Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Cross-cultural invariance of the Spanish version of the COVID-19 Assessment Scorecard to measure the perception of government actions against COVID-19 in Latin America

Abstract Objectives The present study aimed to evaluate the measurement invariance of a general measure of the perception of governmental responses to COVID--19 (COVID-SCORE-10) in the general population of 13 Latin American countries. Methods A total of 5780 individuals from 13 Latin American and Caribbean countries selected by non-probabilistic snowball sampling participated. A confirmatory factor analysis was performed and the alignment method was used to evaluate invariance. Additionally, a graded response model was used for the assessment of item characteristics. Results The results indicate that there is approximate measurement invariance of the COVID-SCORE-10 among the participating countries. Furthermore, IRT results suggest that the COVID-SCORE-10 measures with good psychometric ability a broad spectrum of the construct assessed, especially around average levels. Comparison of COVID-SCORE-10 scores indicated that participants from Cuba, Uruguay and El Salvador had the most positive perceptions of government actions to address the pandemic. Thus, the underlying construct of perception of government actions was equivalent in all countries. Conclusion The results show the importance of initially establishing the fundamental measurement properties and MI before inferring the cross-cultural universality of the construct to be measured.

Implicación de la inhibición cognitiva en el gasto financiero en jóvenes de México. Estudio preliminar en neuroeconomía / Involvement of cognitive inhibition in financial spending in young people of Mexico. Preliminary study in Neuroeconomics

Resumen La psicología y las neurociencias ofrecen nuevas perspectivas para comprender el comportamiento económico y del consumidor. La neuroeconomía provee un nuevo marco de referencia para comprender la forma en la que las estructuras neuroanatómicas del cerebro se encuentran implicadas en las decisiones financieras de los individuos. En este contexto, el objetivo de la investigación es identificar la asociación entre la inhibición cognitiva y la cantidad de dinero que gastan los universitarios. Participaron 40 jóvenes universitarios, 47.5 % hombres y 52.5 % mujeres, entre 18 y 25 años, de la Ciudad de Querétaro, México. La inhibición cognitiva se evaluó con el Test de Stroop. Además, se preguntó sobre datos sociodemográficos y los gastos mensuales. Los resultados muestran descriptivamente el nivel de gasto de los jóvenes y las puntuaciones del efecto Stroop. Los jóvenes tienen puntuaciones medias en Palabra, Color, Palabra - Color e Interferencia, acorde a los parámetros establecidos. Respecto al gasto mensual se observa que, en promedio, gastan $ 666 pesos mexicanos (34.04 USD / 31.13 EUR). Adicionalmente, se encontró un déficit en el control inhibitorio relacionado con un aumento en el nivel de gasto realizado por los estudiantes universitarios, es decir, aquellos que gastan y compran, en mayor medida presentan dificultades en su inhibición cognitiva (autocontrol). El control inhibitorio se asoció con la edad y esta, a su vez, con el nivel de dinero gastado. Por último, se profundiza en la utilidad de los resultados dentro de la neuroeconomía en México y demás países latinoamericanos, así como su aporte como línea de investigación.

