[Validation of the SF-36 questionnaire in adults with asthma and allergic rhinitis in Mexican population]. / Validación del cuestionario SF-36 en pacientes adultos con asma y rinitis alérgica.

BACKGROUND: Multiple questionnaires demonstrated the effect of the disease on the Quality of Life (QL), especially on allergies. Asthma and allergic rhinitis contributes to the reduction of QL. One of the accepted instruments for the evaluation of QL in chronic diseases is the questionnaire SF-36 (SF-36). Our objective was to validate the SF-36 in Mexican asthmatic with allergic rhinitis adult patients. METHODS: Fifty asthmatic patients with allergic rhinitis participated. They were placed according to the severity of their asthma (GINA 2004) and of allergic rhinitis (ARIA). The SF-36 was applied. The results were analyzed by descriptive statistics and validation by internal consistency through the Cronbach's test. RESULTS: It was observed that greater deterioration of QL in asthmatic patients with allergic rhinitis is directly related with the severity of their disease. Greater deterioration was observed on physical nature and of the perception of health. The aspect less affected was the social function and mental health. The Cronbach's test showed a coefficient of global reliability of 0.9314. CONCLUSIONS: The results obtained for the validation of SF-36, through the Cronbach's test in the population studied allows their use for later studies.

Variable designs of clinical trials of neuromuscular blocking agents: an example of studies comparing rocuronium and vecuronium.

BACKGROUND: Published clinical trials on neuromuscular blocking (NMB) agents are being reported with large variations in their protocols and conflictiing results may emerge from these differences. Because they have been compared in several clinical trials, the study was focused on rocuronium and vecuronium in order to evaluate whether these NMB agents were compared under homogeneous conditions. MATERIAL/ METHOD: A search was made in PubMed, Embase Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Studies on the neuromuscular response at the adductor pollicis to an i.v. bolus dose of rocuronium or vecuronium in humans were included. Quality of all reports was assessed by means of the 3-item Jadad et al. scale. Twenty-five studies met our inclusion criteria and all were retrieved. RESULTS: Randomization was performed in 21 (80.8%) studies. Blinding procedure for drug administration was mentioned in only one study without clarifying the procedure. Induction was most commonly performed with thiopental, followed by propofol. Two studies were performed in children and two in elderly patients. Withdrawals or dropouts were not mentioned in any paper. Electromyography and mechanomyography were the most common monitoring procedures. The time to maximal response, the maximum effect and the time to reach 25% recovery of neuromuscular function were the most used pharmacodynamic parameters. CONCLUSIONS: Clinical trials on neuromuscular blocking agents, e.g. vecuronium versus rocuronium, are being performed with large variability and without following established guidelines.

[Mortality risk factors in the child of a toxemic mother]. / Factores de riesgo de mortalidad en el hijo de madre toxémica.

OBJECTIVE: To determine risk factors of mortality in the infant of a toxemic mother. MATERIAL AND METHODS: A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. RESULTS: There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR = 4.25, 95%CI 1.76-10.39, p = 0.0002), placental detachment (OR = 8.13, 95%CI 2.29-31.4, p = 0.00007), general anesthesia (OR = 5.32, 95%CI 1.74-16.51, p = 0.0005), respiratory distress syndrome (OR = 23.68, 95%CI 3.31-478 p = 0.00004), mechanic ventilation (OR = 334, 95%CI 42.63-7084, p = 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p = 0.0000001), acute renal failure (OR = 26.13, 95%CI 5.21-177, p = 0.0000002) and pulmonary hemorrhage (OR = 8.40, 95%CI 2.71-27.11, p = 0.000006). We observed as protective factors: high maternal educational level (OR = 0.110, 95%CI 0.01-0.66, p = 0.02), intrauterine malnutrition (OR = 0.39, 95%CI 0.18-0.84, p = 0.008) and transient tachypnea of the newborn (OR = 0.021, 95%CI 0.00-0.15, p = 0.00000001). CONCLUSIONS: We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factors is interesting.

