Factors Associated with Readmission within 30 Days of Hospital Discharge of Psychiatric Patients: Case-Control Study.

BACKGROUND: Readmission, defined as any admission after discharge from the same hospital, has negative implications for health outcomes. This study aims to identify the sociodemographic and clinical factors associated with hospital readmission among psychiatric patients. METHODOLOGY: This case-control study analyzed 202 clinical records of patients admitted to a psychiatric hospital between 2019-2021. The sample was selected using simple random sampling. Qualitative variables were presented using frequencies, percentages, and chi-square tests for association. Quantitative variables were described using central tendency measures and dispersion of data, investigated with the Kolmogorov-Smirnov test, Student's t-test or Wilcoxon test as appropriate. Regression analysis was conducted to determine factors linked to readmission. p < 0.05 was considered. RESULTS: Women accounted for a higher readmission rate (59%). Patients diagnosed with schizophrenia had a higher readmission rate (63%), experienced longer transfer times to the hospital during readmissions, and had shorter hospital stays. Polypharmacy and pharmacological interactions were associated with readmission. Olanzapine treatment was identified as a risk factor for readmission (ExpB = 3.203, 95% CI 1.405-7.306, p = 0.006). CONCLUSIONS: The findings suggest avoiding polypharmacy and medications with high side effect profiles to reduce readmissions. This study offers valuable insights for clinical decision-making from admission to discharge planning, aiming to enhance the quality of care.

Puntaje de riesgo finlandés para detección de disglucemia en adultos en Unidad de Medicina Familiar

Establecer la capacidad discriminativa del puntaje de riesgo finlandés para disglucemia en usuarios de una unidad de medicina familiar localizada en zona conurbana del Estado de Guerrero, México. Material y métodos: Realizamos un estudio transversal de marzo a diciembre del 2021 en una Unidad de Medicina Familiar. Previo consentimiento informado aplicamos a 200 personas de 20 a 60 años, el puntaje de riesgo finlandés para detección de disglucemia, obtuvimos medidas somatométricas y cifras de glucosa plasmática en ayuno. Estimamos sensibilidad, especificidad, valor predictivo positivo y negativo, razón de verosimilitud positiva y negativa, y calculamos el área bajo la curva (AUC) para estimar la capacidad discriminativa del puntaje de riesgo, donde la prueba de referencia fue la glucosa en ayuno. Realizamos análisis bivariado para identificar factores asociados a disglucemia, obteniendo Odds Ratio (OR), e intervalos de confianza del 95 % (IC95%). La ocurrencia de disglucemia fue de 26.5 % (53/200). El AUC de la curva ROC del puntaje finlandés para disglucemia fue de 0.65 (IC95% 0.57-0.74). Los factores asociados a diabetes fueron ≥40 años (OR 2.1; IC95% 1.1-3.9), índice de masa corporal ≥25 Kg/m2 (OR 2.8; IC95% 1.2-6.7) y padecer hipertensión arterial (OR 2.2; IC95% 1.1-4.4). El FINDRISC demostró por AUC ser una mala herramienta para detectar personas en riesgo de padecer disglucemia, en población adscrita a unidad médica conurbana.

To establish the discriminative capacity of the Finnish risk score for dysglycemia in users of a family medicine unit located in the suburbs of the State of Guerrero, Mexico. We conducted a cross-sectional study from March to December 2021 in a Family Medicine Unit. With prior informed consent, we applied the Finnish risk score for the detection of dysglycemia to 200 people between the ages of 20 and 60, we obtained somatometric measurements and fasting plasma glucose figures. We estimated sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and calculated the area under the curve (AUC) to estimate the discriminative ability of the risk score, where the reference test was fasting glucose. We performed bivariate analysis to identify factors associated with dysglycemia, obtaining Odds Ratio (OR) and 95% confidence intervals (95%CI). Result: The occurrence of dysglycemia was 26.5% (53/200). The AUC of the ROC curve of the Finnish score for dysglycemia was 0.65 (95%CI 0.57-0.74). The factors associated with diabetes were ≥40 years (OR 2.1; 95%CI 1.1-3.9), body mass index ≥25 Kg/m2 (OR 2.8; 95%CI 1.2-6.7) and suffering from arterial hypertension (OR 2.2; 95%CI 1.1 -4.4). The FINDRISC was shown by AUC to be a poor tool for detecting people at risk of suffering from dysglycemia, in a population attached to a suburban medical unit

Análisis del coste directo de la atención médica y quirúrgica del cáncer de mama. Estudio comparativo entre etapas temprana y tardía en tercer nivel de atención.

