Virulence factors, antibiotic resistance phenotypes and O-serogroups of Escherichia coli strains isolated from community-acquired urinary tract infection patients in Mexico.

BACKGROUND/PURPOSE: Uropathogenic Escherichia coli (UPEC) strains isolated from patients with community-acquired urinary tract infections (UTIs) were assessed to determine the prevalence of virulence genes, antibiotic resistance, and the O-serogroup of the strains. METHODS: Consenting patients with community-acquired UTI were enrolled at Unidad Médica Familiar Number 64 (Instituto Mexicano del Seguro Social, Estado de Mexico, Mexico) and 321 urine samples were collected. Polymerase chain reaction (PCR) was used to assess 24 virulence genes and 14 O-serogroups. The Kirby-Bauer method was used to evaluate the antibiotic susceptibility of the isolated strains to 12 commonly used antibiotics. RESULTS: A total of 194 strains were identified as E. coli using standard biochemical tests, followed by PCR amplification of 16S ribosomal RNA gene. Only 58.2% of the strains belonged to the assessed 14 O-serogroups. The serogroups O25, O15, O8, and O75 were present in 20.6%, 17%, 6.1%, and 4.6% of strains, respectively. The most frequently occurring virulence genes among UPEC strains included kpsMT (92.2% strains), usp (87.1%), irp2 (79.3%), iha (64.9%), fim (61.3%), set (36%), astA (33.5%), pap (24.7%), and papGII (21.1%). In addition, 97% of the strains were multi-drug resistant (coresistance to 3-11 antibiotics). CONCLUSION: The isolated UPEC strains predominantly belonged to three serogroups (O25, O15, and O8), harboured numerous virulence genes, and are multiresistant to antibiotics. The findings of this study could be used to orient UTI treatment strategies and in epidemiological studies in Mexico.

[Stages of grief in diabetes and metabolic control]. / Etapas del duelo en diabetes y control metabólico.

BACKGROUND: To identify type 2 diabetic patients, the stages of grief and its association with metabolic control. METHODS: 186 patients both sexes, without recent loss of a loved one or a terminal illness. We applied a previously validated instrument, which explored the stages of grief (denial, anger/disbelief, bargaining, depression, and acceptance). There was measured BMI, waist circumference, and 6-month averages of glucose, cholesterol and triglycerides. RESULTS: The associations between the stages of grief and clinical variables showed that BMI is greater denial 33.1 ± 6.2 vs 28.9 ± 4.6 33.1 with p = 0.001, in disbelief stage glucose is greater 190 ± 67 vs 167 ± 51 with p < 0.05. The negotiation phase is associated with older age, 65.6 ± 10 vs 59.1 ± 11 years with p = 0.001 and higher cholesterol level against 229.4 ± 39.1 vs 206.6 ± 40 with p < 0.05. The stage of depression was associated with increased diagnostic time vs. 13.3 ± 8.9 vs 9.4 ± 7.1 years with p < 0.05 and the blood glucose level 198.9 ± 60, vs 164 ± 51 mg/dL p = 0.001. CONCLUSIONS: There are logical associations between clinical variables and stages of grief. Identify the stages of grief, as an additional element in the evaluation of patients with diabetes will develop strategies to improve adherence to medical management and metabolic control.

Introducción: el objetivo de este artículo es identificar las etapas del duelo y su asociación con el control metabólico en pacientes diabéticos tipo 2. Métodos: se incluyeron 186 sujetos diabéticos, de ambos sexos, sin pérdida reciente de un ser querido ni enfermedades terminales. Se les aplicó un instrumento validado que exploró las etapas del duelo (negación, ira/incredulidad, negociación, depresión, y aceptación). Se midió: IMC, perímetro de cintura, niveles promedio de glucosa, colesterol y triglicéridos en los últimos 6 meses. Resultados: las asociaciones entre las etapas del duelo y las variables clínicas mostraron que en la negación, el IMC es mayor 33.1 ± 6.2 contra 28.9 ± 4.6 con p = 0.001; en etapa de incredulidad, la glucemia es mayor 190 ± 67 frente a 16 ± 51 con p < 0.05; la etapa de negociación se asocia a mayor edad 65.6 ± 10 contra 59.1 ± 11 años con p = 0.001 y con nivel de colesterol mayor de 229.4 ± 39.1 frente a 206.6 ± 40 con p < 0.05; la etapa de depresión se asoció con mayor tiempo de diagnóstico 13.3 ± 8.9 frente a 9.4 ± 7.1 años, con p < 0.05 y con el nivel de glucemia de 198.9 ± 60 frente a 164 ± 51 mg/dL con p = 0.001. Conclusiones: existen asociaciones lógicas entre variables clínicas y etapas del duelo. Se debe identificar el duelo como un elemento adicional en la evaluación de pacientes con diabetes y establecer estrategias que mejoren la adherencia al tratamiento y el control metabólico.