Factores de riesgo de mortalidad en el hijo de madre toxémica / Mortality Risk Factors in the Child of a Toxemic Mother

Objetivo. Determinar los factores de riesgo de mortalidad en el hijo de madre toxémica. Material y métodos. Estudio de casos y controles en hijos de toxémicas, de producto único, de 28 a 42 semanas de gestación; los casos fueron los fallecidos y los controles los sobrevivientes. Resultados. Fueron 57 casos y 114 controles. Los factores de riesgo significativos: eclampsia (RM= 4.25, IC95% 1.76-10.39, p= 0.0002), desprendimiento placentario (RM= 8.13, IC95% 2.29-31.4, p= 0.00007), anestesia general (RM= 5.32, IC95% 1.74-16.51 p= 0.0005), síndrome de dificultad respiratoria (RM= 23.68, IC95% 3.31-478 p= 0.00004), ventilación mecánica (RM= 334, IC95% 42.63-7084, p=0.000000001), hemorragia peri-intraventricular (RM= 64.57, IC95% 8.36-1361, p = 0.0000001), insuficiencia renal aguda (RM= 26.13, IC95% 5.21-177, p= 0.0000002 ) y hemorragia pulmonar (RM= 8.40, IC95% 2.71-27.11, p= 0.000006). Se detectaron como factores protectores: alta escolaridad materna (RM= 0.110, IC95% 0.01-0.66, p= 0.02), desnutrición in útero (RM= 0.39, IC95% 0.18-0.84, p= 0.008) y taquipnea transitoria del recién nacido (RM= 0.021, IC95% 0.00-0.15, p= 0.00000001 Conclusiones. Los factores de riesgo maternos fueron: eclampsia, desprendimiento placentario, anestesia general y muerte materna; en el producto: síndrome de dificultad respiratoria, ventilación mecánica y hemorragia peri-intraventricular. Es interesante el hallazgo de los factores de protección.

Objective. To determine risk factors of mortality in the infant of a toxemic mother. Material and Methods. A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. Results. There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR= 4.25, 95%CI 1.76-10.39, p =0.0002), placental detachment (OR = 8.13,95%CL 2.29-31.4, p= 0.00007), general anesthesia (OR= 5.32, 95%CI 1.74-16.51, p=0.0005), respiratory distress syndrome (OR= 23.68, 95%CI 3.31-478 p= 0.00004), mechanic ventilation (OR= 334, 95%CI 42.63-7084, p= 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p= 0.0000001), acute renal failure (OR=2613, 95%CI 5.21-177, p=0.0000002) and pulmonary hemorrhage (OR= 8.40, 95%CL 2.71-27.11, p= 0.000006). We observed as protective factors: high maternal educational level (OR=0.110, 95%CI 0.01-0.66, p= 0.02), intrauterine malnutrition (OR= 0.39, 95%CL 0.18-0.84, p= 0.008) and transient tachypnea of the newborn (OR= 0.021, 95%CI0.00-0.15,p= 0.00000001). Conclusions. We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factorsis unteresting.

[Local analgesia in postoperative cleansing of head and neck infected wounds]. / Analgesia local en el aseo postoperatorio de heridas infectadas de cabeza y cuello.

INTRODUCTION: After debridement of head and neck abscess, patients require multiple post-surgical cleansing procedures that produce mild or severe pain because are performed without any effective analgesia. Sedation techniques could not be applied at every cleansing process and even local anesthesia injected into the tissues during the procedure is contraindicated. MATERIAL AND METHODS: We present the results of pain control obtained in 600 cleansing procedures performed by irrigating an anesthetic solution over wound tissues exposed after surgical head and neck abscess debridement. RESULTS: All patients had previous surgical debridement of head and neck abscess. All were irrigated with lidocaine solution because dressings were eliminated during every cleansing process. During 5 days of follow-up, at the first and second day only 12.5% of cases reported severe pain when dressing materials were eliminated; at the third day, only one patient (2.5%) reported severe pain when dressings were eliminated. On the first day during surgical cleaning procedure, 25% of cases reported severe pain and 25%, moderate pain; on the second day, 3.3% reported severe pain and 14.1% reported moderate pain. On the third day, 0.8% reported severe pain and 6.6% reported moderate pain; while on the fourth day, no one reported severe pain and only 12.5% reported moderate pain. On the fifth day, noone reported severe pain and only 0.8% reported moderate pain. DISCUSSION: The surgical cleansing methods applied in wounds originated in head and neck abscess debridement produce pain that could be controlled by irrigating lidocaine solution immediately before and during the process of cleansing and is an alternative method bacause general anesthesia, profound sedation, and direct anesthetic injection are contraindicated. This technique was effective in a limited fashion because multiples factors modified local analgesia. This technique should be used in decontamination because dressing materials are eliminated and before wound cleansing action begins.

[Risk factors for Wilms' tumor development in children]. / Factores de riesgo para el desarrollo de tumor de Wilms en la edad pediátrica.

