Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma

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Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

Gestión de mantenimiento y producción más limpia en tres instituciones de salud de medellín, colombia / Cleaner maintenance and production management in three health institutions in medellín, colombia / Gestão de manutenção e produção mais limpa em três instituições de saúde de medellín, colômbia

Objetivo: Realizar un diagnóstico del estado de la gestión del mantenimiento de equipos biomédicos en el área de urgencias de tres (3) instituciones de nivel tres de complejidad médica de la ciudad de Medellín, Colombia, dentro del proyecto de investigación producción más limpia en salud. Metodología: Se diseñó una encuesta a partir de la Guía Sectorial de Producción más Limpia, en hospitales, clínicas y centros de salud, donde se obtuvo una lista de chequeo para la revisión del estado de la gestión de mantenimiento de los equipos biomédicos más complejos utilizados en urgencias. Resultados: La gestión de mantenimiento de los equipos biomédicos más complejos es muy buena en el hospital 1 y excelente en los hospitales 2 y 3; la metrología y gestión de mantenimiento en los equipos biomédicos del área de urgencias de los tres hospitales es excelente. Conclusión: La gestión de mantenimiento es muy importante para el ahorro económico en las instituciones, ya que se pueden reducir tiempos muertos de los equipos sin afectar la prestación de los servicios, aparte de que se reducen gastos en la compra de repuestos, y generación de residuos causantes de impactos negativos al medio ambiente.

Objective: to perform a diagnosis of the state of biomedical equipment maintenance management in the emergency areas of three (3) institutions of level three of medical complexity in the city of Medellín, Colombia. The realm is within the cleaner production in health research project. Methodology. A survey was designed based on the Cleaner Production Sector. Guide: in hospitals, clinics and health centers, where a check list was obtained to review the state of maintenance management of the most complex biomedical equipment used in the emergency room. Results: maintenance management of the most complex biomedical equipment is very good in hospital 1 and excellent in hospitals 2 and 3. Metrology and maintenance management in the biomedical equipment of the emergency area of all three hospitals is excellent. Conclusion: maintenance management is very important for financial savings in institutions, since they can thus reduce equipment downtime without hindering the provision of services, along with reducing costs in the purchase of spare parts and generation of waste, which causes a negative impact on the environment.

Objetivo: Realizar um diagnóstico do estado da gestão da manutenção de equipamentos biomédicos na área de urgências de três (3) instituições de nível três de complexidade médica da cidade de Medellín, Colômbia, dentro do projeto de investigação produção mais limpa em saúde. Metodologia: Desenhou-se uma pesquisa a partir da Guia Setorial de Produção mais limpa, em hospitais, clínicas e centros de saúde, onde se obteve uma lista de verificação para a revisão do estado da gestão de manutenção dos equipamentos biomédicos mais complexos utilizados em urgências. Resultados: A gestão de manutenção dos equipamentos biomédicos mais complexos é muito boa no hospital 1 e excelente nos hospitais 2 e 3; a metrologia e gestão de manutenção nos equipamentos biomédicos da área de urgências dos três hospitais é excelente. Conclusão: A gestão de manutenção é importantíssima para a poupança económica nas instituições, já que podem-se reduzir tempos mortos dos equipamentos sem afetar a prestação dos serviços, aparte de que se reduzem despesas na compra de repostos, e geração de resíduos causantes de impactos negativos ao meio ambiente.

Alteraciones tiroideas: ¿Predictores de mortalidad en Cuidados Intensivos? / Thyroid disorders: Predictors of mortality in Intensive Care?

Introducción: El objetivo del estudio es describir y analizar la función tiroidea en el paciente crítico. Describir si algún patrón se asocia a una mayor tasa de mortalidad. Métodos: Se analizó a todos los pacientes ingresados en nuestra Unidad de Cuidados Intensivos, entre enero de 2015 y agosto de 2016, y que permanecieron allí, al menos, siete días. Resultados: Se incluyeron 242 pacientes. Se hallaron diferencias significativas en los valores medios de los índices de gravedad entre los no supervivientes y los supervivientes: SOFA (10,45 vs. 7,9); APACHE II (24,42 vs. 20,71); SAPS II (63,14 vs. 50,69). Se encontraron diferencias estadísticamente significativas en los valores medios de T3 en el grupo de supervivientes y no supervivientes: 1,5 pg/ml vs. 1,15 pg/ml (p <0,001; IC95% 0,224 ± 0,487). No hubo diferencias estadísticamente significativas en los valores medios de T4 y TSH. Al realizar el subanálisis según grupo de ingreso, no se hallaron diferencias estadísticamente significativas entre las cifras de TSH, T3 o T4. Sí hubo diferencias significativas en los valores medios de T3 en la mayor parte de los subgrupos. Conclusiones: Se hallaron diferencias estadísticamente significativas entre los valores medios de T3 en el grupo de supervivientes y no supervivientes. Los valores de T3 parecen asociarse a la mortalidad. Su descenso no parece asociarse a la enfermedad subyacente, sino a su gravedad.(AU)

