Cambios retinianos periféricos detectados mediante fotografía no midriática de campo ultra amplio en sujetos asintomáticos / Peripheral retinal changes detected by ultra-widefield non-mydriatic photography in asymptomatic subjects

Resumen Objetivo: La fotografía de campo ultra amplio no requiere midriasis, evalúa 200° de la retina y es adecuada para detectar cambios desapercibidos, con riesgo de desprendimiento de retina en individuos asintomáticos; se identificó la frecuencia de cambios periféricos retinianos y cambios con riesgo de desprendimiento de retina, en una muestra de sujetos fáquicos asintomáticos. Materiales y Métodos: Estudio no experimental, analítico, prospectivo, transversal en sujetos con edades de 40-70 años, de cualquier sexo, sin cirugía intraocular previa o síntomas de desgarros retinianos (fotopsias, eritropsia, escotoma periférico). Se obtuvieron imágenes de campo ultra amplio de retina (sin midriasis) con el equipo Optos y se identificó la proporción e intervalos de confianza (I.C.) del 95% de la muestra que tuvo cambios en la retina periférica y cambios con riesgo de desprendimiento de retina (agujeros retinianos, desprendimiento de retina subclínico). Se comparó esta proporción entre sexos y grupos de edad (χ2). Resultados: 1204 ojos de 602 sujetos (promedio de edad 52,92 desviación estándar D.E. ± 7,83 años), 74,41% de los sujetos fueron del sexo femenino. El 16,61% de la muestra presentó cambios periféricos retinianos (I.C. 95% 13,64- 19,58), el 1% de la muestra tuvo cambios con riesgo de desprendimiento de retina. Los cambios periféricos fueron más frecuentes en el grupo de edad de 50-59 años y en mujeres. La miopia superior a -6,00 dioptrías fue infrecuente en ojos con riesgo de desprendimiento de retina. Conclusiones: La fotografía de campo ultra amplio ayuda a demostrar, sin necesidad de dilatar la pupila, que existe una prevalencia baja de cambios retinianos periféricos y cambios con riesgo de desprendimiento de retina en sujetos fáquicos asintomáticos.

Abstract Objective: Ultra wide field photography requires no mydriasis, evaluates 200° of the retina and is adequate to detect overlooked retinal changes, with a risk of retinal detachment in asymptomatic subjects; we identified the frequency of peripheral retinal changes and changes with risk of retinal detachment, in a sample of asymptomatic phakic subjects. Materials and methods: Non-experimental, analytical, prospective, cross- sectional study in subjects aged 40-70 years, of any gender, without previous intraocular surgery or symptoms of retinal tears (photopsia, eritrhopsia, peripheral scotoma). We obtained ultra wide field retinal photographs (without mydriasis) with the Optos device and identified the proportion and 95% confidence intervals (C.I.) of the sample that had peripheral retinal changes and changes with risk of retinal detachment (retinal holes, subclinical retinal detachments). This proportion was compared between genders and age groups (χ2). Results: 1204 eyes of 602 subjects (mean age 59,92 standard deviation ± 7,83 years), 74,41% of the subjects were female. 16,61% of the sample had peripheral retinal changes (95% C.I. 13,64-19,58), 1% of the sample has changes with risk of retinal detachment. Peripheral retinal changes were more frequent in the 50-59 years age group and in women. Myopia over -6.00 diopters was infrequent in eyes with risk of retinal detachment. Conclusions: Ultra wide field photography helped to prove, without the need of mydriasis, that there is a low prevalence of peripheral retinal changes and changes with risk of retinal detachment, in phakic asymptomatic subjects.

Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness? / Afinamento da camada de células ganglionares em pacientes diabéticos sem retinopatia: relacionados ou não à espessura macular total?

ABSTRACT Purpose: Reduction of ganglion cell layer thickness may occur in diabetic patients without retinopathy. The relationships of this preclinical finding with retinal thickness or reduced parafoveal vessel density have not been established. This study investigated the relationships of ganglion cell layer thickness with retinal thickness and parafoveal vessel density in patients with and without diabetes. Methods: This was an observational, cross-sectional, prospective study that used optical coherence tomography angiography to compare non-diabetic patients (group 1) with diabetic patients without retinopathy (group 2). Ganglion cell layer thickness, macular thickness, and parafoveal vessel density (central, inner, and complete) medians were compared between groups (Mann-Whitney U test), and their relationships were assessed in each group (Spearman Rho test). Results: In total, 68 eyes were included in this study: 34 in group 1 and 34 in group 2. Ganglion cell layer thickness did not differ between groups in any sector. There were strong positive correlations between fields 2 (superior parafoveal), 3 (temporal parafoveal), and 4 (inferior parafoveal) of the optical coherence tomography macular thickness map and the ganglion cell layer thickness in all sectors in both groups. Central vessel density mean was lower in diabetic patients. In group 1 alone, thickness changes in the inferior and nasal inferior ganglion cell layer sectors were partially explained by inner vessel density (r2=0.32 and r2=0.27). Conclusions: Mean ganglion cell layer thickness was not lower in diabetic patients without retinopathy than in non-diabetic patients. Moreover, it exhibited a substantial correlation with total macular thickness. Parafoveal vessel density decreased before ganglion cell layer thinning was observed.