Expression of enterotoxin-coding genes in methicillin-resistant Staphylococcus aureus strains isolated from Mexican haemodialysis patients.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) causes severe catheter-related infections in haemodialysis patients ranging from local-site infections and septic thrombophlebitis to bacteraemia but the associated virulence factors and exotoxins remain unclear. FINDINGS: We employed an in vitro infection model using reconstituted human epithelium (RHE) to analyse the expression profiles of 4 virulence genes and 12 exotoxin-coding virulence genes in 21 MRSA strains isolated from catheter-related infections in 21 Mexican patients undergoing haemodialysis. All 21 strains (100%) expressed the seg, seh, sei, eta, etb, or hla genes coding staphylococcal toxins. Eleven MRSA strains (52.3%) expressed the sea gene coding staphylococcal enterotoxin A, and two strains (9.5%) expressed the v8 gene coding serine protease. The tst, chp, and arcA genes coding toxic shock syndrome toxin 1, chemotaxis inhibitory protein, and arginine deiminase, respectively, were expressed in separate single strains (4.7%). The most frequent expression profile (42.8% of the strains) comprised seg, seh, sei, eta, etb, and hla. CONCLUSION: It is likely that the SEG, SEH, SEI, ETA, ETB, and Hla toxins may play a role in MRSA catheter-related infections. Consideration of these toxins in the development of a vaccine or as targets for monoclonal antibody therapy could provide an improved therapeutic strategy for the treatment of catheter-related infections in haemodialysis patients.

[Satisfactory cervical cytology. Circular exocervical cytologic smears against longitudinal exocervical smears]. / Citología cervical satisfactoria. Extendido exocervical circular comparado con longitudinal.

BACKGROUND: In the Mexican Institute of Social Security, since 1962 the exocervical sample is normally extended with a circular motion technique (the usual technique). In 2006, the Ministry of Health established that the exocervical sample shall be extended with longitudinal technique (standard technique). We proposed a new technique: the exocervical widespread. Our objective was to evaluate the efficacy and quality of three techniques. METHODS: A quasi-experimental study in patients who applied for cervical cytology was performed. The variables analized were the exocervical extended technique, the cell coverage and the quality of exocervical sample. Groups were formed according to the exocervical extended technique. Cytology was processed with Papanicolaou technique and reported according to Bethesda System by three observers. Z-test, chi-squared test, Anova and relative risk were used as statistical methods. RESULTS: The sample size was 213 smears, 71 per group. The inadequate cellular coverage was 2.75 times more frequent with the circular extended technique than with the one we proposed. The exocervical sample quality complies with circular technique; however, with the new tecnique increases 1.5 times (p < 0.05). CONCLUSIONS: The proposed widespread technique allows greater possibilities of exocervical cell coverage, ensuring quality-cellularity and decreasing the amount of inadequate smears.

INTRODUCCIÓN: en el Instituto Mexicano del Seguro Social, la muestra del frotis del cuello uterino se extiende en el portaobjetos mediante movimientos circulares (técnica habitual) desde el año de 1962. En 2006, la Secretaría de Salud estableció que el extendido exocervical se realizara de forma longitudinal (técnica convencional). El objetivo de la investigación que se presenta fue evaluar la eficacia y calidad de la técnica de extendido exocervical habitual, convencional y una nueva que se propone. MÉTODOS: estudio cuasiexperimental en mujeres que solicitaron prueba citológica cervical. Las variables analizadas fueron técnica de extendido, cobertura celular y calidad de la muestra exocervical. Se conformaron grupos según la técnica que se aplicó. Los estudios citológicos fueron procesados con técnica de Papanicolaou y los resultados fueron informados por tres observadores conforme al sistema Bethesda. Se utilizó prueba Z, ?2, Anova y riesgo relativo. RESULTADOS: la muestra estuvo integrada por 213 frotis (71 por cada grupo de estudio). Con la técnica de extendido circular, la cobertura celular inadecuada fue 2.75 veces más frecuente que con la propuesta. Si bien la calidad de la muestra exocervical fue adecuada con la técnica circular, con la de extendido que se propone se incrementó 1.5 veces (p < 0.05). CONCLUSIONES: la técnica de extendido que se propone permite mayores posibilidades de cobertura celular exocervical, asegura muestra celular de calidad y disminuye cantidad de citologías inadecuadas.

[Life style and metabolic control in DiabetIMSS program]. / Estilo de vida y control metabólico en diabéticos del programa DiabetIMSS.

