Characteristics of COVID-19 and mortality-associated factors during the first year of the pandemic in southeast Mexico.

Aim: The present study was designed to evaluate the clinical characteristics of COVID-19 and mortality-associated factors during the first year of the pandemic in patients from southeastern Mexico. Patient & methods: A total of 953 records from patients with COVID-19 were cross-sectionally studied in a primary care hospital in southeast Mexico between 2020 and 2021. Results: The prevalent symptoms were fever (78.6%), cough (80.5%) and headache (82.8%) and dyspnea reached 13.5%. The mortality rate was 7.63% and the clinical variables associated with it were age >60 years, hypertension, severe disease, radiographic pneumonia, days to diagnosis and having two Mayan surnames. Conclusion: Future health strategies should consider age, comorbidities, disease severity, clinical manifestations and possessing ethnicity of risk (i.e., Mayan genetic background).

Hypozincemia in Mexican patients with diabetic foot ulcer treated out of hospital.

OBJECTIVE: To know the frequency of people with hypozincemia in a group of Mexican patients with Diabetic Foot Ulcers (DFU)m and its relationship with metabolic and clinical profile. MATERIAL AND METHODS: Cross-sectional, analytical, and observational study in patients with and without DFU, treated in Family Medicine Units from Instituto Mexicano del Seguro Social (IMSS) in Mérida, Yucatán, México. Frequency of hypozincemia (Zn serum < 70 g/ml) and its relationship with the levels of Glycosylated Hemoglobin (HbA1c), cholesterol and triglycerides was analyzed. RESULTS: 70% of patients with DFU and 25% without DFU had hypozincemia (OR = 5.2, 95% CI 2.139-12.65, p = 0.0004). Patients with hypozincemia were older and the highest prevalence was between 50 and 60 years. The average area of the DFU showed no differences in patients with and without hypozincemia. Patients with DFU reported higher levels of HbA1c, cholesterol, triglycerides, BMI, and blood pressure compared to patients without DFU. Hypozincemia was associated with higher BMI values. CONCLUSION: The frequency of hypozincemia in diabetic patients with UPD is high and is behaving as a risk factor for presenting UPD, so its identification should be routine.

OBJETIVO: Conocer la frecuencia de hipozinquemia en pacientes Mexicanos con úlceras de pie diabético (UPD) y su relacion con el perfil clínico y metabólico. MATERIAL Y MÉTODOS: Estudio transversal, analítico, en pacientes con y sin úlceras de pie diabético, tratados en unidades de medicina familiar del Instituto Mexicano del Seguro Social (IMSS) en Mérida, Yucatán, México, que analizó la frecuencia de Hipozinquemia (Zn serico de < 70 mg/ml) y su relación con los niveles de Hemoglobina Glucosilada (HbA1c), colesterol y triglicéridos. RESULTADOS: 70% de los pacientes con UPD y 25% sin UPD tenían hipoziquemia (OR=5.2, IC95% 2.139-12.65, p=0.0004). La mayor prevalencia se encontró entre los 50 y 60 años. El área promedio de las UPD no mostró diferencias entre pacientes con y sin hipozinquemia. Los pacientes con UPD presentaron niveles más altos de HbA1c (p<0.001), colesterol (p<0.001), triglicéridos (p<0.001), IMC (p=0.01) y tensión arterial (p=0.009) en comparación con los pacientes sin UPD. Los pacientes con UPD e hipoziquemia tenían mayores valores de IMC. CONCLUSIÓN: La frecuencia de hipozinquemia en pacientes diabéticos con UPD es alta y es se comporte como un factor de riesgo para presentar UPD, por lo que su identificación deberia ser rutinaria.

Tamoxifen side effects: pharmacogenetic and clinical approach in Mexican mestizos.

