Epidemiological profile of venous thrombosis in the Mexican Republic from 2016 to 2018.

OBJECTIVE: This study aims to analyze the probability of an increase in mortality due to venous thrombosis of the lower limbs (VTLL), and it´s relation to days of hospital stay. MATERIALS AND METHODS: We included all hospital records of patients with thrombosis in the lower limbs as main diagnosis from open access national datasets, we obtained epidemiological description of diagnosis, length of stay and mortality. RESULTS: Deep vein thrombosis (DVT) constituted 69% (1223/1785) of cases. From all the patients registered, 47 (2.63%) died. The highest mortality rate was observed in older adults, and patients with a longer hospital stay. CONCLUSIONS: Patients diagnosed with DVT, who endure a longer hospital stay, face a major risk of death.

OBJETIVO: Analizar la probabilidad de un aumento de la mortalidad por trombosis venosa de miembros inferiores (TVMI) y su relación con los días de estancia hospitalaria. MATERIAL Y MÉTODOS: Se incluyeron los registros de egreso hospitalario con el diagnóstico de VTLL, obtenido de las bases de datos de los hospitales públicos de México. RESULTADOS: El diagnóstico más frecuente fue la trombosis venosa profunda (TVP) con el 69% (1223/1785) de los casos. Del total de casos se registraron 47 (2.63%) muertes, la mortalidad fue más alta a mayor edad y estancia hospitalaria. CONCLUSIONES: Los pacientes diagnosticados por TVP y con estancia hospitalaria prolongada, presentaron mayor mortalidad.

Ethnic and sociodemographic correlates of developmental dysplasia of the hip in newborns from Yucatan, Mexico.

OBJECTIVES: To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects. METHODS: Retrospective, population-based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model. RESULTS: Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first-borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section. CONCLUSION: Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015-2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.

Clinical Manifestations in a Fatal Case of Probable Rickettsia and Leptospira Coinfection in Yucatan, Mexico.

Clinical or serological coinfections of Rickettsia and Leptospira are uncommon but should be included in differential diagnosis when poor sanitation and cohabitation with infected animals may converge. Rickettsial and leptospiral infections have been continuously increasing throughout the past decade in Yucatan, Mexico. Leptospirosis is a zoonotic disease caused by aerobic spirochetes, while rickettsiosis is an arthropod-borne disease. In 2020, 16% of all rickettsiosis cases and 10% of leptospirosis in the country originated in Yucatan. The objective of the present case report was to document an unusual case of probable coinfection with Rickettsia and Leptospira with emphasis on clinical manifestations and the epidemiological context that may orient future multidisciplinary measures. Here, we presented the case of a 12-year-old female whose mother had recently recovered from a rickettsial infection. The patient presented with fever and developed unspecific signs and symptoms of infection; however, her condition quickly deteriorated with gastrointestinal, hepatic, renal, and neurological dysfunction. After discounting rabies and identifying infection with Rickettsia and Leptospira, antibiotic treatment was indicated, but it was too late to prevent death. Simultaneous infections of Rickettsia and Leptospira may be considered in endemic regions when environmental, epidemiological, and clinical conditions converge.

La baraja del Joker: factores desencadenantes de la conducta agresiva en el paciente con afección pseudobulbar / The Joker's deck: factors triggering the aggressive behavior on a patient with a pseudobulbar affect

La trama del Joker nos muestra el surgimiento del antihéroe a partir de Arthur, un individuo con un trastorno llamado afectación pseudobulbar, con antecedentes de abandono y abuso físico severo y maltrato con probable traumatismo encefálico, que vive sin vínculos sociales, carente de afecto, como cuidador primario de una familiar dependiente enteramente de él; el protagonista se mueve en un ambiente adverso, hostil en el que la sociedad que espera que él se comporte como si no tuviera ningún trastorno. un comportamiento normal”. Sin recursos y rechazado por su medio, resulta colateralmente afectado por la reducción de presupuesto para terapia y medicamentos. En un momento decisivo, convergen los diferentes detonantes de sus manifestaciones psicopatológicas que dan paso a la transformación del joker y paradójicamente lo llevarán a ser aceptado socialmente. Joker nos invita a reflexionar sobre la importancia de a los programas de salud mental, los valores humanos, la cultura de la Paz y el buen trato como pilares fundamentales para promover la salud mental en la sociedad. El presente artículo tiene por objetivo el revisitar la fisiopatología de la afección pseudobulbar y establecer los aspectos clínicos, familiares, ambientales y socioculturales potencialmente asociados a la conducta destructiva de Joker

The plot of the Joker shows us the emergence of the antihero from Arthur, an individual with a pseudobulbar disorder, a history of abandonment and severe physical abuse and abuse with probable brain trauma, living without social ties, lacking affection, as a primary caregiver of a relative dependent entirely on him; the protagonist moves in an adverse, hostile environment in which the society that expects him to behave as if he had no disorder. normal behavior. «Without resources and rejected by its means, it is collaterally affected by the reduction of budget for therapy and medications. At a decisive moment, the different triggers of his psychopathological manifestations converge that give way to the transformation of the joker and paradoxically lead him to be socially accepted. Joker invites us to reflect on the importance of mental health programs, human values, the culture of Peace and good treatment as fundamental pillars to promote mental health in society. This article aims to revisit the pathophysiology of the pseudobulbar condition and establish the clinical, family, environmental and sociocultural aspects potentially associated with Joker’s destructive behavior

Asthma Mortality and Hospitalizations in Mexico from 2010 to 2018: Retrospective Epidemiologic Profile.

