Comparison between the KARVI scale and the Child Development Evaluation test (EDI) as a screening tool for suspected neurodevelopmental delay.

BACKGROUND: Early detection of suspected neurodevelopmental delay allows for timely diagnosis and appropriate intervention, for which numerous screening tests have been developed. However, most are complex and impractical for health-care workers at the community level. This study aimed to validate the KARVI scale in the neurodevelopment assessment of children under 1 year of age. METHODS: We conducted an observational, longitudinal, comparative, inferential, and prospective study. Healthy children without risk factors for developing neurodevelopmental delay from 0 to 12 months of age were evaluated remotely using the Zoom® application. The Child Development Evaluation Test and the KARVI scale were applied once a month for four consecutive months. RESULTS: Fifty individuals were analyzed, with a predominance of males in 52%. Adequate percentages for a screening test were obtained in the first evaluation with a sensitivity of 70% (confidence interval [CI] 95% 34.75-93.33) and a specificity of 75% (CI 95% 58.8-87.31), and in the fourth evaluation with a sensitivity of 100% (CI 95% 29.4-100) and a specificity of 78.72% (CI 95% 64.34-89.3), being significant in both evaluations (p = 0.007 and p = 0.001, respectively). CONCLUSIONS: The KARVI scale has the elements to be an effective screening test for suspected neurodevelopmental delay, but more extensive studies are needed to obtain more reliable results.

INTRODUCCIÓN: La identificación temprana de retraso en el neurodesarrollo permite un diagnóstico oportuno y una intervención apropiada. Para ello, se han creado diversas pruebas de tamizaje; sin embargo, la mayoría son complejas y poco prácticas para el personal de la salud a nivel comunitario. El objetivo del estudio fue realizar la validación de la escala KARVI en la valoración del neurodesarrollo en niños menores de un año. MÉTODOS: Se realizó un estudio observacional, longitudinal, comparativo inferencial y prospectivo, en el cual se evaluaron, vía remota mediante la aplicación Zoom®, niños sanos de 0 a 12 meses de edad sin factores de riesgo para desarrollar retraso en el neurodesarrollo. Se aplicaron la prueba EDI (Evaluación del Desarrollo Infantil) y la escala KARVI una vez al mes por cuatro meses consecutivos. RESULTADOS: Se analizaron 50 individuos, con predominio del sexo masculino en el 52%. Se obtuvieron porcentajes adecuados para una prueba de tamizaje tanto en la primera evaluación, con sensibilidad de 70% (IC 95% 34.75-93.33) y especificidad de 75% (IC 95% 58.8-87.31), como en la cuarta, con sensibilidad de 100% (IC 95% 29.4-100) y especificidad de 78.72% (IC 95% 64.34-89.3), con significación estadística en ambas evaluaciones (p = 0.007 y p = 0.001, respectivamente). CONCLUSIONES: Se considera que la escala KARVI cuenta con los elementos para considerarla como una prueba de tamizaje efectiva para detectar retraso del neurodesarrollo, sin embargo. Sin requieren estudios más extensos para obtener resultados más confiables.

Comparison between the KARVI scale and the Child Development Evaluation test (EDI) as a screening tool for suspected neurodevelopmental delay / Comparación entre la escala KARVI y la prueba de Evaluación del Desarrollo Infantil (EDI) como tamizaje para la sospecha de retraso en el neurodesarrollo

Abstract Background: Early detection of suspected neurodevelopmental delay allows for timely diagnosis and appropriate intervention, for which numerous screening tests have been developed. However, most are complex and impractical for health-care workers at the community level. This study aimed to validate the KARVI scale in the neurodevelopment assessment of children under 1 year of age. Methods: We conducted an observational, longitudinal, comparative, inferential, and prospective study. Healthy children without risk factors for developing neurodevelopmental delay from 0 to 12 months of age were evaluated remotely using the Zoom® application. The Child Development Evaluation Test and the KARVI scale were applied once a month for four consecutive months. Results: Fifty individuals were analyzed, with a predominance of males in 52%. Adequate percentages for a screening test were obtained in the first evaluation with a sensitivity of 70% (confidence interval [CI] 95% 34.75-93.33) and a specificity of 75% (CI 95% 58.8-87.31), and in the fourth evaluation with a sensitivity of 100% (CI 95% 29.4-100) and a specificity of 78.72% (CI 95% 64.34-89.3), being significant in both evaluations (p = 0.007 and p = 0.001, respectively). Conclusions: The KARVI scale has the elements to be an effective screening test for suspected neurodevelopmental delay, but more extensive studies are needed to obtain more reliable results.

