Ensayo pictórico: descripción del posicionamiento del túnel femoral en distintas técnicas de reconstrucción del ligamento cruzado anterior (lca) / Pictory essay: description of the positioning of the femoral tunnel in different techniques of reconstruction of the anterior cruciate ligament

En la práctica radiológica habitual el radiólogo se encuentra frecuentemente con distintas técnicas de reconstrucción del LCA que debe conocer de manera general para una adecuada descripción e interpretación de los hallazgos. En el presente ensayo pictórico exponemos diferentes tipos de técnica de reconstrucción del LCA, con énfasis en el concepto de reconstrucción anatómica, presentando distintas posiciones del túnel femoral, buscando entregar herramientas al radiólogo para reconocer la normalidad postoperatoria e interpretar posibles complicaciones.

In daily radiological practice, we frequently fid different ACL reconstruction techniques, which we must know in order to achieve adequate interpretation of the fidings. In this pictorial essay, we show different types of LCA reconstruction techniques, highlighting the anatomical reconstruction concept and presenting different positions of the femoral tunnel, seeking to deliver tools to the radiologist in order to recognize the normal postoperative fidings and possible complications.

Antifungal activity of caspofungin in experimental infective endocarditis caused by Candida albicans

BACKGROUND Infective endocarditis is a disease characterised by heart valve lesions, which exhibit extracellular matrix proteins that act as a physical barrier to prevent the passage of antimicrobial agents. The genus Candida has acquired clinical importance given that it is increasingly being isolated from cases of nosocomial infections. OBJECTIVE To evaluate the activity of caspofungin compared to that of liposomal amphotericin B against Candida albicans in experimental infective endocarditis. METHODS Wistar rats underwent surgical intervention and infection with strains of C. albicans to develop infective endocarditis. Three groups were formed: the first group was treated with caspofungin, the second with liposomal amphotericin B, and the third received a placebo. In vitro sensitivity was first determined to further evaluate the effect of these treatments on a rat experimental model of endocarditis by semiquantitative culture of fibrinous vegetations and histological analysis. FINDINGS Our semiquantitative culture of growing vegetation showed massive C. albicans colonisation in rats without treatment, whereas rats treated with caspofungin showed significantly reduced colonisation, which was similar to the results obtained with liposomal amphotericin B. CONCLUSIONS The antifungal activity of caspofungin is similar to that of liposomal amphotericin B in an experimental model of infective endocarditis caused by C. albicans.

High Prevalence of ITPA Alleles Associated with Ribavirin-Induced Hemolytic Anemia Among Mexican Population

ABSTRACT Background. The prevalence of two functional polymorphisms (rs1127354 and rs7270101) of the inosine triphosphatase (ITPA) gene associated with ribavirin-induced hemolytic anemia (RIHA) during antiviral therapy for hepatitis C virus (HCV) infection varies by ethnicity. In Mexico, the distribution of these polymorphisms among Native Amerindians (NA) and admixed population (Mestizos) is unknown. This study aimed to determine the prevalence of the ITPA polymorphisms among healthy NA and Mestizos, as well as in HCV patients from West Mexico. Material and methods. In a cross-sectional study, 600 unrelated subjects (322 Mestizos, 100 NA, and 178 treatment-naïve, HCV-infected Mestizos patients) were enrolled. A medical history was registered. ITPA genotype was determined by Real-Time PCR. Fst-values and genetic relatedness between study and reference populations were assessed. Results. The frequency of the risk genotypes rs1127354CC and rs7270101AA was higher among NA (98-100%) than in Mestizos (87-92.9%), (p < 0.05). The NA presented the highest prevalence of the rs1127354CC genotype reported worldwide. The Fst-values revealed a genetic relatedness among Mexican NA, South Americans and African populations (p > 0.05). The frequency of the predicted risk for RIHA was higher among NA (98%) than in Mestizos (80.5%) and HCV-infected patients (81.5%) (p < 0 .01). The CC/AA alleles were associated with lower values of total bilirubin, aspartate/alanine aminotransferases, and aspartate-to-platelet-ratio-index score among HCV-patients. Conclusion. A high prevalence of the ITPA polymorphisms associated with RIHA was found in Mexican NA. These polymorphisms could be a useful tool for evaluating potential adverse effects and the risk or benefit of antiviral therapy in Mexicans and other admixed populations.