RESUMO Objetivo: Pode ocorrer redução da espessura da camada de células ganglionares em pacientes diabéticos sem retinopatia. As relações desse achado pré-clínico com a espessura da retina ou a densidade reduzida de vasos parafoveais não foram estabelecidas. Este estudo investigou as relações da espessura da camada de células ganglionares com a espessura da retina e densidade dos vasos parafoveais em pacientes com e sem diabetes. Métodos: Estudo prospectivo, observacional, transversal que utilizou angiotomografia de coerência óptica para comparar pacientes não diabéticos (grupo 1) com pacientes diabéticos sem retinopatia (grupo 2). As médias da espessura da camada de células ganglionares, espessura macular e densidade dos vasos parafoveais (central, interno e completo) foram comparadas entre os grupos (teste U de Mann-Whitney) e suas relações foram avaliadas em cada grupo (Teste de Spearman Rho). Resultados: No total, 68 olhos foram incluídos neste estudo: 34 no grupo 1 e 34 no grupo 2. A espessura da camada de células ganglionares não diferiu entre os grupos em nenhum setor. Houve fortes correlações positivas entre os campos 2 (parafoveal superior), 3 (parafoveal temporal) e 4 (parafoveal inferior) do mapa da espessura macular da tomografia de coerência óptica e a espessura da camada de células ganglionares em todos os setores dos dois grupos. A média da densidade central dos vasos foi menor nos pacientes diabéticos. Somente no grupo 1, as alterações de espessura da camada de células ganglionares nos setores inferior e nasal inferior foram parcialmente explicadas pela densidade do vaso interno (r2=0,32 e r2=0,27). Conclusões: A média da espessura da camada de células ganglionares não foi menor em pacientes diabéticos sem retinopatia do que em pacientes não diabéticos. Além disso, exibiu uma correlação substancial com a espessura macular total. A densidade dos vasos parafoveais diminui antes do desbaste da camada de células ganglionares.

Psychometric properties of the Hospital Anxiety and Depression Scale in Mexican pregnant women / Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión en mujeres embarazadas mexicanas

Abstract Introduction Anxiety and depression in pregnant women are a public health problem. Their adequate detection requires valid and reliable instruments that are also useful for prevention and treatment. Objective To identify the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of Mexican pregnant women. Method The HADS was applied to 716 pregnant women between 13 and 46 years old (M = 26.55; SD = 6.56) attended in a public hospital in Mexico City. Results With a sample of 358 participants, a parallel analysis indicated a bifactorial structure for HADS, identified by exploratory factor analysis (Factor 1: anxiety, Factor 2: depression). The factors explained 53% of the variance and correlated positively (r = .36). The global internal consistency (Cronbach's α = .81; ordinal α = .93) and by factor (anxiety: Cronbach's α = .79; ordinal α = .88; depression: Cronbach's α = .79; ordinal α = .87) was acceptable. With data from the remaining 358 participants, a confirmatory factor analysis showed an acceptable fit for the structure detected (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discussion and conclusions The Hospital Anxiety and Depression Scale has adequate psychometric properties to be used in pregnant Mexican women. Its use in routine pregnancy controls would be useful to prevent, detect, and timely treat these conditions.

Resumen Introducción La ansiedad y la depresión en gestantes representan un problema de salud pública. Su adecuada detección requiere de instrumentos válidos y confiables que también sirvan para su prevención y tratamiento. Objetivo Identificar las propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una muestra de mujeres embarazadas mexicanas. Método Se aplicó la HADS a 716 gestantes de entre 13 y 46 años (M = 26.55; DE = 6.56), atendidas en un hospital público en la Ciudad de México. Resultados Con una muestra de 358 participantes, un análisis paralelo indicó una estructura bifactorial para la HADS, identificada mediante análisis factorial exploratorio (Factor 1: ansiedad, Factor 2: depresión). Los factores explicaron el 53% de la varianza y correlacionaron positivamente (r = .36). La consistencia interna global (α de Cronbach = .81, α ordinal = .93) y por factor (ansiedad: αde Cronbach = .79, α ordinal = .88; depresión: α de Cronbach = .79, α ordinal = .87) fue aceptable. Con los datos de las 358 participantes restantes, un análisis factorial confirmatorio mostró un ajuste aceptable para la estructura detectada (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discusión y conclusión La Escala Hospitalaria de Ansiedad y Depresión posee adecuadas propiedades psicométricas para su empleo en mujeres embarazadas mexicanas. Su uso en controles rutinarios del embarazo sería útil para prevenir, detectar y atender oportunamente estos padecimientos.

Clima organizacional de equipos directivos y su relación con los resultados en la atención a la salud / Organizational climate in management teams and its relationship with health care outcomes

Objetivo. Identificar la relación entre el clima organizacional de los equipos directivos y el desempeño de los servicios de salud. Material y métodos. Estudio transversal y analítico. Se utilizó la Escala de Clima Organizacional (EDCO). El desempeño se valoró por el logro de indicadores a través de correlación y regresión múltiple. Se evaluaron 34 jefaturas de servicios de prestaciones médicas del Instituto Mexicano del Seguro Social. Resultados. De 862 participantes, 238 (27.6%) evaluaron el clima de sus organizaciones con nivel alto. El promedio de desempeño fue 0.79±0.07 (mínimo: 0.65; máximo: 0.92). Se muestra una correlación positiva entre clima organizacional y desempeño (r=0.4; p=0.008). Conclusiones. El clima organizacional de las jefaturas de servicios de prestaciones médicas se relaciona con el desempeño en la atención a la salud.