Resumen Introducción: La identificación temprana de retraso en el neurodesarrollo permite un diagnóstico oportuno y una intervención apropiada. Para ello, se han creado diversas pruebas de tamizaje; sin embargo, la mayoría son complejas y poco prácticas para el personal de la salud a nivel comunitario. El objetivo del estudio fue realizar la validación de la escala KARVI en la valoración del neurodesarrollo en niños menores de un año. Métodos: Se realizó un estudio observacional, longitudinal, comparativo inferencial y prospectivo, en el cual se evaluaron, vía remota mediante la aplicación Zoom®, niños sanos de 0 a 12 meses de edad sin factores de riesgo para desarrollar retraso en el neurodesarrollo. Se aplicaron la prueba EDI (Evaluación del Desarrollo Infantil) y la escala KARVI una vez al mes por cuatro meses consecutivos. Resultados: Se analizaron 50 individuos, con predominio del sexo masculino en el 52%. Se obtuvieron porcentajes adecuados para una prueba de tamizaje tanto en la primera evaluación, con sensibilidad de 70% (IC 95% 34.75-93.33) y especificidad de 75% (IC 95% 58.8-87.31), como en la cuarta, con sensibilidad de 100% (IC 95% 29.4-100) y especificidad de 78.72% (IC 95% 64.34-89.3), con significación estadística en ambas evaluaciones (p = 0.007 y p = 0.001, respectivamente). Conclusiones: Se considera que la escala KARVI cuenta con los elementos para considerarla como una prueba de tamizaje efectiva para detectar retraso del neurodesarrollo, sin embargo. Sin requieren estudios más extensos para obtener resultados más confiables.

Pediatric Inflammatory Multisystem Syndrome or Multisystem Inflammatory Syndrome in Children: A New Thread in Pandemic Era.

After the perturbing effects of the COVID-19 Pandemic, we observed intense public health efforts in a global-scale to prevent, control, and treat the SARS-CoV-2. Hundreds of clinical center researched for adequate treatments, other were devoted to the development the COVID-19 vaccines and other studied the nature and the effects of this mutant coronavirus SARS-CoV-2. As time goes by, the pediatric inflammatory multisystem syndrome has been recently defined and associated the COVID-19 past infection and is now considered a shot to middle-term complication of COVID-19. In this paper, we review the actual concepts of PIMS in children, the epidemiology, the clinical presentation, and evolution, the recommended laboratory and other testing. The recommended specialties interconsultation for hospitalized patients and a full discussion on the appropriate treatment of these patients. We include the Latin-American experience with PIMS and a final discussion on the outcome of this disease.

Spatial interaction between breast cancer and environmental pollution in the Monterrey Metropolitan Area.

This research examines the spatial structure of a sample of breast cancer (BC) cases and their spatial interaction with contaminated areas in the Monterrey Metropolitan Area (MMA). By applying spatial statistical techniques that treat the space as a continuum, degrees of spatial concentration were determined for the different study groups, highlighting their concentration pattern. The results indicate that 65 percent of the BC sample had exposure to more than 56 points of PM10. Likewise, spatial clusters of BC cases of up to 39 cases were identified within a radius of 3.5 km, interacting spatially with environmental contamination sources, particularly with refineries, food processing plants, cement, and metals. This study can serve as a platform for other clinical research by identifying geographic clusters that can help focus health policy efforts.

Epidemiologic Impacts in Acute Infectious Disease Associated with Catastrophic Climate Events Related to Global Warming in the Northeast of Mexico.

Rising global temperatures and seawater temperatures have led to an increase in extreme weather patterns leading to droughts and floods. These natural phenomena, in turn, affect the supply of drinking water in some communities, which causes an increase in the prevalence of diseases related to the supply of drinking water. The objective of this work is to demonstrate the effects of global warming on human health in the population of Monterrey, Mexico after Hurricane Alex. We interpolated data using statistical downscaling of climate projection data for 2050 and 2080 and correlated it with disease occurrence. We found a remarkable rise in the incidence of transmissible infectious disease symptoms. Gastrointestinal symptoms predominated and were associated with drinking of contaminated water like tap water or water from communal mobile water tanks, probably because of the contamination of clean water, the disruption of water sanitation, and the inability to maintain home hygiene practices.

