[Considerations on family dynamics and the malnutrition syndrome in Mexican children]. / Consideraciones sobre la dinámica familiar y el síndrome de la mala nutrición en niños mexicanos.

Since the early 1990s we noted that family dysfunction was more common in children with severe primary malnutrition than in children admitted to the hospital without malnutrition. Defects on feeding habits during the first year of life, especially early weaning and inadequate complementary feeding were more common in dysfunctional families. We also observed that chronic malnutrition in preschool children, and overweight and obesity in schoolchildren were more common in children from dysfunctional families. Once the association between dysfunctional family dynamics and obesity in schoolchildren was demonstrated, it was observed that low education of fathers and mothers increased twofold the possibility of family dysfunction: OR: 2.06; 95% CI: 1.37-3.10 and OR: 2.47; 95% CI: 1.57-3.89, respectively. In addition, the low-income and the lower purchasing power of foods were associated to family dysfunction (p<0.05). A remaining task is to explore how to assess family dysfunction in composite, extended, single-parent families where there exist other persons vulnerable to the different entities of malnutrition syndrome and indeed depend on adults for their care, food and nutrition.

[Implications in primary health care of medical genetics and genomic in type 2 diabetes mellitus]. / Implicaciones en la atención primaria en salud de la genética y genómica en la diabetes mellitus tipo 2.

Type 2 diabetes mellitus is a complex disease and a global health problem. Therefore, the first level of health care should handle the approaches of medical genetics and genomics to reduce its incidence. The aim is to present perspectives analyzed by our group in two areas of genetics and its clinical application. Emphasis is placed on the coexistence of several genetic forms clinically detectable in patients with diabetes, missing heritability associated with low penetrance, and epigenomics mechanism. It is discussed the effect of genetic variation associated with resistance to insulin, beta-cell dysfunction, shaft incretin, and other points of interest, such as thrifty genotype hypothesis, conformational disease, genetically unknown foods, phenocopies as clinically silent hypercortisolism, molecular phytopharmacology in the clinical management. Finally, the result was displayed in the Mexican population from genetic studies and new findings of clinical importance, such as involvement of melatonin and effect of variations in the number of copies in a genomic region.

La diabetes mellitus tipo 2 es una enfermedad multifactorial y un problema de salud mundial. De ahí que en el primer nivel de atención en salud se deben manejar los abordajes de la genética médica y genómica para disminuir su incidencia. El propósito de este artículo es presentar perspectivas analizadas por nuestro grupo en dos áreas de la genética, así como su aplicación clínica. Se hace hincapié en la coexistencia de varias formas genéticas clínicamente detectables en el paciente diabético, la heredabilidad perdida relacionada con baja penetrancia y fenómenos epigenómicos. Se discute el efecto de la variación genética relacionada con la resistencia a la insulina, la disfunción de las células beta, el eje incretínico, otros puntos de interés como las hipótesis del genotipo ahorrador, la patología conformacional, comidas genéticamente desconocidas, fenocopias como el hipercortisolismo clínicamente silente y la fitofarmacología molecular en el manejo clínico. Finalmente, se muestran resultados de estudios genéticos en población mexicana y nuevos hallazgos de importancia en la clínica, como la participación de la melatonina y el efecto de las variaciones en el número de copias en una región genómica.

[The family dysfunction as a risk factor of obesity in Mexican school children]. / La disfunción familiar como factor de riesgo para obesidad en escolares mexicanos.

BACKGROUND: it has been demonstrated that children obesity is a multifactorial disease and probably, the alteration of the family dynamic is another potential risk factor. The objective was to identify the association between obesity and family dysfunction in school children who attend to a family medicine unit. METHODS: case and control study at Mexican Social Security Institute in Guadalajara, Jalisco, Mexico. Sociodemographic factors and family dynamic of obese and non-obese subjects (n = 452) of six to nine years old from nuclear families were achieved. RESULTS: the association between family dysfunction and obesity was [OR = 1.63 (1.08-2.46), p = 0.01]. Area II, Identity formation, and area VI, Discipline and methods, showed a lower score in cases of children with obesity (p < 0.001 and p = 0.005, respectively). In a logistic regression model family dysfunction [RM 1.79 (1.19, 2.71), p = 0.005] and low literacy of mothers [RM 1.61 (1.06, 2.45), p = 0.02)] were risk factors for obesity in school children. CONCLUSIONS: the results showed an association between family dysfunction and obesity in school children. We suggest to consider it in the prevention of obesity in Mexican school children.

[Socioeconomic, demographic and family dysfunction related to obesity in 6 to 9 year-old children]. / Obesidad en niños de 6 a 9 años. Factores socioeconómicos, demográficos y disfunción familiar.

OBJECTIVE: To identify the association between family dysfunction and obesity in children six to nine year-old. METHODS: A case-control study that included children with obesity (cases, n = 64) with body mass index (BMI) > 95th percentile and triceps skinfold (TSF) > 90th percentile; and a control group (n = 120) with BMI < 85th percentile and TSF < 90th percentile was performed. Anthropometric measurements were made and a questionnaire assessing eight areas of family dynamics was applied. We compared the frequency of family dysfunction among cases and controls with the χ² test and its association with obesity through the odds ratio. RESULTS: The average score of the questionnaire was 80.8 ± 11.3 with no differences between groups. The categories "probably dysfunctional" and "dysfunctional" were more common in the obese group but the differences were not significant. The score of the areas "dynamics of parents as a couple" (p = 0.053) and "structure of authority in the family" (p = 0.061) was higher in the control group. CONCLUSIONS: Although no association was seen between family dysfunction and obesity, we found a tendency toward obesity in dysfunctional families.