Objective. To identify the relationship between organizational climate of management teams and the performance of health services. Materials and methods. A transversal and analytical study was designed. The Organizational Climate Scale (OCS) was utilized and performance was assessed by the achievement indicators through correlation analysis and multiple regression. Thirty four medical benefits services headquarters (JSPM) were measured of the Mexican Social Security Institute. Results. Of 862 participating, 238 (27.6%) evaluated the climate of their organizations with a high level; the maximal score was 56%. Average performance value was 0.79 ± 0.07 (minimal: 0.65; maximal: 0.92). A positive correlation was demonstrated between organizational climate level and performance (r=0.4; p=0.008). Conclusions. The organizational climate of the health services managers (JSPM) is directly related with performance in health care.

Parafunctional oral habits and itsrelationship with family structure in a Mexican preschoolers group, 2013 / Hábitos orales parafuncionales y su relación con la estructura familiar en un grupo de preescolares mexicanos, 2013

Introduction. Habit is any act acquired through experience and performed regularly and unconsciously. Parafunctional habits are resulting from the perversion of a normal function, acquired by repeated practice of an act that is not functional or necessary, may be signs of adjustment problems or inappropriate emotional expression. Its importance lies in the fact that they can interfere with the development of dental occlusion. Objective. To evaluate the prevalence of parafunctional oral habits and their possible association with the type of family, in a group of preschool children from eastern Mexico City. Methodology. Observational, descriptive and cross-sectional study was carrying on. Preschool children group and their parents were surveyed before an examiner calibration (k =0.87, p=0.001). The detection of different parafunctional habits was conducted in two stages: 1) application of a parent questionnaire and 2) clinical assessment of the child. Results and discussion. 57.7 percent of the studied population had at least one parafunctional oral habit. Onycophagia habit was the most prevalent. The relationship between prevalence of parafunctional habits with family type was significant (X2=87.439, p=0.0001). Conclusions. The prevalence of parafunctional habits was high which was associated with family type also the most frequent parafunctional habit onycophagia.

Introducción. Un hábito es cualquier acto adquirido mediante la experiencia y realizado regular e inconscientemente. Los hábitos bucales parafuncionales son los que resultan de la alteración de una función normal, o los que se adquieren por la práctica repetida de un acto que no es funcional ni necesario, pudiendo ser signos de problemas de adaptación o de expresión emocional inadecuada. Su importancia radica en el hecho de que pueden interferir con el desarrollo de la oclusión dental, razón por la cual el objetivo del presente estudio fue evaluar la prevalencia de hábitos bucales parafuncionales y su posible relación con la estructura familiar, en un grupo de preescolares de un Centro de Desarrollo Infantil del oriente de la Ciudad de México. Metodología. El estudio fue de carácter observacional, descriptivo y transversal, en el que 111 preescolares y sus padres fueron encuestados previa calibración de una examinadora (k=0.87, p=0.001). La detección de los diferentes hábitos bucales parafuncionales se realizó en dos etapas: 1) aplicación de un cuestionario al padre de familia y 2) valoración clínica del niño. Resultados y discusión. El 57.7 por ciento de la población estudiada presentó, al menos un hábito bucal parafuncional. La onicofagia fue el hábito de mayor prevalencia. La relación entre la prevalencia de hábitos parafuncionales con la estructura familiar resultó ser significativa (X2=87.439, p=0.0001). Conclusiones. La prevalencia de hábitos bucales parafuncionales fue alta la cual estuvo relacionada con la estructura familiar, asimismo, el hábito parafuncional más frecuente fue la onicofagia.

Estimación del daño por trauma ocular en Pediatría sin la evaluación de la agudeza visual / Estimation of damage in pediatric ocular trauma without evaluating visual acuity

Introducción. La cuantificación de la agudeza visual (AV) en el niño con trauma ocular puede ser limitada. El objetivo de este estudio fue estimar si los parámetros del sistema de clasificación de lesiones mecánicas oculares (SCLMO) podrían detectar la afección visual significativa (AVS) y el daño del segmento posterior (DSP), sin evaluar la AV. Métodos. Se realizó un estudio observacional, analítico, transversal, retrospectivo y abierto. Se incluyeron niños con trauma ocular y calificación del SCLMO. Se identificaron los ojos con AVS y DSP y se compararon sus proporciones entre los parámetros del SCLMO (χ², razón de momios RM). Resultados. Se analizaron doscientos ojos de pacientes con edad promedio de 10.88 años. Los parámetros asociados con AVS fueron: globo abierto con trauma abierto tipo A (p =0.002, RM=14.14), globo con trauma abierto (p <0.001, RM=11.25), zona II (p =0.001, RM=3.17) y pupila positiva (p <0.001); los asociados con DSP: zona III (46.5%, p <0.001, RM=26.43) y globo con trauma abierto tipo A (40.0%, p=0.059, RM=3.39). Conclusiones. La AVS podría detectarse sin medir la AV en pacientes pediátricos siempre que se evalúen los parámetros restantes del SCLMO.

