Clinical profile and management of a Spanish single-center retrospective cohort of patients with post-chikungunya associated complications.

BACKGROUND: This study aims to describe post-chikungunya complications chronically developed cases in returning travelers from some epidemic/endemic regions, and the variables that are associated with the progression of acute or subacute cases to the chronic phase. METHODS: This single-center retrospective cohort study included chikungunya fever cases treated at La Paz-Carlos III University Hospital in Madrid, Spain, April 2014 to September 2016, when the chikungunya outbreak in Latin America started through the time of its greatest impact. RESULTS: The analysis included 119 cases. Of these, 67.2 % were male, with a median age of 41.0 years [IQR 16.0 to 76.0] years. Only 25.6 % of the patients attended a pre-travel advice consultation. Most patients reported arthralgias, which significantly impacted their daily quality of life (86 %). The mean duration of joint symptoms was 129.4 days, with a median of 90 days [IQR 0 to 715]. Factors found to be associated with chronic arthralgia include female sex, country of infection, age at diagnosis, previous diseases, symptoms during the acute phase, pain in previously injured tendons/joints, acute phase severity, and various laboratory markers such as hemoglobin, hematocrit, total serum bilirubin, and creatinine. Progression to chronic arthralgia significantly increased the need for changes in daily activity. Furthermore, 42.6 % of patients with chronic arthralgia reported recurrence of symptoms once they felt they had disappeared. Targeted treatment regimens led to significant improvements in these patients. CONCLUSIONS: The results of this study underscore the need for: (1) comprehensive pre-travel advice; (2) effective management of patients in specialized units, alongside early diagnosis and treatment, to prevent trivialization of these viral infections; and (3) the development of interdisciplinary recommendations to assist physicians in treating patients and enhancing outcomes.

Morphologic and genetic variation within a relict Andean catfish, Hatcheria macraei , and its relationship with Trichomycterus areolatus and Bullockia maldonadoi (Siluriformes: Trichomycteridae).

The South American siluriform fishes are found primarily in the Neotropical region, north and east of the Colorado River of Argentina, with a few relict species distributed southward and westward on both sides of the Andes Mountains. Three of these, the closely related trichomycterids Hatcheria macraei, Trichomycterus areolatus and Bullockia maldonadoi, have been subject to historical taxonomic and nomenclatural arrangements. Here, we amplify a 652-bp fragment of COI mtDNA from 55 H. macraei individuals and use publicly available Cytb mtDNA sequences of the three taxa to assess their relationship, genetic variation and haplotype distribution in relation to hydrographic basins. In addition, we extend a recent morphometric study on H. macraei by analyzing body shape in 447 individuals collected from 24 populations across their entire cis-Andean distribution. We identified some lineages previously assigned to T. areolatus that show a closer relationship to either B. maldonadoi or H. macraei, revealing new boundaries to their currently known trans-Andean distribution. We found a great morphologic variation among H. macraei populations and a high genetic variation in H. macraei, T. areolatus and B. maldonadoi associated with river basins. We highlight further integrative studies are needed to enhance our knowledge of the southern Andean trichomycterid diversity.

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip.

Transient osteoporosis of pregnancy (TOP) is a self-limiting pathology with unspecified etiology. It is typically found in women in late pregnancy or early postpartum. A femoral neck fracture is an infrequent complication. Herein, we describe a TOP case in a 38-year-old female who suffered a displaced sub-capital femoral neck fracture without obvious trauma at 28 weeks of gestation. The patient underwent operative treatment using closed reduction and internal fixation (CRIF), using cannulated screws, with no intraoperative complications. The postoperative radiograph revealed a collapse and further displacement of the femoral neck. A decision was made to postpone a definitive treatment to a postpartum date. The patient underwent a cesarean section at 38-week of gestation with no complications. At her latest follow-up, 24 months postoperatively, the patient was asymptomatic. Pelvic and hip radiographs demonstrated consolidation of the fracture. Level of evidence: IV.

Three dimensional printing as an aid for pre-operative planning in complex cases of total joint arthroplasty: A case series.

Purpose: Digital templating is an essential aspect of pre-operative planning for total joint arthroplasty procedures. For complex cases of joint reconstruction, the standard templating software is insufficient to achieve the desired accuracy. 3D printing significantly aids the pre-operative planning in complicated cases of joint reconstruction and offers immense potential towards improving outcomes in these cases. The purpose of the present study is to present the various ways in which 3D printing has aided our department in facilitating complex cases of lower extremity reconstruction. Methods: Data was retrospectively retrieved for all patients that underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) with the aid of 3D printing technology at our institution between January 2016-February 2021. Patient pain was determined before and after surgery using the visual analogue scale (VAS). Patient reported outcome measures (PROMs) were additionally analyzed using the hip disability and osteoarthritis outcome score (HOOS) and knee injury and osteoarthritis outcome score (KOOS). Results: The final study population consisted of 39 patients that underwent TKA or THA procedures with the use of 3D printing. Twenty-four (61.5%) of the surgeries in the study were THA procedures, whereas 15 (38.5%) were TKA procedures. The average VAS for patients reduced from 8.4% before surgery to 5.4% after surgery (p < 0.001). The mean KOOS of patients that underwent TKA was 17.33 ± 9.33 (43%) and the mean HOOS of patients that underwent THA was 13.79 ± 6.6 (42%). Conclusions: The following series demonstrates the ability by which 3D printing facilitates complex cases of hip and knee reconstruction. 3D printing offers an improvement in understanding of patient specific anatomy, enhancing patient outcomes. Departments should consider the use of 3D printing technology as an adjunct when performing complex cases of lower extremity reconstruction.

Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle - A series of 14 cases.

BACKGROUND: The surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions. METHODS: All patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures. RESULTS: Fourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients' symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss. CONCLUSION: Navigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.

Bacterial travellers' diarrhoea: A narrative review of literature published over the past 10 years.

Travellers' diarrhoea (TD) is the most frequent illness experienced by international travellers to lower-income countries with bacterial agents considered to account for 80-90% of cases. In this review, we summarise evidence published on bacterial TD over the past 10 years, focusing on the epidemiology and aetiology of TD. Diarrhoeagenic Escherichia coli (DEC) continue to be the most commonly implicated bacteria in TD, although Enteropathogenic E. coli (EPEC) and Enteroaggregative E. coli (EAEC) now appear to be predominant where Enterotoxigenic E. coli (ETEC) was previously considered most prevalent globally. Where fluroquinolone resistance had primarily been documented for Campylobacter in Southeast Asia, widespread resistance has been observed in most regions of the world for multiple enteropathogens, including Shigella, Salmonella, ETEC and EAEC. Implementation of novel molecular methods for pathogen detection has led to identification of bacterial pathogens, including Clostridium difficile (with and without the use of prior antibiotics), Arcobacter species and Bacteroides fragilis, as aetiological agents in TD. The widespread resistance to first-line antibiotics in multiple bacterial enteropathogens warrants continued surveillance and re-evaluation of current treatment practices. Further investigations are required to determine the prevalence and geographical distribution of bacterial enteropathogens that have been more recently implicated in TD.

Tumores gástricos peculiares: tumor glómico, schwannoma, leiomioma y cistoadenoma en el páncreas ectópico. Serie de casos y revisión de la literatura / Unusual gastric tumors: Glomus tumor, schwannoma, leiomyoma, and cystadenoma in ectopic pancreas. A case report and literature review

Resumen Introducción: la patología gástrica es excepcionalmente benigna, se registra a nivel mundial un porcentaje de aparición de las mismas del 0,005 %-4 %. Además de lo anterior, suele plantearse como primer diagnóstico diferencial un carcinoma gástrico, por lo que la mayoría de los pacientes termina en un procedimiento quirúrgico mayor. El objetivo de este estudio fue describir una serie de casos registrados en una institución de alta complejidad, así como la revisión de la literatura al respecto del tema. Pacientes y métodos: se realizó la revisión de las bases de datos del servicio de cirugía general de la Clínica Universitaria Colombia y se encontraron 4 tumores gástricos de presentación inusual, de los cuales se hizo revisión de la historia clínica y las imágenes disponibles (diagnósticas y de las piezas de cirugía). Resultados: en la revisión de la base de datos, se encontraron 4 casos, 2 de sexo femenino y 2 de sexo masculino, con una media de edad de 51 años (26-75 años). El 100 % de los pacientes tenía una lesión en la región antral y solo uno de ellos tenía una segunda lesión a nivel prepilórico. La totalidad de los pacientes fue llevada a gastrectomía subtotal con reconstrucción en Y de Roux por abordaje laparoscópico y la media de estancia hospitalaria fue de 3,5 días (2-6 días). Conclusión: para determinar la mejor opción de tratamiento en general en pacientes con lesiones gástricas siempre hay que considerar tanto las características endoscópicas y endosonográficas como las histológicas.

Abstract Introduction: Gastric pathology is exceptionally benign with a percentage of appearance between 0.005% - 4% worldwide. Moreover, gastric carcinoma is often suggested as the first differential diagnosis and for that reason, the outcome for a vast majority of admitted patients is a major surgical procedure. This study aims to describe a series of cases recorded in a high complexity medical institution and to carry out a literature review related to that subject. Patients and Methods: Databases from the general surgery service of the Clínica Universitaria Colombia were reviewed, and four unusual gastric tumors were found. A review of the related medical records and available images (diagnostic images and surgical elements) was performed. Results: After the database review, four cases were found: two female cases and two male cases, with a mean age of 51 years (26-75 years). All the patients had lesions in the antrum area and only one of them has an additional lesion in the prepyloric region. All patients were treated with a laparoscopic subtotal gastrectomy with Roux-en-Y reconstruction and the mean length of hospital stay was 3.5 days (2-6 days). Conclusion: It is required to consider the endoscopic, endosonographic, and histological examinations and their features to determine the best treatment for patients with gastric lesions.

Mortality trends and risk of dying from liver cancer in Mexico, 2000-2013.

