The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review.

BACKGROUND: The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. OBJECTIVE: This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. METHODS: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. RESULTS: No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. CONCLUSIONS: This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient's physical and mental health, and reducing the disease burden. TRIAL REGISTRATION: PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41555.

Prescription of Physical Activity: How Does the Internist Perceive it?

OBJECTIVE: To assess the meaning of a physical activity prescription (PAP) from the physician's point of view and to examine current PAP-related clinical practices and stage of change, including the factors that influence them. METHODS: Mixed methodology was applied to obtain valid, high-quality data. During the qualitative phase, the "free-listing" technique was used to explore the "cultural domain" of a physician's perception of PAP, as well as the construction of culturally relevant items used during the last phase of the study. A survey was conducted to evaluate clinical practices, attitudes, and physician state of change regarding PAP. The convenience sample of 58 (qualitative phase) and 350 internists (quantitative phase) who attended the International Congress of Internal Medicine was interviewed. RESULTS: A majority of internist reported having adequate knowledge, positive attitude, being in the maintenance phase with no barriers to prescribe physical activity (PA). Prescription was associated with physician training, their workplace, and experience. However, physicians do not satisfactorily evaluate the level of patient's PA nor recommend an adequate level of PA, which is necessary to achieve health goals. CONCLUSIONS: Physicians had great acceptance of PAP. However, there were low levels of knowledge of current PA guidelines, although most physicians thought they had sufficient knowledge. Training seems to be an excellent way to improve PAP.

[High-intensity chemotherapy versus palliative chemotherapy in patients over 60 years with acute myeloid leukemia]. / Quimioterapia intensa frente a quimioterapia paliativa en pacientes con leucemia mieloblástica mayores de 60 años.

BACKGROUND: The use of high-intensity chemotherapy (HIC) for acute myeloid leukemia (AML) in the elderly is controversial. In the present study, it was assessed complete remission and overall survival of AML patients over 60 years treated with HIC or palliative chemotherapy. METHODS: Patients with ECOG ≤ 2 and adequate organic function received HIC with a base of cytarabine for five or seven days, and an anthracycline for three days. If patients achieved complete remission of leukemia, they received one or two cycles of consolidation with cytarabine. Palliative treatment consisted of supported measures and/or oral or intravenous low-dose chemotherapy. RESULTS: Seven patients treated with HIC achieved complete remission versus only one in the palliative group. Only one patient died during HIC treatment. Median survival for HIC-treated patients was 13.25 months, and only 3.35 months for patients treated with palliative therapy (p < 0.05). CONCLUSION: AML patients of 60 years or older, with good performance status (ECOG ≤ 2) and adequate organ function, may benefit from HIC treatment, with better survival, compared with palliative therapy.

Introducción: el tratamiento con quimioterapia intensa (QTI) en pacientes con leucemia mieloblástica (LMA) mayores de 60 años es controversial. En el presente estudio se evaluó la remisión completa y la supervivencia global de pacientes con LMA mayores de 60 años, tratados con QTI o quimioterapia paliativa. Métodos: los pacientes con adecuada función orgánica y ECOG ≤ 2 recibieron QTI a base de citarabina por cinco o siete días más un antracíclico por tres días y terapia de soporte. En caso de lograr remisión completa de la leucemia recibieron uno o dos ciclos de consolidación con citarabina. El tratamiento paliativo consistió en medidas de soporte o quimioterapia oral o intravenosa en dosis bajas. Resultados: del grupo de QTI siete pacientes alcanzaron remisión completa, comparados con uno del grupo de quimioterapia paliativa. La supervivencia global fue de 13.25 meses para los pacientes con QTI y de 3.35 meses para los pacientes de quimioterapia paliativa (p < 0.05). Conclusión: es posible que los pacientes con LMA mayores de 60 años de edad se beneficien de recibir QTI, comparada con la quimioterapia paliativa.

Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition.

BACKGROUND: There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN. METHOD: Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement. RESULTS: One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000). CONCLUSION: High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.