BACKGROUND: Tamoxifen metabolism is translated into four genetic phenotypes (GP): genetic poor metabolizer (gPM); genetic intermediate metabolizer (gIM); genetic normal metabolizer (gNM); and genetic ultra-rapid metabolizer (gUM). Although CYP2D6 is involved in tamoxifen biotransformation, its association with tamoxifen side effects (TSE) is limited. Therefore, we evaluated CYP2D6 GP and clinical variables as potential predictors of TSE in Mexican Mestizo patients. METHODS: This cross-sectional study evaluated CYP2D6 GP, clinical data, and self-reported TSE in 71 women. Potential predictors were tested in uni- and multivariable models. RESULTS: Hot flashes (57.75%), arthralgia (45.07%), headache (43.66%), and cramps (39.44%) were the most frequent TSE. Three GP were identified: gPM (2.8%); gNM (93.0%); and gUM (4.2%). In the univariate analysis, none of the GP was predictive of TSE. However, the uni- and multivariable models showed contraceptive use and chemotherapy treatment prior to tamoxifen therapy to be predictive. Two alleles were identified for the first time at unusually high frequencies: CYP2D6*34 (13.2%); and *39 (14.7%). CONCLUSIONS: Our findings indicate that CYP2D6 GP were not significantly predictive of TSE, though two clinical descriptors were. The present results are a valuable contribution to pharmacogenetic characterization of Mexican Mestizo populations who, like other Latin-American groups, are poorly represented in the literature.

Development of a high-performance liquid chromatography method with fluorescence detection for the routine quantification of tamoxifen, endoxifen and 4-hydroxytamoxifen in plasma from breast cancer patients.

To date, several methods for the quantification of tamoxifen and its metabolites have been developed, most of which employ liquid chromatography tandem-mass spectrometry (LC-MS/MS). These methods are highly sensitive and reproducible, but are also time-consuming and require expensive equipment; one of their main disadvantages is matrix ionization effects. A more viable option, particularly in developing countries, is high-performance liquid chromatography coupled with UV or fluorescence detection. We developed and validated a method for simultaneous quantification of tamoxifen, endoxifen and 4-hydroxytamoxifen based on high-performance liquid chromatography with fluorescence detection in a reverse-phase column. The method is rapid (16 min plus 5 min of column re-equilibrium), accurate (80-100%) and precise (0.23-6.00%), and does not require any additional irradiation process. Sample pretreatment consists of protein precipitation with acetonitrile under alkaline conditions, employing only 200 µL plasma. The validated method's wide range allowed quantification of steady-state levels in patients under standard tamoxifen treatment (20 mg/day). This assay is ready for application in clinical studies and routine quantification of tamoxifen, endoxifen and 4-hydroxytamoxifen in healthcare institutions.

Healthcare delay in breast cancer patients: a case study in a low-density population region from Mexico.

AIM: To describe delay intervals, their impact on clinical stage and initiation of first oncologic treatment, and evaluate associated factors in breast cancer patients in Yucatan, Mexico, a low-density population region. PATIENTS & METHODS: A retrospective analysis was done of 92 medical records, and bivariate and multivariate models applied to identify associations between healthcare delay and several factors. RESULTS: System delay accounted for most of the delay (median: 86 days; 61% of delay). Socioeconomic status and delivery to tertiary-care hospital predicted delay. Clinical stage determined initiation of first oncologic treatment. CONCLUSION: Delay in treatment was largely due to system delay. Only a few variables explained this delay. Clinical stage had the strongest effect on initiation of first oncologic treatment.

[Clinical and epidemiological characteristics of humeral supracondylar fractures in pediatric patients in a Regional General Hospital]. / Perfil clínico-epidemiológico de las fracturas supracondíleas de húmero en pacientes pediátricos en un hospital general regional.

BACKGROUND: Supracondylar humerus fractures are common in children between 5-7 years of age and more frequent in the males, 90-95% of these fractures are in extension mechanism, the urgency of immediate attention is to prevent complications and sequelae. OBJECTIVE: To establish the clinical and epidemiological profile of supracondylar humerus fractures, in a General Regional Hospital from the Instituto Mexicano del Seguro Social in Yucatan Mexico, during 2011-2013. MATERIAL AND METHODS: A cross-sectional study. Strength association was measured by odds ratios and statistical significance with chi(2) test, p value was considered in < 0.05 RESULTS: 56 cases were analyzed, the mean age was 2.6 ± 5.33 years, the mechanism of injury was falling over at home, male gender is associated with extent injure mechanism (OR 5.6, 95% CI 1.0-30.1, p = 0.03), we observed that at most time elapsed between injury and medical means more hospital days (r = 0.40; p = 0.002), surgical treatment was established in 44 cases (78.6%), 18 (40.9%) with closed technique and placement of cloves and 26 (59.1%) with open reduction, in 100% cross configuration was used, ten complications were reported. CONCLUSIONS: Supracondylar humerus fractures are a common injury in children, males are more likely to be injured by extension, and the speed in medical treatment is an important issue.