Abstract Psychology and neuroscience offer new perspectives to understand consumer and economic behaviour. Neuroeconomics provides a new frame of reference to understand the way in which the neuroanatomical structures of the brain are involved in the financial decisions of people. Currently, measurement scales are an application alternative to assess people's executive functions and cognitive inhibition quickly. In the present study for the evaluation of cognitive inhibition we will use the Stroop Test (Golden, 1994), which examines the cognitive processes associated with cognitive flexibility; the interference resistance from external stimuli and its effect on behaviour. The plates that make up the Stroop test present different possibilities for analysis and interpretation. Within neuroeconomics, there is an area that investigates how cognitive and affective regulation is critical to achieve economic results, in addition to investigating the problems caused by consumption and spending that people have in their daily lives. There is research shown that individuals who make compulsive purchases show cognitive deficiencies and difficulties in inhibiting their responses. Furthermore, compulsive purchases correlate with financial executive functioning, particularly with impulse control, organization and planning, showing that compulsive purchases are not limited only to impulse control. In Latin America and particularly in Mexico, there are few studies on neuroeconomics or consumer neuroscience, so consider that this research is an innovative contribution to the subject in our region. In this context, the objective of the research is to identify the association between cognitive inhibition and the money university students spend. This research evaluated the association between cognitive inhibition and the money university students spend. A total of 40 university students participated, 47.5 % men and 52.5 % women, between 18 and 25 years, from the City of Querétaro, Mexico. Cognitive inhibition was evaluated with the Stroop Test. In addition, sociodemographic data and monthly expenses were asked. The results descriptively detailed the level of youth spending and the Stroop effect variables. Young people have mean scores in Word, Colour, Word - Colour and Interference, according to the established parameters. Regarding monthly expenses, it is observed that on average they spend $ 666 Mexican pesos (34.04 USD / 31.13 EUR). In addition, a deficit was found in the inhibitory control related to an increase in the level of expenditure made by university students, that is, those who spend and buy more have difficulties in their cognitive inhibition (self-control). Inhibitory control is associated with age and this time with the level of money spent. Additionally, the inhibition processes allows us to assume certain activity in the orbitofrontal cortex (OFC) and the dorsolateral prefrontal cortex (DLFC), while they are ready to spend and who has problems with the control of their money, they cannot realize the excessive expenses that it does not recognize the symptoms that drive it to compulsive buying. The findings provide evidence to the neuroeconomy, as well as to the posture of cognitive control. Furthermore, it is corroborated that performance tests are an alternative in the detection of executive functioning deficiencies in a short time of application and provide evidence in the approach to neuroeconomics through this form of measurement. This offers a novel vision to understand the personal finances of Mexicans and their economic behaviour. Financial and consumer behaviour has become our main line of research from a neuroeconomic perspective; in the future, we intend to continue this study by incorporating affective and neurobehavioral factors involved in financial decisions in young people of our country. Finally, the usefulness of the results within the neuroeconomics in Mexico and Latin America is deepened, as well as its contribution as a line of research.

Comparación de la búsqueda de sensaciones en diferentes niveles de la conducta alimentaria de riesgo en jóvenes / Comparative sensation seeking traits in different risky eating behaviors in young people

Resumen Los objetivos de la presente investigación son describir las conductas alimentarias, así como comparar la búsqueda de sensaciones en diferentes niveles de riesgo alimentario. Se midieron las conductas alimentarias de riesgo y la búsqueda de sensaciones. Se seleccionó una muestra no probabilística de tipo intencional de 1012 jóvenes, de entre 14 y 22 años de edad (M = 16.7). Los resultados mostraron que las mujeres se preocupan más por su peso, vomitan, ayunan, hacen dieta y usan pastillas para perder peso, en comparación con los hombres, quienes practican más atracones y tienen una mayor falta de control al comer que las mujeres. Además, quienes presentan alto riesgo alimentario tienen mayores niveles de búsqueda de sensaciones. La discusión analiza la utilidad de lo encontrado para prevenir los problemas alimentarios en los jóvenes, así como identificar a la búsqueda de sensaciones como un factor de riesgo del comportamiento alimentario dentro de los programas de nutrición y salud.

Abstract The objective of this research was to describe the risk behavior eating and analyze differencces in sensatión seeking into risk disorder eating. A questionnaire was used that included risk eating behaviors and sensation seeking inventory. A sample was use formed by 1012 youths between 14 and 22 (mean 16.7) years old, in México City. The results revealed that the woman concern about weight, vomit, fast, make restrictive dieting and use pills for weight reduce, a difference of the man, this make binge eating, lose self- control for eating, more than the woman. The youths male and female with high nutritional risk have higher levels in sensations seeking. The discussion analyzes the utility for prevent eating disorders in youths and identify the sensation seeking as a risk factor for eating behavior within the nutrition and health programs.

Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction?

ABSTRACT Purpose To review current literature regarding sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD) focused on indications, barriers and latest technological developments. Material and Methods A PubMed database search was performed in April 2020, focusing on SNM and various neuro-urological conditions. Results SNM has been increasingly indicated for lower urinary tract dysfunction (LUTD) in neuro-urological patients. Most studies are cases series with several methodological limitations and limited follow-up, lacking standardized definition for SNM clinical success. Most series focused on neurogenic overactive bladder in spinal cord injured (incomplete lesions) and multiple sclerosis patients. Barriers for applying this therapy in neurogenic LUTD were mainly related to magnetic resonance imaging incompatibility, size of the implantable pulse generator (IPG), and battery depletion. Newer technological advances have been made to address these limitations and will be widely available in the near future. Conclusions SNM seems a promising therapy for neurogenic LUTD in carefully selected patients with incomplete lesions. Further studies are still needed to define which subgroups of neurological patients benefit the most from this minimally invasive technique.

Development and validation of the Inventory of Emotional and Reasoned Purchases Decision-Making Styles (PDMI) / Desarrollo y validación del Inventario de Estilos de Toma de Decisiones de Compras Emocionales y Razonadas (ITDC)

Abstract Consumer decision-making is part of the purchase process. Therefore, as a relevant element for the evaluation of the purchase process, it is essential to have valid, reliable and culturally relevant measurements. For that reason, in this study the development and validation of the Purchases Decision-Making Inventory (PDMI) are presented. The general sample consisted of 518 Mexican participants, which were randomly divided into two groups, 300 for exploratory analysis, and 218 for confirmatory analysis. The results show that PDMI evaluated from its general components of emotional and reasoned decisions in purchases, present high internal consistency. The confirmatory factor analysis shows a good fit to dimensions extracted from the exploratory analyses. In terms of convergent, divergent, and discriminant validity, relations according to the nomological network were found, and the factors showed independency. Finally, from the confirmed structures of the inventory, spending per week was modelled, finding that emotional decisions turned out to be a positive significant predictor. PDMI is an evaluation tool with cultural relevance and appropriate psychometric indexes that can be used to integrate into consumer behavior models.

Resumen La toma de decisiones del consumidor es parte del proceso de compra. Por tanto, al ser un elemento relevante para la evaluación del proceso de compra, es esencial contar con mediciones válidas, confiables y culturalmente relevantes. Por esta razón, en este artículo se presenta el desarrollo y validación del inventario de toma de decisiones de compras (ITDC). La muestra general estuvo conformada por 518 participantes mexicanos, la cual se dividió aleatoriamente en dos, 300 para análisis exploratorios y 218 para análisis confirmatorios. Los resultados muestran que el ITDC, evaluado a partir de sus componentes generales de decisiones emocionales y razonadas en las compras, presenta altos índices de consistencia interna. El análisis factorial confirmatorio muestra buen ajuste a las dimensiones extraídas en los análisis exploratorios. En términos de validez convergente, divergente y discriminante, se encontraron relaciones según la red nomológica, y los factores mostraron independencia. Por último, a partir de las estructuras confirmadas del inventario, se modeló el gasto por semana. Encontrando que las decisiones emocionales resultan ser un predictor significativo positivo. ITDC es una herramienta de evaluación con relevancia cultural e índices psicométricos apropiados, que se pueden utilizar para integrar en modelos de comportamiento del consumidor.