INTRODUCTION: Liver cancer (LC) is a public health problem in the world, since is the second leading cause of death and Mexico is no exception, in 2013 the LC ranked fourth of mortality among malignancies. MATERIAL AND METHODS: The records of mortality associated to LC for the period 2000-2013 were obtained from National Institute of Statistics and Geography. National mortality rates were calculated by state and by socioeconomic region. The strength of association of the states of residency and educational level with mortality from LC was determined. RESULTS: In 2000-2013, the crude death rate per 100,000 people increased from 4.2 to 4.9. Individuals with no schooling or incomplete elementary school the relative risk (RR) of dying from LC was the highest (RR 8.61, 95% CI 8.35-8.89), while in individuals with senior in high school or equivalent the RR decreased (RR 0.74, 95% CI 0.71-0.77). Chihuahua had the highest risk of dying [RR 30.3, 95% CI 19.6-46.8 (2000) and RR 22.3, 95% CI 15.1-33 (2013)]. Region 2 had the highest mortality rate. CONCLUSIONS: In Mexico in the study period, the crude death rate increased from LC. Individuals with no schooling or with incomplete elementary school the RR of dying from LC was the highest. Chihuahua had the highest mortality rate and the highest risk of dying. Region 2 had the highest mortality rate. ANTECEDENTES: El cáncer de hígado es un problema de salud pública en el mundo, ya que es la segunda causa de muerte, y México no es la excepción; en 2013, dicho cáncer ocupó el cuarto lugar en mortalidad entre las neoplasias malignas. MÉTODO: Se obtuvieron los registros de mortalidad asociada al cáncer de hígado correspondientes al periodo 2000-2013 del Instituto Nacional de Estadística y Geografía. Se calcularon las tasas de mortalidad nacional, por Estados y por región socioeconómica. Se determinó la fuerza de la asociación de los Estados donde residían los individuos y el nivel de estudios con la mortalidad por cáncer de hígado. RESULTADOS: En 2000-2013, la tasa cruda de mortalidad por 100,000 individuos se incrementó de 4.2 a 4.9. En individuos sin escolaridad o con primaria incompleta, el riesgo relativo (RR) de morir por cáncer de hígado fue el mayor (RR: 8.61; intervalo de confianza del 95% [IC95%]: 8.35-8.89), mientras que en aquellos con preparatoria disminuyó (RR: 0.74; IC95%: 0.71-0.77). El Estado que tuvo el mayor riesgo de morir fue Chihuahua (RR: 30.3, IC95%: 19.6-46.8 en 2000 y RR: 22.3, IC95%: 15.1-33 en 2013). La región socioeconómica con la mayor tasa de mortalidad fue la región 2. CONCLUSIONES: En México, en el periodo de estudio, la tasa cruda de mortalidad por cáncer de hígado se incrementó. En individuos sin escolaridad o con primaria incompleta, el RR de morir por cáncer de hígado fue el mayor. El Estado que tuvo la mayor tasa de mortalidad y el mayor riesgo de morir fue Chihuahua. La región socioeconómica con la mayor tasa de mortalidad fue la región 2.

Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers.

Cholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and in these areas, it remains a disease associated with poverty. In developed nations, cholera is rare, and cases are typically imported from endemic areas by returning travellers. Cholera is readily preventable with the tools available to modern medicine. In developing nations, cholera transmission can be prevented through improved water, sanitation, and hygiene services and the use of oral cholera vaccines (OCVs). For travellers, risk can be mitigated by practicing regular hand hygiene and consuming food and water from safe sources. OCVs should be considered for high-risk travellers likely to be exposed to cholera patients or contaminated water and food. There are currently three World Health Organization pre-qualified OCVs, which are based on killed whole-cell strains of Vibrio cholerae. These established vaccines offer significant protection in adults and children for up to 2 years. A novel live attenuated vaccine that provides rapid-onset protection in adults and children is licensed in the USA and Europe only. Live attenuated OCVs may mimic the natural infection of V. cholerae more closely, generating rapid immune responses without the need for repeat dosing. These potential benefits have prompted the ongoing development of several additional live attenuated vaccines. The objective of this article is to provide a general review of the current landscape of OCVs, including a discussion of their appropriate use in international travellers.

Sexting en universitarios: relación con edad, sexo y autoestima

El sexting es un fenómeno social globalizado que aumenta con la edad en adolescen tes, aunque hay pocas investigaciones centradas en conocer su práctica en universitarios, mo tivo del presente estudio, en el que participaron 899 jóvenes estudiantes de la Universidad de Granada (España) con edades entre 18 y 24 años. Los objetivos eran conocer (mediante análisis de frecuencias y correlaciones) la prevalencia del sexting entre hombres y mujeres, analizar su relación con la edad, el sexo y la autoestima; y determinar la prevalencia de la práctica del sex-ting por edad. Se utilizaron dos instrumentos, la Escala de Conductas sobre Sexting y la Escala de Autoestima de Rosenberg. La relevancia del estudio radica en que constata que tanto chicos como chicas realizan sexting, más los chicos, y que la práctica se incrementa hasta los 21 años, descendiendo ligeramente a los 24. No se encontró relación con autoestima. Como conclusión se recomienda prudencia (puesto que la mayoría ha realizado sexting alguna vez) al ser una práctica no exenta de riesgo de la que pueden derivarse consecuencias personales y profesio nales negativas, por la amplia difusión y permanencia que puede tener este material en la red.