Background. Quantifying visual acuity (VA) can be limited in children with ocular trauma. Could the parameters of the system for classifying mechanical injuries of the eye (SCMIE) detect the eyes with significant visual affection (SVA) and damage in the posterior ocular segment (DPOS) without the need for visual acuity evaluation? Methods. An observational, analytical, cross-sectional, retrospective and open label study was conducted. Pediatric patients with uni- or bilateral eye trauma and grading using the SCMIE were evaluated. We identified eyes with SVA and those with DPOS. Their rates were then compared between the parameters of SCMIE (χ2 and odds ratio, OR). Results. Two hundred eyes were evaluated (mean age: 10.88 years). The parameters associated clinically with SVA were type A open globe (p = 0.002, OR = 14.14), open globe (p <0.001, OR = 11.25), zone II (p = 0.001, OR = 3.17) and positive pupil (p <0.001). Those associated with DPOS were zone III (46.5%, p <0.001, OR = 26.43) and type A open globe (40.0%, p = 0.059, OR = 3.39). Conclusions. Ocular trauma that causes SVA in children may be detected without measuring VA, provided that the remaining parameters of the SCMIE are evaluated.

El virus del papiloma humano como factor pronóstico en pacientes con carcinoma epidermoide de cabeza y cuello / Human papilloma virus in patients with epidermoid head and neck carcinoma: a prognostic factor

Introducción: Los tres principales factores pronóstico en pacientes con carcinoma epidermoide de cabeza y cuello (CECyC) son tamaño del tumor, estado histológico ganglionar y origen del tumor. Se ha reconocido al virus del papiloma humano, sobre todo la variedad 16 (VPH-16), como factor pronóstico, sin embargo, resulta controversial que los pacientes VPH+ tengan mejor supervivencia que los VPH−. El objetivo del presente es conocer si la infección por VPH tiene valor pronóstico en pacientes con CECyC. Material y métodos: Evaluación retrospectiva de pacientes con CECyC. Se analizó supervivencia, localización tumoral, estado general (ECOG), tipo de tratamiento y asociación a VPH identificado por PCR en tejido tumoral. Análisis descriptivo de frecuencias simples, medidas de tendencia central y dispersión, de acuerdo con el tipo de variables. Análisis descriptivo para supervivencia con Kaplan-Meier y regresión de Cox, con intervalo de confianza de 95%. Resultados: Se incluyeron 179 pacientes, 119 (66.5%) hombres; promedio de edad de 64 años; 34% de los tumores se localizó en cavidad oral y 33% en laringe. Factores asociados con supervivencia: ECOG (RR = 11.3, 2.6-48), estadio clínico (RR = 7.8, 1.7-34), edad mayor a 70 años (RR = 3.5, 1.4-8.5) y tratamiento no quirúrgico (RR = 2.3, 1.4-3.8). La mediana de supervivencia para pacientes con VPH-16 fue de 22 meses versus 28 meses de quienes tuvieron otros tipos virales. La infección por VPH no se asoció con el pronóstico. Conclusiones: El ECOG en el momento del diagnóstico y la etapa clínica fueron los factores pronóstico más importantes en esta serie; el VPH no mostró valor pronóstico.

BACKGROUND: The three most important prognostic factors in patients with head and neck squamous cell carcinoma (HNSCC) are tumor size, nodular histological condition and tumor origin. Recently, human papilloma virus (HPV), particularly HPV-16, has been acknowledged as a prognostic factor. HPV+ patients have better survival than HPV-. This has created a controversy because other factors may influence the prognosis. The objective of this study was to investigate whether HPV has prognostic value in patients with HNSCC. METHODS: We carried out a retrospective evaluation of patients with HNSCC and the following variables were analyzed: survival, tumor location, stage, general condition according to Eastern Cooperative Oncology Group (ECOG) status, treatment and HPV association identified by PCR. We used a descriptive analysis of simple frequencies and central tendency and dispersion measures according to the type of variables. We used descriptive analysis for overall survival with Kaplan- Meier and Cox regression with 95% confidence interval. RESULTS: There were 179 patients included: 119 (66.5%) were male. Average age of patients was 64 years; 34% of the tumors were located in the oral cavity and 33% were located in the larynx. Factors associated with survival were ECOG (RR = 11.3; 2.6-48), clinical stage (RR = 7.8; 1.7-34), age >70 years (RR = 3.5, 1.4-8.5) and nonsurgical treatment (RR = 2.3; 1.4-3.8). Average overall survival for patients with HPV16 was 22 months vs. 28 months in those with other types of viruses. HPV infection was not associated with the prognosis in this series. CONCLUSIONS: ECOG at the time of the diagnosis and clinical stage were the most significant prognostic factors in this series. HPV did not show any prognostic value.

Ocular trauma score para la evaluación inicial del trauma ocular / Ocular trauma score at the initial evaluation of ocular trauma

Introducción: El sistema de clasificación de lesiones mecánicas oculares establece el estado del ojo lesionado pero no tiene valor pronóstico. El objetivo de esta investigación fue identificar la proporción de ojos lesionados sin alteraciones que requirieron la participación del oftalmólogo durante la evaluación inicial, para saber si el ocular trauma score (que estima el pronóstico visual a los seis meses) pudiera ser empleado por médicos no oftalmólogos en la sala de trauma. Material y métodos: Con el sistema de clasificación de lesiones mecánicas oculares se evaluaron pacientes con trauma ocular atendidos en un hospital general de la ciudad de México entre 1995 y 2008. Se identificó la proporción de ojos que requería la evaluación por el oftalmólogo por desprendimiento de retina o endoftalmitis. A todos los ojos se les asignó una categoría del ocular trauma score. Se determinó la proporción y el intervalo de confianza de 95% de los ojos en que podría aplicarse el ocular trauma score en la sala de trauma. Resultados: Se evaluaron 742 ojos. Seis presentaron desprendimiento de retina (0.8%, IC 95% 0.16-1.44) y dos endoftalmitis (0.3%, IC 95% 0-0.69). La proporción de ojos en que podría aplicarse el ocular trauma score en la sala de trauma fue de 98.9% (IC 95% 98.15-99.65). Conclusiones: El ocular trauma score puede utilizarse en casi todos los ojos lesionados para estimar el pronóstico visual durante la evaluación inicial en la sala de trauma, sin la participación de un oftalmólogo.