Introduction: The aim of this study is to describe and analyse the thyroid function in the critically ill patient, and to describe if any pattern is associated with a higher mortality rate. Methods: Patients admitted to the Intensive Care Unit, between January 2015 and August 2016, with a stay of seven days or more, were enrolled. Results: Two hundred and forty-two patients were included. Significant differences were observed in the severity scores related to mortality during their stay in the Intensive Care Unit (no survivors vs. survivors): SOFA (10.45 vs. 7.9); APACHE II (24.42 vs. 20.71); SAPS II (63.14 vs. 50.69). Statistically significant differences were observed in the mean values of T3 between survivors and non-survivors: 1.5 pg/ml vs. 1.15 pg/ml (p <0.001; CI95% 0.224 ± 0.487). There were no statistically significant differences in the mean values of T4 and TSH. After subgroup analysis according to the admission group, no significant differences among the TSH, T3 and T4 values were detected. However a statistically difference in T3 average value was found in most subgroups. Conclusions: A statistically significant difference was found in mean T3 values in survivors and non-survivors. T3 concentration appears to be associated with mortality. Decrease of this thyroid hormone does not seem to associate with the underlying disease, but with its severity.(AU)

Diagnosis of ganglionar tuberculosis by endoscopic ultrasonography.

INTRODUCTION: The endoscopic ultrasonography (EUS) is an endoscopic technique of proven clinical validity today, having a significant impact on the diagnosis and evaluation of several diseases with a low complication rate. The EUS-fine-needle aspiration (FNA) allows the evaluation of subepithelial lesions, extra-luminal lymph nodes or the gastrointestinal tract that are difficult to access by other methods with safe and high diagnostic accuracy. AIMS AND METHODS: In the case reported, the EUS-FNA was useful for the differential diagnosis with residual biliary microlithiasis and the diagnosis of non-oncologic pathology. RESULTS: Male, white, 35-year-old, human immunodeficiency virus and tuberculosis treatment for about 5 months presented with jaundice. No fever, weight loss or abdominal pain. Choluria and hipocholia. History of cholecystectomy for about 1 year due to cholelithiasis. Laboratory tests showed cholestatic jaundice (direct hyperbilirrubinemia). Abdominal ultrasound showed liver without particularities, without biliary dilatation or filling defects. Initially suspected hepatitis due tuberculosis drugs so, the treatment was suspended. After a week with no drugs, no improvement in jaundice was observed. In contrast, a progressive increase indirect bilirubin. EUS performed with identification of mass along the distal common bile duct near the duodenal papilla. FNA performed with the presence of lymphocytes and tuberculosis bacile positive. After, endoscopic retrograde cholangiopancreatography was performed with sphincterotomy and placement of endoprosthesis for biliary drainage. The tuberculosis drugs were restarted with the plan to complete. The jaundice was resoluted. The patient completed 9 months of treatment and abdominal tomography has not identified a mass in that place. CONCLUSION: The EUS-FNA was proven to be a useful tool for diagnosis of non-oncologic pathologies like tuberculosis.

Design of organic scintillators for non-standard radiation field dosimetry: experimental setup.

This paper describes an experimental setup designed for sensing the luminescent light coming from an organic plastic scintillator stimulated with ionizing radiation. This device is intended to be a part of a complete dosimeter system for characterization of small radiation fields which is the project of the doctoral thesis of the medical physicist at the Radiation Oncology facility of Hospital San Vicente Fundación in conjunction with the Universidad de Antioquia of Medellín Colombia. Some preliminary results predict a good performance of the unit, but further studies must be conducted in order to have a completed evaluation of the system. This is the first step in the development of an accuracy tool for measurement of non-standard fields in the Radiotherapy or Radiosurgery processes.