Liderazgo transformacional en estudiantes de ciencias de la salud / Transformational leadership in students of health sciences

Introducción: El estudio del liderazgo ha desarrollado teorías que, en su mayoría, coinciden con que es una competencia profesional a través de la cual resulta factible orientar e impulsar a los equipos y/o seguidores hacia una meta, mediante relaciones motivadoras y llenas de energía. La influencia del líder infunde un sentido a esta misión, al catalizar el potencial de los seguidores y desencadenar procesos automotivacionales en el colectivo. Objetivo: Identificar los estilos de liderazgo a través de la autopercepción evaluada en estudiantes universitarios de ciencias de la salud. Métodos: Se aplicó el Multifactorial Leadership Questionnaire a 109 alumnos. Se identificó el estilo de liderazgo predominante, según la teoría de Bass y Avolio: liderazgo transformacional, transaccional y pasivo-evasivo, mediante un análisis de regresión múltiple y mediacional. Resultados: En los estudiantes de medicina se alcanzó un coeficiente beta de 0,50 con una R2 de 63 por ciento entre el liderazgo transformacional y las variables de resultado. El liderazgo transformacional tuvo un efecto directo mayor sobre el esfuerzo extra (coeficiente = 0,85). En el género femenino el efecto directo hacia las variables de resultado fue más alto que en el masculino. Conclusiones: El estudio permitió probar la herramienta Multifactorial Leadership Questionnaire para evaluar perfiles de liderazgo en estudiantes de pregrado y conocer sus características predominantes(AU)

Introduction: Research about leadership has developed theories that, for the most part, coincide with the fact that it is a professional competence through which it is feasible to guide and drive teams and/or followers towards a goal, through motivating and energetic relationships. The leader influence guarantees a meaning to this mission, catalyzing the potential of the followers and triggering self-motivational processes in the collective. Objective: To identify leadership styles through self-perception evaluated in university students of health sciences. Methods: The "Multifactorial Leadership Questionnaire" was applied to 109 students. The predominant leadership style was identified, according to the theory of Bass and Avolio (transformational, transactional, and passive-evasive leadership), using a multiple and mediational regression analysis. Results: In medical students, a beta coefficient of 0.50 was reached with R2 of 63 percent between transformational leadership and the outcome variables. Transformational leadership had a greater direct effect on extra effort (coefficient=0.85). In the female gender, the direct effect towards the outcome variables was higher than in the male gender. Conclusions: The study allowed to try the tool "Multifactorial Leadership Questionnaire" for evaluating leadership profiles in undergraduate students and to know their predominant characteristics(AU)

Clinical Characterization of 2 Siblings with a Homozygous SPAST Variant.

BACKGROUND Hereditary spastic paraplegia (HSP or SPG) consists of a heterogeneous group of disorders, clinically divided into pure and complex forms. The former is characterized by neurological impairment limited to lower-extremity spasticity. The latter presents additional symptoms such as seizures, psychomotor impairment, cataract, deafness, and peripheral neuropathy. The genetic structure of HSP is diverse, with more than 72 loci and 55 genes identified so far. The most common type is SPG4, accounting for 40% of cases. This case report describes 2 siblings presenting SPG4, one presumptive and one confirmed with a homozygous SPAST variant. CASE REPORT Two siblings born to third-degree consanguineous and healthy parents presented a SPG4 complex phenotype characterized by progressive psychomotor deterioration, mixed seizure patterns, corneal opacity, dysostotic bones, limb spasticity with extensor plantar responses, and axial hypotonia. After ruling out most inborn errors of metabolism in one of the patients, the complexity of the case derived from exome sequencing. The identification of a homozygous variant in the SPAST gene established a diagnosis for SPG4. The phenotype-genotype did not correlate to classical manifestations, most likely due to the variant's zygosity. Moreover, 34 patient's relatives were identified with SPG4 clinical manifestations or asymptomatic with the same genetic variant in heterozygous state. CONCLUSIONS We described visual loss and seizures for SPG4 complex phenotype associated with a homozygous variant in the SPAST gene. This diagnosis will lead clinicians to consider it as a differential diagnosis providing adequate genetic counseling.

Venoarterial extracorporeal membrane oxygenation in heart surgery post-operative pediatric patients: A retrospective study at Christus Muguerza Hospital, Monterrey, Mexico.