Los factores de la teoría de la conducta planeada relacionados con el patrón de consumo de bebidas endulzadas en jóvenes universitarios / Factors from the theory of planned behavior and soda consumption patterns among university students

RESUMEN En México, el consumo de bebidas endulzadas o refrescos es uno de los más altos a nivel mundial, esto representa un factor de riesgo para el desarrollo de obesidad y enfermedades metabólicas. En este estudio empleamos la Teoría de la Conducta Planeada (TCP) para identificar factores cognitivos asociados a la frecuencia de consumo de refrescos en adultos jóvenes mexicanos. Estudiamos una muestra de 261 personas, 110 hombres y 151 mujeres, de 18 a 45 años de edad (M= 22.51; DE = 4.2). Los participantes completaron cuestionarios de frecuencia de consumo e instrumentos basados en la TCP. Se encontraron dos factores predictores independientes y significativos de la frecuencia de consumo, el principal fue la baja autoeficacia, seguido por la intención. Ambos factores explican el 27.3% de la varianza de la frecuencia de consumo. Estos resultados contribuyen a entender los factores cognitivos involucrados en el consumo de refrescos, y sugieren que la alta frecuencia de consumo es una conducta no racional, por lo que podrían estar implicados aspectos afectivos y motivacionales, lo que deberá ser dilucidado con más investigación que permita explorar nuevas alternativas para el desarrollo de programas de prevención y tratamiento del consumo de bebidas con riesgo para la salud humana.

ABSTRACT Consumption of sugar sweetened beverages (SSB) in Mexico is one of the highest in the world, which represents a risk factor for the development of obesity and metabolic diseases. In the present study we used the Theory of Planned Behavior (TPB) to identify cognitive factors associated with the frequency of SSB consumption in Mexican young adults. We studied a sample of 261 people, 110 men and 151 women, from 18 to 45 years of age (M = 22.51, SD = 4.2). Participants completed consumption frequency questionnaires and instruments based on TPB. Two independent and significant predictors of consumption frequency were found: low self-efficacy and intention. Both factors explained 27.3% of the variance in consumption frequency. These results contribute to the understanding of the cognitive factors underlying SSB consumption, and suggest that high consumption frequency is a non-rational behaviour. It is possible that affective and motivational aspects could also be involved, which should be clarified with more research, in order to explore alternatives for the prevention and treatment of unhealthy consumption of beverages that are a risk to human health.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser / Predictors of stone-free status in the first flexible ureteroscopy with laser lithotripsy

Resumen Introducción: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. Objetivo: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. Método: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. Resultados: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. Conclusiones: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Abstract Introduction: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. Objective: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. Method: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. Results: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. Conclusions: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea / Stone-free rate without major complication as a definition of success in percutaneous nephrolithotomy

Resumen Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Abstract Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Desarrollo y validación de escalas para medir el valor que las mujeres dan a la saciedad y a la alimentación: un factor crítico para el tratamiento de la obesidad / Development and validation of scales to measure women's eating and satiation values: a criti- cal factor in the treatment of obesity

La sobrevaloración de la alimentación y de la saciedad en familias que viven en un medio influenciado por la globalización y desarrollo de la industria alimentaria, puede estar teniendo un efecto sinérgico en el desarrollo de la obesidad y sus comorbilidades en países de ingreso medio. El objetivo de este trabajo fue desarrollar y validar escalas para medir el valor otorgado a la alimentación y la saciedad en mujeres. Se desarrolló un instrumento y se aplicó en querétaro, México (n=243), se midieron variables socioeconómicas y de percepción de peso corporal. Se realizó análisis factorial explorato- rio, confirmatorio y ANOVA. Las escalas del valor que las mujeres dan a la alimentación como base del bienestar, a la saciedad y a la alimentación como base del bienestar del hijo, se validaron (α-Cronbach>0.66) y se confirmaron (CFI>0.98;RMSEA<0.05). Los puntajes de valor de la alimentación y de la saciedad se asociaron con un menor nivel socioeconómico y educativo, inseguridad alimentaria en el pasado, menor intención de perder peso y con percepción bajo peso en los hijos. En conclusión, las es- calas para medir el valor de la alimentación y la saciedad tienen validez para ser utilizadas en futuros estudios; su utilización puede contribuir a desarrollar estrategias que consideren la verdadera motivación de la alimentación en los segmentos poblacionales más desfavorecidos(AU)