BACKGROUND: Management of breast cancer is increased by late diagnoses. OBJECTIVE: To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute. METHOD: Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student's t test was used to determinate differences between groups, as well as descriptive statistics. RESULTS: The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024). CONCLUSIONS: Cost of medical attention in the initial stage is lower than that of the advanced stage.

ANTECEDENTES: Los diagnósticos tardíos elevan los costes de atención del cáncer de mama. OBJETIVO: Analizar los costes directos de la atención del cáncer de mama en etapa temprana y avanzada en el tercer nivel de atención en el Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional que compara los costes directos de atención en cáncer de mama en estadios clínicos inicial y avanzado. Los datos analizados fueron estudios de laboratorio, gabinete, tratamiento y hospitalización. El tiempo evaluado incluyó desde la primera atención hasta la finalización del primer tratamiento. Se determinaron los costes de acuerdo con la tabla de Costes Unitarios por Nivel de Atención Médica para el año 2019 del IMSS. Se utilizó la prueba t de Student para diferencias entre grupos, así como estadística descriptiva. RESULTADOS: El estadio avanzado, comparado con el estadio inicial, ocasiona un número mayor de estudios de laboratorio-gabinete, cirugías, día/cama e interconsultas. El coste promedio de la atención del cáncer de mama por paciente es $99,280,36 (US$5,230.78) y $148,023.60 (US$7,789.92) para los estadios inicial y avanzado, respectivamente (p = 0.024). CONCLUSIONES: El coste de la atención médica del estadio inicial es menor que el del estadio avanzado.

[Factors associated with the development of stress, anxiety and depression in the context of COVID-19 pandemic in Peruvian healthcare facilities]. / Factores asociados al desarrollo de estrés, ansiedad y depresión en trabajadores sanitarios en el contexto de la pandemia por COVID-19 en Perú.

OBJECTIVE: To describe the sociodemographic characteristics and determine the factors associated with psychological manifestations of depression, anxiety, and stress in healthcare workers in the context of COVID-19 pandemic in health facilities in Peru during the month of May 2020. METHODS: An analytical cross-sectional study was conducted out in healthcare workers of hospital establishments in Peru. To evaluate the outcome of interest, we administered a structured questionnaire that asked about type of healthcare personnel; sociodemographic characteristics; Generalized Anxiety Disorder scale (GAD-7); Patient Health Questionnaire scale (PHQ-9); and the Revised Stressor Impact scale (IES-R). We used generalized linear Poisson models, with a logarithmic link function and robust variance. RESULTS: Out of 258 respondents, 254 completed the survey; 61.8% were women; the most common work area was emergency department or hospitalization (inpatient) services (62.2%). The median PHQ-9 score was 4 points (IQR: 2-7); for the GAD-7, it was 6 points (IQR: 4-8), and for the IES-R, 16 points (IQR: 8-24). The multivariate analysis showed that being a physician was associated with less anxiety (PR: 0.77; 95% CI: 0.62-0.94), whereas living alone was associated with a greater risk of depression (PR: 1.46; 95% CI: 1.11-1.92). CONCLUSIONS: Healthcare personnel are at risk of manifesting psychological alterations, mainly associated with the female gender, non-medical personnel and living alone.

