Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial.

INTRODUCTION: Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions. METHODS AND ANALYSIS: People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences. TRIAL REGISTRATION NUMBER: NCT06046326.

Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial.

Aim: To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods: An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results: Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion: The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.

Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis.

Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].

Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists.

This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program.

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis.

BACKGROUND: Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. METHODS: We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. RESULTS: Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). CONCLUSIONS: Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. TRIAL REGISTRATION: International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723 .

Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad / Mobile applications to improve drug adherence: Review and quality analysis

Objetivo: Revisar las aplicaciones móviles en español para mejorar la adherencia farmacológica y evaluar sus características y calidad con el fin de identificar aplicaciones de alta calidad. Médoto: Se ha hecho una revisión siguiendo un procedimiento por pasos similar a una revisión sistemática de la literatura. La fuente de los datos han sido plataformas de distribución digital de aplicaciones móviles Apple Apps Store y Google Play Store. Se han seleccionado aquellas aplicaciones dirigidas a apoyar la autogestión de los medicamentos, capaces de generar recordatorios, en español, actualizadas en los últimos 2 años y gratuitas. Los análisis de las aplicaciones se han hecho según un conjunto de características consideradas deseables y evaluación de la calidad con la herramienta Mobile App Rating Scale. Resultados: De 708 aplicaciones, se seleccionaron 3. Las aplicaciones Medisafe y Mytherapy presentaron el 89% y el 78% de las características deseables, respectivamente. La aplicación de Sergio Licea presentó el 56%. La mayor puntuación global de calidad la obtuvo MyTherapy (3,79/5; RIQ: 3-4), seguida de Medisafe (3,72/5; RIQ: 3-4) y, por último, Sergio Licea (2,87/5; RIQ: 2-4). La valoración de la calidad es coincidente con la hecha por los usuarios. Hay muchas aplicaciones disponibles, sin embargo, la mayoría no cumplieron los criterios de selección establecidos. Conclusiones: Através de un proceso sistemático por pasos, identificamos la aplicación de mayor calidad en español para que sea probada en un estudio futuro, que proporcionará evidencia sobre el uso de una intervención multicomponente para mejorar la adherencia a la medicación.(AU)

Objective: To review the mobile apps in the Spanish market to improve adherence to medications and evaluate their characteristics and quality to identify high-quality applications. Method: A review was carried out following a stepwise procedure similar to a systematic review of the scientific literature. Apple Apps Store and Google Play Store mobile application digital distribution platforms. Applications aimed at supporting self-management of treatment, which generate reminders, in Spanish, updated in the last 2 years and free. We evaluate the applications according to a set of characteristics considered desirable and the quality with the Mobile App Rating Scale tool. Results: Out of 708 applications, 3 applications were selected. The Medisafe and Mytherapy applications had 89% and 78% of the desirable characteristics, respectively. Sergio Licea's application only had 56%. The highest global quality score was obtained by the MyTherapy application (3.79/5, IQR: 3-4), followed by Medisafe (3.72/5, (IQR: 3-4) and, finally, Sergio Licea (2.87/5, IQR: 2-4). The quality assessment coincides with the user assessment. There are many available applications, however, most did not meet the selection criteria. Conclusions: A systematic stepwise process was able to identify the quality application to be tested in a future study that will provide evidence on the use of a multicomponent inter.(AU)

[Mobile applications to improve drug adherence: Review and quality analysis]. / Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad.

OBJECTIVE: To review the mobile apps in the Spanish market to improve adherence to medications and evaluate their characteristics and quality to identify high-quality applications. METHOD: A review was carried out following a stepwise procedure similar to a systematic review of the scientific literature. Apple Apps Store and Google Play Store mobile application digital distribution platforms. Applications aimed at supporting self-management of treatment, which generate reminders, in Spanish, updated in the last 2 years and free. We evaluate the applications according to a set of characteristics considered desirable and the quality with the Mobile App Rating Scale tool. RESULTS: Out of 708 applications, 3 applications were selected. The Medisafe and Mytherapy applications had 89% and 78% of the desirable characteristics, respectively. Sergio Licea's application only had 56%. The highest global quality score was obtained by the MyTherapy application (3.79/5, IQR: 3-4), followed by Medisafe (3.72/5, (IQR: 3-4) and, finally, Sergio Licea (2.87/5, IQR: 2-4). The quality assessment coincides with the user assessment. There are many available applications, however, most did not meet the selection criteria. CONCLUSIONS: A systematic stepwise process was able to identify the quality application to be tested in a future study that will provide evidence on the use of a multicomponent intervention to improve medication adherence.

Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study.

