Revista medica del Instituto Mexicano del Seguro Social

Publisher: Instituto Mexicano del Seguro Social

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Website Revista medica del Instituto Mexicano del Seguro Social website
Other titles Revista médica, Revista médica
ISSN 0443-5117
OCLC 10512384
Material type Government publication, National government publication, Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Parenteral nutrition (PN) is a mixture that covers the nutritional needs when enteral nutrition is not an option; however, PN is not free of complications. The aim of our study was to determine the indication and frequency of NP complications in pediatric patients treated at a tertiary center. Methods: Children receiving PN at the Hospital de Pediatría del Centro Médico Nacional Siglo XXI were included. Demographic and anthropometric characteristics were recorded, as well as the reason of indicating PN, the time of administration, and the complications associated to this type of nutrition. Results: Sixty-nine pediatric patients with PN were included: 33 neonates, 18 infants (between one and 11 months of age), nine preschoolers (from 1 to 5 years of age), and nine children over five years of age. Instructions for initiating the PN were given for the treatment of 71 % of the patients with diseases of the digestive tract who were treated surgically. Complications of PN occurred in 87 % of the children and 76.7 % had more than one complication. Metabolic complications occurred in 98 % of the children while mechanical and infectious complications only in 1 %, respectively. Conclusions: Parenteral nutrition was indicated more frequently in pediatric patients with digestive diseases treated surgically. Metabolic complications were the main concern in pediatric patients with PN.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S262-S269.
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    ABSTRACT: Background: In 2009 it was introduced a new diagnostic criteria based on hemoglobin A1c (HbA1c) greater than or equal to 6.5 % in the adult population; some studies suggest that the cutoff may be smaller in pediatric population. The objective was to determine the utility of HbA1c greater than or equal to 6.5 % as a diagnostic test for DM in Mexican adolescents with overweight or obesity. Methods: Full somatometry was performed. Also, Tanner stage, blood pressure, blood glucose, glucose tolerance curve (GTC) and HbA1c were analyzed. Specificity, sensitivity, positive and negative predictive values and ROC curve were calculated for the diagnosis of DM with HbA1c. Results: 109 adolescents between 10 and 16 years referred for obesity or overweight plus comorbidities were studied; 58 % were females, the age was of 13 ± 1.74 years, the BMI percentile 95.3, and the HbA1c 5.73 ± 0.9 %. It was made a diagnosis of DM in 9 cases (8.3 %), prediabetes in 8 (7.3 %) and normal glucose tolerance in 92 (84.4 %). The HbA1c mean was 5.6 ± 0.04, 5.7 ± 0.4, and 5.6 ± 0.73 %, respectively. HbA1c greater than or equal to 6.5 % had a sensitivity of 12.5 %, a specificity of 89.8 %, a PPV of 10.65 and a NPV of 14.28. The best cutoff point for diagnosing DM through ROC curve was 5.45 %, with a sensitivity of 62.5 %, a specificity of 57.1 %, PPV 2.53 and NPV 33.3. Conclusions: The level of HbA1c greater than or equal to 6.5 % had low sensitivity and specificity for the diagnosis of DM. A lower cutoff point is insufficient to use HbA1c as a diagnostic criterion. These results are consistent with the ones of other journals.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S294-S299.
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    ABSTRACT: Background: It has been suggested that patients with nephrotic syndrome (NS) have an increased frequency of cardiovascular risk factors. The aim of this study was to determine the frequency of cardiovascular risk factors in children with primary NS. Methods: Cross-sectional, descriptive and prospective study. Fifty-five patients with primary NS were included. The presence of overweight/obesity, hypertension, dyslipidemias, hyperglycemia, elevated C-reactive protein and carotid intima-media thickness (IMT) was evaluated. The treatment time, the type of treatment and the number of relapses were analyzed. For statistical analysis chi-square and Spearman's rho were used. Results: The most frequent cardiovascular risk factor was increased carotid IMT (98.1 %), followed by hypertriglyceridemia (54.4 %) and total cholesterol (40 %). Patients with corticosensitive NS had fewer risk factors compared with patients with steroid-resistant NS. There was also a positive correlation of longer time of evolution and number of relapses with the increase in the number of factors. Conclusions: Ninety-eight percent of children with primary NS had at least one cardiovascular risk factor. Certain clinical features, such as steroid-resistant NS, and the time of evolution and treatment, seem to be related to the presence of larger number of risk factors.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S284-S293.