OBJETIVO: Describir las características sociodemográficas y determinar los factores asociados a manifestaciones psicológicas de depresión, ansiedad y estrés en trabajadores sanitarios en el contexto de la pandemia por COVID-19 en los establecimientos de salud del Perú durante mayo de 2020. Métodos: Se realizó un estudio transversal en trabajadores sanitarios de establecimientos hospitalarios del Perú. Se elaboró un cuestionario estructurado que incluía las características sociodemográficas, la profesión, área y lugar de trabajo, y cuestionarios validados para trastorno de ansiedad generalizada (GAD-7), Salud del paciente (PHQ-9) y la Escala de impacto del estresor revisada (IES-R). Para el análisis se utilizó modelos lineales generalizados de Poisson, función de enlace logarítmico y varianzas robustas. Se calculó el rango intercuartílico (RIC) y la razón de prevalencia ajustada (RPa) y su intervalo de confianza del 95% (IC95%). RESULTADOS: De un total de 258 encuestados, 254 (98%) completaron al cuestionario, siendo el 61,8% mujeres y el área de trabajo más común emergencia u hospitalización (62,2%). La puntuación mediana del PHQ-9 fue 4 (RIC:2-7), del GAD-7 fue 6 (RIC:4-8) y para el IES-R fue 16 (RIC:8-24). El análisis multivariado mostró que ser médico se asocia con una menor prevalencia de ansiedad (RPa: 0,77; IC 95%: 0,62-0,94), mientras que vivir solo se asoció con una mayor prevalencia de depresión (RPa: 1,46; IC 95%: 1,11-1,92). Conclusión: El personal sanitario manifestó alteraciones psicológicas, asociado principalmente al personal no médico y vivir solo.

Motivation for weight loss among completers of a free community-based weight loss program in a US-Mexico border region: A self-determination theory perspective.

This study explores the perceptions and motivation for weight loss among participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border using a Self-Determination Theory (SDT) perspective. This manuscript is timely as qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is currently lacking. Individual semi-structured interviews were conducted with 20 participants (80%, n = 16 female) who completed a community weight-loss intervention to assess motivation for weight loss and participating, and the role of social support and self-efficacy in weight loss. Directed content analysis was used with SDT guiding the questions and subsequent theme analysis. The findings communicate perspectives of participants relevant to 8 prominent themes. The regulation types and constructs related to SDT included: non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation as well as competence and relatedness. Participants mentioned external sources of motivation, such as wanting to improve their physical appearance, and motivation due to financial incentives. Fewer participants reported intrinsic motivators, which the literature suggests are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively and sustain weight loss. A greater emphasis during weight loss programs on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at enhancing intrinsic motivation for weight loss may be beneficial.

Factors associated with post-traumatic stress disorder symptoms in the post-quarantine context of the COVID-19 pandemic in Peruvian medical students.

Background: In March 2020, the Peruvian state introduced quarantine as a measure to control the spread of SARS-CoV-2. It has been suggested that being in quarantine is associated with the development of symptoms of Post-traumatic Stress Disorder (PTSD). The present study aims to explore the factors associated with the development of PTSD in a post-quarantine context due to COVID-19 in medical students. Objectives: To evaluate the factors associated with the development of post-quarantine PTSD symptoms in medical students from a Peruvian university. Methods: Analytical cross-sectional study. The objective will be developed after the lifting of the quarantine in Peru. Medical students enrolled during the 2020-01 academic cycle of the Peruvian University of Applied Sciences will be included. To collect the outcome variable (PTSD), the Impact of Event Scale - Revised (IES-R) will be used. The associated factors will be collected through a form that will be validated by experts and piloted in the field. The crude and adjusted coefficients will be calculated, using bivariate and multivariate linear regression models, respectively. We will use the "manual forward selection" technique to obtain a final model with minimally sufficient fit. After each model comparison and decision, multicollinearity will be evaluated with the variance inflation factor and matrix of independent variables. Results: Not having health insurance, having relatives or close friends who contracted the disease and having a lower family income are factors associated with PTSD in the post-quarantine context of the COVID-19 pandemic in medical students at a Peruvian university. Conclusions: Clinical evaluation is important for medical students with a high probability of having PTSD symptoms. We recommend conducting a longitudinal study to identify causality and other unstudied factors related to PTSD.

Characterization of Adverse Events Following Childhood Immunizations in Pinar del Río, Cuba.