OBJECTIVES: Extracorporeal membrane oxygenation is a life support procedure developed to offer cardiorespiratory support when conventional therapies have failed. The purpose of this study is to describe the findings during the first years using venoarterial extracorporeal membrane oxygenation in pediatric patients after cardiovascular surgery at Christus Muguerza High Specialty Hospital in Monterrey, Mexico. METHODS: This is a retrospective, observational, and descriptive study. The files of congenital heart surgery post-operative pediatric patients, who were treated with venoarterial extracorporeal membrane oxygenation from January 2013 to December 2015, were reviewed. RESULTS: A total of 11 patients were reviewed, of which 7 (63.8%) were neonates and 4 (36.7%) were in pediatric age. The most common diagnoses were transposition of great vessels, pulmonary stenosis, and tetralogy of Fallot. Survival rate was 54.5% and average life span was 6.3 days; the main complications were sepsis (36.3%), acute renal failure (36.3%), and severe cerebral hemorrhage (9.1%). The main causes of death were multi-organ dysfunction syndrome (27.3%) and cerebral hemorrhage (18.2%). CONCLUSION: The mortality rates found are very similar to those found in a meta-analysis report published in 2013 and the main complication and causes of death are also very similar to the majority of extracorporeal membrane oxygenation reports for these kinds of patients. Although the results are encouraging, early sepsis detection, prevention of cerebral hemorrhage, and renal function monitoring must be improved.

Genetic variants in CYP2A6 and UGT1A9 genes associated with urinary nicotine metabolites in young Mexican smokers.

Nicotine is the major pharmacologically active substance in tobacco. Several studies have examined genotypes related to nicotine metabolism, but few studies have been performed in the Mexican population. The objective was to identify associations between gene variants in metabolizing enzymes and the urinary levels of nicotine metabolites among Mexican smokers. The levels of nicotine and its metabolites were determined in the urine of 88 young smokers from Mexico, and 167 variants in 24 genes associated with nicotine metabolism were genotyped by next-generation sequencing (NGS). Trans-3'-hydroxy-cotinine (3HC) and 4-hydroxy-4-(3-pyridyl)-butanoic acid were the most abundant metabolites (35 and 17%, respectively). CYP2A6*12 was associated with 3HC (p = 0.014). The rs145014075 was associated with creatinine-adjusted levels of nicotine (p = 0.035), while the rs12471326 (UGT1A9) was associated to cotinine-N-glucuronide (p = 0.030). CYP2A6 and UGT1A9 variants are associated to nicotine metabolism. 4HPBA metabolite was an abundant urinary metabolite in young Mexican smokers.

Spatial Clusters of Children with Cleft Lip and Palate and Their Association with Polluted Zones in the Monterrey Metropolitan Area.

This study examines the spatial structure of children with cleft lip and palate (CLP) and its association with polluted areas in the Monterrey Metropolitan Area (MMA). The Nearest Neighbor Index (NNI) and the Spatial Statistical Scan (SaTScan) determined that the CLP cases are agglomerated in spatial clusters distributed in different areas of the city, some of them grouping up to 12 cases of CLP in a radius of 1.2 km. The application of the interpolation by empirical Bayesian kriging (EBK) and the inverse distance weighted (IDW) method showed that 95% of the cases have a spatial interaction with values of particulate matter (PM10) of more than 50 points. The study also shows that 83% of the cases interacted with around 2000 annual tons of greenhouse gases. This study may contribute to other investigations applying techniques for the identification of environmental and genetic factors possibly associated with congenital malformations and for determining the influence of contaminating substances in the incidence of these diseases, particularly CLP.

Gradientes de idoneidad para impulsar la mejora continua de campos clínicos utilizados en programas de Especialidades Médicas en México / Suitability of a gradient scale to promote for continuous improvement in clinical sites used in Mexican Medical Specialties

OBJETIVO: Desarrollar una metodología de evaluación de campos clínicos mediante la percepción de los médicos residentes. MATERIAL Y MÉTODOS: Se identificaron 20 variables, que se agruparon en cuatro categorías: 1) profesor tutor; 2) organización hospitalaria; 3) complementos educativos, y 4) opinión global. RESULTADOS: Se diseñó y validó una herramienta y escala de gradientes de idoneidad, encontrando el nivel de idoneidad aceptable en el 55% de los campos clínicos, en contraste con un 45% ubicado en el nivel no aceptable. CONCLUSIÓN: Esta herramienta permitió medir y comparar por gradientes la calidad de los campos clínicos para entrenamiento de los médicos residentes