INTRODUCTION: Wilms' tumor (WT) is the most frequent embryonic renal neoplasia in children. OBJECTIVE: This study was carried out to investigate risk factors in the development of WT. MATERIAL AND METHODS: A design of cases and controls, proactive, of incident cases, with four controls per case. The study population of cases were children of two oncologic reference Center of the Mexican Institute of Social Security (IMSS) in the Mexican Federal District during 5-year period. For the control group, children were frequency matched by age and sex at with cases from the same clinic. A questionnaire, previously validated, was applied to determine risk factors in both groups. RESULTS: During the period of study, 34 cases and 136 controls were revised. Significant risk factors were: antecedent of a relative with Down syndrome (OR = 7.6, 95%CI 1.4-51.1, p = 0.008), eczema (OR = 3.7, 95%Cl 1.1-12, p = 0.01); having been conceived in autumn (OR = 5.4, 95%CI 1.3-31.6, p = 0.007) or winter (OR = 4.9, 95%Cl 1.1-29.9, p = 0.01), and beet ingestion (OR = S. 7, 95%Cl 1.7-19.4, p = 0.0007). CONCLUSIONS: In this study, influence of prenatal factors are shown and we attempt to explain the etiology of WT, the important of beet ingestion, and conclusions suggest that that more epidemiologic studies are necessary to determine the chain of events that causes Wilms' tumor.

Factores de riesgo para el desarrollo de tumor de Wilms en la edad pediátrica / Risk factors for Wilms' tumor development in children

INTRODUCTION: Wilms' tumor (WT) is the most frequent embryonic renal neoplasia in children. OBJECTIVE: This study was carried out to investigate risk factors in the development of WT. MATERIAL AND METHODS: A design of cases and controls, proactive, of incident cases, with four controls per case. The study population of cases were children of two oncologic reference Center of the Mexican Institute of Social Security (IMSS) in the Mexican Federal District during 5-year period. For the control group, children were frequency matched by age and sex at with cases from the same clinic. A questionnaire, previously validated, was applied to determine risk factors in both groups. RESULTS: During the period of study, 34 cases and 136 controls were revised. Significant risk factors were: antecedent of a relative with Down syndrome (OR = 7.6, 95CI 1.4-51.1, p = 0.008), eczema (OR = 3.7, 95Cl 1.1-12, p = 0.01); having been conceived in autumn (OR = 5.4, 95CI 1.3-31.6, p = 0.007) or winter (OR = 4.9, 95Cl 1.1-29.9, p = 0.01), and beet ingestion (OR = S. 7, 95Cl 1.7-19.4, p = 0.0007). CONCLUSIONS: In this study, influence of prenatal factors are shown and we attempt to explain the etiology of WT, the important of beet ingestion, and conclusions suggest that that more epidemiologic studies are necessary to determine the chain of events that causes Wilms' tumor.

Estudio comparativo entre el tratamiento de la uveítis autoinmune con prednisona y con ciclofosfamida y azatioprina / Conparative study between the treatment of the autoimune uveitis with prednisona and with ciclofosfamida and azatioprina

Antecedentes: la uveítis es una enfermedad autoinmune que compromete cualquier estructura interna del globo ocular; su característica principal es la inflamación intraocular. Objetivo: determinar cuál es la opción terapéutica más efectiva en contra de la uveítis autoinmune: ciclofosfamida, azatioprina o prednisona. Material y métodos: pacientes de uno y otro sexo entre 16 y 65 años de edad con diagnóstico de uveítis autoinmune (anterior, intermedia y posterior), a quienes se les realizó historia clínica, exploración física y estudios clínicos. Se les solicitó su consentimiento informado por escrito y se asignaron al azar a tres grupos de tratamiento: grupo 1 (azatioprina) 14 (42.4 por ciento) pacientes; grupo 2 (prednisona) 15 (45.5 por ciento) pacientes, y grupo 3 (ciclofosfamida) 4 (12.1 por ciento) pacientes. Se realizaron observaciones doble ciego y valoraciones al día 0 y a las semanas 1, 2, 4 y 6 de tratamiento. Resultados: de 33 pacientes estudiados 13 (39.4 por ciento) fueron hombres y 20 (60.6 por ciento) mujeres, el diagnóstico más frecuente fue uveítis por toxoplasmosis. Se observó un control mejor y más rápido de la inflamación a las 6.2 semanas en la cámara anterior con 100 mg/día de azatioprina con p < 0.0001, para prednisona: p = .000 y para ciclofosfamida: p = 135. En la cámara posterior no se observaron cambios inflamatorios significativos para los tres grupos con p =.353. Los efectos adversos observados con más frecuencia ocurrieron en el grupo de prednisona con p < 0.05 en 24.2 por ciento, caracterizados por neutropenia e infección de las vías urinarias. Conclusiones: la azatioprina, a dosis de 100 mg/día oral durante seis semanas, se considera el medicamento más eficaz, ya que demostró disminución significativa del proceso inflamatorio en menor tiempo, con menos efectos colaterales y con conservación de la agudeza visual.