CARACTERIZACIÓN CLÍNICA DE LOS PACIENTES CON DIABETES MELLITUS DEL REGISTRO ESTATAL DE DIABETES EN UN ESTADO DE MÉXICO / CLINICAL CHARACTERIZATION OF PATIENTS WITH DIABETES MELLITUS FROM THE STATE REGISTER OF DIABETES IN A STATE OF MEXICO

Introducción: La diabetes mellitus representa un reto para los sistemas de salud debido a la complejidad de la atención, la calidad y el acceso a tratamientos. Objetivo: Describir las características clínicas de los pacientes con diabetes mellitus del registro estatal de diabetes del Estado de Hidalgo en México de los años 2007 a 2012. Material y Métodos: Estudio transversal descriptivo del Registro Estatal de Diabetes (RED) durante 2007 al 2012. Se realizó descripción estadística simple para caracterizar a la población del estudio, proporciones y razones para variables cualitativas y para variables cuantitativas medidas de tendencia central y de dispersión (media, mediana, moda, desviación estándar y varianza). Para el análisis de las variables continuas se hizo la prueba de t de Student. Resultados: Se identificaron 10.198 pacientes del RED, el 66,4% fueron mujeres y el 33,52% hombres. La media de edad fue 52,2 ±12,8 años. Respecto a la glucosa en ayuno, la media fue de 239,1±95,3 mg/dl; la media de glucosa postprandial 293,6±122,7 mg/dl y la de glucosa casual 247,9±102,3 mg/dl. Las actividades del RED incluyeron a 5.795 personas que fueron detectadas en ese momento, lo que corresponde al 56,8%. De las cuales, 11,9% manifestó tener visión borrosa, 48,5% poliuria, 4,7% infecciones, 44,07% polidipsia, 13,19% polifagia, 26,9% pérdida de peso y 35,2% fatiga. Al comparar las que estaban en tratamiento con las que ingresaban no encontramos diferencias estadísticas. Mientras que las que se encontraban en tratamiento, quienes mencionaron solo tener dieta fueron el 33,5%, metformina 72,58%, sulfonilureas 62,9%, acarbosa 3,59%, insulina 9,4%, rosiglitazona 0,66%. Discusión: El RED tiene estándares de control glicémico bajo. Se sugiere la elaboración de indicadores internos para que estos les permitan realizar la toma de decisiones desde el interior de la unidad y ofrecer una mejor calidad de atención, el cumplimiento y oportunidad.

Introduction: Diabetes mellitus is a challenge for health systems due to the complexity of care, and the quality and access to treatment. Objective: To describe the clinical characteristics of patients in the Diabetes Mellitus State Register in the state of Hidalgo in Mexico from 2007 to 2012. Methods: Cross-sectional descriptive study of the Diabetes State Register (DSR) between 2007 and 2012. Simple statistics description to characterize the studied population, proportions and reasons for qualitative variables and for quantitative measures of central tendency and continuous and dispersion variables (media, median, mode, deviation, standard and variance) were carried out. The t student test was used for the analysis of continuous variables. Results: 10,198 patients from the Diabetes State Register were identified; 66.4% were women and 33.52% men. The mean age was 52.2±12.8. Regarding fasting glucose, the mean was 239.1±95.3 mg/dl; the post-prandial glucose mean was 293.6±122.7 mg/dl and casual glucose was 247.9±102.3 mg/dl. The DSR activities included 5,795 people that were detected at that time which correspond to 56.8% from which 11.9% reported having blurred vision, polyuria 48.5%, infections 4.7%, polydipsia 44.07%, polyphagia 13.19%, weight loss 26.9% and fatigue 35.2%. When comparing people under treatment with those admitted, no statistical difference was found While those who were under treatment, who mentioned only having diet were 33.5%, metformin72.58%, sulfonylureas 62.9%, acarbose 3.59%, insulin 9.4%, and rosiglitazone 0.66%. Discussion: The Diabetes State Register has low glycemic control standards. Development of internal indicators is suggested to allow medical staff to make decisions from inside the unit and provide a better quality of care, compliance and opportunity.