Genetic diversity among Mycobacterium tuberculosis isolates from Mexican patients.

Forty-six isolates of the Mycobacterium tuberculosis complex were typified by PCR of the IS6110 region and by Mycobacterium bovis specific primers JB21/JB22. Isolate MVG01 was typified as M. bovis, being the first record of a case of human tuberculosis caused by this species in Mexico. RAPD-PCR was used to describe the genetic diversity of the remaining 45 M. tuberculosis complex isolates. The corrected genotypic diversity value calculated for the analyzed population was 0.96, the estimated mean gene diversity was 0.235, and the corrected Shannon-Weiner index was 2.15. All allele-loci combinations generated showed significant linkage disequilibria. The distribution of genetic variation was analyzed both by the unweighted pair group method with arithmetic averages clustering and by principal coordinates analysis. Unweighted pair group method with arithmetic averages clustering resulted in a tree with four main clusters and one unclustered strain (MVG20), the principal coordinates analysis strain distribution pattern being consistent with this grouping. The obtained results suggest that the studied isolates belong to a clonal population having significant genetic diversity. Our genetic diversity results are comparable with those reported for other populations of M. tuberculosis, although only three RAPD primers were used.

A new procedure to differentiate citrus tristeza virus isolates by hybridisation with digoxigenin-labelled cDNA probes.

A non-isotopic hybridisation procedure was developed to differentiate isolates of citrus tristeza virus (CTV) using digoxigenin (DIG)-labelled cDNA probes and different kinds of target RNA. Hybridisation of DIG-probes with purified double-stranded RNA (dsRNA) or concentrated total RNA extracts spotted on nylon membranes allowed detection of CTV nucleic acid equivalent to as little as 0.1-1 mg infected tissue, when the reaction was developed with a chemiluminiscent substrate. This sensitivity was similar to or slightly better than that obtained by hybridisation with a 32P-labelled probe. CTV was also detectable by hybridisation of DIG-probes with tissue prints from freshly cut young citrus shoots. Hybridisation of tissue prints with DIG-probes under stringent conditions (60 degrees C and 50% formamide) could differentiate CTV isolates in citrus, whether grown in the greenhouse or in the field. This rapid and sensitive procedure can easily be applied to many samples, even under field conditions, and opens the way to monitoring spatio-temporal movement of specific CTV strains (or groups of strains) in epidemiological studies.

Electroquimioluminscencia una alternativa válida en el inmunodiagnóstico no radioisotópico / Electroquimioluminscencia a valid alternative in the inmunodiagnóstico of radioisotopo

Los avances de los últimos años en el campo del inmunodiagnóstico han sido muy significativos, especialmente por la incorporación de metodologías quimiolumiscentes que mantienen una creciente aceptación en los laboratorios, por las ventajas que estos ofrecen en cuanto a sensibilidad, rangos de medición y tiempos de trabajo. La introducción comercial de un sistema que utiliza Electroquimioluminscencia (ECL), con algunas ventajas sobre ensayos luminiscentes convencionales u otras metodologías, aporta de manera importante al mejoramiento en el campo de los inmunoensayos heterogéneos aplicados a la clínica, con grandes perspectivas en la investigación bacteriológica, ambiental y de biología molecular.

[Decentralization of health services in Mexico in the 80's]. / La descentralización de los servicios de salud en México en la década de los ochenta.

The objective of this article is to review the decentralization process that took place in the 1980s. First, some principles in relation to this topic are presented. Next, the legal foundations and the agreements which were established for Federation-states coordination are outlined, as well as basic points related to the introduction of the decentralization strategy. The favorable and unfavorable factors that affect the process are established and, finally, the possibility of carrying out decentralization of health services at the municipal level is briefly discussed.

[Psychiatry in colonial Mexico]. / La psiquiatría en el México colonial.

This article describes the knowledges, descriptions and treatments of the mental illnesses by the physicians of the Colonial Mexico (XVI to XIX Centuries). In the first part we can appreciate the spanish ascendancy in the XVI century; in the second one the influence in our country of the Malleus Maleficarum and in the third one the renovation of the Mexican medicine who tries to be part of the universal movement, although in this case, the universe is practically France in the XVIII century and the beginning of the XIX.

