[Maternal mortality: relation between directive management and opportune clinical care]. / Mortalidad materna: enlace entre gestión directiva y atención clínica oportuna.

The authorities of the High Medical Specialized Units (HMSUs) Obstetric/Gynecology Service (OB/GYN) and Intensive Care Unit (ICU) elaborated a strategy, which included the organization and interrelation of both hospital services and the implementation of an Epidemiologic Monitoring Program for all critical complicated pregnancies. This plan consisted in an assignment of personnel for special care, immediate communication with heads of services to coordinate the attention and to facilitate the resources for medical attention in these patients, as well as daily follow up by the authorities until complete resolution. Through epidemiological monitoring, 274 cases of pregnant women with high risk of mortality were identified during 2005, and 437 during 2006 (increased 59 %). The admittance to ICU for this reason in 2003 was 17; in 2005 was 24 and in 2006 was 42 (147 % from 2003 to 2006). Maternal deaths diminished from: 3/17 (17.6 %) to 1/24 (4.1 %) to 2/42 (4.7 %) during the same years, respectively. The maternal death rate from 2004 to 2006 was: 33.2, 17.4, and 22 per 100,000 newborns, respectively, below the national and institutional average. The coordination between the Headquarters and the HMSUs that take care of obstetrical patients helped diminution maternal death over this period.

Improvement of diastolic function after regression of left ventricular hypertrophy / Mejora de la función diastólica tras regresión de la hipertrofia ventricular izquierda

OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.

Improvement of diastolic function after regression of left ventricular hypertrophy.

OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.

[Modification of risk factors in the developing of diabetes mellitus type 2 in obese children]. / Modificación de factores de riesgo para desarrollar diabetes mellitus tipo 2 en escolares obesos.

OBJECTIVE: To determine if an educational and dietetic program diminish the risk factors of diabetes mellitus type 2 in obese children. DESIGN: quasi-experimental trial. MATERIAL AND METHODS: We performed a study in 28 obese children. They received instruction in diabetes mellitus, participated in a nutritional education group, and received an individual dietetic treatment during six months. There was used a 24-hour recall about dietary intake, body mass index and blood pressure measure monthly. Glucose, leptin, and insulin levels were measured at baseline and after the six months of treatment. Kruskal-Wallis and Wilcoxon tests were used. RESULTS: We studied 13 female and 15 male obese children with an age average of 9.7 years. Body mass index (29.0 versus 25.6), blood pressure (121/80 versus 118/78 mm Hg), fasting glucose (95 versus 92 mg/dL), total cholesterol (166 versus 155 mg/dL), triglycerides (144 versus 142 mg/dL), insulin resistance index (5.9 versus 4.9), leptin (56.1 versus 57.3 ng/mL), and energy intake (3409 versus 2243 kcal) decreased, at the begin and at the end of the study. Nutriment and sufficiency balance were lower too (p<0.05). CONCLUSIONS: The program diminished the risk factors for diabetes mellitus and cardiovascular disease.

[Factors for expulsion of intrauterine device Tcu380A applied immediately postpartum and after a delayed period]. / Factores de expulsión del dispositivo intrauterino TCu380A aplicado en puerperio inmediato y tardío.

OBJECTIVE: To determine the frequency of expulsion of the intrauterine device TCu380A (IUD) inserted either immediately postpartum or after a delayed period. We aimed to identify the factors associated with expulsion. MATERIALS AND METHODS: A longitudinal and comparative study was carried out in three Family Medicine Units of the Instituto Mexicano del Seguro Social (IMSS) of Leon, Guanajuato. One hundred twenty-five women who had a vaginal delivery and who elected to have IUD inserted immediately after delivery participated in the study along with 125 women who elected to have the IUD inserted after a delayed period after delivery. Studied factors were parity, technique, and insertion by the doctors assigned to the service and medical personnel in training (pre or postdegree). A medical review was performed one month and three months after insertion of the IUD. Results were analyzed by chi-square and Student t test. RESULTS: The expulsion rates of IUDs during immediate puerperium and also after a delayed period were 16 and 2.7%, respectively (p<0.0004). There was no statistically significant association between expulsion of the IUD and the following factors that were taken into account: age, primipara, personnel who inserted the device, and the application technique. In immediate puerperium, 25.9% of women who had multiple deliveries expelled the IUD, and in those who delayed IUD insertion, it was 4% (p=0.03). CONCLUSIONS: There is a greater risk of expulsion if the IUD is inserted immediately after delivery and it is associated with multiparity. The percentage of expulsion in immediate puerperium is similar to that reported in the literature.

Peso, talla y estado de salud según tipo de lactancia en menores de seis meses de edad que acuden a una unidad de medicina familiar de León, Guanajuato / Weigth, height and health status according type of feeding in 6 months old children. Experience in a primary care clinic in Leon, Guanajuato

Objetivo. Comparar el peso, talla y frecuencia de diarreas e infecciones respiratorias en los menores de seis meses, según el tipo de lactancia en la unidad de medicina familiar No. 47 del Instituto Mexicano del Seguro Social de León, Gto. Material y Métodos. Se realizó un estudio comparativo, longitudinal y prospectivo de enero a junio de 1995, con 204 recién nacidos. De estos se eligieron al azar a 33 que llevaron lactancia materna durante seis meses para compararlos con 78 lactantes que les proporcionaron lactancia materna y/o mixta. Se evaluaron mensualmente a los lactantes, peso, talla, frecuencia de enfermedades respiratorias agudas y diarreas. Resultados. El peso siempre fue mejor en los alimentados con lactancia materna, la talla fue ligeramente menor con una p > 0.05 con una equivalencia de crecimiento y nutrición mejores que el grupo alimentado con lactancia artificial p>0.05. La frecuencia de infecciones respiratorias y diarreicas son mayores en los lactantes que reciben otro tipo de lactancia p=0.01. Conclusiones. La promoción del uso de lactancia materna debe de continuar en todas las instituciones de salud para disminuir el número de infecciones respiratorias y de diarreas. El disminuir la frecuencia de estas enfermedades, también disminuyen las cifras de mortalidad en los menores de seis meses

Estudio comparativo de hiperlipidemia entre pacientes hipertensos y normotensos / Comparative study of hyperlipidemia between hyper and normotensive patients

Estudio prospectivo realizado en la Undidad de Medicina Familiar No. 47 de León, Guanajuato del Instituto Mexicano del Seguro Social, con 115 pacientes de hipertensos y 115 pacientes normotensos, con la finalidad de investigar el comportamiento de hiperlipidemia entre ambos grupos. Se elaboraron los exámenes de colesterol y triglicéridos utilizando el analizador de química clínica 550 express, así como la prueba de colesterol -HDL (High Density Lipoproteins) (técnica manual). La prevalencia de hiperlipidemia es mayor en los pacientes hipertensos en número y porcentaje estadísticamente significativos en comparación con los normotensos y el riesgo de cardiopatía coronaria aumenta en esos sujetos a medida que asciende su colesterol sanguíneo, aunado al aumento de LDL (Low Density Lipoproteins). Sin embargo, el estudio reportó que entre los normotensos también se encuentran cifras altas de colesterol y/o triglicéridos, por lo que es conveniente realizar estos estudios periódicamente