Medicamentos biocomparables en México: la postura del Colegio Mexicano de Reumatología, 2012 / Biosimilar drugs in Mexico: Position of the Mexican College of Rheumatology, 2012

Los medicamentos biotecnológicos (MBT) son moléculas complejas cuyo proceso de elaboración impide replicar con gran exactitud la sustancia original, por lo que no existe una equivalencia absoluta entre el fármaco original (innovador) y el biocomparable. Los MBT han probado su eficacia en diversas afecciones reumáticas, aunque su alto coste impide su utilización en muchos pacientes. Diversas patentes de medicamentos biotecnológicos han expirado o expirarán próximamente, detonando así el desarrollo de fármacos estructuralmente similares y probablemente con eficacia y seguridad comparable a los medicamentos innovadores, aunque estas características deben ser probadas. La Ley General de Salud Mexicana actual contempla el registro de estos medicamentos para su utilización en nuestro país. Este documento es una reflexión de miembros del Colegio Mexicano de Reumatología, farmacólogos e investigadores en epidemiología, en conjunción con nuestras autoridades sanitarias, sobre los estudios científicos necesarios de los biocomparables previos y posterior a su incursión en el mercado mexicano (AU)

Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market (AU)

Biosimilar drugs in Mexico: position of the Mexican College of Rheumatology, 2012.

Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market.

Effects of a physical activity program on markers of endothelial dysfunction, oxidative stress, and metabolic status in adolescents with metabolic syndrome.

The metabolic syndrome (MetS) is a precursor of diabetes. Physical activity (PA) improves endothelial dysfunction and may benefit patients with MetS. Aims. To evaluate the effect of a physical activity (PA) program on markers of endothelial dysfunction and oxidative stress in adolescents with (MetS). Methods. We carried out a cohort study of 38 adolescents with and without MetS (18 females and 20 males). All participants completed a 3-month PA program. All variables of the MetS as well as markers of endothelial dysfunction and oxidative stress tests were evaluated. Results. Females with and without MetS showed significant differences for almost all components of the MetS, whereas males were significantly different in half of the components. After the PA program, components of the MetS were not different from baseline values except for HDL-C levels. Some baseline endothelial dysfunction markers were significantly different among adolescents with and without MetS; however, after the PA program, most of these markers significantly improved in subjects with and without MetS. Conclusion. PA improves the markers of endothelial dysfunction in adolescents with MetS although other changes in the components of the MetS were not observed. Perhaps the benefits of PA on all components of MetS would appear after a PA program with a longer duration.

Impact of nutritional support on length of hospitalization and mortality in children after open heart surgery

Background. Malnutrition is a common cause of morbidity in children with congenital heart disease (CHD). The aim of this study was to assess the impact of malnutrition and nutritional support on the length of hospitalization and mortality at the Pediatric Intensive Care Unit (PICU) in children with CHD after undergoing surgery. Methods. Clinical records (2000-2008) of patients £3 years old with CHD who were admitted for surgery were evaluated for nutritional status, nutritional support, and risk factors. Mortality was evaluated from the beginning of surgery and during the patient's stay at the PICU. Long-term hospitalization was considered according to the length of hospital stay on percentile >50. A multiple logistic regression model was used. Results. Two hundred eighty nine patients were included. Factors related to mortality were malnutrition before surgery (OR 3.447; 95% CI 1.006-11.812, p = 0.049), early or delayed enteral nutrition (OR 0.007; 95% CI 0.000-0.097, p = 0.000, and OR 0.011; 95% CI 0.001-0.126, p = 0.000, respectively), and early parenteral nutrition (OR 0.032; 95% CI 0.002-0.452, p = 0.000) vs. no nutritional support. Factors related to long-term stay were malnutrition at birth (OR 2.772; 95% CI 1.282-5.995, p = 0.010) and delayed parenteral nutrition (OR 12.049; 95% CI 1.626-94.724, p = 0.015). Conclusion. Malnutrition at birth and before surgery increases length of stay and mortality of children after open heart surgery. Early nutritional support reduces length of stay and mortality.

Incidencia de delirium y morbilidad asociada en Medicina Interna / Delirium in inpatients

Para evaluar la incidencia de delirium en pacientes hospitalizados en el Servicio de Medicina e identificar la comorbilidad asociada al trastorno, se aplicó el CAM (Método de Evaluación de la Confusión), el MMSE (Exámen Mínimo del Estado Mental de Folstein) y el subtest de dígitos de WAIS (Escala de Inteligencia Wechsler para el adulto). En los primeros 7 días de internación se identificó que el 15,9 por ciento de los pacientes internados en la Unidad de Medicina Interna desarrollaron delirium. La comorbilidad que se encontró más asociada al delirium fué la diabetes mellitus (p menor 0,02); la hipertensión arterial no alcanzó significación estadística (p menor 0,10)

Incidencia de delirium y morbilidad asociada en Medicina Interna / Delirium in inpatients