OBJECTIVE: To compare the lifestyle and metabolic control of diabetes patients included and not included in the DiabetIMSS program. METHODS: Subjects with diabetes in the DiabetIMSS program and the general clinic were divided into three groups: group 1 first attended the program, group 2 were enrolled during the study, and group 3 had not been included the program. Demographic and clinical aspects were measured and the IMEVID instrument was applied. RESULTS: We included 539 type-2 diabetes patients, predominantly females (73.3%), mainly of primary school level, and more frequently on double-drug therapy. There were clinical differences between the three groups for program leavers in terms of weight, waist, blood pressure, fasting glucose, HbA1c, triglycerides, and IMEVID qualification, all p < 0.05; correlation analysis of the variables with the qualification of IMEVID was significant at p < 0.05. The higher number of variable control targets was for leavers (71% of group); those who were enrolled in the study was 32%, and who had not was 17.2%. CONCLUSIONS: There are significant differences in lifestyle and control target parameters in subjects who completed the DiabetIMSS program.

Implementation of a novel in vitro model of infection of reconstituted human epithelium for expression of virulence genes in methicillin-resistant Staphylococcus aureus strains isolated from catheter-related infections in Mexico.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) are clinically relevant pathogens that cause severe catheter-related nosocomial infections driven by several virulence factors. METHODS: We implemented a novel model of infection in vitro of reconstituted human epithelium (RHE) to analyze the expression patterns of virulence genes in 21 MRSA strains isolated from catheter-related infections in Mexican patients undergoing haemodialysis. We also determined the phenotypic and genotypic co-occurrence of antibiotic- and disinfectant-resistance traits in the S. aureus strains, which were also analysed by pulsed-field-gel electrophoresis (PFGE). RESULTS: In this study, MRSA strains isolated from haemodialysis catheter-related infections expressed virulence markers that mediate adhesion to, and invasion of, RHE. The most frequent pattern of expression (present in 47.6% of the strains) was as follows: fnbA, fnbB, spa, clfA, clfB, cna, bbp, ebps, eap, sdrC, sdrD, sdrE, efb, icaA, and agr. Seventy-one percent of the strains harboured the antibiotic- and disinfectant-resistance genes ermA, ermB, tet(M), tet(K), blaZ, qacA, qacB, and qacC. PFGE of the isolated MRSA revealed three identical strains and two pairs of identical strains. The strains with identical PFGE patterns showed the same phenotypes and genotypes, including the same spa type (t895), suggesting hospital personnel manipulating the haemodialysis equipment could be the source of catheter contamination. CONCLUSION: These findings help define the prevalence of MRSA virulence factors in catheter-related infections. Some of the products of the expressed genes that we detected in this work may serve as potential antigens for inclusion in a vaccine for the prevention of MRSA-catheter-related infections.

Frequency and expression of ALS and HWP1 genotypes in Candida albicans strains isolated from Mexican patients suffering from vaginal candidosis.

To detect the frequency and expression of eight ALS (agglutinin-like sequence) genes and the HWP1 genotype in a group of Candida albicans strains isolated from Mexican women suffering from vaginal candidosis. A group of 264 women (age 15-57 years) with vaginal infections were evaluated. C. albicans was identified by PCR amplification of the rRNA internal transcribed spacer regions ITS1 and ITS2. The ALS and HWP1 genes were identified by conventional PCR, and their expression levels were determined by real-time PCR after growing C. albicans strains in reconstituted human vaginal epithelium (RHVE). C. albicans was identified in 50 women (18.9%). The genotypic frequencies were ALS1 100%, ALS2 60%, ALS3 36%, ALS4 54%, ALS5 70%, ALS6 56%, ALS7 64%, ALS9 66% and HWP1 92%. The most frequently expressed genes in the strains harbouring all of the genes were ALS4 (100%), ALS1 (87.5%), ALS2 (87.5%), ALS3 (87.5%), ALS5 (87.5%), ALS7 (87.5%) and HWP1 (75.0%). Nineteen per cent of the vaginal infections were caused by C. albicans, and a high proportion of the strains carried genes encoding proteins involved in adhesion to epithelia. The ALS and HWP1 genes were expressed in RHVE, suggesting that the Als and Hwp1 proteins play an important role in the pathogenesis of the infection.