BACKGROUND: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room. METHODS: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined. RESULTS: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65). CONCLUSIONS: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.

Valor de la gammagrafía con Tc-99m-tetrofosmín en el diagnóstico del cáncer bien diferenciado de tiroides / Value of (99m)Tc tetrofosmin scan in well-differentiated thyroid cancer

Introducción: Los pacientes con nódulos tiroideos hipocaptantes sin sospecha ultrasonográfica y con citología benigna o indeterminada pueden ser vigilados. El gammagrama con Tc- 99m-tetrofosmín (Tc-99m-TS) identifica pacientes en los que la vigilancia es más segura. La ausencia de captación nunca ocurre en pacientes con carcinoma. El objetivo de este estudio fue conocer el valor predictivo negativo del Tc-99m-TS en pacientes con nódulo tiroideo. Material y métodos: Evaluación preoperatoria con Tc-99m-TS de pacientes con nódulo tiroideo candidatos a cirugía. Tiroidectomía de acuerdo con el diagnóstico en todos. Evaluación de valor predictivo negativo y sensibilidad al comparar con el resultado histopatológico. Se administraron 296-370 MBq (8-10 mCi) de Tc-99m-TS; evaluación de imágenes a los 120 minutos. Resultado reportado con actividad metabólica aumentada (AMA) o sin actividad metabólica aumentada (SAMA). Resultados: Se incluyeron 86 pacientes consecutivos. Sesenta (69.7 %) tuvieron AMA, 20/60 con carcinoma (33 %), en 67 % el diagnóstico fue de nódulo benigno. En 26 (30.2 %) SAMA, 11.5 % tuvo carcinoma y 88.4 % neoplasia benigna. Sensibilidad de 91.43 % (IC 95 % = 80.73-100 %), especificidad de 45.10 % (IC 95 % = 30.46-59.73), valor predictivo positivo de 53.33 % (IC 95 % = 39.8-66.79), valor predictivo negativo de 88.46 % (IC 95 % = 74.26-100). Razón de verosimilitud negativa = 0.19. Conclusiones: Tc-99m-TS con AMA es poco específico en cáncer tiroideo; en pacientes SAMA 13 % tiene carcinoma. La mayoría de los pacientes (70 %) mostró AMA, 33 % con carcinoma. Valor predictivo negativo en grupo SAMA = 88 %. Tc-99m-TS podría ser útil en la decisión terapéutica de pacientes con nódulo tiroideo en los que existe duda de cirugía; su utilidad radica en el valor predictivo negativo.

BACKGROUND: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTc-tetrofosmin scan (99mTc-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTc-TS negative predictive value (NPV) in patients with cold thyroid nodules. METHODS: An evaluation with 99mTc-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTc-tetrofosmin was administered, and scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). RESULTS: Included in the study were 86 consecutive patients. In 60 patients the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA. In this group, 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% CI = 80.73-100), specificity = 45.10 (95% CI = 30.46-59.73), positive predictive value = 53.33 (95% CI = 39.8-66.79) and NPV = 88.46 (95% CI 74.26-100). Negative probability ratio = 0.19. CONCLUSIONS: IMA-99mTc-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTc-TS may be useful in the therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.

Neuropatía óptica traumática bilateral asimétrica: informe de un caso / Asymmetrical bilateral optic neuropathy: case report

Introducción: La neuropatía óptica traumática puede ser difícil de diagnosticar en un primer contacto, por la ausencia de cambios en el disco óptico o por la coexistencia de lesiones más aparentes. Aunque existen datos funcionales que la sugieren, la falta de un parámetro contralateral de comparación puede limitar la detección. El objetivo fue analizar el caso de un paciente con neuropatía óptica traumática con afección bilateral asimétrica, para hacer énfasis en la necesidad de evaluar funcionalmente los ojos lesionados. Caso clínico: Hombre de 34 años de edad con traumatismo craneoencefálico severo, pérdida del estado de alerta y fractura facial tipo Lefort III por accidente automovilístico. A las 72 horas del accidente únicamente percibía luz y tenía un defecto pupilar aferente en el ojo izquierdo; el ojo derecho tenía deficiencia visual, no justificada por alteraciones del segmento anterior. El tratamiento se enfocó al ojo izquierdo, pero durante el seguimiento se identificó tardíamente afección del ojo derecho. Se analizó la evolución del paciente y las causas que limitaron la detección temprana de la neuropatía traumática en el ojo derecho. Conclusiones: La neuropatía óptica traumática debe buscarse mediante la evaluación funcional en todos los ojos lesionados. La ausencia de alteraciones en el fondo del ojo no la descarta, particularmente si existe deficiencia visual. Es necesario identificar los pacientes con pupila positiva durante la evaluación inicial y referirlos oportunamente al especialista, quien identificará los casos atípicos e implementará tempranamente el tratamiento.