AIMS: To evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD). METHODS: We conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD. RESULTS: A total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03-1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7-8% (53-64 mmol/mol) (OR 1.24; 95% CI: 1.05-1.47) and 8-9% (64-75 mmol/mol) (OR 1.31; 95% CI: 1.04-1.66). CONCLUSIONS: Poor glycemic control reveals a weak association with increased risk of COPD in T2D patients.

Pre-deployment dissociation and personality as risk factors for post-deployment post-traumatic stress disorder in Danish soldiers deployed to Afghanistan.

Objective: This study investigated whether pre-deployment dissociation was associated with previously identified post-traumatic stress disorder (PTSD) symptom trajectories from before to 2.5 years after military deployment. Furthermore, it examined whether the tendency to dissociate, pre-deployment personality factors, conceptualized by the Big Five model, and previous trauma represented independent risk factors for post-deployment PTSD symptoms. Method: This prospective study included the entire team of 743 soldiers from the Danish Contingent of the International Security Assistance Force 7 deployed to Afghanistan in 2009. Data consisted of self-report measures and were collected six times: before deployment; during deployment; and 1-3 weeks, 2 months, 7 months and 2.5 years after homecoming. Results: The findings indicate significant associations between pre-deployment dissociation and six PTSD trajectories (p < 0.001, η2 = 0.120). Based on mean differences in dissociation for the six trajectories, two main groups emerged: a group with high dissociation scores at pre-deployment, which had moderate PTSD symptom levels at pre-deployment and fluctuated over time; and a group with low dissociation scores at pre-deployment, which had low initial PTSD symptom levels and diverged over time. Our study also confirmed previous findings of a positive association between neuroticism and dissociation (r = 0.31, p < 0.001). This suggests that negative emotionality may be a vulnerability that enhances dissociative experiences, although a causal link cannot be concluded from the findings. Finally, pre-deployment dissociation, pre-deployment neuroticism and a history of traumatic events, as independent factors, were significant predictors of post-deployment PTSD (p < 0.001, R2 = 0.158). Conclusions: The study emphasizes the multiplicity of factors involved in the development of PTSD, and group differences in dissociative symptoms support the heterogeneity in PTSD. Further, this study points to specific aspects of personality that may be targeted in a clinical setting and in pre-deployment assessments in the military.

Objetivo: En este estudio investigamos si la disociación previa a un despliegue militar estaba asociada con trayectorias de síntomas de TEPT previamente identificadas desde antes hasta 2,5 años después del despliegue militar. Además, examinamos si la tendencia a disociarse, los factores de personalidad previos al despliegue, conceptualizados por el modelo Big Five y el trauma previo, representaban factores de riesgo independientes para los síntomas de TEPT posteriores al despliegue.Método: El estudio prospectivo actual incluyó a todo el equipo de 743 soldados del contingente danés de la Fuerza de Asistencia Internacional a la Seguridad Internacional 7 desplegados en Afganistán en 2009. Los datos consistieron en medidas de autoinforme, y se recogieron 6 veces: antes del despliegue, durante el despliegue. 1­3 semanas después del regreso al hogar, 2 meses después del regreso al hogar, 7 meses después del regreso al hogar y 2.5 años después del regreso al hogar.Resultados: Los hallazgos indican asociaciones significativas entre la disociación previa al despliegue y seis trayectorias de TEPT (p < 0.001, η2 = 0.120), y en base a diferencias medias en la disociación para las seis trayectorias surgieron dos grupos principales: Un grupo con puntuaciones de disociación altas previas al despliegue, que tenían niveles moderados de síntomas de TEPT antes del despliegue y fluctuaban con el tiempo. Un segundo grupo con puntuaciones de disociación bajas previas al despliegue, que tenían bajos niveles iniciales de síntomas de TEPT y divergían con el tiempo. Además, nuestro estudio confirmó los hallazgos previos sobre una asociación positiva entre el neuroticismo y la disociación (r = 0.31, p < 0.001). Esto podría sugerir que la emocionalidad negativa puede ser una vulnerabilidad que aumenta las experiencias disociativas, aunque no se puede concluir un vínculo causal a partir de los hallazgos. Finalmente, la disociación previa al despliegue, el neuroticismo previo al despliegue y una historia de eventos traumáticos, como factores independientes, fueron predictores significativos de TEPT posterior al despliegue (p < 0.001, R2 = 0.158).Conclusiones: El estudio enfatiza la multiplicidad de factores involucrados en el desarrollo del TEPT y las diferencias grupales en los síntomas disociativos apoyan la heterogeneidad en el TEPT. Además, este estudio apunta a aspectos específicos de la personalidad en los que se puede trabajarse en un entorno clínico, así como en las evaluaciones previas al despliegue en el ejército.