Efectos de la glicina sobre los trastornos de conducción del nervio auditivo en pacientes diabéticos tipo 2 con otoneuropatía / Effects of glycine on auditory evoked potentials among diabetic patients with auditory pathway neuropathy

Background: Glycine inhibits the formation of advanced glycation end products that may cause central and peripheral neuronal damage, affecting also the auditory nerve. Aim: To evaluate the effect of glycine on auditory nerve conduction and hearing level among patients with type 2 diabetes mellitus and auditory neuropathy. Material and Methods: Twenty grams of oral glycine per day were administered during 6 months to 28 type 2 diabetic patients aged 58 ± 6 years, with auditory pathway neuropathy. Hearing tests and evoked otoacustic potentials were performed regularly. Fifteen diabetic patients aged 49 ± 8 years, without auditory nerve neuropathy did not receive glycine and were followed as a control group. Results: Among patients receiving glycine, a significant improvement in left ear audiometry at 125, 250 and 500 Hz and right ear audiometry at 500 Hz, was observed. Waves I, III and V (p= 0.02) of evoked otoacustic potentials improved significantly in the left ear and wave I in the right ear. Among controls, waves V and III of evoked otoacoustic potentials had a significant impairment in the left ear. Conclusions: There was an improvement in auditory evoked potentials in patients receiving glycine and an impairment in untreated control patients.

[Effects of glycine on auditory evoked potentials among diabetic patients with auditory pathway neuropathy]. / Efectos de la glicina sobre los trastornos de conducción del nervio auditivo en pacientes diabéticos tipo 2 con otoneuropatía.

BACKGROUND: Glycine inhibits the formation of advanced glycation end products that may cause central and peripheral neuronal damage, affecting also the auditory nerve. AIM: To evaluate the effect of glycine on auditory nerve conduction and hearing level among patients with type 2 diabetes mellitus and auditory neuropathy. MATERIAL AND METHODS: Twenty grams of oral glycine per day were administered during 6 months to 28 type 2 diabetic patients aged 58 ± 6 years, with auditory pathway neuropathy. Hearing tests and evoked otoacustic potentials were performed regularly. Fifteen diabetic patients aged 49 ± 8 years, without auditory nerve neuropathy did not receive glycine and were followed as a control group. RESULTS: Among patients receiving glycine, a significant improvement in left ear audiometry at 125, 250 and 500 Hz and right ear audiometry at 500 Hz, was observed. Waves I, III and V (p= 0.02) of evoked otoacustic potentials improved significantly in the left ear and wave I in the right ear. Among controls, waves V and III of evoked otoacoustic potentials had a significant impairment in the left ear. CONCLUSIONS: There was an improvement in auditory evoked potentials in patients receiving glycine and an impairment in untreated control patients.

[Risk of glucose metabolism changes in spouses of Mexican patients with type 2 diabetes]. / Riesgo de alteración en el metabolismo de la glucosa en cónyuges de pacientes mexicanos con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: To determine whether in the Mexican population the spouses of patients with type 2 diabetes mellitus (DM2) have an increased risk of any degree of glucose intolerance compared with spouses of subjects without diabetes. SUBJECTS AND METHOD: An analytical cross-sectional study was made in the Family Medicine Unit number 62 of the Mexican Institute of Social Security, located in the State of México. A random sample of 87 spouses of patients with DM2 (group ED) was compared with 87 spouses of subjects with a normal glucose tolerance (group ENOD). Risk factors for DM2 were investigated; spouses in both groups underwent oral glucose tolerance test, and total cholesterol, triglycerides, blood pressure, body mass index and waist circumference were measured. The frequency of impaired fasting glucose, impaired glucose tolerance and DM2 were compared in both groups and the odds ratio was calculated. RESULTS: In the group ED there were 38 (43.7%) subjects with any degree of glucose intolerance vs. 23 (26.4%) in the ENOD group -odds ratio = 2.16 (95% confidence interval, 1.14-4.08) in the bivariate analysis, and odds ratio = 2.37 (95% confidence interval, 1.14-4.91) in the logistic regression-. In the group ED a higher systolic blood pressure was observed (P=.02). There were no significant differences in age, sex, body mass index, waist circumference, total cholesterol, triglycerides and diastolic blood pressure. The frequency of risk factors for diabetes was similar in both groups. CONCLUSIONS: In the Mexican population, the spouses of subjects with DM2 have a higher risk of any alteration in the glucose tolerance than spouses of subjects with a normal glucose metabolism.