Effects of diazepam on fentanyl-induced epileptoid EGG activity and increase of multineuronal firing in limbic and mesencephalic brain structures

Electroencephalographic and clinical signs of epileptoid activity have been associated with the administration offentanyl during surgery in patients. These phenomena have been in turn related to changes in metabolic rate, oxygen consumption, and blood flow in specific brain structures both in humans and experimental animals. However, direct evidence showing changes in neuronal firing in specific brain regions during fentanyl-induced epileptoid activity has not been reported. Eight adult male cats with chronically implanted bipolar electrodes in the mesencephalic reticular formation, hippocampus, amygdala, and parieto-occipital cortex were included in the study. Different treatments i.e., vehicle-fentanyl or diazepam-fentanyl, were administered to the experimental animals at 7-day intervals under neuromuscular blockade and assisted ventilation. Electroencephalographic (EEG) seizures, grouped and isolated spikes, and significant increases of multineuronal activity (MUA) were elicited by fentanyl, 50 µg/kg iv, in these brain structures. Both EEG and MUA changes reached their maximal values within 6 min of fentanyl administration, and then diminished as time elapsed. Diazepam, 100, 200, or 400 µg/kg, but not 50 µg/kg iv, significantly reduced or prevented the fentanyl-induced epileptoid EEG activity and MUA increases. The present results show that both entanyl- induced epileptoid EEGactivity as wel as the concomitant increase in MUA of brain subcortical structures are part of the same epileptogenic phenomenon, mainly generated at limbic structures. In addition, the effects of fiazepamagainst both epileptoid EEG activity and increase of MUA of brain subcortical structures support the use of benzodiazepine as premedicants for fentanyl anesthesia in order to prevent or to reduce epileptoid phenomena that can results from opioid administration during the anesthetic procedures

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

Effects of nimodipine on multiunit activity of several brain structures following acute global cerebral ischemia-anoxia in cats

Se investigaron los efectos de nimodipina, una 1.4 dihidropiradina, bloqueador de los canales de calcio, sobre la actividad multineuronal (AMN) de varias estructuras cerebrales de gatos al aplicarse durante las 6 hrs siguientes a un estado de isquemia-anoxia cerebral global inducida por un paro cardiorespiratorio (PCR) de 10 min, así como en gatos expuestos a procedimientos control correspondientes al PCR. Se estudiaron cuatro grupos de gatos: 1 PCR y administración continua de nipodipina, 1 microg/kg/min iv durante 6 hrs; 2) PCR y administración continua del vehículo; 3) procedimietnos control y administración contínua de nipodipina 1 microg/kg/min iv durante 6 hrs; 4) procedimientos control y administración continua de vehículo. La AMN y el electroencefalograma desaparecieron durante el periodo de isquemia/anoxia; se recuperaron durante las horas siguientes al PCR, pero 6 hrs después del PCR la AMN era aún menor que sus valores previos al paro en todas las estructuras subcorticales que se registraron. Durante la recuperación de la actividad EEG se presentaron ondas delta, espigas aislada y trenes de ondas EEG rápidas (20 a 22 HZ). La nimodipina inhibió los aumentos de la AMN que de otro modo se hubieran presentado en la formación reticular mesencefálica, hipocampo y putamen, pero no en el hipotálamo ventromedial, en las horas siguientes al periodo de isquemia/anoxia cerebral global aguda. En los gatos sometidos a PCR y tratados con nimodipina no se observaron espigas aislada ni trenes de actividad EEG rápida. En los gatos control, no sometidos a PCR, la nimodipina redujo significativamente la AMN en el hipocampo pero no en otras estructuras cerebrales. Los resultados sugieren la participación de canales de calcio sensibles a 1,4-dihidropiridina en los mecanismos celulares relacionados con la actividad neuronal que se presenta después de la isquemia-anoxia, así como la posible relación entre los efectos de nimodipina sobre la AMN y las majores condiciones funcionales del sistema nervioso central después de un periodo de isquemia-anoxia cerebral global aguda.