OBJECTIVE: To develop a method for the evaluation of clinical sites through the perspective of medical residents. MATERIAL AND METHOD: A set of 20 variables were selected and grouped into the following categories: (I) teaching staff; (II) hospital organisation; (III) educational program, and (IV)overall opinion. RESULTS: A gradient scale of the suitability of the clinical site was designed, and validated, with 55% of the clinical sites being at an acceptable level and 45% being unacceptable below. CONCLUSION: This tool permitted the quality of the clinical sites used by the medical residents to be measured using a gradient scale

The Incidence of Transient Neonatal Tyrosinemia Within a Mexican Population

Abstract Transient neonatal tyrosinemia (TNT) is a form of hypertyrosinemia produced by the immaturity of 4-hydroxyphenylpyruvate dioxygenase (4-HPPD), a high intake of phenylalanine and tyrosine, and a relative ascorbic acid deficiency. Our objectives are to determine the incidence of TNT in Mexican newborns and to correlate it based on their sex, gestational age, and weight for gestational age to determine whether these are risk factors that predict the development of TNT. A cross-sectional descriptive study was conducted from January 2006 to August 2017. We analyzed 175 976 of newborn screening reports and found that the overall incidence of TNT was 1 (0.29%) in 342 newborns. It is more prevalent in preterm infants and in small for gestational age newborns (0.35%).The TNT incidence was determined in this Mexican population, and it was established as the most frequently occurring amino acid defect. We propose that pediatricians intentionally search for this pathology to offer patients access to adequate and timely treatment.

Alteración de la percepción del estado nutricional por parte de padres de preescolares: un factor de riesgo para obesidad y sobrepeso / Altered perception of the nutritional status of preschoolers by their parents: A risk factor for overweight and obesity

Introducción. Muchos padres de familia tienen una percepción inadecuada del tamano de su hijo; en general, subestiman el sobrepeso y la obesidad. Objetivo. Identificar la diferencia entre la percepción de los padres del estado nutricional del niño y el índice de masa corporal medido. Población y métodos. Se realizó un estudio analítico, descriptivo y transversal entre padres de niños de 2 a 6 años de edad. Se determinó el índice de masa corporal de los niños y se evaluó la percepción de los padres mediante una escala visual de imágenes corporales en forma de pictogramas (dibujos de siluetas equivalentes a percentiles del índice de masa corporal). Resultados. Fueron evaluados 605 niños y sus padres. Se encontró sobrepeso en 74 casos (12,2%) y obesidad en 87 casos (14,3%). De 161 niños con sobrepeso u obesidad, 98,8% (159) de los padres subestimaron el estado nutricional de sus hijos. Tener una imagen paterna de la figura del cuerpo infravalorada presentó un OR= 2,1 ± 0,5, p= 0,002 (IC 95%: 1,32-3,32) para obesidad y un OR= 4,42 ± 1,2, p < 0,001 (IC 95%: 2,631-7,439) para sobrepeso. Conclusiones. El 98,8% (159) de los padres de niños con sobrepeso u obesidad subestimaron el peso de sus hijos. Esta subestimación por parte de los padres puede considerarse un factor de riesgo significativo para el desarrollo y/o mantenimiento del sobrepeso y la obesidad en sus hijos.

Introduction. Many parents have a misperception of their children's body size; in general, they underestimate overweight and obesity. Objective. To identify the difference between parents' perception of their children's nutritional status and measured body mass index. Population and methods. An analytical, descriptive and cross-sectional study was conducted among parents of children aged 2 to 6 years old. Children's body mass index was measured, and parents' perception was assessed using a visual scale of body size pictograms (drawings of body figures equivalent to body mass index percentiles). Results. A total of 605 children and their parents were assessed. Seventy-four (12.2%) were overweight and 87 were obese (14.3%). There were 161 overweight or obese children, but 98.8% (159) of parents underestimated their children's nutritional status. Parents' underperception of their children's body size accounted for an OR= 2.1 ± 0.5, p= 0.002 (95% confidence interval [CI]: 1.32-3.32) for obesity and an OR = 4.42 ± 1.2, p < 0.001 (95% CI: 2.631-7.439) for overweight. Conclusions. Among parents of overweight and obese children, 98.8% (159) underestimated their children's weight status. Such underestimation by parents may be a significant risk factor for the development and/or persistence of overweight and obesity in their children.

Altered perception of the nutritional status of preschoolers by their parents: A risk factor for overweight and obesity. / Alteración de la percepción del estado nutricional por parte de padres de preescolares: un factor de riesgo para obesidad y sobrepeso.