Riesgo de alteración en el metabolismo de la glucosa en cónyuges de pacientes mexicanos con diabetes mellitus tipo 2 / Risk of disorders in the glucose metabolism in spouses of Mexican patients with type 2 diabetes

FUNDAMENTO Y OBJETIVO: Determinar si en la población mexicana los cónyuges de pacientes condiabetes mellitus tipo 2 (DM2) tienen mayor riesgo de alteración en el metabolismo de la glucosa(AMG) que los cónyuges de personas sin diabetes.SUJETOS Y MÉTODO: Se ha realizado un estudio transversal analítico en la Unidad de Medicina Familiarnúmero 62 del Instituto Mexicano del Seguro Social, ubicada en el Estado de México. Secomparó una muestra aleatoria de 87 esposos de pacientes con DM2 (grupo ED), con 87 espososde personas con metabolismo normal de la glucosa (grupo ENOD). En ambos grupos se investigaronlos factores de riesgo para diabetes, se realizó una curva de tolerancia a la glucosaoral y se midieron el colesterol total, triglicéridos, presión arterial, índice de masa corporal ycircunferencia de la cintura. Se comparó la frecuencia de AMG (alteración de la glucosa enayunas, intolerancia a la glucosa y diabetes mellitus) y se calculó la odds ratio.RESULTADOS: En el grupo ED hubo 38 personas (43,7%) con alguna AMG, frente a 23 (26,4%)en el grupo ENOD, con una odds ratio de 2,16 (intervalo de confianza del 95%, 1,14-4,08) enel análisis bivariado y de 2,37 (intervalo de confianza del 95%, 1,14-4,91) en la regresión logística.En el grupo ED se observó una mayor presión arterial sistólica (p = 0,02). No hubo diferenciassignificativas en cuanto a la edad, sexo, índice de masa corporal, circunferencia de lacintura, colesterol total, triglicéridos y presión arterial diastólica. La frecuencia de factores deriesgo para diabetes fue similar en ambos grupos.CONCLUSIONES: En población mexicana, los cónyuges de pacientes con DM2 tienen mayor riesgode AMG que los cónyuges de personas con metabolismo normal de la glucosa

BACKGROUND AND OBJECTIVE: To determine whether in the Mexican population the spouses of patientswith type 2 diabetes mellitus (DM2) have an increased risk of any degree of glucose intolerancecompared with spouses of subjects without diabetes.SUBJECTS AND METHOD: An analytical cross-sectional study was made in the Family Medicine Unitnumber 62 of the Mexican Institute of Social Security, located in the State of México. A randomsample of 87 spouses of patients with DM2 (group ED) was compared with 87 spouses ofsubjects with a normal glucose tolerance (group ENOD). Risk factors for DM2 were investigated;spouses in both groups underwent oral glucose tolerance test, and total cholesterol, triglycerides,blood pressure, body mass index and waist circumference were measured. The frequencyof impaired fasting glucose, impaired glucose tolerance and DM2 were compared inboth groups and the odds ratio was calculated.RESULTS: In the group ED there were 38 (43.7%) subjects with any degree of glucose intolerancevs. 23 (26.4%) in the ENOD group –odds ratio = 2.16 (95% confidence interval, 1.14-4.08) in the bivariate analisys, and odds ratio = 2.37 (95% confidence interval, 1.14-4.91) inthe logistic regression–. In the group ED a higher systolic blood pressure was observed(P=.02). There were no significant differences in age, sex, body mass index, waist circumference,total cholesterol, triglycerides and diastolic blood pressure. The frequency of risk factors fordiabetes was similar in both groups.CONCLUSIONS: In the Mexican population, the spouses of subjects with DM2 have a higher risk ofany alteration in the glucose tolerance than spouses of subjects with a normal glucose metabolism

[Differences of risk factors for peripheral arterial disease in type 2 diabetes patients in urban and suburban populations]. / Enfermedad arterial periférica y factores de riesgo en pacientes diabéticos tipo 2: Diferencias en medio urbano y suburbano.

OBJECTIVES: To determine the prevalence of peripheral arterial disease (PAD) in type 2 diabetes patients and to measure the strength of the association of selected risk factors. METHODOLOGY: A cross-sectional study including two hundred and fifty-two type 2 diabetes patients older than 40 years was conducted in three family medicine clinics, one clinic located within the city and two clinics in the suburb. PAD was diagnosed by Doppler pulsed in the patients with an ankle/arm index < 0.9. CLINICAL VARIABLES: Serum cholesterol and triglycerides levels, body mass index (BMI), waist-hip index (WHI), blood pressure (BP) and fasting blood glucose average of the last six months. To ascertain the differences in the prevalence of PAD, chi(2) test was used; t test was used for quantitative variables; and to estimate the risks the odds ratios were calculated. RESULTS: Among urban population the prevalence of PAD was of 25.6% while for those living in the suburb was 9.8 % (p = 0.002). Serum levels of blood glucose and cholesterol were lower in the latter (p = 0.01 and p = 0.001 respectively). PAD was associated with serum blood glucose levels higher than 140 mg/dL (OR = 3.1; 95% CI: 1-9.7); total cholesterol higher than 200 mg/dL (OR = 2.8; 95% CI: 1.1-7.4); proteinuria (OR = 4.9; 95% CI: 1.7-30.6) and blood pressure higher than 140/90 mm Hg (OR = 2.11; 95% CI: 1.08-4.14). CONCLUSIONS: Prevalence of PAD was higher in type 2 diabetes patients receiving care in urban clinics when compared to those cared for at suburban family medicine clinics and its corresponding risk factors showed significant values.