The overvaluation of eating and satiation in families whose environment has been influenced by globalization and the food industry, could be inducing obesity and its co-morbidities in midd- le income countries. The objective was to develop and validate scales to measure women's eating and satiation values. A measurement instrument was developed and ad- ministered to women from querétaro, Mexico (n=243), it also measured socioeconomic (SE) and body weight per- ception variables. Analyses included exploratory and con- firmatory factorial analyses and ANOVA. The scales that represented the value of feeding as basis of wealth, the va- lue of satiation and the value of feeding a child as the basis of the child's wealth, were validated (Cronbach-α>0.66) and confirmed (CFI >0.98; RMSEA<0.05).The scores were associated with a lower SE status, lower education level, childhood food insecurity, low intention to lose weight and with an underweighted child perception. In conclusion, the scales that measure the value of eating and satiation have the validity to be used in future studies; its utilization can contribute to develop strategies to improve eating behavior of underprivileged population segments, that take into consideration the real motives of eating(AU)

Evaluación psicométrica de una escala de autoeficacia de la conducta alimentaria / A psychometric assessment of a self-efficacy eating consumption scale

Background: We evaluated the reliability, factorial validity and criteria validity of a psychometric test designed to measure eating behavior self-efficacy. Materials and methods: This construct was measured using a 21 item scale appplied to a sample of 300 between 14 and 74 years (M=29.89), from the Metropolitan Area of México City, Mexico. Results: Data analysis revealed a four factor structure with high reliability. These factors characterized 4 different types of eating behaviors: 1) high fat eating consumption; 2) healthy eating consumption; 3) sweets consumption and 4) drink consumption. Additionally, we measured physical activity as a factor that could be related with healthy eating. Conclusion. We analyzed feasibility of using this psychometric tool to assess self-efficacy in our sample and its potential implication for nutritional programs. It is also considered feasible to apply this scale in new settings, such as educational programs on nutrition and in the nutritionist practice, since it can provide a predictive tool for eating behaviors.

Objetivo: Evaluar la confiabilidad, la validez factorial y de criterio de un instrumento diseñado para medir autoeficacia alimentaria. Material y métodos: Se utilizó una escala de estimación de 21 ítems, aplicado a una muestra de 300 personas entre 14 y 74 años de edad (M= 29.89) de la Zona Metropolitana de la Ciudad de México, México. Resultados: El instrumento incorporó cuatro factores: 1) consumo de alimentos altos en grasa; 2) consumo de alimentos saludables; 3) consumo de alimentos dulces y 4) consumo de bebidas. Se encontró que la capacidad de alimentarse sanamente se encuentra presente en las personas que realizan actividad física frecuentemente. Conclusiones: Se plantea su utilidad en la evaluación de la autoeficacia de la conducta alimentaria en contextos como los programas de educación nutricional y la práctica del nutriólogo. Este instrumento puede proveer de una herramienta predictora de las conductas alimentarias.

AfroColombian ethnicity, a paradoxical protective factor against Dengue / La etnia afrocolombiana, factor protector paradójico contra el Dengue