INTRODUCTION: The Cuban national program for childhood immunizations began in 1962 and has included a surveillance system for monitoring adverse events following immunization since 1999. The expected rate of adverse events following childhood immunization in Cuba is 50 per 100,000 vaccine doses administered. In 2017, Pinar del Río Province reported higher-than-expected rates of adverse events, which motivated this study on their frequency and types. OBJECTIVE: Characterize adverse events following immunization reported in children in Pinar del Río Province in 2017. METHODS: We examined reports of adverse events following immunization in children from 2 months through 14 years of age in Pinar del Río Province, Cuba, from January 1, 2017 through December 31, 2017. We found 487 adverse events that met the criteria established by the national surveillance system. Information was obtained from epidemiological surveys of adverse events following immunization in Pinar del Río Province municipalities. Recorded were age, municipality, signs and symptoms, vaccine type, number of doses, anatomical site and route of vaccine administration, and the institution where the child was vaccinated. We estimated proportions for intensity and frequency related to vaccination, and calculated rates for 100,000 vaccine doses administered. We then compared the rates of observed adverse events with those of expected events. RESULTS: The overall rate of adverse events was 305.6 per 100,000 doses administered. Highest rates were reported in children aged ⟨1 year (580.9 per 100,000 doses administered); in Guane Municipality (610 per 100,000 doses), for the pentavalent (DTwP-HB-Hib) vaccine (1567.7 per 100,000 doses), and in applications to the anterolateral quadrant of the thigh (772.5 per 100,000 doses). Symptoms classifi ed as moderate, common, and general occurred more often, with fever being the most frequent. Severe induration, hypotonic and hyporesponsive episodes, persisten crying and rashes were observed more frequently than expected. CONCLUSIONS: The rate of adverse events following childhood immunization is similar to that reported in other provinces and elsewhere in the world. Of all childhood vaccines, the pentavalent vaccine is the most reactogenic. The absence of serious adverse events demonstrates the safety of childhood immunization in Cuba.

Puberty blockade: Clinical guideline for the diagnosis and treatment of precocious puberty.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the interventions for the inhibition of central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.

La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con las intervenciones para inhibir la pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Diagnosis of precocious puberty: clinical guideline for the diagnosis and treatment of precocious puberty.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be accessed in this same supplement.

La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de pubertad precoz. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este suplemento.

Methodology for the development of the Clinical guideline for the diagnosis and treatment of precocious puberty.

Background: The Mexican Society of Pediatric Endocrinology presents recommendations for the diagnosis and treatment of precocious puberty (PP), a condition defined as the development of sexual characteristics due to an increase in pituitary gonadotropin secretion before 8 or 9 years of age in girls and boys, respectively. Methods: Three systematic reviews were conducted: controlled clinical trials on interventions for PP treatment, diagnostic tests, and observational studies on the long-term effects of PP. The quality evaluation and data extraction from the studies were conducted by two independent reviewers. The Scottish Intercollegiate Guidelines Network and the Oxford Center for Evidence-Based Medicine systems were used for grading the quality of evidence for recommendations on intervention and diagnosis, respectively. Recommendations were submitted to a consensus by a Delphi method and were validated by another 143 certified pediatric endocrinologists through an online questionnaire. Results: The group generated 12 recommendations on the diagnosis of PP, seven on the diagnosis of secondary causes of PP, eight on interventions for inhibition of puberty, five on other interventions for PP treatment, and 14 for the monitoring and follow-up of these patients. The online questionnaires submitted to certified pediatric endocrinologists showed more than 90% of approval for each one of the recommendations. Conclusions: Although a high degree of consensus for the recommendations for diagnosis, treatment, and monitoring of PP among pediatric endocrinologists was achieved, most of these recommendations showed a low level of evidence.