[Professional burnout in family physicians and its association with social demographic and labor factors]. / Desgaste profesional en médicos familiares y su asociación con factores sociodemográficos y laborales.

OBJECTIVE: To determinate the prevalence of burnout in family physicians of the Family Medicine Units in the Estado de México and its association with labor and socio demographics factors. MATERIAL AND METHODS: A transversal study was made in five Family Medicine Units. 154 physicians of both sex participated in this study. The Maslach Burnout Inventory (MBI) which measures the burnout in its three dimensions: emotional fatigue (EC), depersonalization (DP) and personal realization (PR), was applied by self-administration. Socio-demographic and labor details were obtained. RESULTS: Response rate was 85. A high CE was significantly associated to inadequate physical area, OR 3.9 CI 95% 1.5-10.6; to work load OR 7.6 CI 95% 1.6-50.7 and to lack of labor incentives OR 4.4 CI 95% 1.7-11.9 depersonalization was associated only with salary OR 2.6 CI 95% 1.05-6.4. CONCLUSIONS: Family physicians of Mexican Institute of Social Security have labor factors that are associated with burnout that can affect patient's attention.

[Acute cystitis in women with type 2 diabetes. Three antimicrobial schemes]. / Cistitis aguda en mujeres con diabetes mellitus tipo 2. Comparación de tres esquemas antimicrobianos.

OBJECTIVE: To compare the effectiveness and secondary effects of trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and nitrofurantoin in women with type 2 diabetes mellitus (DM2) and acute community-acquired cystitis. METHODS: A randomized single blind clinical trial was conducted in the family medicine clinic No. 91 of Instituto Mexicano del Seguro Social in Coacalco, Mexico. The study included women with DM2 and acute cystitis who were randomly allocated to one of the following schemes: TMP-SMX (160/800 mg every 12 h), ciprofloxacin (500 mg every 12 h) or nitrofurantoin (100 mg every 6 h) for 10 days. RESULTS: Sixty-one patients fulfilled the inclusion criteria. Bacteriologic eradication at the end of the treatment was observed in 18/23 (78 %) of patients treated with ciprofloxacin; 14/18 (78%) of patients treated with nitrofurantoin; and 9/20 (45 %) of patients treated with TMP-SMX (p = .036). The difference between nitrofurantoin and TMP-SMX, as well as between ciprofloxacin with TMPSMX, was 33 % for both (95 % confidence interval = 4 %, 62 %, and 5 %, 61 % , respectively). The most frequently isolated bacterium was Escherichia coli (75 %), The in vitro resistance rate to TMP-SMX was 76 %, to ciprofloxacin 17 % and to nitrofurantoin 13 % (p = 0.05). The main adverse effects were slight to moderate headache, nausea, and pyrosis in the three groups. CONCLUSIONS: ciprofloxacin and nitrofurantoin were more effective than TMP-SMX for the treatment of community-acquired acute cystitis in Mexican women with DM2. This is probably due to differences in the resistance rates and is probably not specific for diabetic patients; All three antimicrobials were safe.

[Asymptomatic bacteruiria frequency in pregnant women and uropathogen in vitro antimicrobial sensitivity]. / Frecuencia de bacteriuria asintomática en embarazadas y sensibilidad antimicrobiana in vitro de los uropatógenos.

OBJECTIVES: To estimate the frequency of asymptomatic bacteriuria in pregnant women attended in Family Medicine Units of the Instituto Mexicano del Seguro Social and to determine the in vitro sensitivity rate of the microorganisms to ampicillin, trimethoprim-sulfamethoxazole, nitrofurantoin and amikacin. PATIENTS AND METHODS: We carried out an observational, prospective and transversal study at Family Medicine Units 62 and 64 of the Mexico State Delegation, located in the urban area of Mexico City. Women with lesser than 32 weeks of pregnancy without urinary tract symptoms were included. Urine culture of a midstream urine specimen with > or = 10(5) colony forming units/mL urine of an only germen was used as the gold standard. The in vitro antimicrobial sensitivity was established according to the Bauer Kirby technique. RESULTS: 874 pregnant women were included and 73 had a positive urine culture, with a frequency of 8.4%, IC 95% = 6.6 - 10.2%, of asymptomatic bacteriuria. Escherichia coil was the most frequent isolated agent (77%). In vitro sensitivity to ampicillin of the microorganisms isolated was of 27%, IC 95% = 16 - 38%; to trimethoprim-sulfamethoxazole of 40%, IC95% = 29 - 51%; to amikacin of 68%, IC 95% = 57 - 79%, and to nitrofurantoin of 79%, IC 95% = 70 - 88%. CONCLUSIONS: The frequency of asymptomatic bacteriuria in the studied population is similar to the reported by the literature. The in vitro sensitivity rates of E. coil to ampicillin and to trimethoprim-sulfamethoxazole are very low. The best sensitivity corresponded to the nitrofurantoin. The treatment of the asymptomatic bacteriuria must be based on the local patterns of antimicrobial sensitivity and resistance.