Particularidades de la educación sexual en Cuba / Peculiarities of sex education in Cuba

Se expone un estudio evolutivo de las particularidades del proceso de la educación de la sexualidad en Cuba desde los puntos de vista pedagógico, psicológico y sociológico, en el cual se utilizó el método histórico-lógico para la determinación de las tendencias históricas. Asimismo, para el análisis se empleó el enfoque teórico-metodológico del proceso de educación de la sexualidad en la crítica social, implementado en el Programa Nacional de Educación Sexual elaborado por el Centro Nacional de Educación Sexual (CENESEX) y se identificaron 4 etapas de su desarrollo, así como las tendencias en sus transformaciones(AU)

A developmental study of peculiarities of the sex education process in Cuba from the pedagogical, psychological and sociological points of view is presented, which used the historical and logical method for determining historical trends. Also, the analysis was performed using the theoretical and methodological approach to the process of sex education in social criticism, implemented in the National Sex Education Program developed by the National Center of Sex Education(CENESEX), and 4 stages of its development were identified, as well as the trends in its transformations(AU)

Particularidades de la educación sexual en Cuba / Peculiarities of sex education in Cuba

Se expone un estudio evolutivo de las particularidades del proceso de la educación de la sexualidad en Cuba desde los puntos de vista pedagógico, psicológico y sociológico, en el cual se utilizó el método histórico-lógico para la determinación de las tendencias históricas. Asimismo, para el análisis se empleó el enfoque teórico-metodológico del proceso de educación de la sexualidad en la crítica social, implementado en el Programa Nacional de Educación Sexual elaborado por el Centro Nacional de Educación Sexual (CENESEX) y se identificaron 4 etapas de su desarrollo, así como las tendencias en sus transformaciones.

A developmental study of peculiarities of the sex education process in Cuba from the pedagogical, psychological and sociological points of view is presented, which used the historical and logical method for determining historical trends. Also, the analysis was performed using the theoretical and methodological approach to the process of sex education in social criticism, implemented in the National Sex Education Program developed by the National Center of Sex Education(CENESEX), and 4 stages of its development were identified, as well as the trends in its transformations.

Fly ash from a Mexican mineral coal I: Mineralogical and chemical characterization.

The properties of coal fly ash are strongly dependent on the geological origin and the combustion process of the coal. It is important to characterize regional fly ash in detail to ascertain its potential uses as raw material in the production of high value products. The physicochemical properties of fly ash coming from the "Jose Lopez Portillo" coal-fired power plant, Coahuila, Mexico (MFA), are presented in this work. A detailed study of trace elements, the chemical composition of the amorphous phase, thermal stability and the leaching of contaminant elements under different conditions are included. MFA is composed of mullite, quartz, calcite, magnetite and an amorphous phase. This material contains mainly silica (59.6%), alumina (22.8%) and magnetite (5.6%). Its amorphous phase (78.3%) has a high silica (49.4%) and alumina (14.4%) content. According to its mineralogical and chemical composition, MFA is potentially useful as a raw material for making cement, silica, and alumina, as well as low silica/alumina ratio zeolites. Deleterious elements could be removed during the zeolitization process or with an additional acid treatment. Because of its morphological properties and structural and thermal stability, MFA can be used in thermal isolation and refractory materials and as a support for heterogeneous catalysts.

Perfil académico del personal de enfermería en el Instituto Mexicano del Seguro Social 2005-2006 / Academic profile of nursing personnelin the Instituto Mexicano del Seguro Social, 2005-2006

Introducción: El Instituto Mexicano del Seguro Social (IMSS) es el principal proveedor de servicios de salud en México. La creciente demanda de enfermedades crónico-degenerativas lo han obligado a reorganizar y descentralizar la atención, esto requiere de acciones estratégicas que fortalezcan la fuerza de trabajo. A partir de 2001 en el Instituto se implantó un Programa de Profesionalización con el propósito de incrementar el nivel profesional hasta lograr el grado académico de licenciatura del personal de enfermería. Objetivos: Determinar el nivel académico del personal de enfermería del IMSS. Metodología: De un total de enfermeras en el Régimen Obligatorio de 86,088 y en IMSS-Oportunidades de 11,603 se autoaplicó un cuestionario de 28 preguntas cerradas en relación a las características personales, laborales y académicas del personal que se encontraba en ese momento en las unidades. Se utilizó análisis descriptivo. Resultados: Contestaron la encuesta 77.8% de Régimen Obligatorio y 90.2% de IMSS-Oportunidades, 17% del personal de enfermería del Régimen Obligatorio y 5% del personal de enfermería de IMSS-Oportunidades cuentan con licenciatura. La mitad del personal encuestado realizó la licenciatura a través de Sistema Universitario Complementario. Tres cuartas partes del personal en el primer nivel ya cuentan con estudios técnicos. Conclusiones: Cabe destacar que el porcentaje del personal de enfermería con licenciatura aumentó de 9.3 a18% en el Régimen Obligatorio, sin embargo, es indispensable que el IMSS continúe con este Programa de Profesionalización, a fin de propiciar la igualdad de oportunidades para mejorar el nivel académico del personal de enfermería.

