Expresión clínica del dengue en usuarios del Instituto Mexicano del Seguro Social, Veracruz, México / Clinical expression of dengue in beneficiaries of the Instituto Mexicano del Seguro Social in Veracruz, Mexico

Objective: To describe and compare the clinical behavior of Dengue Fever (DF) and Hemorrhagic Dengue Fever (HDF) in beneficiaries of the Instituto Mexicano del Seguro Social (IMSS). Methods: Transversal study in beneficiaries from Veracruz, selected among those who sought attention at two medical attention units, with probable dengue diagnosis. Surveys were performed to know personal and epidemiological data, as well as a clinical follow up. Blood samples were taken for RT-PCR viral identification and antibodies against Dengue. In the same way, platelet, hemoglobin, and hematocrit tests were performed for their determination. The SPSS 12.0 software was used for the process and analysis of the information, and simple frequencies, proportions, and means were estimated. Results: 109 patients were studied, classified as 72 DF and 37 as HDF. 40 isolations were performed, and the circulation of the four types of dengue virus was identified, although most of the isolations corresponded to serotype 2 (Asian-American genotype). In one patient, a simultaneous infection of dengue viruses 1 and 2 was identified. A group of patients did not present hemorrhages, capillary fragility, or liquid permeation, but with important thrombocytopenia and hemoconcentration, all infected with den-1 and den-2. Conclusions: The presence of cases with atipical behavior of the diseases were identified. The characteristics and immunologic experience of the populations, as well as the simultaneous circulation of various dengue viruses and their changing structure could be related with the current clinical behavior of Dengue in Mexico. It is important to continue the research to confirm these asseverations.

Estrategia educativa para la toma de citología cervical / Educational Strategy to improve the Quality of Cervical Cytology Making

Resumen

Objetivo: evaluar la estrategia educativa de visita del profesor para mejorar la calidad en la toma de citología cervical del programa DOCCACU en IMSS Zona Xalapa, Veracruz.

Metodología: en la primera fase se aplicó un instrumento con preguntas abiertas y una lista de verificación que describe la técnica, al personal que toma las muestras. En la segunda fase se desarrolló la intervención educativa visita de profesor y en la tercera fase nuevamente se aplicó la misma herramienta con observación directa del procedimiento. El impacto se midió comparando la proporción de laminillas adecuadas antes del estudio y tres meses después de la intervención educativa.

Resultados: se evaluaron 89 enfermeras antes de la capacitación con una media de aciertos de seis, después de la capacitación la media fue de 11, con un valor de p < 0.05. En cuanto al impacto de la capacitación sobre el programa, encontramos que en el 2009 de junio a septiembre, las muestras inadecuadas fueron 208, en el 2010 en el mismo periodo de tiempo, después de la estrategia educativa fueron 151, con un valor de p < 0.05.

Conclusión: dentro de las instituciones del sector salud existen indicadores que nos hablan de cobertura e impacto en la población pero muy pocos que nos hablen de la calidad de los procesos, lo cual se ve reflejado en las tasas de mortalidad. La estrategia educativa de visita del profesor mejora la calidad de la toma de la muestra al disminuir el número de muestras inadecuadas y aumentar la detección de lesiones así como mejora el conocimiento en los alumnos.

Summary

Objective: to evaluate the educational strategy of teacher’s visit to improve the quality of the specimen collection for Cervicovaginal Cytology of the Program Opportune detection of Cervico-uterine Cancer in the units of Familiar Medicine of the Instituto Mexicano del Seguro Social (IMSS) of the Zone Xalapa, Veracruz, Mexico.

Methodology: in the first phase a questionnaire was applied by opened questions and a list of check that describes the technique, to the personnel that takes the slides. The second phase developed the educational intervention (the visit of the teacher) and in the third phase again the same tool was applied by direct observation of the procedure. The impact was measured up comparing the proportion of good technique realized slides before the study and the ones realized 3 months after the educational intervention

Results: there were evaluated a total of 89 nurses finding before the training an average of successes of 6 slides, and after the training an average of 11, with a value of p minor of 0.05. As for the impact of the training on the program, we find that in 2009 from June to September, the inadequate technique realized slides samples were 208, in 2010 in the same period of time, after the educational strategy they were 151, with a value of p of 0.001.

Conclusion: the Health Sector has documents that indicate about coverage and Impact in the population but very few ones which speak about the quality of the process, which seems reflected in the rates of mortality. The educational strategy of teacher’s visit improves the quality of the specimen collection, decreasing the number of inadequate specimen collection and increasing the detection of injuries, as well as it improves the knowledge in the pupils.

Identificación de un caso de fenilcetonuria a través del tamizaje neonatal / Diagnosis of phenylketonuria by newborn screening

Introducción. La fenilcetonuria es una enfermedad hereditaria autosómica recesiva, causada por un defecto de la enzima fenilalanina hidroxilasa, la cual es responsable de la conversión de la fenilalanina en tirosina. Es la segunda causa más frecuente de retardo mental prevenible. Se desconoce su incidencia en México. En el caso que aquí se presenta, el diagnóstico precoz fue realizado con el tamiz neonatal ampliado y el tratamiento consistió en una dieta baja en fenilalanina. Caso clínico. Paciente masculino de 2 meses de edad sin datos de retardo psicomotor. Se le realizó la prueba de tamiz neonatal a los 3 días de nacido con valores de fenilalanina de 15.25 mg/dL y control a los 2 meses de 39.7 mg/dL. El diagnóstico fue confirmado con el análisis cuantitativo de la concentración de fenilalanina y de tirosina, por medio de la cromatografía de líquidos de alta resolución. Se recomendó un tratamiento de fórmula láctea libre de fenilalanina y dieta vegetariana. Conclusión. Las pruebas de tamizaje neonatal permiten la detección oportuna de enfermedades metabólicas en pacientes asintomáticos, como en el caso de la fenilcetonuria.

Introduction. Phenylketonuria is an autosomic recessive hereditary disease caused by a defect of the enzyme phenylalanine hydroxylase, which is responsible for the phenylalanine conversion to tyrosine. It is the second most frequent although preventable cause of mental retardation. Its incidence in Mexico is unknown. Early diagnosis is made through extended newborn screening, and treatment consists of a low-phenylalanine diet. Case report. Masculine 2-months old with no data of psycho-motor retardation. Newborn screening tests were performed. Values of phenylalanine were 15.25 mg/dL 3 days after delivery, whereas follow-up values at 2 months of age were 39.7 mg/dL. Diagnosis was confirmed with quantitative analysis of phenyla-lanine and tyrosine concentration by HPLC. Treatment consisted of phenylalanine-free infant formula and vegetarian diet. Conclusion. Newborn screening tests allow early detection of metabolic diseases in asymptomatic patients, such as phenylketonuria.