BACKGROUND: Diagnosis of traumatic optic neuropathy is difficult during primary care as a result of the absence of optic disk changes or coexisting injuries that may be more apparent. Although there are functional signs that suggest its presence, the lack of a comparison parameter may further prevent its detection. A case of bilateral traumatic optic neuropathy is analyzed to emphasize the need for functional evaluation in the injured eye. CLINICAL CASE: A 34-year-old male presented with severe head trauma, loss of consciousness and type III Lefort facial fracture as a result of a vehicular accident. Seventy two hours after the accident, the left eye had only light perception and an afferent pupillary defect. The right eye had visual deficiency not explained by anterior segment injuries. Therapy was aimed at the left eye and, during follow-up, involvement of the right eye was identified very late. The patient's evolution is analyzed, as well as the causes that prevented early detection of traumatic optic neuropathy in the right eye. CONCLUSIONS: Functional evaluation must be used to search for traumatic optic neuropathy in every injured eye. The absence of ocular fundus abnormalities does not rule out the disease, especially when visual deficiency exists. Detection of patients with a positive pupil during initial evaluation of trauma is required in order to refer the patient in a timely manner to the ophthalmologist. The specialist should identify atypical cases and therapy should be initiated as early as possible.

Acción antiedemagénica de los extractos de corteza del fruto de Citrus sinensis L y Citrus aurantiun L en modelo de hiperpermeabilidad vascular en ratas / Anti-edematogenic action of extracts from Citrus sinensis L and Citrus aurantium L fruit barks on a vascular hypermeability model in rats

Introducción: a los extractos de Citrus sinensis L. y Citrus aurantium L. se les atribuyen acciones farmacológicas útiles para las enfermedades circulatorias, sin embargo, no existe una demostración científica que pueda avalar tales efectos. Objetivo: evaluar la acción antiedemagénica de los extractos de corteza del fruto seca de Citrus sinensis L. y Citrus aurantium L. Métodos: se calculó el área del edema formado en la piel del lomo de las ratas tratadas con extractos de Citrus sinensis L. y Citrus aurantium L. 60 ratas Wistar con peso promedio de 250 g, fueron divididas en 3 grupos de 20 animales cada una y tratadas con los extractos por vía oral (50, 100 y 200 mg/kg) en distintos tiempo (2 h; 3, 7 y 14 d); 24 h después de tratadas se inyectó por vía intradérmica histamina y dextrana grado A 200-27500 para inducirle el incremento de la permeabilidad. Se midieron los edemas producidos en el lomo de las ratas. Se calculó el área y se comparó con el grupo control. Resultados: se observó marcada reducción de edemas en la piel de las ratas tratadas al compararlas con los controles. El tiempo óptimo de tratamiento para producir el efecto deseado fue de 7 d Conclusiones: se demostró la acción antiedemagénica de los extractos estudiados.

Introduction useful pharmacological actions upon circulatory disorders have been attributed to the Citrus sinensis L. and Citrus aurantium extracts. However, there is no scientific evidence endorsing such benefits. Objective: to evaluate the anti-edematogenic action of extracts from Citrus sinensis L. y Citrus aurantium dry fruit barks. Methods: the edematous area that appeared on the rat´s back skin, which had been treated with extracts from Citrus sinensis L. y Citrus aurantium, was estimated. Sixty Wistar rats weighing 250 g as average were divided into 3 groups of 20 animals each and orally treated with the extracts (50, 100 and 200 mg/kg) at different intervals (2 h; 3, 7 and 14 days); 24 hours after treatment, they were intradermically injected histamine and grade A dextrane 200-27500 in order to induce increased permeability. All the edemas on the back of rats were measured. The area was estimated and compared with that of the control group. Results: substantial reduction of edemas on the skin of treated rats was observed when making a comparison with the control group. The optimal treatment time to reach the desired effect was 7 days. Conclusions: the anti-edematogenic action of the studied extracts was demonstrated.

Frecuencia de crisis epilépticas en pacientes pediátricos de la consulta externa de un hospital general / Seizures rate in pediatric outpatients at a general hospital in México City

Introducción. Las crisis epilépticas son la segunda enfermedad neurológica más común. Se identificó la proporción de crisis epilépticas y su distribución por tipo en pacientes pediátricos de la consulta externa de un hospital general. Métodos. Se registraron los pacientes con diagnóstico clínico de crisis epilépticas, realizado por el pediatra, atendidos en la consulta externa pediátrica durante un mes. Se determinó la proporción que representaba en el período y se calcularon intervalos de confianza (IC) del 95%. Se identificó la distribución por tipo de crisis convulsiva y se comparó la edad en los distintos tipos. Resultados. La proporción encontrada fue 11.5% (n =382, IC95% 8.31-14-69) a expensas principalmente de crisis tónico-clónico generalizadas 5.5% (47% de todas las crisis, n =44), la frecuencia de crisis epilépticas no difirió significativamente entre los diferentes grupos de edad (P =0.483). Las crisis febriles representaron sólo 0.8% (6.8% de todas las crisis, n =44). Conclusiones. La proporción encontrada fue alta; la proporción de crisis febriles fue menor a la reportada.