Abstract Introduction: Dengue is a priority public health problem. During epidemics in Cuba and Haiti, ethnic African descendant population had lower risk of dengue, and the ethnic factor was proposed as a protective one. Objective: To determine the relation between the Dengue's cumulative incidence and the Afro-Colombian proportion in communities of Cali, during the epidemic of 2013. Methods: This study was conducted in Cali, Colombia. The design was ecological, using information from the National Census 2005 projected to 2013, from the National Administrative Department of Statistics (DANE), and the National Epidemiological Surveillance System. It was obtained the Pearson´s correlation coefficient between cumulative incidence and the proportion of Afro-Colombian population by communities. Additionally, the cumulative incidences of dengue were evaluated in two zones with different proportion of Afro-Colombian population. The association was also evaluated for aggregation bias, confounding by social variables, and interaction by area of ​​residence. Results: Dengue´s cumulative incidence was significantly lower for Afro-Colombians regardless of the proportion of Afro-Colombian population in the area of residence. The relative risk of dengue between non-Afro-Colombians and Afro-Colombians was 9.4 (95% CI=8.4-10.6) in zones with high proportion of Afro-Colombian population, while the relative risk of dengue was 4.0 (95% CI :3.6 - 4.4) in the zone with lower proportion of Afro-Colombian population. There was no evidence of aggregation bias or confounding in the association by social variables. Conclusions: The Afro-Colombian population had a significantly lower risk of getting dengue and its complications, compared with the non-Afro-Colombian population. The non-Afro-Colombian populations living in areas with a high proportion of Afro-Colombians increase their risk of dengue more than double, suggesting an asymptomatic viremic environment...(AU)

Resumen Introducción: el dengue es un problema prioritario en salud pública. Durante epidemias en Cuba y Haití, la población étnica afro-descendiente tuvo menor riesgo de dengue. Por ello, se propuso el factor étnico como protector. Objetivo: Determinar la relación entre la incidencia acumulada de dengue y la proporción de población Afrocolombiana de Cali, durante la epidemia de 2013. Métodos: Este estudio se realizó en Cali, Colombia. El diseño fue ecológico, con información del Censo Nacional 2005 y su proyección a 2013 del DANE y del Sistema de entre las incidencias acumuladas de dengue y la proporción de afrocolombianos, según comunidades. Adicionalmente, fueron evaluadas las incidencias acumuladas de dos zonas con diferente proporción de habitantes afrocolombianos. También se evaluó la presencia del sesgo de agregación, de confusión por variables sociales y de interacción según la zona de residencia. Resultados: Para afrocolombianos, la incidencia acumulada de dengue fue significativamente menor, independientemente de la proporción de población afrocolombiana en la zona de residencia. El riesgo relativo de dengue entre no-afrocolombianos y afrocolombianos fue 9.4 (IC 95%= 8.4-10.6) en la zona con más alta proporción de población afrocolombiana, mientras que el riesgo relativo fue 4.0 (IC 95%= 3.6-4.4) en la zona de más baja proporción de población afrocolombiana. No se evidenció sesgo de agregación ni confusión de la asociación por variables sociales. Conclusiones: La población afrocolombiana presentó un riesgo significativamente menor de enfermar por dengue y sus complicaciones en comparación con no-afrocolombianos. La población no-afrocolombiana que reside en zonas con alta proporción de población afrocolombiana aumenta el riesgo de dengue a más del doble, lo cual sugiere un entorno virémico asintomático...(AU)

Association study between the MDR1 gene and clinical characteristics in schizophrenia

Objective: Schizophrenia is a complex psychiatric disorder, characterized by disturbed patterns of thought and affecting 0.3-2.0% of the world population. Previously, the multidrug resistance 1 (MDR1) gene has been associated with schizophrenia in treatment response studies in psychotic patients. The aim of this study was to determine the association between MDR1 gene polymorphisms and clinical characteristics in patients with schizophrenia. Methods: Positive and negative symptoms of schizophrenia were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) in 158 Mexican patients with schizophrenia. Analyses of MDR1 gene polymorphisms were performed using TaqMan technology. A multivariate ANOVA was performed with MDR1 polymorphisms and gender as independent variables. Results: Males with the G/G genotype of MDR1 rs2032582 presented significantly higher levels of delusions (p = 0.02). When comparing female vs. male groups, the difference was statistically significant (p = 0.0003). Analyses of the MDR1 gene rs1045642 variant showed no significant differences. Conclusion: Our findings suggest that male carriers of the G allele of variant rs2032582 exhibit greater severity of delusions; however, these results should be taken as preliminary, and replication studies in other populations of different ethnic origins are required to confirm these findings. .