La psiquiatría en el México colonial / [Psychiatry in colonial Mexico]

This article describes the knowledges, descriptions and treatments of the mental illnesses by the physicians of the Colonial Mexico (XVI to XIX Centuries). In the first part we can appreciate the spanish ascendancy in the XVI century; in the second one the influence in our country of the Malleus Maleficarum and in the third one the renovation of the Mexican medicine who tries to be part of the universal movement, although in this case, the universe is practically France in the XVIII century and the beginning of the XIX.

La psiquiatría en el México colonial. / [Psychiatry in colonial Mexico]

This article describes the knowledges, descriptions and treatments of the mental illnesses by the physicians of the Colonial Mexico (XVI to XIX Centuries). In the first part we can appreciate the spanish ascendancy in the XVI century; in the second one the influence in our country of the Malleus Maleficarum and in the third one the renovation of the Mexican medicine who tries to be part of the universal movement, although in this case, the universe is practically France in the XVIII century and the beginning of the XIX.

[Psychiatry in ancient Mexico]. / La psiquiatría en el antiguo México.

Using studies on prehispanic and early post-conquest documents of Ancient Mexico--such as the Badianus Manuscript, also known as Libellus de Medicinalibus Indorum Herbis, and Brother Bernardino de Sahagún's famous work History of the Things of the New Spain, a description of some existing medical and psychiatric problems, and treatments Ancient Aztecs resorted to, is presented. The structure of the Aztec family, their problems with the excessive ingestion of alcoholic beverages, and the punishments native authorities had implemented in order to check alcoholism up are also described.

[Coverage of health services]. / Cobertura de los servicios de salud.

In this paper the concepts and criteria related to health coverage are discussed in the context of the organization of national health systems. The main international agreements based on WHO/PAHO proposals are also described. The relationship between primary health care and health coverage is analyzed and the evolution of the programs for the extension of health coverage in Mexico are discussed, with emphasis on the problems of overlap and definition of the universe in the several institutions of the health sector. Finally, the author reviews the problems to measure coverage in order to guarantee social and operative efficiency of the Mexican health system.

La psiquiatría en el antiguo México. / [Psychiatry in ancient Mexico]

Using studies on prehispanic and early post-conquest documents of Ancient Mexico--such as the Badianus Manuscript, also known as Libellus de Medicinalibus Indorum Herbis, and Brother Bernardino de Sahagúns famous work History of the Things of the New Spain, a description of some existing medical and psychiatric problems, and treatments Ancient Aztecs resorted to, is presented. The structure of the Aztec family, their problems with the excessive ingestion of alcoholic beverages, and the punishments native authorities had implemented in order to check alcoholism up are also described.

La psiquiatría en el antiguo México. / [Psychiatry in ancient Mexico]

Using studies on prehispanic and early post-conquest documents of Ancient Mexico--such as the Badianus Manuscript, also known as Libellus de Medicinalibus Indorum Herbis, and Brother Bernardino de Sahagúns famous work History of the Things of the New Spain, a description of some existing medical and psychiatric problems, and treatments Ancient Aztecs resorted to, is presented. The structure of the Aztec family, their problems with the excessive ingestion of alcoholic beverages, and the punishments native authorities had implemented in order to check alcoholism up are also described.

[Prospective study of nosocomial infections at a pediatrics unit]. / Estudio prospectivo de infecciones nosocomiales en una unidad de pediatría.

During a 10-month period a surveillance program was conducted to detect nosocomial infections (NIs) in the Pediatric Unit at the Hospital General O'Horan in Mérida, Yucatán. Five hundred and five infections were detected among 359 patients from a total of 2823 discharges, yielding a 17.9% rate. The NI rate among newborns delivered in the hospital was 13.1%; among the other pediatric services the rate was 26.4%, and was 30% in the ICU. Forty-four percent of the infections were epidemic. In decreasing order, the most common NIs were diarrhea, bacteremia and "suspect bacteremia", omphalitis, conjunctivitis and phlebitis associated with intravenous cannulas. Cultures of the infection sites isolated gram-negative bacteria in 97%. The most frequently isolated bacteria were Salmonella spp, and Escherichia coli. Our results, in conjunction with data obtained from other recent studies, suggest that the global NI rate in México is probably greater than previously estimated, with a high proportion of epidemic infections. This underscores the urgent need to establish a national surveillance program in order to determine the epidemiology of NIs more accurately, and thus implement effective control measures.