ABSTRACT
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Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.
ABSTRACT
Objetivo. Determinar la frecuencia de infecciones nosocomiales en el Instituto Nacional de la Nutrición Salvador Zubirán (INNSZ) desde la instauración del programa de vigilancia hasta la actualidad y conocer su impacto en estancia hospitalaria y mortalidad. Material y métodos. Se realizó un estudio descriptivo, retrospectivo y retrolectivo en un hospital de referencia de tercer nivel de atención. Se obtuvieron las frecuencias, el tipo y la distribución de infecciones nosocomiales de la base de datos del Departamento de Epidemiología Hospitalaria entre 1991 y 1996. Se determinó en cada paciente el grado de gravedad de su enfermedad mediante la escala de McCabe-Jackson, así como la edad promedio y el tiempo de estancia hospitalaria. Se aplicó la prueba de X² para tendencias de los diferentes parámetros evaluados. El estudio se dividió en tres etapas: prerremodelación (1991-1993), remodelación (1994-1995) y posremodelación (1996). Se compararon los periodos prerremodelación contra posremodelación. Resultados. Durante este periodo (1991-1996) la tasa de infecciones nosocomiales fue de 8.6 por 100 egresos en promedio, con una disminución de 20 por ciento en su frecuencia a lo largo del mismo (p<0.01), comparando las tasas que se observaron durante la prerremodelación con las de la posrremodelación. El área hospitalaria con mayor frecuencia de infecciones es la Unidad de Terapia Intensiva (26.9 infecciones por 100 egresos), seguida de áreas de hospitalización con cuartos compartidos (9.47 por ciento) y con cuartos privados (7.5 por ciento)...