Preferencias de especialidad médica entre los estudiantes de pregrado de la Facultad de Medicina de la UNAM: ¿En qué lugar se ubica la Psiquiatría? / Medical specialty preferences among undergraduate students of the Faculty of Medicine at UNAM: where is psychiatry?

Introduction In several countries, the number of candidates to enter Psychiatry is diminishing. In Mexico, the kind of factors that influence the preference for a medical specialty and the way the selection tendencies change across the years of the medical career is not well known. In this study we analyzed the specialty preferences in a representative sample of students from different years of Medicine School at the National Autonomous University of Mexico (UNAM). Material and methods Descriptive cross-sectional study. Specialty preferences were assessed in students enrolled in the 2009-2010 school year of the Medicine School through a questionnaire designed expressly for this research. Data were analyzed quantitatively and qualitatively. Results A total of 2737 students participated. Most of the students (n = 2634) had already considered a specialty. Preferred specialties were General surgery (n=403, 14.72%), followed by Internal medicine (n=382, 13.96%) and Pediatrics (n=261, 9.54%). On the other hand, Radiology (n=314, 11.47%), Pediatrics (n=280, 10.23%) and Family medicine (n=263, 9.61%) were all specialties that students would not choose. For Psychiatry, there was a greater tendency only among first year students to see it as a choice of specialty. Compared with men (n=114, 11.53%), the percentage of women (n=259, 14.81%) who considered Psychiatry as an option of medical residency was higher. Discussion We could see that Psychiatry is neither the most preferred nor the most rejected specialty among medical students. Unfortunately, misconceptions still prevail around it and they do not favor its selection as a potential option of residency. It would be necessary to strengthen the knowledge about mental health and psychiatry, and to have the teachers promoting it in order to change the trends of selection.

Introducción En diversos países el número de candidatos para ingresar a la especialidad de Psiquiatría es cada vez menor. En México desconocemos a detalle los factores que inciden en la preferencia por una especialidad médica y la forma en que esa tendencia se va modificando a través de los años de la carrera de Medicina. En este estudio analizamos las preferencias de especialidad en una muestra representativa de estudiantes de los diferentes años de la carrera de Medicina en la Universidad Nacional Autónoma de México (UNAM). Material y métodos Estudio transversal descriptivo. Por medio de un cuestionario diseñado ex profeso para la indagación de las preferencias de especialidad, se evaluaron a los alumnos inscritos en el ciclo escolar 2009-2010 de la carrera de Medicina que aceptaron participar. Los datos se analizaron cuanti y cualitativamente. Resultados Participaron 2737 estudiantes. La mayor parte de los alumnos (n=2634) ya tenía considerada una opción de especialidad. Con una p<0.001, las especialidades preferidas fueron: Cirugía general (n=403, 14.72%), seguida de Medicina interna (n=382, 13.96%) y Pediatría (n=261, 9.54%). Mientras que Radiología (n=314, 11.47%), Pediatría (n=280, 10.23%) y Medicina familiar (n=263, 9.61%) se mencionaron como las especialidades que no elegirían. En cuanto a la Psiquiatría, sólo entre los alumnos de primer año se observó una mayor tendencia a considerarla como una opción de especialidad. En comparación con los hombres (n=114, 11.53%), fueron más las mujeres (n=259, 14.81%) que la consideraron como una alternativa para cursar una residencia. Discusión Si bien la Psiquiatría no se encuentra entre las especialidades más rechazadas por los alumnos participantes, tampoco figura dentro de las preferidas. Desafortunadamente siguen prevaleciendo concepciones erróneas a su alrededor que no favorecen su selección como una potencial especialidad a cursar. Sería necesario reforzar el conocimiento sobre la salud mental y la psiquiatría y su promoción por parte de los docentes en la búsqueda de un cambio en las tendencias.