[Factors associated with complaints against physicians working at Mexican Institute of Social Security hospitals]. / Factores asociados a la gestión de quejas contra médicos que laboran en hospitales del Instituto Mexicano del Seguro Social.

OBJECTIVE: To identify the factors associated with complaints of patients against physicians who work at general hospitals of the Mexican Institute of Social Security (MISS). MATERIAL AND METHODS: All the medical complaint files in a three-year period at the nine general hospitals of Mexico State MISS East District were examined. For each complaint filed, two control files were selected from the same hospital and clinical area. Associations were assessed using odds ratios and logistic regression. RESULTS: A total of 130 complaint cases and 260 controls were included. Seven out of 14 risk factors were selected: complications during hospitalization (OR 2.8, 95% CI 1.3-5.8), diagnostic error (OR 3.18, 95% CI 1.7-5.6), use of diagnostic tests (OR 3.7, 95% CI 1.2-11.3), insufficient information given by physicians (OR 2.64, 95% CI 1.22-5.7), voluntary hospital discharge (OR 7.2, 95% CI 2.22-23.6), lack of clinical monitoring during hospitalization (OR 19.12, 95% CI 2.25-162.6), and multiple vaginal revisions during labor (OR 5.17, 95% CI 1.5 17.07). Complaints were filed more often when there was a poor patient-physician relationship, deficient monitoring during labor, therapeutic error, and delay in surgery. Statistical significance was not attained. CONCLUSIONS: Complaints against Mexico State MISS hospital physicians were associated with diagnostic technical factors, as well as with the patients' perception of receiving deficient information and care during hospitalization. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Factores asociados a la gestión de quejas contra médicos que laboran en hospitales del Instituto Mexicano del Seguro Social / Factors associated with complaints against physicians working at Mexican Institute of Social Security hospitals

OBJETIVO: Identificar los factores asociados a la gestión de quejas contra los médicos que trabajan en hospitales generales del Instituto Mexicano del Seguro Social. MATERIAL Y MÉTODOS: Se revisaron las quejas presentadas y los expedientes clínicos correspondientes, en los nueve hospitales de la Delegación Estado de México Oriente, del Instituto Mexicano del Seguro Social. Por cada expediente clínico con queja se seleccionaron como controles dos expedientes sin queja, de la misma unidad y servicio. Se buscaron asociaciones por medio de razón de momios y regresión logística. RESULTADOS: Se incluyeron 130 expedientes motivo de queja y 260 expedientes control. Se identificaron siete factores asociados a queja de 14 investigados: complicaciones durante la atención RM 2.8 (IC 95 por ciento 1.3-5.8), error diagnóstico RM 3.18 (IC 95 por ciento 1.7-5.6), utilización de estudios de gabinete RM 3.7 (IC 95 por ciento 1.2-11.3), información deficiente por parte del médico RM 2.64 (IC 95 por ciento 1.2-5.7), alta voluntaria RM 7.2 (IC 95 por ciento 2.2-23.6), falta de vigilancia durante la hospitalización RM 19.12 (IC 95 por ciento 2.2-162.6) y revisiones vaginales múltiples durante el trabajo de parto RM 5.17 (IC 95 por ciento 1.5-17.07). Hubo tendencia a la presentación de quejas cuando se reportaron: mala relación médico-paciente, deficiente atención del trabajo de parto, error terapéutico y diferimiento de cirugía, sin significancia estadística. CONCLUSIONES: Las quejas contra médicos de hospitales del Instituto Mexicano del Seguro Social en el Estado de México se asocian con aspectos técnicos en el diagnóstico y con la percepción del derechohabiente de recibir información y vigilancia deficientes durante la hospitalización.