Sexting is a globalized social phenomenon that increases with age in adolescents, although there are few researches focused in its practice in university students, goal of the present study, which involved 899 students of the University of Granada (Spain) with ages between 18 and 24 years. The objectives were to know (through analysis of frequencies and correlations) the prevalence of sexting between men and women, to analyze the re lation with age, sex and self-esteem; and to determine the prevalence of the practice of sexting by age. Two instruments were used, the Sexting Behaviors Scale and the Rosen berg Self-Esteem Scale. The relevance of the study lies in the fact that confirm that both men and women practice sexting, more men, and that the practice increases until the 21 years, falling slightly at 24. No relation was found with self-esteem. The study concludes that since most of the students have done sexting, precaution is recommended, because of the risk of the negative personal and professional consequences that may result, for the wide dissemination and permanence that can have this information in the network.

Tendencias de mortalidad y años potenciales de vida perdidos por cáncer de ovario en México, 2000-2014.

INTRODUCCIÓN: En México, el cáncer de ovario representa 5.3 % de los diagnósticos de cáncer en todos los grupos de edad y 21 % de los cánceres ginecológicos; en las últimas tres décadas ha tenido un aumento constante. OBJETIVO: Determinar la tendencia de la mortalidad por cáncer de ovario y los años potenciales de vida perdidos (APVP) por estado y región socioeconómica de México entre 2000 y 2014. MÉTODO: Se obtuvieron los registros de cáncer de ovario del Instituto Nacional de Estadística y Geografía. Se identificaron los códigos de la CIE-10 correspondientes a la causa básica de defunción por cáncer de ovario. Se calcularon las tasas de mortalidad y las tasas de APVP a nivel nacional, por estado y región socioeconómica. RESULTADOS: Entre 2000 y 2014, las tasas ajustadas por edad por 100 000 mujeres se incrementaron de 3.3 a 4.1. Las mayores tasas de mortalidad se identificaron en la región 7, en Chihuahua, Baja California Sur, Colima, Quintana Roo, Zacatecas, Sonora, Coahuila, Aguascalientes, Querétaro. La mayor tasa de APVP por cáncer de ovario se registró en las regiones 7, 5 y 6, en Nayarit, Baja California Sur, Zacatecas, Colima, Tlaxcala, Oaxaca, Quintana Roo, Coahuila, Aguascalientes y Querétaro. CONCLUSIONES: La región socioeconómica 7 de México presentó las mayores tasas de APVP y de mortalidad por cáncer de ovario. INTRODUCTION: In Mexico, ovarian cancer accounting for 5.3% of cancer diagnoses in all age groups and 21% of gynecological cancers and it has had a steady increase in the last three decades. OBJECTIVE: To determine mortality trends from ovarian cancer and potential years of life lost (PYLL) by state and socioeconomic region of Mexico between 2000 and 2014. METHOD: Records of ovarian cancer were obtained from the National Institute of Statistics and Geography. ICD-10 codes corresponding to ovarian cancer as the basic cause of death were identified. Mortality rates and YPLL rates were calculated by nationwide, states and socioeconomic region. RESULTS: Between 2000 and 2014, age-adjusted rates per 100,000 women increased from 3.3 to 4.1. The highest mortality rates were identified in region 7, in Chihuahua, Baja California Sur, Colima, Quintana Roo, Zacatecas, Sonora, Coahuila, Aguascalientes and Queretaro. The highest rates of PYLL due to ovarian cancer were recorded in regions 7, 5 and 6, Nayarit, Baja California Sur, Zacatecas, Colima, Tlaxcala, Oaxaca, Quintana Roo, Coahuila, Aguascalientes and Queretaro. CONCLUSIONS: Mexico's socioeconomic region 7 had the highest rates of PYLL and mortality from ovarian cancer.

Mortality trends from congenital malformations of the heart and the great vessels in children and adults in the seven socioeconomic regions of Mexico, 2000-2015.

BACKGROUND: Congenital heart disease (CHD) represents a global health problem. In Mexico, in children <1 year of age it is the second cause of mortality. The aim was to determine mortality trends from CHD and the great vessels in children and adults nationwide, by state and socioeconomic region. METHODS: Records of mortality associated to CHD and the great vessels for 2000-2015 were obtained from the National Institute of Statistics and Geography. This information is collected from death certificates issued nationwide. International Classification of Diseases, 10th revision, codes corresponding to the basic cause of death from CHD and the great vessels. To calculate mortality rates for individuals ≥1 year of age, population counts from the national population, estimated by the National Population Council for 2000-2015, were used in the denominator; for infant mortality, live birth counts were used. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The seven socioeconomic regions were elaborated by the National Institute of Statistics and Geography and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. RESULTS: In the period 2000-2015, 70 741 individuals among children and adults died from CHD. Age-adjusted mortality rate per 100 000 individuals increased from 3.3 to 4. In the age group <1 year of age, mortality rate per 100 000 live births increased from 143.9 to 217.3. CONCLUSIONS: In the period 2000-2015, age-adjusted mortality rate per 100 000 individuals increased from 3.3 to 4. Mexico City as region 7 had the highest mortality from CHD and the great vessels.