Introduction. Seizures are the second most common neurological disease. Objective: To identify the rate and type of seizures in pediatric outpatients of a general hospital. Methods. Patients with a clinical diagnosis of seizures attend-ing the outpatients Pediatrics clinic were enrolled in this one-month study. Rate ratios and 95% confidence intervals (CI) were calculated. Distributions of seizure type according to gender and age were calculated. Results. The rate ratio found was 11.5% (n =382, 95% CI 8.31-14.69); the most common seizure type was generalized tonic-clonic seizure 5.5% (47% of total seizures, n =44); seizure frequency did not show any statistical difference among age-group (P =0.483). Febrile seizures represented only 0.8% (6.8% of total seizures, n =44). Conclusions. The seizure rate observed was higher than the expected rate. The febrile seizure rate was lower than those reported in previous works.

Motivos de abandono en el proceso de atención médica de lesiones precursoras de cáncer cervicouterino / Medical care abandon factors in precursor lesions of cervical cancer

Objective. To determine factors associated with medical care abandon of women with CIN. Material and methods. A nested case-control study in a cohort was done. Patients referred to clinical Dysplasia of Gyneco-Obstetrician Services in third level Hospitals were considered. Cases: Patients who abandoned medical care. Controls: women who attend their medical appointments during follow-up. All subjects underwent structured interviews focused on social, clinical and health services factors in two different times, applied at the beginning of study and the end of follow-up. Clinical records were reviewed to obtain clinical information. Analysis: Descriptive and inferential statistical was done. Non conditional Logistic Regression analysis was done to obtain adjusted association. Results. Abandon cumulative incidence rate was 108/525 = 20.7% (I.C 95% = 17.2-24.3); 60.2% happened in diagnosis phase, 17.7% ocured during therapeutic phase and 23.1% happened in surveillance phase. We studied 108 cases and 417 controls to analysis. Next adjusted risk factors were obtained: Afraid to death (ORa = 4.2, I.C.95% = 1.8-9.5), long appointments (ORa = 6.6, I.C95% = 3.4-13.0), lack of privacity (ORa = 12.5, I.C.95% = 2.6-59.8), reject to treatment (ORa = 40.4, I.C.95% = 2.1-785.4), lack of information (ORa = 41.9, I.C95% =14.2-124.1) and other factors. Conclusions. Patient perception, access and barriers in health services were the most important factors associated with medical care abandon.

Objetivo. Determinar factores asociados al abandono del proceso de atención de NIC. Material y métodos. Se realizó un estudio de casos y controles anidado en una cohorte de mujeres referidas a las clínicas de displasias de dos hospitales de tercer nivel. Casos: pacientes que abandonaron su atención médica. Controles: pacientes que cumplieron con sus citas médicas. Las pacientes contestaron una entrevista estructurada respecto a variables sociodemográficas y de atención médica al inicio y al final del seguimiento. Los datos clínicos se obtuvieron de la revisión de expedientes. Análisis: Medidas de frecuencia y asociación, ajustando variables con Regresión Logística no Condicionada. Resultados. La tasa de abandono fue de 108/525 = 20.7% (17.2-24.3); 60.2% ocurrieron en la fase diagnóstica, 17.7% durante el tratamiento y 23.1% en la fase de vigilancia y/o control. Un total de 108 casos y 417 controles fueron considerados para el análisis. Los factores de riesgo ajustados fueron: miedo a la muerte (ORa = 4.2, I.C.95% = 1.8-9.5), citas prolongadas (ORa = 6.6, I.C.95% = 3.4-13.0), falta de privacidad (ORa = 12.5, I.C.95% = 2.6-59.8), rechazo al tratamiento propuesto (ORa = 40.4, I.C.95% = 2.1-785.4) y falta de información (ORa = 41.9, I.C.95% = 14.2-124.1) entre otros. Conclusiones. Los factores relacionados con la percepción de gravedad de la enfermedad y las barreras al acceso de los servicios de salud fueron los de mayor importancia para abandonar la atención médica.

Análisis de expresión global del cáncer cérvico uterino: rutas metabólicas y genes alterados / Global expression analysis in uterine cervical cancer: Metabolic pathways and altered genes

High risk human papillomavirus (HPV) infection is considered to be the most important etiological factor of Cervical Uterine Cancer. In order to determine the global expression pattern and to identify possible molecular markers of cervical cancer, cDNA arrays with probe sets complementary to 8,000 human genes were used to examine the expression profiles among 5 cell lines derived from human cervical cancer, three HPV16(+) tumor samples and three normal cervical tissues HPV(-). The levels of expression of different cellular processes were identified. Hierarchical clustering was performed and the gene expression using RT-PCR was confirmed. Two genes were found to be consistently overexpressed in invasive cervical cancer biopsies; one of them, IL-6 was previously reported to be overexpressed in cervical cancer and one novel gene, MMP10, previously not known to be related to cervical cancer. Hierarchical clustering of the expression data revealed that samples with common HPV type infection grouped together, maybe this could mean that differences between HPV types could be indirectly determined by expression profiles.

La infección por virus de papiloma de alto riesgo (VPH) es considerada como el factor etiológico más importante del cáncer cérvico uterino (CaCU). Con el fin de determinar el patrón de expresión global e identificar algunos posibles genes marcadores del CaCU, se utilizaron microhileras de DNA que contenían 8,000 secuencias que codificaban para transcritos diferentes, para estudiar los perfiles de expresión de cinco líneas celulares derivadas de CaCU, tres muestras tumorales conteniendo VPH 16 y tres muestras normales negativas para la presencia de VPH. Se identificaron los niveles de expresión de genes relacionados con diferentes rutas metabólicas. Se llevó a cabo el análisis de agrupamiento jerárquico y posteriormente se confirmó la sobrexpresión de dos genes mediante RT-PCR. Estos dos genes se encontraron sobrexpresados en biopsias tumorales cervicales. Uno de ellos, el gen de IL6, que ha sido previamente reportado en relación con CaCU, así como el gen de la matriz-metaloproteasa 10 (MMP10) por primera vez relacionado con esta neoplasia. El análisis de agrupamiento jerárquico, además, reveló que las muestras que contienen el mismo tipo viral están asociadas, sugiriendo posibles diferencias en expresión entre tipos virales.

