Renal Doppler ultrasound resistive index vs. renal scintigraphy with 99mTc-DTPA as diagnostic test for ureteropelvic junction obstruction in children. / Ecografía Doppler renal con medición de índices de resistencia vs. gammagrafía renal con 99mTc-DTPA para el diagnóstico de estenosis ureteropiélica en niños.

OBJECTIVE: A cross-sectional study was carried out with the objective of evaluating the usefulness of Doppler ultrasound with resistive index (RI) measure compared with renal scintigraphy with 99mTc-DTPA in children with unilateral ureteropelvic junction obstruction. METHODS: The study included children under 15 years with a diagnosis of unilateral ureteropelvic junction obstruction, healthy contralateral kidney with or without an antecedent of ureteropyeloplasty. The selected patients were sent to the Nuclear Medicine Department to carry out a renal scintigraphy with 99mTc-DTPA and days later were sent to the Radiology Department for the performance of Renal Doppler Ultrasound with RI. RESULTS: A total of 21 patients were included in the study, 15 males and 6 females, representing 71.4% and 28.6%, respectively. Mean age was 5.3 years. Only 3 had an antecedent of ureteropyeloplasty in the affected kidney. The scintigraphy reported data of unilateral obstruction in 18 patients, including the 3 patients with previous surgery. The average glomerular filtration rate (GFR) obtained with the scintigraphy was 100.28ml/min. The average GFR in affected kidneys was 43.03ml/min and 57.24ml/min in healthy kidneys (p<.001). Doppler ultrasound with RI reported ectasia in 100% of the affected kidneys and one normal contralateral kidney. The average RI in affected kidneys was 0.69mm/s and 0.50mm/s in healthy kidneys (p<.001). CONCLUSIONS: With the results obtained, we can suggest that ultrasound Doppler with measurement of RI can be an alternative tool to renal scintigraphy with 99mTc-DTPA in some cases.

Efficacy of fish oil on serum of TNF α , IL-1 ß , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b.

UNLABELLED: Multiple sclerosis (MS) is a chronic inflammatory disease, which leads to focal plaques of demyelination and tissue injury in the central nervous system. Oxidative stress is also thought to promote tissue damage in multiple sclerosis. Current research findings suggest that omega-3 polyunsaturated fatty acids (PUFAs) such as eicosapenta-enoic acid (EPA) and docosahexaenoic acid (DHA) contained in fish oil may have anti-inflammatory, antioxidant, and neuroprotective effects. The aim of the present work was to evaluate the efficacy of fish oil supplementation on serum proinflammatory cytokine levels, oxidative stress markers, and disease progression in MS. 50 patients with relapsing-remitting MS were enrolled. The experimental group received orally 4 g/day of fish oil for 12 months. The primary outcome was serum TNF α levels; secondary outcomes were IL-1 ß 1b, IL-6, nitric oxide catabolites, lipoperoxides, progression on the expanded disability status scale (EDSS), and annualized relapses rate (ARR). Fish oil treatment decreased the serum levels of TNF α , IL-1 ß , IL-6, and nitric oxide metabolites compared with placebo group (P ≤ 0.001). There was no significant difference in serum lipoperoxide levels during the study. No differences in EDSS and ARR were found. CONCLUSION: Fish oil supplementation is highly effective in reducing the levels of cytokines and nitric oxide catabolites in patients with relapsing-remitting MS.

Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?

Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5-84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3-8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0-1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.

Manejo quirúrgico y recurrencia de la fístula preauricular congénita / Surgical management and recurrence of congenital preauricular fistula

El artículo describe el manejo quirúrgico y recurrencia postoperatoria de la fístula preauricular (FPA) ya que el tratamiento quirúrgico se caracteriza por elevada recurrencia. Los antecedentes clínicos, operatorios y postoperatorios fueron recogidos retrospectivamente de expedientes de pacientes que fueron sometidos a manejo quirúrgico primario de la FPA en cinco hospitales en Guadalajara, Jalisco, durante el periodo de enero 2001 a diciembre 2006. Un total de 44 escisiones de FPA se realizaron en 38 pacientes (15 hombres, 23 mujeres).Infección recurrente y secreción fueron los síntomas más comunes. El manejo quirúrgico incluyó 25 intervenciones con técnica estándar(sinectomía) y 19 abordajes supra-auriculares. La recurrencia global ocurrió en el 59% de las FPA y difirió ampliamente entre las técnicas utilizadas. Con la técnica estándar, la recurrencia fue significativamente elevada 52,2 vs 6,8% resultante mediante el abordaje supraauricular (p= 0,01). También, los pacientes en quienes no se realizó escisión de la raíz del hélix, 84,6% recurrieron vs 15,3% cuando el cartílago fue extirpado (p=0,01). Los resultados muestran que, independientemente de la presentación clínica de la FPA, la técnica estándar y la falta de escisión de la raíz del hélix contribuyeron a recurrencia. Recomendamos el abordaje supra-auricular, en particular en casos con historia de abscesos (AU)

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients’s charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery (AU)

[Predictors of use of ante-natal care]. / Predictores de utilización de la atención prenatal.