Concordancia interobservador de hallazgos cardiopulmonares en la radiografía de tórax entre radiólogos y médicos generales de un servicio de urgencias / Interobserver agreement of cardiothoracic diseases in chest radiography between radiologists and general practitioners

Resumen Objetivo: estimar la concordancia inter-observador de hallazgos cardiopulmonares en la radiografía de tórax de adultos entre dos grupos independientes de radiólogos y médicos generales. Materiales y métodos: dos grupos de evaluadores, uno de radiólogos (n=2) y uno de médicos generales (n=5) valoraron 100 radiografías de tórax. Los ítems de evaluación fueron la calidad técnica radiológica, la normalidad de la radiografía y 27 hallazgos radiológicos comunes en la consulta de urgencias. Los evaluadores calificaron la posibilidad de encontrar los hallazgos específicos en la radiografía (cinco por cada placa) en un formato similar a un script de concordancia, con escala de respuesta tipo Likert. El cálculo de concordancia se realizó con el estadístico kappa por grupos de Vanbelle (K2g). Resultados: los grados de concordancia entre radiólogos y médicos generales fueron débiles para la identificación de hallazgos cardiopulmonares (K2g 0,46; IC 95 % 0,43 - 0,51), calidad de la imagen (K2g 0,44; IC 95 % 0,35 - 0,53) y determinación de normalidad (K2g 0,58; 0,44 - 0,72). Los índices de prevalencia fueron elevados (mín. - max.: 0,59 - 0,85) en la valoración de normalidad de las placas. Conclusiónes: El grado de acuerdo en la determinación de normalidad puede estar subestimado por un alto índice de prevalencia. El poco tiempo de formación en radiología y de experiencia en el campo de los médicos generales podrían estar asociados al bajo grado de acuerdo entre los grupos.

Abstract Objective: To estimate the inter-observer agreement between two independent groups of radiologists and general practitioners in the identification of cardiopulmonary findings via standard plain chest radiographs in adults. Materials and methods: Two groups of independent raters (Radiologists, n=2; General Practitioners, n=5) analyzed 100 chest radiographs according to the technical quality, normality, and 5 specific findings. Cardiopulmonary findings were registered via a script concordance-like test. We calculated agreement between groups with Vanbelle’s kappa coefficient (K2g). Results: The concordance between the groups of radiologists and general practitioners in specific chest x-ray findings (K2g 0.46, 95 %CI 0.43 - 0.51), image technical quality (K2g 0.44; 95 %CI 0.35 - 0.53), and normality (K2g 0.58; 95 %CI 0.44 - 0.72) was weak. Prevalence indices were high in the analysis of chest x-ray normality (min. - max.: 0.59 - 0.85). Conclusions: Kappa coefficients in the determination of normality could have been biased downward due to high prevalence indices. Short time of training in radiology and experience in the field could account for low agreement between the groups.

Tendencias de mortalidad y riesgo de muerte por tuberculosis pulmonar en las 7 regiones socioeconómicas y los 32 estados de México, 2000-2009 / Mortality Trends and Risk of Dying From Pulmonary Tuberculosis in the 7 Socioeconomic Regions and the 32 States of Mexico, 2000-2009

Introducción: La tuberculosis (TB) es un problema de salud pública mundial que continúa teniendo una morbimortalidad elevada, principalmente en los países con más desigualdades económicas. Se ha observado que la pobreza, la desnutrición, la infección por VIH, la resistencia a medicamentos, la diabetes y las adicciones, principalmente el alcoholismo, son factores que han contribuido a producir la persistencia de a TB como problema de salud pública importante en México. Métodos: Se obtuvieron los registros de mortalidad asociada a la tuberculosis pulmonar (TBP) correspondientes al periodo 2000-2009 a partir del Sistema Nacional de Información de la Secretaría de Salud. Se calcularon las tasas de mortalidad nacionales, por estados y por regiones socioeconómicas. Se determinó la fuerza de asociación de los estados en los que residían los individuos, las regiones socioeconómicas y el nivel de estudios con la mortalidad por TBP. Resultados: Las tasas de mortalidad debida a TBP por 100.000 habitantes ajustadas por edad disminuyeron de 4,1 a 2 entre 2000 y 2009. Los varones (67,7%) presentaron una mortalidad superior a la de las mujeres (32,3%). En los individuos que no habían completado los estudios primarios el riesgo de muerte por TBP fue superior (RR 1,08 [IC 95%: 1,05-1,12]). Las regiones socioeconómicas y las entidades con mayor fuerza de asociación fueron la región 1, 5, Chiapas y Baja California. En 2007 la región 1 presentó un RR de 7,34 (IC 95%: 5,32-10,13), y en 2009 la región 5 presentó un RR de 10,08 (IC 95%: 6,83-14,88).Conclusiones: En México hubo una disminución de la tasa de mortalidad anual por TBP. Los varones presentaron una mortalidad superior a la de las mujeres. Los individuos que no habían completado los estudios primarios presentaron un riesgo superior de muerte por TBP. Los estados y regiones de México que presentaron una mayor fuerza de asociación con la mortalidad por TBP fueron los de Chiapas y Baja California, regiones 1 y 5