Virus de papiloma humano de alto riesgo (VPH-AR) y neoplasia intraepitelial cervical (NIC) en mujeres de dos hospitales de la Ciudad de México / High-risk human papilloma virus and cervical intraepithelial neoplasia in women at 2 hospitals in Mexico City

OBJECTIVE: To determine the high risk HPV (HR-HPV) association with Cervical Intraepithelial Neoplasia (CIN) in women of two Dysplasia Clinics in Mexico City. MATERIAL AND METHODS: Prolective case-control study was done. Women with and without security affiliation attended in Instituto Mexicano del Seguro Social (Hospital 1) and Hospital General de MÚxico (Hospital 2) were included in the study. Cases were women with histopathologic diagnosis of CIN and controls were women with negative dysplasia in cytologic study (Pap). Information was obtained by direct interview. HR-HPV was determined by Hybrid Capture II assay, in cervical samples. Bivariate and logistic regression analysis was done. RESULTS: One hundred and two cases and 192 controls from Hospital 1 and 89 cases and 66 controls from Hospital 2 were included. 83.3 and 77.3 of women from Hospital 1 and 2 respectively were positive to HR-HPV. The association HR-HPV and CIN in Hospital 1 was ORa = 40.6, C.I. 95 = 17-96.8; while in Hospital 2 there was not association. Age was an effect modifier in the HR-HVP and CIN association, in Hospital 1. It was observed a correlation between viral load and CIN degree. CONCLUSIONS: The HR-HPV infection frequency in controls and CIN I was higher than the reported in other studies. Age was a modifier in the HR-HPV association and CIN. In dysplasia clinics without medical referral system of patients is possible to observe similar risk factors to cervical cancer.

Utilidad de las imágenes centelleográficas con 111In. CYT-103 en el diagnóstico de recurrencia del cáncer de colon y recto / Usefulness of scintigraphy images with 111In-CYT-103 in the diagnosis of colonic and rectal recurrence

OBJECTIVE: To determine the effectiveness of radioimmunoscintigraphy (RIC) with 111In-CYT-103 in detecting the extension of malignant disease in patients surgically treated for colorectal adenocarcinoma under suspicion of recurrence in comparison to CT scan (computed tomography) and exploratory laparotomy. DESIGN: Prospective and observational study. MATERIAL AND METHODS: A total of 26 patients under suspicion of recurrence, with a total of 31 lesions. All the patients had performed the following studies with GT, RIC with 111In-CYT-103, exploratory laparotomy and histopathology. RESULTS: A sensitivity of 96.8, and specificity of 77.8, and accuracy of 92 were found for the RIC. CT scan had a sensitivity, specificity and accuracy of 71.5, 88.8, and 75.7, respectively in extrahepatic lesions. When both methods are combined, results shows an increment in sensitivity. Hepatic lesions were present in 50 of the patients; a sensitivity of 85, a specificity of 92, and accuracy of 89 for RIC and sensitivity, specificity and accuracy of 92 for the CT. CONCLUSION: The results of clinical studies with 111In-CYT-103 in detecting the occurrence of colorectal carcinoma provided additional information, making this method a valuable complementary test that contributes to patient management.

Infección por virus del papiloma humano de alto y bajo riesgo en mujeres con NIC. Características diferenciales / High and low risk human papilloma virus infection in women with CIN. Differential characteristics

The objective of this study was to determine high risk human papillomavirus infection (HPV-RH) and factors with cervical intraepithelial neoplasia appears (CIN). MATERIAL AND METHOD: From October 1998 to January 2000, a case-control study, was made; women with benefit package from Mexican Institute of Social Security. The cases were of the colposcopic clinic of the department of the Hospital Obstetrics and Gynecology Luis Castelazo Ayala, women histologically diagnosed with colposcopy and CIN cervical biopsy, and controls patients with negative cervical uterine cytologic study of the Preventive Medicine Department, Unit of Familiar Medicine No. 8, of Mexico City. Trained personnel obtained information about socioeconomic and reproductive factors did the interview. A cytobrush was used to take the cervical sample for HPV-RH to determine HPV-RH utilizing Hybrid Capture II test. Both bivariate analysis and logistic regression analysis were used for the adjustment of variables. RESULTS: We analyzed 102 cases and 192 controls, 79 (44/56) of the cases with CIN I and 89 (37/42) of CIN II-III as 21 of controls, respectively, were positive for HPV-RH. Global risk for HPV-RH association to CIN was OR = 40.6 (95 CI, = 17-96.8). Women age was determinative for HPV-RH association to CIN. We observed a high correlation between HPV positive magnitude and CIN degree. CONCLUSIONS: Frequency of RH-HPV in controls and CIN I is higher than other reports in the literature. HPV was identified as the most important agent associated with this neoplasia, other factors involved and age is an important modifier in HPV-RH and CIN.