Introducción: La Sociedad Mexicana de Endocrinología Pediátrica presenta recomendaciones para el diagnóstico y el tratamiento de la pubertad precoz (PP), condición definida como el desarrollo de caracteres sexuales por incremento en la secreción hipofisiaria de gonadotropinas antes de los 8 años en las niñas y de los 9 años en los niños. Métodos: Se realizaron tres revisiones sistemáticas de ensayos clínicos controlados sobre intervenciones para el tratamiento de la PP, pruebas diagnósticas y estudios observacionales sobre efectos a largo plazo de la PP. La evaluación de la calidad de los estudios y la extracción de datos se realizó por pares. La evidencia se graduó con el sistema de la Scottish Intercollegiate Guidelines Network (SIGN) y del Oxford Centre for Evidence-Based Medicine (OCEBM) para las recomendaciones sobre la intervención y el diagnóstico, respectivamente. Las recomendaciones generadas se sometieron a un consenso por el método Delphi y fueron validadas por otros 143 endocrinólogos pediatras certificados mediante un cuestionario en línea. Resultados: Mediante consenso se generaron 12 recomendaciones para el diagnóstico de PP, siete sobre diagnóstico de causas secundarias de PP, ocho sobre intervenciones para inhibición de la pubertad, cinco sobre otras intervenciones en PP y 14 para la monitorización del tratamiento y el seguimiento de estos pacientes. Se obtuvo más del 90% de aprobación para cada una de las recomendaciones por el grupo de endocrinólogos certificados que respondieron el cuestionario en línea. Conclusiones: Si bien se logró un alto grado de consenso para las recomendaciones para el diagnóstico, el tratamiento y la monitorización de la PP entre los endocrinólogos pediatras, el nivel de evidencia para la mayoría de estas recomendaciones resultó bajo.

Diagnosis of secondary causes of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of secondary causes of central PP. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.

La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de causas secundarias de pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Adjuvant interventions in the treatment of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the complementary interventions for the treatment of precocious puberty besides puberty blockade. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.

La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con intervenciones adyuvantes en el tratamiento de la pubertad precoz distintas de la inhibición de la pubertad. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Monitoring during the treatment of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the monitorization of the treatment and follow-up of patients with central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.

La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con la monitorización del tratamiento y el seguimiento de pacientes con pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Synthesis of the evidence: Clinical guideline for the diagnosis and treatment of precocious puberty.

Three systematic reviews were conducted to formulate the recommendations on diagnosis, treatment and follow-up of patients with precocious puberty: interventions for the treatment of precocious puberty that included the outcomes of final or near-final height, mental health, metabolic health, health bone, or blockade success; comparative observational studies evaluating long-term outcomes in subjects with a history of precocious puberty; and diagnostic test accuracy studies for puberty.

Se realizaron tres revisiones sistemáticas para la formulación de las recomendaciones sobre diagnóstico, tratamiento y seguimiento de pacientes con pubertad precoz: intervenciones para el tratamiento de la pubertad precoz que incluyeran los desenlaces de talla final o casi final, salud mental, salud metabólica, salud ósea o éxito en el bloqueo; estudios observacionales comparativos que evaluaran desenlaces a largo plazo en sujetos con antecedentes de pubertad precoz; y por último, estudios de exactitud de prueba diagnóstica para pubertad.

Chagas disease in the United Kingdom: A review of cases at the Hospital for Tropical Diseases London 1995-2018. The current state of detection of Chagas disease in the UK.

BACKGROUND: Chagas disease (CD), is a parasitic disease endemic in Latin America. Presentation in non-endemic areas is either in the asymptomatic indeterminate phase or the chronic phase with cardiac and/or gastrointestinal complications. METHODS: The Hospital for Tropical Diseases (HTD) based in central London, provides tertiary care for the management of CD. We reviewed all cases managed at this centre between 1995 and 2018. RESULTS: Sixty patients with serologically proven CD were identified. Most were female (70%), with a median age at diagnosis of 41 years. Three quarters of the patients were originally from Bolivia. 62% of all patients were referred to the HTD by their GP. Nearly half of the patients were asymptomatic (47%). Twelve patients had signs of cardiac involvement secondary to CD. Evidence of gastrointestinal damage was established in three patients. Treatment was provided at HTD for 31 patients (47%). Most patients (29) received benznidazole, five of them did not tolerate the course and were switched to nifurtimox. Of the seven patients receiving this second line drug, five completed treatment, whilst two interrupted it due to side effects. CONCLUSIONS: Despite the UK health system having all the resources required to diagnose, treat and follow up cases, there is lack of awareness of CD, such that the vast majority of cases remain undiagnosed and therefore do not receive treatment. We propose key interventions to improve the detection and management of this condition in the UK, especially in pregnant women and neonates.