OBJECTIVE: To establish the association and possible interactions between emotional and cognitive factors in pregnant women and their use of institutional antenatal care. It was assumed that the knowledge and attitude of a pregnant woman determines her approach to demanding antenatal care. DESIGN: Analytic study. SETTING: Hospitals in the Health Area of Jalisco, Mexico. PARTICIPANTS: 2955 women leaving hospital early who had had at least 2 antenatal consultations. MAIN MEASUREMENTS: Personal and reproductive characteristics of the women, opportunity and continuity of antenatal care, knowledge of pregnancy and the antenatal care programme, attitudes towards institutional medical care of pregnancy. RESULTS: In the logistical regression model, 6 associations or interactions between unsatisfactory antenatal care and the variables analysed were found. The strong association of positive attitudes and sufficient knowledge in achieving satisfactory antenatal care was notable, and was even placed above the question of receiving, or otherwise, free medical provision from the health service. CONCLUSIONS: Undoubtedly, women's educational background plays a major role. This obliges the health services to strengthen their educational programmes by adjusting them to women's culture.

Predictores de utilización de la atención prenatal / Predictors of use of ant-natal care

Objetivo. Establecer la asociación y las posibles interacciones entre los aspectos cognitivos y emocionales de la mujer gestante y la utilización de la atención prenatal institucional. Se partió del supuesto de que el conocimiento y la actitud de la mujer gestante orienta el comportamiento hacia la demanda de atención prenatal. Diseño. Estudio analítico. Emplazamiento. Hospitales del Sector Salud de Jalisco,México. Participantes. Participaron en el estudio 2.955 mujeres con un alta hospitalaria temprana que hubieran tenido un mínimo de 2 consultas prenatales. Mediciones principales. Características personales y reproductivas de las mujeres, oportunidad y continuidad de la atención prenatal, conocimiento sobre embarazo y el programa de atención prenatal, actitudes hacia la atención médica institucional del embarazo. Resultados. En el modelo de regresión logística obtenido se observan 6 asociaciones e interacciones entre una atención prenatal no satisfactoria (APNS) y las variables analizadas. Destacan por su fuerte asociación para el logro de una atención prenatal satisfactoria las actitudes positivas y los conocimientos adecuados, aun ante la posibilidad de contar o no con servicios médicos de la seguridad social. Conclusiones. Es indudable que el referente educacional de la mujer desempeña un papel importante, situación que obliga a los servicios de salud a fortalecer los programas educativos de acuerdo con la cultura de la mujer

Objective. To establish the association and possible interactions between emotional and cognitive factors in pregnant women and their use of institutional antenatal care. It was assumed that the knowledge and attitude of a pregnant woman determines her approach to demanding antenatal care. Design. Analytic study. Setting. Hospitals in the Health Area of Jalisco,Mexico. Participants. 2955 women leaving hospital early who had had at least 2 antenatal consultations. Main measurements. Personal and reproductive characteristics of the women, opportunity and continuity of antenatal care, knowledge of pregnancy and the antenatal care programme, attitudes towards institutional medical care of pregnancy. Results. In the logistical regression model, 6 associations or interactions between unsatisfactory antenatal care and the variables analysed were found. The strong association of positive attitudes and sufficient knowledge in achieving satisfactory antenatal care was notable, and was even placed above the question of receiving, or otherwise, free medical provision from the health service. Conclusions. Undoubtedly, women’s educational background plays a major role. This obliges the health services to strengthen their educational programmes by adjusting them to women’s culture

Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico.

AIM: To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes. DESIGN: Cross-sectional. SETTING: Fourteen nursing homes in Guadalajara. PARTICIPANTS: Data were drawn from a random sample of 451 elderly, aged 60-104 years. MEASUREMENTS: The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained. RESULTS: The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression. CONCLUSION: The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression.

Weight, physical activity, and smoking as determinants of insulinemia in adolescents.

BACKGROUND: It is known that insulinemia is the result of the interaction among several factors, such as weight, body fat pattern distribution, and physical activity as well as ethnicity. There is little information regarding this question among Mexican adolescents. The association among fasting insulin levels, weight, fat distribution, physical activity, and cigarette smoking was studied in Mexican adolescents. METHODS: Cross-sectional data were collected from 352 Mexican adolescents aged 14-19 years (response rate 41.5%). Fasting insulin levels were measured by microparticle enzyme immunoassay; body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) were determined using standardized techniques, while physical activity was determined by 7-day Stanford physical activity inventory. Cigarette smoking was defined as number of cigarettes/year. RESULTS: Increased BMI and waist circumference, low physical activity, younger age, and non-smoking were associated with high insulin levels. Non-smokers had higher fasting insulin levels compared to smokers (57.8 pmol +/- 1.84 vs. 49.7 pmol/L +/- 2.8; p = 0.034). However, adjusted odds ratio (OR) between insulin and smoking status was not significant. Multivariate analysis showed the following: insulin increased 1.06 pmol/L for each unit of change in BMI; increased 1.02 pmol/L for each unit of change in waist circumference; increased 1.16 pmol/L for non-smoking, and decreased 1.07 pmol/L for each 250 kcal/day of energy expenditure. CONCLUSIONS: Our results support the concept that Mexican adolescents who are overweight have abdominal fat distribution and physical inactivity, and significant hyperinsulinemia. The relationship between smoking and lower insulinemia found in this research warrants further study.