[Clinical guide for diagnosis, treatment and prevention of overweight and obesity in children]. / Guía clínica para el diagnóstico, tratamiento y prevención del sobrepeso y la obesidad en pediatría.

The prevalence of overweight has significantly increased thorough the world and Mexico is not an exception considering that the National Survey of Nutrition (1999) showed that 19.5% of scholar children in Mexico have overweight and other survey from Mexico City (ENURBAL, 2002) have shown that 17% in the same range of age are obese. Therefore, this clinical guide pretends to be an instrument for supporting the professionals of health for the diagnosis, treatment and prevention of obesity in children using the levels of medical attention. It is known that the treatment is difficult and it requires a full multidisciplinary team of professionals and that the key of prevention is the modification of the sedentary lifestyle and the decrease of energy intake. This guide was elaborated by pediatricians working in nutrition in public and university institutions, family and general physicians and pediatricians with private practice.

Grado de correlación en la percepción de la dinámica familiar entre ambos padres de preescolares que acuden a Guarderías del DIF Jalisco / Correlation of the family dinamic score between fathers and mothers of preschool children attending the integral development of the family system (DIF) of Guadalajara, Jalisco (Mexico)

Introducción. Objetivo: identificar la correlación entre la calificación de dinámica familiar de papá y mamá de preescolares que acuden a Guarderías del Sistema Nacional del Desarrollo Integral de la Familia Jalisco. Material y métodos. Estudio transversal analítico. Se incluyeron 138 encuestas de dinámica familiar aplicadas a ambos padres. Se utilizó un instrumento de medición con 8 áreas: I. Dinámica de pareja; II. Formación de identidad; III. Comunicación, expresión, solidaridad; IV. Estructura de autoridad; V. Manejo del conflicto y agresividad;VI. Disciplina y método; VII. Sistema de Valores; VIII.Aislamiento e integración sociocultural. Resultados. No hubo diferencia en la calificación entre ambos padres ni entre los promedios de las 8 áreas. Hubo una correlación significativa entre ambos padres (r = 0.759, P <0.001). El área I tuvo mayor correlación con las demás áreas (P <0.005). La correlación entre las diferentes áreas de papá y mamá fue significativo. Destacaron por ausencia de correlación: área III de papá vs área II y VIII de mamá; área IV de papá vs área I, II,VII y VIII de mamá. Conclusión. La elevada correlación de cada díada papá-mamá sobre su dinámica familiar, de sus áreas recíprocas y entre las áreas de cada cónyuge da gran consistencia al instrumento de evaluación.

Introduction. Objective: to test the correlation of the family dynamic score between fathers and mothers of preschool children attending the Integral Development of the Family System (DIF) of Guadalajara City. Material and methods. In a cross sectional study design 140 family dynamic surveys were included. Eight areas of the dynamic of the family of both parents were explored: I. Dynamic of the couple; II. Formation of identity; III. Communication, expression and solidarity; IV. Structure of the authority;V. Management of the conflict and aggressiveness;VI. Discipline and method;VII. System of values;VIII. Socio cultural integration and isolation. Results. There were not differences between fathers and mothers in the eight explored areas.The score of fathers and mothers had a significant correlation (r =0.759). Area I had the higher correlation with the rest of the areas (P <0.005).The correlation among different areas of father and mother were also significant. It was no correlation of area III of fathers vs area II and VIII of mothers; area IV of fathers vs area I, II,VII and VIII of mothers. Conclusion. The strong correlation of the family dynamic score of each couple and among the majority of reciprocal areas gives a high consistency to the instrument of evaluation.

Reparación de la pars inter-articular en la espondilolistesis espondilolítica, osteosíntesis con tornillos transpendiculares y banda de tensión / Repair of inter articularis pars in spondylolitic spondylolysthesis. Osteosynthesis by transpendicular screws and tension bands

Se operaron 20 pacientes de 25 a 55 años con espondilolistesis espondilolítica, mediante fijación con tornillo de compresión de esponjosa 6.5 mm con cuerda de 32 mm y arandela. Se obtuvo reducción de la olistesis grado 1 en 100 por ciento en 9 casos (45 por ciento), 50 por ciento en 4 (20 por ciento) y persistió sin cambio en 7 (35 por ciento).

Biopsia percutánea con trefina para el diagnóstico etiológico de procesos destructivos no traumáticos de la columna vertebral / Trephine percutaneous biopsy for ethiologic diagnosis of non-traumatic destructive lesions of the spine

El 80 por ciento de los procesos destructivos de la columna vertebral se localizan el cuerpo vertebral, lo que dificulta la toma de biopsia directa, indispensable para el conocimiento de diagnóstico etiológico de la lesión. Se analiza la utilidad de la toma de biopsia percutánea con la trefina ideada en el Servicio de Columna del Hospital de Ortopedia ®Victorio de la Fuente Narváez¼. Se aplicó en 20 pacientes con una efectividad del 95 por ciento, abreviando el tiempo de estudio y la morbimortalidad propia de una biopsia abierta