Introduction: Tuberculosis (TB) is a world public health problem that still has a high morbidity and mortality rate mainly in countries with significant wealth gaps. Poverty, malnutrition, HIV infection, drug resistance, diabetes and addictions (mainly alcoholism) have been seen to contribute to the persistence of TB as an important health problem in Mexico. Methods: Death certificates associated with pulmonary tuberculosis (PTB) for 2000-2009 were obtained from the National Information System of the Secretariat of Health. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The strength of association between states where individuals resided, socioeconomic regions, and education with mortality from PTB was determined. Results: Age-adjusted mortality rates per 100,000 inhabitants who died from PTB decreased from 4.1 to 2 between 2000 and 2009. Men (67.7%) presented higher mortality than women (32.3%). Individuals failing to complete elementary education presented a higher risk of dying from PTB (RR 1.08 [95% CI: 1.05-1.12]). The socioeconomic region and the entities with the strongest association were region 1, 5, Chiapas and Baja California. Region 1 in 2007 presented RR 7.34 (95% CI: 5.32-10.13), and region 5 in 2009 had RR 10.08 (95% CI: 6.83-14.88). Conclusions: In Mexico, the annual mortality rate from PTB decreased. Men presented higher mortality than women. Individuals failing to complete elementary education showed a higher risk of dying fromPTB. The states and regions of Mexico that presented a stronger association with mortality from PTB were Chiapas and Baja California, region 1 and 5

Mortality trends and risk of dying from pulmonary tuberculosis in the 7 socioeconomic regions and the 32 States of Mexico, 2000-2009.

INTRODUCTION: Tuberculosis (TB) is a world public health problem that still has a high morbidity and mortality rate mainly in countries with significant wealth gaps. Poverty, malnutrition, HIV infection, drug resistance, diabetes and addictions (mainly alcoholism) have been seen to contribute to the persistence of TB as an important health problem in Mexico. METHODS: Death certificates associated with pulmonary tuberculosis (PTB) for 2000-2009 were obtained from the National Information System of the Secretariat of Health. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The strength of association between states where individuals resided, socioeconomic regions, and education with mortality from PTB was determined. RESULTS: Age-adjusted mortality rates per 100,000 inhabitants who died from PTB decreased from 4.1 to 2 between 2000 and 2009. Men (67.7%) presented higher mortality than women (32.3%). Individuals failing to complete elementary education presented a higher risk of dying from PTB (RR 1.08 [95%CI: 1.05-1.12]). The socioeconomic region and the entities with the strongest association were region 1, 5, Chiapas and Baja California. Region 1 in 2007 presented RR 7.34 (95%CI: 5.32-10.13), and region 5 in 2009 had RR 10.08 (95%CI: 6.83-14.88). CONCLUSIONS: In Mexico, the annual mortality rate from PTB decreased. Men presented higher mortality than women. Individuals failing to complete elementary education showed a higher risk of dying from PTB. The states and regions of Mexico that presented a stronger association with mortality from PTB were Chiapas and Baja California, region 1 and 5.

Preeclampsia is associated with lower production of vascular endothelial growth factor by peripheral blood mononuclear cells.

BACKGROUND: Recent studies show that vascular endothelial growth factor (VEGF) downregulation is implicated in preeclampsia (PE) pathophysiology. This study assessed the relationship between PE and VEGF levels produced by peripheral blood mononuclear cells (PBMCs) and their serum levels. METHODS: A cross-sectional design was performed in 36 patients who had hypertensive disorders during pregnancy. We also used a longitudinal design with 12 pregnant women with risk factors for PE development and/or abnormal uterine arteries by Doppler study. VEGF and soluble fms-like tyrosine kinase-1 (sFlt-1) levels were measured for all patients in both designs. RESULTS: sFlt-1 serum was higher in preeclamptic patients (n = 26), whereas VEGF produced by stimulated PBMCs was lower than in healthy pregnant women and VEGF levels produced by stimulated PBMCs were even lower (p <0.003) in severe PE (n = 16). The receiver-operating characteristic curve analysis allowed establishing a cut-off value to identify patients with PE. VEGF production by PBMCs was 339.87 pg/mL. In addition, a robust linear regression model was performed to adjust the variance in VEGF levels. The patients' age decreased VEGF levels and was adjusted by weeks of gestation (WG) in our model. In the longitudinal study, 7/12 patients developed PE. VEGF produced by PBMCs cells was significantly lower in PE at 24-26 WG. CONCLUSIONS: VEGF production by PBMCs is inhibited during PE, creating a downregulation of the microenvironment; this deficiency may contribute to the pathogenesis of disease.