INTRODUCTION: Many parents have a misperception of their children's body size; in general, they underestimate overweight and obesity. OBJECTIVE: To identify the difference between parents' perception of their children's nutritional status and measured body mass index. POPULATION AND METHODS: To identify the difference between parents' perception of their children's nutritional status and measured body mass index. RESULTS: A total of 605 children and their parents were assessed. Seventy-four (12.2%) were overweight and 87 were obese (14.3%). There were 161 overweight or obese children, but 98.8% (159) of parents underestimated their children's nutritional status. Parents' underperception of their children's body size accounted for an OR= 2.1 ± 0.5, p= 0.002 (95% confidence interval [CI]: 1.32-3.32) for obesity and an OR = 4.42 ± 1.2, p < 0.001 (95% CI: 2.631-7.439) for overweight. CONCLUSIONS: Among parents of overweight and obese children, 98.8% (159) underestimated their children's weight status. Such underestimation by parents may be a significant risk factor for the development and/or persistence of overweight and obesity in their children.

INTRODUCCIÓN: Muchos padres de familia tienen una percepción inadecuada del tamano de su hijo; en general, subestiman el sobrepeso y la obesidad. OBJETIVO: Identificar la diferencia entre la percepción de los padres del estado nutricional del niño y el índice de masa corporal medido. POBLACIÓN Y MÉTODOS: Se realizó un estudio analítico, descriptivo y transversal entre padres de niños de 2 a 6 anos de edad. Se determinó el índice de masa corporal de los niños y se evaluó la percepción de los padres mediante una escala visual de imágenes corporales en forma de pictogramas (dibujos de siluetas equivalentes a percentiles del índice de masa corporal). RESULTADOS: Fueron evaluados 605 niños y sus padres. Se encontró sobrepeso en 74 casos (12,2%) y obesidad en 87 casos (14,3%). De 161 niños con sobrepeso u obesidad, 98,8% (159) de los padres subestimaron el estado nutricional de sus hijos. Tener una imagen paterna de la figura del cuerpo infravalorada presentó un OR= 2,1 ± 0,5, p= 0,002 (IC 95%: 1,32-3,32) para obesidad y un OR= 4,42 ± 1,2, p < 0,001 (IC 95%: 2,631-7,439) para sobrepeso. CONCLUSIONES: El 98,8% (159) de los padres de niños con sobrepeso u obesidad subestimaron el peso de sus hijos. Esta subestimación por parte de los padres puede considerarse un factor de riesgo significativo para el desarrollo y/o mantenimiento del sobrepeso y la obesidad en sus hijos.

Osteocondromatosis múltiple hereditaria en una familia / Multiple hereditary osteochondromatosis in a family

Resumen: Introducción: La osteocondromatosis múltiple hereditaria se caracteriza por el crecimiento de múltiples tumores benignos, cartilaginosos, que crecen en forma de exostosis predominantemente en las metáfisis de los huesos largos. Se ha descrito una prevalencia de 1/50,000 individuos. Casos clínicos: Se presenta la información clínica y patrón hereditario autosómico dominante, en el que están afectados los genes de exostosina (familia de genes EXT) en tres miembros de una familia con osteocondromatosis múltiple. Los tres pacientes han presentado alteraciones en los arcos de movimiento de muñecas, hombros o tobillo. El diagnóstico clínico fue confirmado con estudios radiológicos y no hay evidencia de que las lesiones se hayan malignizado. Conclusiones: Esta entidad requiere de supervisión periódica, corrección quirúrgica de las deformaciones que limiten la función, vigilancia de la transformación maligna y consejería genética.

Abstract: Background: Multiple hereditary osteochondromatosis is characterized by the growing of benign cartilaginous tumors in form of exostosis, predominately in the metaphysis of long bones. It is described with a prevalence of 1/50,000 individuals. Case reports: This article presents the clinical information and its autosomal dominant inheritance pattern where exotoxin genes (EXT gene family) were affected in a three-member family with multiple hereditary osteochondromatosis. The three patients showed altered arcs of movement of wrists, shoulders and ankles. Clinical diagnosis was confirmed with radiology and malignancy was ruled out in all patients. Conclusions: This disease requires frequent medical evaluation, surgical bone correction when the normal function is involved, surveillance for malignant transformation, and genetic counseling.

Source apportionment of PM2.5 for supporting control strategies in the Monterrey Metropolitan Area, Mexico.

