic microbiota: spatial-temporal changes in the sediment of a tropical coastal lagoon with ephemeral inlet in the Gulf of Mexico / Microbiota anaerobia: cambios espacio-temporales en el sedimento de una laguna costera tropical con boca efímera en el Golfo de México

Abstract:Sulfate-reducing bacteria (SRB) and methanogenic archaea (MA) share common niches in coastal sediments during the terminal phases of the anaerobic mineralization of organic matter. The purpose of this study was to analyze the spatial - temporal variation of SRB and MA in the sediments of a tropical coastal lagoon with ephemeral inlet (La Mancha, Veracruz, Gulf of Mexico) and its relationship with environmental changes. A total of 24 sediment samples were collected during the dry (April, May), rainy (July, September) and Northern (November, February) seasons in the period 2013-2014. Microbiological analyses included the quantification of the viable SRB and MA with different substrates, as well as mineralization experiments to determine the effect of sulfate on acetate oxidation. The analyzed environmental variables in the sediments included: temperature, pH, Eh, salinity, sulfates, H2S, volatile solids, carbohydrates, and granulometric characteristics. Major changes occurred between the dry and rainy seasons. During the dry season, sulfate-reducing abundance was significantly greater with lactate (8.3x105 - 1.2x107 cells / g) and propionate (1.8x105 - 6.6x106 cells / g) as substrates, while the MA that use methanol were dominant (4.2x105 - 9.1x106 cells / g). In contrast, during the rainy season, hydrogenophylic (2.6x105 - 8.3x106 cells/g) and acetoclastic (5.4x105-6.4x106 cells / g) MA increased significantly and SRB decreased in the analyzed substrates. An apparent competition for acetate was observed, with a greater oxidation in the media with sulfates in the dry season (0.06 mM acetate / g sediment / day), and a greater oxidation in the media without sulfates in the rainy season (0.02 mM acetate / g sediment / day). SRB and MA were present throughout the sediment column, however SRB dominated in the first centimeters of the sediment while MA were abundant in deeper layers. In conclusion, SRB and MA together played a role in the mineralization of organic matter in the sediments of La Mancha lagoon, with sulfate-reduction dominating in the dry season (closed inlet) and methanogenesis during the rainy season (open inlet). Changes in rainfall and river input in this lagoon significantly affect salinity and sulfate content, the main factors that regulate the dynamics of SRB and MA in the sediments. Rev. Biol. Trop. 64 (4): 1759-1770. Epub 2016 December 01.

Resumen:Las bacterias sulfatorreductoras (BSR) y las arqueas metanogénicas (AM) comparten nichos comunes en los sedimentos costeros durante las fases terminales de la mineralización anaerobia de la materia orgánica. El objetivo del presente estudio fue analizar la variación espacio-temporal de las BSR y AM en los sedimentos de una laguna costera tropical con una boca efímera (La Mancha, Veracruz, Golfo de México) y su relación con los cambios ambientales. Un total de 24 muestras de sedimentos fueron recolectadas en las temporadas de secas (abril, mayo), lluvias (julio, septiembre) y nortes (noviembre, febrero) en el periodo 2013 - 2014. Los análisis microbiológicos incluyeron la cuantificación de las BSR y AM viables con diferentes sustratos, así como experimentos de mineralización para determinar el efecto de los sulfatos en la oxidación del acetato. Las variables ambientales analizadas en los sedimentos incluyeron la temperatura, pH, Eh, salinidad, sulfatos, H2S, sólidos volátiles, carbohidratos y las características granulométricas. Los principales cambios se presentaron entre las estaciones de secas y lluvias. En la temporada de secas la abundancia sulfatorreductora fue significativamente superior con lactato (8.3x105 - 1.2x107 células / g) y propionato (1.8x105 - 6.6x106 células / g) como sustratos, mientras que las AM que emplean metanol dominaron (4.2x105 - 9.1x106 células / g). Por el contrario, en la época de lluvias aumentaron significativamente las AM hidrogenofílicas (2.6x105-8.3x106 células / g) y acetoclásticas (5.4x105-6.4x106 células / g), disminuyendo las BSR con los sustratos analizados. Se determinó una competencia aparente por el acetato. Su oxidación fue mayor en los medios con presencia de sulfatos en las temporadas de secas (0.06 mM acetato / g sedimento / día), mientras que aumentó en los medios sin sulfatos en la época de lluvias (0.02 mM acetato / g sedimento / día). Las BSR y las AM estuvieron presentes a lo largo de la columna sedimentaria; sin embargo, las BSR dominaron en los primeros centímetros del sedimento y las AM abundaron a mayor profundidad. En conclusión las BSR y AM participaron de manera conjunta en la mineralización de la materia orgánica en los sedimentos de la laguna de La Mancha, dominando la sulfatorreducción en la temporada de secas (boca cerrada) y la metanogénesis en la época de lluvias (boca abierta). Los cambios en el aporte fluvial y la precipitación en esta laguna afectaron significativamente la salinidad y el contenido de sulfatos, siendo los principales factores que regularon la dinámica de las BSR y AM en los sedimentos.