Barriers to implementing the «2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis» in primary healthcare practice / Barreras para la implementación de la «Guía Mexicana de Práctica Clínica para el manejo de osteoartritis de cadera y rodilla en el primer nivel de atención 2008» en la práctica de atención primaria

Objective: To evaluate the implementability of the «2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care» within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Methods: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Results: Reviewers’ agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients’ beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. Conclusions: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers (AU)

Objetivo. Evaluar las barreras de implementación de la guía de práctica clínica para el manejo de osteoartritis de cadera y rodilla en el primer nivel de atención 2008 dentro de la práctica clínica de 3 regiones mexicanas, usando la metodología Guideline Implementability Appraisal version 2 (GLIA v2). Métodos. Seis médicos familiares, representantes del sur, norte y centro de México, y un médico rehabilitador mexicano evaluaron las 45 recomendaciones propuestas en la guía de práctica clínica. La metodología GLIA v2 incluye la ejecución de técnicas cualitativas y semicuantitativas. Resultados. En su mayoría, el acuerdo entre revisores fue de moderado a casi completo. El 69% de las recomendaciones fueron consideradas como difíciles de implementar en la práctica clínica. Ocho recomendaciones no tienen un formato apropiado. Únicamente 6 recomendaciones pueden ser aplicadas consistentemente en la práctica clínica. En 25 recomendaciones, se detectaron barreras de implementación relacionadas al contexto de una o más de las instituciones/regiones exploradas. Estas barreras se relacionan con las creencias de proveedores de salud y pacientes, procesos de atención en cada institución y disponibilidad de algunos de los tratamientos recomendados en la guía. Conclusiones. La guía contiene recomendaciones poco claras y concisas, lo que afecta negativamente a su aplicación dentro del primer nivel de atención mexicano. Identificamos características individuales, organizacionales y sistemáticas, comunes a las 3 instituciones/organizaciones estudiadas, que significan barreras para implementar la guía en México. Se recomienda que esta guía sea revisada y reestructurada con el fin de mejorar la claridad de sus recomendaciones. Proponemos algunas estrategias para hacer esto y atacar algunas de las barreras identificadas relacionadas dentro de las regiones exploradas (AU)

Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

OBJECTIVE: To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). METHODS: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. RESULTS: Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. CONCLUSIONS: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.

[Burnout syndrome among family physicians]. / Síndrome de agotamiento profesional en los médicos familiares.

BACKGROUND: burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians. METHODS: a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test. RESULTS: there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome. CONCLUSIONS: the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

Introducción: el síndrome de agotamiento profesional es un estado de agotamiento físico y emocional que puede presentarse en trabajadores que interactúan con otras personas. El objetivo de esta investigación fue conocer la prevalencia de este síndrome y los factores relacionados en médicos familiares de Mérida, Yucatán, México. Métodos: se realizó una encuesta transversal en la que se aplicó el Maslach Burnout Inventory a médicos familiares seleccionados mediante muestreo no probabilístico por conveniencia. Se analizaron las medidas de tendencia central y dispersión y se determinó la prevalencia del síndrome de agotamiento profesional. La significación estadística de los factores asociados se determinó mediante χ2. Resultados: se obtuvieron 59 casos de síndrome de agotamiento profesional: 36 con afectación en un componente del Maslach Burnout Inventory, 15 en dos y ocho en los tres. El 35 % de los casos indicó trabajar en promedio 10 turnos extra al mes (p = 0.013); tener un segundo trabajo también se relacionó con el síndrome. Conclusiones: los resultados son consistentes con los obtenidos en estudios similares. Trabajar turnos extra o tener otro trabajo fueron los factores relacionados con el síndrome de agotamiento profesional.