Acute respiratory infections have been established as the principal cause of disease in the Mexican population from 2000 to 2018; however, even when these diseases may aggravate asthma, there is a lack of epidemiologic evidence on the health outcomes when both conditions coexist. Learning about the asthma hospitalizations trends will help us identify monthly variation of hospitalizations, vulnerable groups, needed services, and improvements in therapeutics and prevention. This study aims to analyze the variation in asthma hospitalizations and mortality during the 2010-2018 period in Mexico. Data were obtained from the General Board of Health Information (DGIS) Open Access datasets, which were analyzed taking hospital discharges and hospital deaths recorded from 2010 to 2018 from all public hospitals nationwide. The binomial logistic regression analyses were performed to determine the association between patient ages, hospitalization month, and mortality. The death rate from asthma in Mexico decreased between 2010 and 2018. Still, the hospital mortality rate shows recent improvement; however, prognosis of hospitalized patients depends on their age, accurate diagnosis, length of hospital stay and occurrence of nosocomial infection.

Demographic and Health Indicators in Correlation to Interstate Variability of Incidence, Confirmation, Hospitalization, and Lethality in Mexico: Preliminary Analysis from Imported and Community Acquired Cases during COVID-19 Outbreak.

This study's objective is to analyze the incidence, lethality, hospitalization, and confirmation of COVID-19 cases in Mexico. Sentinel surveillance for COVID-19 cases in Mexico began after the confirmation of the first patient with community transmission. Methods: This epidemiologic, cross-sectional study includes all clinically suspected, and laboratory-confirmed cases nationwide from the beginning of the outbreak to 21 April 2020. State-cluster demographic data and health indicators were analyzed in reference to epidemiologic measures, with logistic regressions for the dependent variables of incidence, confirmation, and lethality. Results: The national incidence was 13.89/100,000 inhabitants with a 6.52% overall lethality and a confirmed-case mortality of 11.1%. The incidence variation significantly correlated with migration, but not urbanization. Pediatric patients were less prone to be tested (OR = -3.92), while geriatric individuals were a priority. State lethality positively correlated with the proportion of the population assisted at public hospitals and correlated inversely to the number of hospitals and clinics in the state. Conclusions: Migration strongly correlated with incidence; elderly patients had lower odds of being hospitalized but were likely to die. Patients aged <15 were less prone to be laboratory-confirmed. Case confirmation was not performed in all hospitalized patients, but 72.15% of hospitalized patients had favorable outcomes to date.

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies / Desempeño de los estudiantes de pregrado de medicina en una actividad basada en simulación para el proceso de consentimiento informado en investigación en salud

INTRODUCTION: Training through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research. OBJECTIVE: To facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality. MATERIALS AND METHODS: In this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico. RESULTS: The mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4-74.5); 86.2 ± 0.96 (95% CI = 84.2-88.0); and 77.7 ± 0.72 (95% CI = 76.3-79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00. DISCUSSION: This study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses

INTRODUCCIÓN: La capacitación mediante la simulación médica permite un aprendizaje continuo bajo condiciones controladas. Las actividades de capacitación basadas en simulación se pueden utilizar simultáneamente con otras estrategias educativas para fortalecer las habilidades actitudinales que se necesitan para desarrollar un proceso de consentimiento informado en el contexto de la investigación en salud. OBJETIVO: Facilitar un aprendizaje en estudiantes de medicina de pregrado y evaluar sus competencias para llevar a cabo un proceso de consentimiento informado en un escenario que semeje la realidad. MATERIALES Y MÉTODOS: En este estudio semilongitudinal desarrollamos una actividad basada en simulación con 136 estudiantes de medicina de cuarto (grupo A) y quinto año (grupo B) de la Universidad Marista de Mérida, al sur de México. RESULTADOS: El puntaje promedio para ambos grupos fue 72,48 ± 1,05 (IC 95% = 70,4-74,5); 86,2 ± 0,96 (IC 95% = 84,2-88,0), y 77,7 ± 0 72 (IC 95% = 76,3-79,1) en el pre-test, la simulación y el pos-test, respectivamente. Los estudiantes del grupo A se autoevaluaron con 3,93/5,00 y los del grupo B, 4,04/5,00. DISCUSIÓN: Nuestro estudio mostró que los estudiantes del grupo A no tenían puntajes más bajos en la actividad basada en simulación al compararlos con los estudiantes en el grupo B, sugiriendo que antes del quinto año de educación médica de pregrado los estudiantes podrían desarrollar adecuadamente un proceso de consentimiento siempre que reciban educación temprana sobre ética médica y bioética de investigación. Los temas relacionados con la bioética en la investigación en salud humana pueden incluirse tan pronto como los estudiantes de medicina inician los cursos de metodología de la investigación