Primary dengue virus infections induce differential cytokine production in Mexican patients

Severe dengue pathogenesis is not fully understood, but high levels of proinflammatory cytokines have been associated with dengue disease severity. In this study, the cytokine levels in 171 sera from Mexican patients with primary dengue fever (DF) and dengue haemorrhagic fever (DHF) from dengue virus (DENV) 1 (n = 116) or 2 (n = 55) were compared. DF and DHF were defined according to the patient’s clinical condition, the primary infections as indicated by IgG enzymatic immunoassay negative results, and the infecting serotype as assessed by real-time reverse transcription-polymerase chain reaction. Samples were analysed for circulating levels of interleukin (IL)-12p70, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, IL-6, and IL-8 using a commercial cytometric bead array. Significantly higher IFN-γ levels were found in patients with DHF than those with DF. However, significantly higher IL-12p70, TNF-α, and IL-6 levels were associated with DHF only in patients who were infected with DENV2 but not with DENV1. Moreover, patients with DF who were infected with DENV1 showed higher levels of IL-12p70, TNF-α, and IL-6 than patients with DHF early after-fever onset. The IL-8 levels were similar in all cases regardless of the clinical condition or infection serotype. These results suggest that the association between high proinflammatory cytokine levels and dengue disease severity does not always stand, and it once again highlights the complex nature of DHF pathogenesis.

Un estudio de la relación entre la memoria, la narrativa y el lenguaje en alumnado con trastorno específico del lenguaje (TEL) / A Study of the Relationship between Memory, Narrative and Language in Pupils with Specific Language Impairment (SLI)

En esta investigación se estudiaron las relaciones entre el lenguaje, la narrativa y la memoria en alumnado con Trastorno Específico del Lenguaje (TEL). La muestra estuvo compuesta por 32 alumnos con TEL y 23 niños con desarrollo típico, diagnosticados con el CELF-3, el Peabody, el ITPA, el Subtest de Dígitos del WISC-IV, el Subtest de Localización Espacial de la WMS-III y la tarea del recontado del cuento Rana, ¿dónde estás?. Los resultados obtenidos relacionan estrechamente la memoria de trabajo y la superestructura narrativa. Además, se distinguen tres subtipos de TEL atendiendo al déficit en memoria. Finalmente, entre todas las dimensiones que conforman el diagnóstico del TEL, son los problemas narrativos los que permiten advertir de mayores dificultades en la memoria.

This research studied the links between language, narrative and memory in Specific Language Impairments (SLI) students. The sample consisted of 32 children diagnosed with SLI and 23 typically developed children, according to different tests as CELF-3, Peabody, ITPA, Digit Span subtest of the WISC-IV, Spatial Span subtest of the WMS-III and the task of retelling the tale Frog, where are you?. The results show a close connection between working memory and narrative superstructure. Besides, three SLI subtypes could be differentiated according to the memory deficits. Finally, among all dimensions that allow the diagnosis of SLI, the narrative problems aware us of bigger memory difficulties.