Metodología para la elaboración de la Guía de práctica clínica / Methodology for the development of the Clinical guideline for the diagnosis and treatment of precocious puberty

Resumen Introducción: La Sociedad Mexicana de Endocrinología Pediátrica presenta recomendaciones para el diagnóstico y el tratamiento de la pubertad precoz (PP), condición definida como el desarrollo de caracteres sexuales por incremento en la secreción hipofisiaria de gonadotropinas antes de los 8 años en las niñas y de los 9 años en los niños. Métodos: Se realizaron tres revisiones sistemáticas de ensayos clínicos controlados sobre intervenciones para el tratamiento de la PP, pruebas diagnósticas y estudios observacionales sobre efectos a largo plazo de la PP. La evaluación de la calidad de los estudios y la extracción de datos se realizó por pares. La evidencia se graduó con el sistema de la Scottish Intercollegiate Guidelines Network (SIGN) y del Oxford Centre for Evidence-Based Medicine (OCEBM) para las recomendaciones sobre la intervención y el diagnóstico, respectivamente. Las recomendaciones generadas se sometieron a un consenso por el método Delphi y fueron validadas por otros 143 endocrinólogos pediatras certificados mediante un cuestionario en línea. Resultados: Mediante consenso se generaron 12 recomendaciones para el diagnóstico de PP, siete sobre diagnóstico de causas secundarias de PP, ocho sobre intervenciones para inhibición de la pubertad, cinco sobre otras intervenciones en PP y 14 para la monitorización del tratamiento y el seguimiento de estos pacientes. Se obtuvo más del 90% de aprobación para cada una de las recomendaciones por el grupo de endocrinólogos certificados que respondieron el cuestionario en línea. Conclusiones: Si bien se logró un alto grado de consenso para las recomendaciones para el diagnóstico, el tratamiento y la monitorización de la PP entre los endocrinólogos pediatras, el nivel de evidencia para la mayoría de estas recomendaciones resultó bajo.

Abstract Background: The Mexican Society of Pediatric Endocrinology presents recommendations for the diagnosis and treatment of precocious puberty (PP), a condition defined as the development of sexual characteristics due to an increase in pituitary gonadotropin secretion before 8 or 9 years of age in girls and boys, respectively. Methods: Three systematic reviews were conducted: controlled clinical trials on interventions for PP treatment, diagnostic tests, and observational studies on the long-term effects of PP. The quality evaluation and data extraction from the studies were conducted by two independent reviewers. The Scottish Intercollegiate Guidelines Network and the Oxford Center for Evidence-Based Medicine systems were used for grading the quality of evidence for recommendations on intervention and diagnosis, respectively. Recommendations were submitted to a consensus by a Delphi method and were validated by another 143 certified pediatric endocrinologists through an online questionnaire. Results: The group generated 12 recommendations on the diagnosis of PP, seven on the diagnosis of secondary causes of PP, eight on interventions for inhibition of puberty, five on other interventions for PP treatment, and 14 for the monitoring and follow-up of these patients. The online questionnaires submitted to certified pediatric endocrinologists showed more than 90% of approval for each one of the recommendations. Conclusions: Although a high degree of consensus for the recommendations for diagnosis, treatment, and monitoring of PP among pediatric endocrinologists was achieved, most of these recommendations showed a low level of evidence.

Diagnóstico de pubertad precoz / Diagnosis of precocious puberty: clinical guideline for the diagnosis and treatment of precocious puberty

Resumen La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de pubertad precoz. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este suplemento.

Abstract The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be accessed in this same supplement.

Diagnóstico de causas secundarias de pubertad precoz / Diagnosis of secondary causes of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty

Resumen La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con el diagnóstico de causas secundarias de pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Abstract The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of secondary causes of central PP. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.

Inhibición de la pubertad / Puberty blockade: Clinical guideline for the diagnosis and treatment of precocious puberty

Resumen La Sociedad Mexicana de Endocrinología Pediátrica elaboró una guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz. Este documento presenta recomendaciones relacionadas con las intervenciones para inhibir la pubertad precoz central. La descripción detallada de la metodología para el desarrollo de esta guía y del sistema de gradación, así como la síntesis de la evidencia en la que se basa, pueden consultarse en este mismo suplemento.

Abstract The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the interventions for the inhibition of central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.