Empleo de la Tarjeta Amarilla y el Formato NOM220 para las notificaciones de sospechas de reacciones adversas a medicamentos / Use of Yellow Card and of NOM220 Format for reporting of suspected adverse drug reactions

Introducción: la notificación de reacciones adversas a medicamentos es una obligación a nivel mundial. Aunque se han establecido muchas metodologías para esta acción, en la actualidad existen problemas. Objetivo: determinar la frecuencia de sospecha de reacciones adversas a la administración de medicamentos en pacientes y comparar la accesibilidad del llenado del formato de la NOM220 de la Secretaría de Salud y la Tarjeta Amarilla propuesta por la Organización Mundial de la Salud. Métodos: estudio transversal y observacional. Participaron 50 médicos responsables de las clínicas de diabetes del Estado de Hidalgo. Inicialmente, los médicos fueron capacitados para identificar las sospechas de reacciones adversas a la administración de medicamentos en los pacientes atendidos. Se realizó un diseño cruzado, en el que el 50 por ciento de los médicos utilizaron por tres meses el formato de la NOM220 y 50 por ciento la Tarjeta Amarilla. Después intercambiaron formatos y los utilizaron durante los tres meses siguientes. Al cabo de este periodo, respondieron un cuestionario para determinar la utilidad, claridad, tiempo de llenado y practicidad de ambos formatos. Se realizó estadística descriptiva y análisis bivariado para determinar los factores asociados a las sospecha de reacciones adversas a medicamentos, con el software SPSS (versión 17). Resultados: se registraron 46 sospechas de reacciones adversas a medicamentos en 46 pacientes con el formato de la NOM220 y 78 sospechas de reacciones adversas a medicamentos con la Tarjeta Amarilla en 78 pacientes. Todas las sospechas de reacciones adversas a la administración de medicamentos fueron tipo A. Los médicos recomiendan la utilización de la Tarjeta Amarilla, consideran claro el formato, sencillo, legible, fácil de llenar, entendible y accesible (p< 0,05). Conclusiones: los resultados permiten proponer la Tarjeta Amarilla como una alternativa más accesible para la notificación de sospechas de reacciones adversas a medicamentos, o se hagan adecuaciones al formato de la NOM220(AU)

Introduction: the reporting of adverse drug reactions is a global obligation. Although many methods have been implemented, there are still problems at present. Objective: to determine the frequency of suspected adverse reactions in patients and to compare the access to filling out the NOM220 formats of the Secretaría de Salud and the Yellow Card suggested by the World Health Organization. Methods: a cross-sectional and observational study was made. Fifty physicians responsible for the diabetes clinics in the state of Hidalgo participated in the study. First, the physicians were trained to identify the suspected adverse drug reactions in their patients. A crossover design was created where 50 percent of physicians used the NOM220 format and 50 percent the Yellow Card. Three months later, they exchanged the formats and used them during the following three months. After this period, questionnaire was administered to determine the usefulness, clarity, filling out time and convenience of the formats. Descriptive statistics and bivariate analyses were applied to determine the factors associated with the suspected adverse drug reactions with SPSS software (version 17). Results: a total of 46 suspected adverse reactions were registered in 46 patients using NOM220 format and 78 with the Yellow Card in 78 patients. All the suspected adverse reactions were type A. The physicians recommended the use of Yellow Card since they considered that it is practical, simple, readable, understandable, accessible and requires less time to fill it out (p< 0.05). Conclusions: the results allow selecting the Yellow Card as the most accessible choice for reporting suspected drug adverse reactions; additionally, they suggest that adjustments should be also made in the NOM220 format(AU)