UNLABELLED: The Monterrey Metropolitan Area (MMA) in Northeast Mexico has shown high PM2.5 concentrations since 2003. The data shows that the annual average concentration exceeds from 2 to 3 times the Mexican PM2.5 annual air quality standard of 12 µg/m(3). In a previous work we studied the chemical characterization of PM2.5 in two sites of the MMA during the winter season. Among the most important components we found ammonium sulfate and nitrate, elemental and organic carbon, and crustal matter. In this work we present the results of a second chemical characterization study performed during the summer time and the application of the chemical mass balance (CMB) model to determine the source apportionment of air pollutants in the region. The chemical analysis results show that the chemical composition of PM2.5 is similar in both sites and periods of the year. The results of the chemical analysis and the CMB model show that industrial, traffic, and combustion activities in the area are the major sources of primary PM2.5 and precursor gases of secondary inorganic and organic aerosol (SO2, NOx, NH3, and volatile organic compounds [VOCs]). We also found that black carbon and organic carbon are important components of PM2.5 in the MMA. These results are consistent with the MMA emission inventory that reports as major sources of particles and SO2 a refinery and fuel combustion, as well as nitrogen oxides and ammonium from transportation and industrial activities in the MMA and ammonium form agricultural activities in the state. The results of this work are important to identify and support effective actions to reduce direct emissions of PM2.5 and its precursor gases to improve air quality in the MMA. IMPLICATIONS: The Monterrey Metropolitan Area (MMA) has been classified as the most air-polluted area in Mexico by the World Health Organization (WHO). Effective actions need to be taken to control primary sources of PM2.5 and its precursors, reducing health risks on the population exposed and their associated costs. The results of this study identify the main sources and their estimated contribution to PM2.5 mass concentration, providing valuable information to the local environmental authorities to take decisions on PM2.5 control strategies in the MMA.

[Multiple hereditary osteochondromatosis in a family]. / Osteocondromatosis múltiple hereditaria en una familia.

BACKGROUND: Multiple hereditary osteochondromatosis is characterized by the growing of benign cartilaginous tumors in form of exostosis, predominately in the metaphysis of long bones. It is described with a prevalence of 1/50,000 individuals. CASE REPORTS: This article presents the clinical information and its autosomal dominant inheritance pattern where exotoxin genes (EXT gene family) were affected in a three-member family with multiple hereditary osteochondromatosis. The three patients showed altered arcs of movement of wrists, shoulders and ankles. Clinical diagnosis was confirmed with radiology and malignancy was ruled out in all patients. CONCLUSIONS: This disease requires frequent medical evaluation, surgical bone correction when the normal function is involved, surveillance for malignant transformation, and genetic counseling.

Risk Factors and Current Health-Seeking Patterns of Migrants in Northeastern Mexico: Healthcare Needs for a Socially Vulnerable Population.

This study identified risk factors for health and access to healthcare services of migrants during their journey across Mexico to the United States. Data were collected in shelters located in Monterrey, the largest city of northeastern Mexico, through a basic clinical examination and a survey completed by 75 migrants; 92% of them were undocumented Central Americans. During their transit, they are at a high risk of contracting, developing, and transmitting diseases. The need of working to survive affects health-seeking behavior and a constant fear of being traced keeps migrants away from public health services, which delays diagnosis and treatment of diseases. Negligent lifestyles, such as smoking, drinking (31.8% of men and 11.1% of women), and drug abuse (13% of men and 11% of women), were found. Regarding tuberculosis (TB), undocumented migrants are usually not screened, even though they come from countries with a high TB burden. Besides, they might be overexposed to TB because of their living conditions in overcrowded places with deficient hygiene, protection, and malnutrition (54.7% of the sample). Possible comorbidities like acquired immune deficiency syndrome (AIDS; 4%) and diabetes (2.7%, but probably under-diagnosed) were referred. Migrants have little TB knowledge, which is independent of their level of education or a previous experience of deportation. About one-third of the migrants were totally unfamiliar with TB-related symptoms, while 36% had correct knowledge of basic TB symptoms. We conclude that a shortage of information on the highly vulnerable migratory population combined with a lack of social support and health education among migrants may play a significant role in the spread of communicable diseases. We recommend that health authorities address this urgent, binational, public health concern in order to prevent outbreaks of emerging infections.