Introduction: The Mexican Social Security Institute (IMSS) is the main supplier of health services in Mexico. Due to the increasing demand of chronical-degenerative diseases the institute has been obliged to reorganize and decentralize health attention, this requires of strategical actions in order to strengthen work force. The institute implemented a professional programme with the intention of increasing the professional level up to an academical bachalorate degree from nursery staff. Objective: To determine academical degree from nursery staff. Methodology: It was autoapplied a questionnarie of 28 closed questions to staff working in the units at that very moment. From a total amount of 86,088 nurses within Obligatory Regimen and an amount of 11,603 from IMSS-Oportunidades. Descriptive analysis was done. Results: This survey was answered by 77.8% from Obligatory Regimen and 90.2% from IMSS-Oportunidades, 17% from obligatory system nursery staff and 5% IMSS-Oportunidades nursery staff are allready bachalorated. Half of surveyed staff got their bachalorate from Complementary University System. The third part of firts level staff already have thecnical degree studies. Conclusions: There is a significant percentage result in bachalorates within nursery staff (9.3 to 18%) in obligatory system. Nevertheless it is of great importance that IMSS keeps on providing professional programmes in order to give the same opportunities to improved academical level in nursery staff.

RET oncogene mutations in medullary thyroid carcinoma in Mexican families.

BACKGROUND: Different RET oncogene mutations have been found to be associated with inherited medullary thyroid carcinoma (MTC) in the context of three different syndromes including multiple endocrine neoplasia types 2A (MEN 2A) and 2B (MEN 2B) and familial medullary thyroid carcinoma (FMTC). These mutations have been recorded in different populations, but to date there is no corresponding study in Mexican families. Our purpose was identification of RET mutations in Mexican families with inherited or sporadic MTC (SMTC) and search for RET protein expression as prognostic marker in MTC tumors. METHODS: Nine unrelated families with MTC corresponding either to two MEN 2A, three MEN 2B, or four SMTC were studied. Screening of exons 10, 11, and 13-16 of RET oncogene in DNA from circulating lymphocytes and tumor samples were analyzed. Immuno- staining for RET was performed in the corresponding tumor. RESULTS: Germline 918 ATG-->ACG RET mutation was present in three unrelated MEN 2B individuals and corresponding somatic mutation in one individual with SMTC; 634 TGC-->TTC RET mutation was detected in two related patients in an MEN 2A family and the 634 TGC-->TAC RET mutation was detected in 12 related individuals from a second MEN 2A family. RET protein expression was detected in all MTC tumors showing different staining intensity. CONCLUSIONS: RET mutations found in Mexican patients with MTC are similar to those previously reported in several MTC families worldwide. This indicates that RET mutations are highly conserved and that MTC etiology does not depend to a great extent on environmental factors or ethnic differences. Detection of RET protein in MTC tissue sections is not useful as prognostic marker.

Tumor mesenquimatoso gigante de la vulva con comportamiento clínico atípico / A giant mesenchymal tumor of the vulva showing atypical clinical crolotion. Clinical report

Los tumores del mesénquima de la vulva son poco frecuentes. Por otra parte, el angiomixoma de comportamiento clínico agresivo es una lesión recientemente caracterizada que se presenta principalmente en los tejidos blandos de la pelvis y tiene tendencia a recurrir localmente. Las variedades benignas suelen ser de dimensiones menores y generalmente se confunden con quistes de la glándula de Bartholin. En este trabajo se describe el caso de un tumor mesenquimatoso mixto gigante y benigno de la vulva con características clínicas atípicas

Teratoma sacrococcígeo. Una urgencia quirúrgica neonatal / Sacrococcygeal teratoma. A neonatal surgical urgency

Los autores informan el caso de un recién nacido quien tuvo un tumor muy vascularizado, variante rara de teratoma sacrococcígeo. Presentó insuficiencia cardiaca congestiva y anemia lo cual ocasionó su fallecimiento. Se revisó la literatura para hacer sugerencias respecto al diagnóstico prenatal y al manejo quirúrgico urgente de esta variante de teratoma sacrococcígeo en la etapa neonatal