Cobertura efectiva del manejo de la violencia contra mujeres en municipios Mexicanos: límites de la métrica / Cobertura efetiva da gestão da violência contra as mulheres nos municípios mexicanos: os limites métricos / Effective coverage to manage domestic violence against women in mexican municipalities: limits of metrics

El estudio estimó la cobertura efectiva de los servicios en salud de primer nivel de atención para el manejo de la violencia doméstica contra la mujer en tres municipios mexicanos. Se estimó la prevalencia y severidad de la violencia usando una escala validada, y la cobertura efectiva con la propuesta de Shengelia y colaboradores, con modificaciones. Se consideró atención con calidad cuando hubo sugerencia de hacer la denuncia a las autoridades. La utilización y calidad de la atención fue baja en los tres municipios analizados, siendo más frecuente la utilización cuando hubo violencia sexual o física. La cobertura efectiva en Guachochi, Jojutla y Tizimín fue de 29.41%, 16.67% y cero, respectivamente. El indicador de cobertura efectiva tiene dificultades para medir eventos y respuestas no se fundamentan en modelos biomédicos. Los hallazgos sugieren que el indicador puede ser mejorado al incorporar otras dimensiones de la calidad.

O estudo estimou a cobertura eficaz dos serviços da atenção primaria em saúde na gestão da violência doméstica contra as mulheres em três cidades mexicanas. Estimou-se a prevalência e a gravidade da violência doméstica por meio de uma escala validada enquanto a cobertura eficaz foi obtida por meio da proposta de Shengelia e colaboradores, com algumas alterações. O atendimento foi considerado de qualidade quando houve a sugestão de fazer a denúncia às autoridades. O uso dos serviços e a qualidade do atendimento foram baixos nos três municípios analisados, sendo mais frequente a utilização do serviço quando houve violência sexual ou física. A cobertura efetiva em Guachochi, Jojutla e Tizimin foi de 29,41%, 16,67% e zero, respectivamente. O índice de cobertura eficaz apresentou dificuldade em medir desfechos reais e respostas não baseadas em modelos biomédicos. Os resultados sugerem que o indicador pode ser melhorado pela incorporação de outras dimensões da qualidade do atendimento.

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

Cobertura efectiva de las intervenciones en salud de América Latina y el Caribe: métrica para evaluar los sistemas de salud / Effective coverage of health interventions in Latin America and the Caribbean: metrics for the assessment of health systems performance

OBJETIVO: Medir la cobertura efectiva para once intervenciones de salud en nueve países de América Latina utilizando las encuestas de demografía y salud o registros administrativos que abarcan la salud infantil, de la mujer y el adulto. MATERIAL Y MÉTODOS: Se seleccionaron las intervenciones y se armonizaron definiciones y métodos de cálculo de acuerdo con la información disponible para lograr la comparabilidad entre países. RESULTADOS: Chile es el país con mejores indicadores de coberturas crudas y efectivas, seguido por México y Colombia, y existen brechas importantes entre regiones, departamentos o estados. CONCLUSIONES: La métrica de cobertura efectiva es un indicador sensible que relaciona la necesidad de las intervenciones en salud, su utilización y calidad, lo que permite valorar los programas de salud al aportar datos precisos de dónde y a quién deben dirigirse los recursos y esfuerzos nacionales para que los países alcancen los propósitos y metas planteados.

OBJECTIVE: To measure effective coverage for ll health interventions in Latin America including the children's, women's and adult health, as part of program evaluation. MATERIAL AND METHODS: Interventions were selected; the definitions and calculation methods were harmonized according to the information available to ensure comparability between countries. RESULTS: Chile has better indicators of crude and effective coverage followed by Mexico and Colombia.There are significant gaps between regions, counties or states. CONCLUSIONS: The health metric on effective coverage is a sensitive indicator that links three important aspects: Coverage of health interventions, use of health services, and access to such services. Effective coverage is a good tool to evaluate health programs performance, and also provides data of where and to whom the system should address national efforts and resources to achieve the purposes and goals set.