Una década de monitoreo de plomo en sangre en niños escolares del área metropolitana de Monterrey, NL / A decade of lead monitoring in schoolchildren in the metropolitan area of Monterrey NL, Mexico

Objetivo. Establecer las concentraciones de plomo (Pb) en sangre en niños escolares de 1998 y 2008, así como su asociación con factores de riesgo. Material y métodos. Se llevó a cabo un monitoreo de Pb en sangre de niños de entre 6 y 12 años que cursan educación primaria en 17 escuelas diferentes, ubicadas en distintas zonas del área metropolitana de Monterrey, de 1998 a 2008. Resultados. Se obtuvieron niveles séricos de 9.6 ± 3.0 (µg/dL rango de 3.18 a 20.88) en 1998 y de 4.5±4.8 µg/dL (rango de 3.3 a 53.7) en 2008, lo que mostró una disminución de 2.1 veces en nivel de Pb (p<0.01). Conclusiones. La reducción de los niveles séricos de Pb demuestran los mejores controles ambientales e industriales y probablemente el éxito de retirar el Pb de la gasolina durante los años noventa.

Objective. To establish the blood lead concentration and associated risk factors in schoolchildren during 1998 and 2008. Materials and methods. A blood lead screening was conducted in schoolchildren of 6-12 years of age, enrolled in 17 elementary schools of the metropolitan area of Monterrey, México, during 1998 and 2008. Results. The mean blood lead level were 9.6 ± 3.0 (µg/dL range of 3.18 to 20.88) in 1998 and 4.5±4.8 µg/dL (range of 3.3 to 53.7) showing a 2.1-times reduction in blood lead levels (p<0.01). Conclusions. This reduction in blood lead levels demonstrate environmental and industrial control improvements and the benefits of fading out the leaded gasoline during the 1990's.

Desarrollo de la capacidad de identificar y reportar eventos adversos en estudiantes de pregrado / Development of the capacity of detecting and reporting adverse events in undergraduate students

Introducción: en los sistemas de reporte de eventos adversos es poco común que se integren estudiantes de pregrado. Es importante que puedan desarrollar la competencia/cultura de identificación y reporte de eventos adversos y esto permitirá el incremento de información para los hospitales/sistemas de salud. Objetivo: describir cómo la capacitación permite fomentar la cultura de reporte de eventos adversos entre estudiantes de Medicina, Nutrición e Ingeniería biomédica. Métodos: estudio retrospectivo, transversal, y analítico de reportes de eventos adversos descritos por estudiantes de Medicina, Nutrición e Ingeniería biomédica y residentes de calidad en Medicina. Se clasificaron los eventos adversos, cuasifallas y centinelas. Las variables de correcto y completo fueron identificadas y la información de reportó con estadísticas descriptivas con los programas STATA Ver. 8.0. Resultados: se recabaron 203 reportes. Los estudiantes fueron de: Medicina 157, Ingeniería biomédica 28, Nutrición 13 y residentes de calidad 7. El 37 % (73 casos) fueron reportes correctos y 52 % (104) fueron completos. Los reportes tanto completos como correctos fueron 19 % (38 casos). Conclusiones: hay partes del reporte de eventos adversos que tienden a no reportarse, limitando el análisis de estos. Se requiere seguir enfatizando en los estudiantes de pregrado la importancia de estos reportes y de que sean llenados sin evadir datos. La competencia de identificación de eventos adversos en estudiantes puede ser determinante para mejorar los sistemas de reporte de eventos adversos, puede fortalecer la cultura de reporte de eventos adversos y todo esto puede mejorar la seguridad del paciente.

Introduction: the involvement of undergraduate students in the systems of adverse event reporting is infrequent. It is then important that they can develop the competence and the culture of identifying and reporting adverse events that will allow providing more information for hospitals and health care systems. Objective: to describe how training makes it possible to encourage the culture of reporting adverse events in medical, nutrition and biomedical engineering students. Methods: retrospective, cross-sectional and analytical study of reports of adverse events described by medical, nutrition and biomedical engineering students as well as medical residents. The adverse events, quasi-faults and sentinels were all classified. The variables called correct and complete were identified and the information was presented with summary statistics using STATA 8.0 programs. Results: two hundred and three reports were collected. The participants were 157 medical students, 28 from biomedical engineering, 13 from nutrition and 7 quality medical residents. In this group, 37 % (73 cases) were correct reports and 52 % (104 cases) were complete. Complete and correct reports represented 19 % (38 cases). Conclusions: some part of the adverse reports tended to be unreported, thus restricting their analysis. It is required to continue insisting on all the undergraduate students about the importance of these reports and of duly and completely filled them in. The competence of identification of adverse events of the students could be determining to improve the systems of adverse event reporting, could strengthen the culture about this process and all this may lead to the improvement of the patient safety.