[Mortality trends and years of potential life lost from prostate cancer in the 32 states and 7 sociecononomic regions of Mexico, 2000-2010]. / Tendencias de mortalidad y años potenciales de vida perdidos por cáncer de próstata en los 32 estados y en las 7 regiones socioeconómicas de México en el periodo 2000-2010.

OBJECTIVE: To determine trends of mortality from prostate cancer (PC) and years of potential life lost (YPLL) by federative entity and by socioeconomic region in the period 2000-2010. METHODS: Records of mortality associated with PC 2000-2010 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics and Geography through death certificates issued throughout the country. International Classification of Diseases, 10th revision, codes corresponding to the basic cause of death from PC were identified. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. Rates of YPLL were calculated by federative entity and by socioeconomic region. The seven socioeconomic regions were elaborated by the National Institute of Statistics and Geography and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. RESULTS: Raw mortality rates per 100,000 inhabitants who died from PC increased from 7.8 to 9.8 between 2000-2010. The states and socioeconomic regions with the higher rates of mortality from PC were Sinaloa, Sonora, Baja California Sur, Nayarit, Colima and regions 6 and 3. The state and socioeconomic regions with higher rate of APVP from PC were Aguascalientes, Nuevo León, Campeche, Baja California Sur, Durango and regions 6, 5, 3, 1 and 2. CONCLUSIONS: Raw mortality rates per 100,000 inhabitants who died from PC increased from 7.8 to 9.8 between 2000-2010. The states and socioeconomic region with the higher mortality rates were Sinaloa, Sonora, Baja California Sur, Nayarit, Colima and regions 6 and 3. Mexico.

Mortality trends from hypertension in Mexico by socioeconomic region and state, 2000-2008.

OBJECTIVE: To determine mortality trends from hypertension in Mexico nationwide, by state, by socioeconomic region, and by sex and to establish an association between education, state of residence, and socioeconomic region with mortality from hypertension in 2000-2008. METHODS: Records of mortality associated with hypertension for 2000-2008 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics, Geography and Informatics through death certificates issued throughout the country. International Classification of Diseases, 10th Revision, codes corresponding to the basic cause of death from hypertension were identified. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The strength of association (obtained by Poisson regression) between states where individuals resided, socioeconomic regions, and education with mortality from hypertension was determined. The seven socioeconomic regions were elaborated by the National Institute of Statistics, Geography and Informatics and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. RESULTS: Individuals who did not complete elementary school had a higher risk of dying from hypertension than people with more or no education [relative risk (RR) 1.462, 95% confidence interval (CI) 1.442-1.482]. Mexico City, Oaxaca, and region 7 had the strongest association with dying from hypertension [Mexico City: RR 2.6, CI 2.1-3.2 (2000) and RR 2.5, CI 2.1-3.1 (2005); Oaxaca: RR 2.4, CI2.0-3.0 (2006) and RR 2.7, CI2.3-3.3 (2008); region 7: RR 1.58, CI 1.45-1.72 (2000) and RR 1.25, CI 1.17-1.34 (2008)]. CONCLUSIONS: Age-adjusted mortality rates per 100 000 inhabitants who died from hypertension increased from 15.7 to 18.5 between 2000 and 2008, taking the world population age distribution as standard. Mortality was higher in women than in men and in individuals who did not complete elementary school than in those with more or no education. The strongest associations were in Mexico City, Oaxaca, and region 7.

Mortality trends from hypertension in Mexico by socioeconomic region and state, 2000–2008 / Tendencias de mortalidad por hipertensión arterial por región socioeconómica y estado en México, 2000­2008

Objective. To determine mortality trends from hypertension in Mexico nationwide, by state, by socioeconomic region, and by sex and to establish an association between education, state of residence, and socioeconomic region with mortality from hypertension in 2000­2008. Methods. Records of mortality associated with hypertension for 2000­2008 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics, Geography and Informatics through death certificates issued throughout the country. International Classification of Diseases, 10th Revision, codes corresponding to the basic cause of death from hypertension were identified. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The strength of association (obtained by Poisson regression) between states where individuals resided, socioeconomic regions, and education with mortality from hypertension was determined. The seven socioeconomic regions were elaborated by the National Institute of Statistics, Geography and Informatics and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. Results. Individuals who did not complete elementary school had a higher risk of dying from hypertension than people with more or no education [relative risk (RR) 1.462, 95% confidence interval (CI) 1.442­1.482]. Mexico City, Oaxaca, and region 7 had the strongest association with dying from hypertension [Mexico City: RR 2.6, CI 2.1­3.2 (2000) and RR 2.5, CI 2.1­3.1 (2005); Oaxaca: RR 2.4, CI 2.0­3.0 (2006) and RR 2.7, CI 2.3­3.3 (2008); region 7: RR 1.58, CI 1.45­1.72 (2000) and RR 1.25, CI 1.17­1.34 (2008)]. Conclusions. Age-adjusted mortality rates per 100 000 inhabitants who died from hypertension increased from 15.7 to 18.5 between 2000 and 2008, taking the world population age distribution as standard. Mortality was higher in women than in men and in individuals who did not complete elementary school than in those with more or no education. The strongest associations were in Mexico City, Oaxaca, and region 7.