[Development and initial validation of an instrument to measure the lifestyles of type 2 diabetes mellitus patients 2]. / Construcción y validación inicial de un instrumento para medir el estilo de vida en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To develop and validate a specific instrument to measure lifestyle of type 2 diabetes mellitus (DM2) patients. MATERIAL AND METHODS: A longitudinal, observational, prospective study was conducted between March 2001 and April 2002 at family medicine healthcare units of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security (MISS)) in Mexico State's East District. A self-administered instrument (instrument to measure diabetic lifestyles, IMEVID) was designed to measure the lifestyles of diabetic patients. It was submitted for review by a multidisciplinary group of experts who assessed its logical and content validity to measure the lifestyle in DM2 patients. The instrument was administered on two different days to 412 adult subjects with DM2. Some items were excluded on the basis of the frequency with which their answer choices were selected, as well as the item-total correlation, and the item's significant loads in several domains in factorial analysis. RESULTS: The sample population consisted of 389 (94.7% response) subjects who completed the study. Intraclass correlation coefficients for logical and content validity were 0.91 and 0.95 respectively. After depuration of items, the instrument had 25 closed items grouped in 7 domains: nutrition, physical activity, tobacco consumption, alcohol consumption, information on diabetes, emotions, and therapeutic adherence. The global rating of the questionnaire had a Cronbach's alpha of 0.81 and a test-retest correlation coefficient of 0.84. CONCLUSIONS: The specific questionnaire IMEVID is the first to measure the lifestyle in subjects with DM2. It has logical validity, content validity, and a good level of consistency.

Construcción y validación inicial de un instrumento para medir el estilo de vida en pacientes con diabetes mellitus tipo 2 / Development and initial validation of an instrument to measure lifestyle of type 2 diabetes mellitus patients

OBJETIVO: Construir y validar un instrumento específico para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2. MATERIAL Y MÉTODOS: Entre marzo de 2001 y abril de 2002 se hizo un estudio observacional, longitudinal y prospectivo en unidades de medicina familiar de la delegación Estado de México Oriente, del Instituto Mexicano del Seguro Social. Se diseñó un instrumento de autoadministración, denominado instrumento para medir el estilo de vida en diabéticos, el cual fue sometido a revisión por un panel multidisciplinario de expertos para determinar su validez lógica y de contenido. Se aplicó el instrumento en dos días diferentes a 412 sujetos adultos con diabetes mellitus. Fueron depurados los ítems considerando la frecuencia de selección de sus opciones de respuesta, su correlación ítem-total y su carga significativa en los dominios durante el análisis factorial. RESULTADOS: Completaron el estudio 389 (94.7 por ciento) sujetos. Los coeficientes de correlación intra-clase para la validez lógica y de contenido fueron de 0.91 y 0.95, respectivamente. Después de la depuración de ítems se obtuvo un instrumento conformado por 25 preguntas cerradas, distribuidas en siete dominios: nutrición, actividad física, consumo de tabaco, consumo de alcohol, información sobre diabetes, emociones y adherencia terapéutica. El a de Cronbach para la calificación total fue de 0.81 y el coeficiente de correlación test-retest de 0.84. CONCLUSIONES: El instrumento para medir el estilo de vida en diabéticos es el primer cuestionario específico para sujetos con diabetes mellitus tipo 2 y tiene validez aparente, validez de contenido y buen nivel de consistencia

Análisis de egresos por diabetes en un hospital de segundo nivel de atención. Evaluación de siete años / Analysis of discharges due to diabetes mellitus in a second level hospital. Evaluation of seven years

Antecedentes: en México la diabetes representa un problema de salud pública de magnitud creciente. Objetivo: determinar el porcentaje de egresos por diabetes mellitus en un hospital de segundo nivel de atención. Material y métodos: se revisaron todas las notas del archivo del servicio de medicina interna del Hospital General Regional número 72 de los pacientes egresados de enero de 1989 a diciembre de 1995 con diagnóstico de diabetes mellitus tipos 1 y 2. Se excluyeron los pacientes con diabetes secundaria y los diabéticos en programa de diálisis peritoneal intermitente. Resultados: se revisó un total de 7,678 notas de pacientes egresados del servicio de medicina interna. Del total de egresos 2,598 (34.1 por ciento) tuvieron diagnóstico de diabetes mellitus. La comorbilidad aguda infecciosa fue de 50.7 por ciento. La comorbilidad aguda infecciosa y no infecciosa fue tres veces más frecuente en mayores de 60 años. La tasa de mortalidad global fue de 45.7 por cada 1,000 egresos. El porcentaje de egresos por la enfermedad varió de 29.4 por ciento en 1992 a 40.8 por ciento en 1994. Conclusiones: la diabetes mellitus es una causa frecuente de hospitalización en el servicio de medicina interna del Hospital General Regional núm. 72. La mortalidad hospitalaria es menor que la reportada en la literatura nacional.