Para evaluar la incidencia de delirium en pacientes hospitalizados en el Servicio de Medicina e identificar la comorbilidad asociada al trastorno, se aplicó el CAM (Método de Evaluación de la Confusión), el MMSE (Exámen Mínimo del Estado Mental de Folstein) y el subtest de dígitos de WAIS (Escala de Inteligencia Wechsler para el adulto). En los primeros 7 días de internación se identificó que el 15,9 por ciento de los pacientes internados en la Unidad de Medicina Interna desarrollaron delirium. La comorbilidad que se encontró más asociada al delirium fué la diabetes mellitus (p menor 0,02); la hipertensión arterial no alcanzó significación estadística (p menor 0,10)

La utilidad de la escala de ASA y de la radiografía de tórax como indicadores de riesgo cardiovascular perioperatorio / The uselfuness of the ASA Scala and Chest X-ray As indicators of perioperative cardiovascular risk

El objetivo del presente trabajo es evaluar la utilidad de las escalas más utilizadas en el riesgo peroperatorio, sin considerar a la gasometría arterial. Con los resultados obtenidos en este estudio, proponemos conjuntar la escala de la Asociación Americana de Anestesiología (ASA), el diagnóstico radiográfico de EPOC con el índice de riesgo multifactorial de Goldman. Esta estrategia incrmenta lacerteza diagnóstica propia del índice de Goldman, es práctica, no implica mayor costo y permite obtener una mayor graduación del riesgo de morbilidad cardiovascular perioperatoria

Análisis de varianza de un factor / Variance analysis of a factor

El análisis de varianza es una herramienta analítica cuando se comparan más de dos grupos independientes; consiste en la partición de los componentes de la variación total presente en un grupo de datos. Cada componente se atribuye a una causa identificable o fuente de variación, además, se estima la variación debida a factores no controlados y a errores al azar asociados con las mediciones de respuesta. El análisis de varianza se utiliza cuando se quiere determinar si las diferencias observadas son mayores que las esperadas sólo para el azar; es decir; que las diferencias son reales y no son dadas sólo por la casualidad. Como en otras pruebas, se debe seleccionar un nivel de significancia llamado nivel alfa, Cuando hay diferencias significativas, deberá buscarse en cuáles pares de grupos eastán esas diferencias. Si no existen, simplemente se declara que no las hay sin hacer más pruebas.

Encuesta de opinión sobre el proceso de enseñanza-aprendizaje de médicos residentes durante su formación en la especialidad / Poll concerning the teaching-learning process of medical residents throghout their course of specialization

Se realizó un estudio transversal descriptivo, aplicando una encuesta de opiniones sobre el proceso de enseñanza-aprendizaje a 212 médicos egresados de 22 cursos de especialización del Hopsital de Especialidades. Se exploraron aspectos relacionados con el programa académico, estrategias de aprendizaje y evaluación, relaciones humanas y escenario académico. Las estrategias que se consideraron de mayor impacto para su aprendizaje fueron la grupal, tutorial y mixta. Las relaciones interpersonales inadecuadas, fueron señaladas como un obstáculo en el proceso enseñanza-aprendizaje. Consideran que las instalaciones académicas son adecuadas y que la bilioteca debería ampliarse en espacio y horario. Entre las sugerencias más relevantes se encuentran el incremento en el apoyo tutorial y en las actividades en aula, así como un decremento en las cargas de trabajo. Un buen número de alumnos aún encuentran difícil integrarse al sistema activo-participativo, por lo que sería conveniente la planeación y programación de actividades que ayuden al paso gradual de la educación tradicional a la educación activa

Regresión lineal simple / Simple linear regresion

El diagnóstico clínico, la decisión terapéutica y el pronóstico de una enfermedad están basados en la experiencia del médico para identificar cada uno de los síntomas y signos del paciente, y en establecer una relación de probalididad entre ellos y una enfermedad o desenlace. Entre los diseños estadísticos que permiten estimar una predicción, se encuentra el análisis de regresión lineal simple, el cual calcula el valor de una variable a partir de otra, a través de la ecuación de la línea de regresión (y= a+bx); siempre que se trate de variables cuantitativas continuas, con distribución normal y con varianzas homogéneas. Deberá quedar claro que la predicción de "y" a partir de "x" no significa causalidad. Además, existen otras curvas de regresión no lineal que permiten estimar "y" a partir de "x". El presente artículo describe el procedimiento del análisis de regresión con el fin de que el clínico reconozca su significado y aplicación