Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México / Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico

Introducción: Las anormalidades en las pruebas de funcionamiento hepático (APFH) y las complicaciones Hepáticas (CH) de la Nutrición Parenteral (NP) son frecuentes y a menudo multifactoriales. Aún no han sido evaluados dichos factores de riesgo en población mexicana adulta. Objetivo: Determinar si la dosis de lípidos prescrita de mayor a 1 g/kg es factor de riesgo para las anormalidades en pruebas de función hepática (APFH) de la NP. Material y métodos: Cohorte que incluyo pacientes mayores de 15 años de edad y excluyó aquellos que fueron manejados en la unidad de cuidados intensivos o con anormalidades en las enzimas hepáticas previo al inicio de NP. Los grupos expuesto (GE) y no expuesto (GNE) fueron aquellos que recibieron más de un gramo y un gramo o menos por kilo de peso de lípidos respectivamente. Las APFH fueron definidas como un incremento mayor al 50% de lo normal de AST, ALT, FA o Bilirubina Total. Resultados: La incidencia de APFH fue de 20 (47,6%) y15 (41,6%), en los GE y GNE respectivamente (RR 1,14IC 95% 0,69-1,88; p = 0,59). El patrón de daño hepático más común fue el colestásico, seguido del mixto y finalmente el hepatocelular. La dosis de lípidos prescrita de más de 1 g/kg, no se asoció con el desarrollo de CH de la APFH. A mayor dosis de proteínas menor frecuencia de APFH Conclusión: La dosis de lípidos prescrita de más de 1g/kg, no se asoció con el desarrollo de APFH de la NP en nuestra población. Estos hallazgos requieren ser confirmados en Ensayos clínicos (AU)

Introduction: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multi-factorial. These factors have not yet been assessed in the adult Mexican population. Objective: To determine whether the dose prescribed >1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. Material and methods: Cohort study including patients older than 15 years and excluding those managed at the intensive care unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of bodyweight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST,ALT, AF or total bilirrubin. Results: the incidence of LFTs abnormalities was 20(47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p =0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. Conclusion: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials (AU)

[Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico]. / Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México.

INTRODUCTION: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multifactorial. These factors have not yet been assessed in the adult Mexican population. OBJECTIVE: To determine whether the dose prescribed > 1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. MATERIAL AND METHODS: Cohort study including patients older than 15 years and excluding those managed at the intensive car unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of body weight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST, ALT, AF or total bilirrubin. RESULTS: the incidence of LFTs abnormalities was 20 (47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p = 0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. CONCLUSION: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials.

[Prevalence of domestic violence in the city of Durango]. / Prevalencia de violencia doméstica en la ciudad de Durango.

OBJECTIVE: To characterize and determine the prevalence of the different types of gender-associated violence in the city of Durango, Mexico. MATERIAL AND METHODS: With a transversal design, 384 women residents of the city of Durango, either living with or having lived with someone before, were interviewed. The sample was proportionately distributed in 6 city sectors which were randomly chosen and representative of the high middle and low socioeconomic levels. Sixty-four interviews were conducted in each city sector. The questionnaire consisted of 184 closed and 22 open questions, including identification, sociodemographic and reproductive data, as well as specific questions on physical, emotional and sexual violence. RESULTS: Median age of the studied group was 41.5 years, ranging from 12 to 48 years. Prevalence of domestic violence was: sexual 42%; physical 40%; emotional 39%. CONCLUSIONS: The problem of violence, in its different forms, is a highly prevalent factor which jeopardizes the welfare of the family nucleus. Higher prevalence values of domestic violence were detected in the presence of factors such as violence antecedents, alcoholism and/or drug consumption by some member of the family.

[Colposcopy and cervical biopsy in patients with routine Papanicolaou smear]. / Colposcopía y biopsia cervical en pacientes con papanicolaou de rutina.

The objective of this report was to assess the sensitivity and specificity of Pap smear and to evaluate if routine colposcopy can improve cervical screening. One hundred and fifty patients undergoing routine cervical cytologic screening in our outpatient clinic were randomly selected. All patients were evaluated by colposcopy and cervical punch biopsy. Pap smears and biopsies specimens were interpreted independently. Colposcopy was performed and interpreted without knowledge of cytologic or histologic findings. The statistical analysis was carried out with a chi square (chi 2) test. A P value of less than 0.05 was considered significant. Twenty three patients (15.3%) who had biopsy proved to have cervical pathology. Pap smear identified only 4/23 (17%) of these patients. Colposcopy noted atypical transformation zones in 20/23 (97%), P < 0.001). Fifteen of 27 patients (55.5%) with negative Pap smears had colposcopic anormalities and histologically proved cervical intraepithelial neoplasia (CIN). We concluded that it is necessary to improve sensitivity and that colposcopy may enhance cervical screening particularly in women with otherwise negative Papapnicolaou smears.

[Factors possibly associated with the age at the onset of menopause. Multicenter study]. / Factores que pueden estar asociados con la edad de presentación de la menopausia. Estudio multicéntrico.

A transversal study was performed in 1987 to examine 9,844 postmenopausal women aging from 39 to 59 years, residents from the cities of Durango, Monterrey, Guadalajara and Leon. They had their last menstruation at least 12 months before the interview and they were not pregnant. The objective was to know if the menarche, number of deliveries, use of contraceptive methods and smoking could affect the age of menopause. A case control analysis was performed. Based on frequency distribution of the age on which the menopause appeared, cases were classified as early and late menopause when a median value minus 2 SD and plus 2 SD were found, respectively. For control subjects a median + 1 SD was selected. Two and three controls were randomly assigned for early and late menopause, respectively. In total 1,610 subjects were studied. As a measure of association it was used the odds ratio with a confidence level of 95%. It was performed an analysis of confusion and interaction of variables in this study. The most relevant results were; a significant association between smoking 15 packages of cigarettes a year with an OR of 2.31 (1.05-5.17), to have more than five pregnancies with an OR of Mantel and Haenzel of 0.51 (0.33-0.76) for the early menopause. No association with late menopause was observed. It was found that the mean age of menopause was 45.5 years + 4.5 SD (n = 9,844).

[Safety, efficacy and control of the menstrual cycle by a monophasic oral contraceptive containing 75 mcg of gestodene and 30 mcg of ethynyl estradiol]. / Seguridad, efectividad y control del ciclo menstrual de una preparación anticonceptiva oral monofásica con 75 mcg de gestodeno y 30 mcg de etinilestradiol.

Al oral monophasic contraceptive formulation containing gestodene (75 mcg) and ethynilestradiol (30 mcg) is evaluated concerning its safety, efficacy and cycle-control. Sixty-seven healthy women were included, allowing a total of 574 evaluable cycles. This formulation showed a high degree of efficacy, with no pregnancies after its utilization. Side affects were similar or lower to other reported with another hormonal contraceptive oral formulations. Hematologic, biochemical or urinary parameters were not altered. An acceptable menstrual pattern was maintained. In conclusion, this formulation constitutes an oral contraceptive with a high efficacy rate, a well degree of acceptability and with a side effects profile similar or lower than those produced by other oral contraceptives.