Manejo nutricional de las intolerancias digestivas más comunes del lactante / Nutritional management of the most common digestive intolerance in infants

Las intolerancias digestivas más comunes del lactante i n c l u y e n e s t r e ñ imi e n t o , r e g u r g i t a c i ó n , llanto/irritabilidad, cólico, gas excesivo y diarrea, que en muchos casos, pueden ser normales, sin embargo, es frecuente ante estas intolerancias, cambiar las fórmulas infantiles. En el presente artículo, un grupo de profesionales de la salud relacionados con la gastroenterología y alergología pediátrica, describen los antecedentes, las definiciones, y el manejo nutricional de cada una de estas intolerancias digestivas.

The most common symptoms of digestive intolerances in infants include constipation, regurgitation,crying/irritability, cramps, excessive gas and diarrhea. Some of these symptoms may be completely normaland are explained in part as a result of the maturation process of the GI tract of young infants. However, it isvery common that parents and doctors due to any of these symptoms switch formulas. A group of experts'pediatric gastroenterologists and pediatric allergists from different countries decided to review this topicand provide practical recommendations.

Absceso lumbar secundario a colelitiasis retenida / Lumbar abscess secundary to retained gallstones

Los cálculos abandonados tras apertura accidental durante una colecistectomía, generalmente laparoscópica, pueden producir complicaciones tardías, siendo el absceso intraabdominal la más frecuente. El diagnóstico se basa en la prueba de imagen (ecografía/tomografía computerizada), siendo el drenaje y la extracción quirúrgica de los cálculos la mejor opción terapéutica, ya que el drenaje percutáneo presenta una elevada tasa de fracasos. Sin embargo, el absceso en pared abdominal posterior como manifestación inicial de un absceso intraabdominal debido a colelitiasis retenida es poco frecuente, por lo que reportamos este caso.

Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.

Trece años de experiencia en el manejo de cáncer vesical con neovejiga ortotópica de Studer / Management of bladder cancer with Studer orthotopic neobladder: 13-year experience

Introducción: Posterior a la cistectomía radical, la derivaciones urinarias ortotópicas han tomado importancia en los últimos años. El objetivo de este informe es presentar los resultados en pacientes sometidos a derivación urinaria ortotópica tipo Studer posterior a cistectomía radical. Material y métodos: Se revisaron expedientes de pacientes con cáncer vesical sometidos a cistectomía radical más realización de neovejiga ileal entre enero de 1992 y diciembre de 2004. Resultados: De los 306 pacientes operados de cistectomía radial con derivación urinaria, se incluyeron 42 (13.7 %) pacientes en quienes la derivación urinaria fue neovejiga tipo Studer, 34 (80.9 %) hombres y ocho (19.1 %) mujeres, con una edad promedio de 60 años. El tiempo quirúrgico promedio fue de siete horas, con sangrado promedio de 1600 ml, requiriendo ingreso a unidad de terapia intensiva 55 % de los casos. La complicación temprana más frecuente fue la acidosis metabólica, presente en 28 (66 %) pacientes, y la más grave fue la fuga urinaria uretero-ileal, en siete (16.6 %). Entre las complicaciones tardías más importantes destacan la incontinencia urinaria diurna y nocturna, frecuentemente relacionadas a infecciones de vías urinarias y oclusión intestinal. A cinco años de seguimiento, la sobrevida global fue de 71 %, la mortalidad específica por cáncer fue de 15 % y la mortalidad relacionada a la cirugía de 7.3 %. Conclusiones: La realización de neovejigas ortotópicas es reproducible en centros con experiencia y una alternativa a la derivación urinaria heterotópica con conducto ileal.

BACKGROUND: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy. METHODS: The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A--60 years old or younger and group B-->60 years old. RESULTS: From 306 patients submitted to radical cystectomy with urinary derivation, there were 42 patients (13.7%) included with Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 cc requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in seven (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%. CONCLUSIONS: The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.