Objetivo. Determinar las tendencias de mortalidad por hipertensión arterial en México a nivel nacional, por estado, por región socioeconómica y por sexo, así como establecer una asociación entre la educación, el estado de residencia y la región socioeconómica y la mortalidad por hipertensión arterial entre los años 2000 y 2008. Métodos. Los datos de mortalidad asociada a la hipertensión arterial correspondientes a los años 2000­2008 se obtuvieron del Sistema Nacional de Información de la Secretaría de Salud. Esta información es generada por el Instituto Nacional de Estadística, Geografía e Informática a través de los certificados de defunción expedidos en todo el país. Se determinaron los códigos de la Clasificación Internacional de Enfermedades, 10.a Revisión, que corresponden a la hipertensión arterial como principal causa de muerte. Se calcularon las tasas de mortalidad en toda la nación, por estado y por región socioeconómica. Se determinó la potencia de la asociación (mediante la regresión de Poisson) entre el estado de residencia, la región socioeconómica y el nivel de educación y la mortalidad por hipertensión arterial. El Instituto Nacional de Estadística, Geografía e Informática agrupa los 31 estados y la Ciudad de México en siete regiones socioeconómicas según los indicadores relativos al bienestar, tales como la educación, la ocupación, la salud, la vivienda y el empleo. Resultados. Las personas que no finalizaron la escuela primaria tenían un riesgo mayor de morir por hipertensión arterial que las personas con un mayor nivel educativo o sin ninguna formación (riesgo relativo [RR]: 1 462; intervalo de confianza de 95% (IC): 1 4421 482). La Ciudad de México, Oaxaca y la región 7 tenían la asociación más potente con la muerte por hipertensión arterial [Ciudad de México: RR: 2,6; IC: 2,13,2 (2000) y RR: 2,5; IC: 2,13,1 (2005); Oaxaca: RR: 2,4; IC: 2,03,0 (2006) y RR: 2,7; IC: 2,33,3 (2008); región 7: RR: 1,58; IC: 1,451,72 (2000) y RR: 1,25; IC: 1,171,34 (2008)]. Conclusiones. Las tasas de mortalidad por hipertensión arterial ajustadas por edad aumentaron de 15,7 a 18,5 por 100 000 habitantes entre los años 2000 y 2008, tomando como estándar la distribución de edades en la población mundial. La mortalidad fue mayor en las mujeres que en los hombres y en las personas que no finalizaron la escuela primaria que las personas con un mayor nivel educativo o sin ninguna formación. Las asociaciones más potentes se observaron en la Ciudad de México, Oaxaca y la región 7.

[Mortality trends from cervical cancer in the seven socioeconomic regions and the thirty two federative entities of Mexico, 2000-2008]. / Tendencias de mortalidad por cáncer cervicouterino en las siete regiones socioeconómicas y en las 32 entidades federativas de México en los años 2000-2008.

OBJECTIVE: To determinate the trend of mortality from cervical cancer nationwide, by federative entities and socioeconomic regions during the years 2000-2008. METHODS: The records of mortality associated to cervical cancer for the period 2000-2008 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics Geography and Informatics through the death certificates issued all around the country. The codes of the international disease classification 10 that correspond to the basic cause of death from cervical cancer were identified. The rates of mortality nationwide, by federative entity and by socioeconomic region were calculated. Through Poisson regression analysis was compared mortality rates from cervical cancer of the socioeconomic regions and federative entities. The 7 socioeconomic regions were elaborated by the National Institute of Statistics, Geography and Informatics and include the 32 federative entities according to indicators that are related to well-being such as education, occupation, health, housing and employment. RESULTS: The federative entities and socioeconomic region with the strongest association with mortality from cervical cancer in the period 2000-2008 were Colima (RR: 1.67, IC 95%: 1.11-2.25 for the year 2000; RR: 1.92, IC 95%: 1.29-2.85 for the year 2008); Veracruz (RR: 1.85,IC 95%: 1.51-2.27 for 2000; RR: 1.91, IC 95%: 1.55-2.35 for 2008); Yucatan (RR: 2.24, IC 95%: 1.74-2.88 for 2000; RR:1.90, IC 95%: 1.44-2.49 for 2008); and region 1 (RR: 1.41, IC 95%: 1.23-1.6 for 2001; RR: 1.38, IC 95%: 1.2-1.58 for 2007).In this region for the year 2000 and 2008 the RR was not statistically significant. CONCLUSIONS: Mortality rates per 100,000 women standardized using the world population decreased from 13.3 to 8.6 in the period 2000-2008. The entities and region with the strongest force of association with mortality due to cervical cancer were Colima, Veracruz,Yucatan and region 1.