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    ABSTRACT: Background: The studies that describe risk factors for the development of ventilator-associated pneumonia (VAP) in newborn infants report dissimilar information, possibly related to the type of intensive care unit and population included. The objective of this study was to identify risk factors for the development of VAP in a neonatal intensive-care unit. Methods: Case-control study. Patients with the diagnosis of VAP were classified as cases and compared with two controls of the same gestational age, weight, and diagnosis at admission. We analysed the data using descriptive and inferential statistics: chi-squared test, Student's t-test, odds-ratio, 95 % confidence interval and logistic regression analysis. Results: A total of 45 cases and 90 controls were analysed. The risk factors statistically significant in the univariate analysis were: previous episode of sepsis, reintubation, airway malformation, exclusive parenteral nutrition, and days of mechanical ventilation. In the logistic regression analysis we obtained these data: reintubation (OR 41.26, CI 95 % 11.9-158.4, p = 0.001), airway malformation (OR 19.5, CI 95 % 1.34-282.3, p = 0.029), and days of mechanical ventilation (OR 8.9, CI 95 % 1.9-40.8, p = 0.005). These were the only risk factors independently associated to VAP. Conclusion: Of the significant risk factors, it is possible to intervene in reintubation events, by securing the endotracheal cannula with an adequate fixation, mobilize the patient ensuring safety, and follow a decannulation protocol to reduce ventilation days.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S254-S260.
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    ABSTRACT: Background: Surveillance of adverse events associated to the use of short peripheral venous catheters (SPVC) is an indicator of quality of service. The objective was to report the incidence and risk factors associated to adverse events in SPVC. Methods: Prospective cohort study. All patients with a SPVC for more than 48 hours were included. The outcome variables were dysfunction, chemical phlebitis and bacterial phlebitis. The data registered were age, sex, underlying diseases, nutritional status, site of placement, skin condition, administered intravenous fluids, and catheter dressing. Regarding statistical analysis, incidence rate for each adverse event was calculated per 100 catheters and per 1000 catheter-days. Univariate and multivariate analysis of risk factors were performed. Results: 410 catheters were analyzed. Median of SPVC use was of three days. There was no evidence of infectious complications: 47 (11.4 %) presented chemical phlebitis and 231 (56.3 %) mechanical malfunction; the incidence rate was 35.6 and 175 per 1000 catheter-days, respectively. In the multivariate analysis, the risk factors associated to chemical phlebitis were skin lesions (p = 0.001, RR 3.479), and additional dressing use (p = 0.007, RR 4.025); for mechanical malfunction the only risk factor was the administration of intravenous chemotherapy (p = 0.026, RR 4.293). Conclusions: The malfunction incidence rate was high; in consequence, the catheter was removed before 96 hours of use. This could explain the absence of infectious complications.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S310-S315.
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    ABSTRACT: Background: The biliary atresia (BA) is the end result of a destructive and idiopathic inflammatory process affecting the intrahepatic and extrahepatic bile ducts, leading to fibrosis and biliary cirrhosis. The objective was to identify factors associated with mortality in children with BA. Methods: Observational, longitudinal, analytical and retrospective study carried out in patients with biliary atresia treated between 2008 and 2012 in a tertiary care hospital from the Instituto Mexicano del Seguro Social. Results: A total of 66 patients with BA; 49 were girls (74.2 %), 47 underwent hepatic portoenterostomy (or Kasai procedure: KP), the age at delivery was 4.5 months. When comparing the groups with and without KP, the lower age at the time of delivery, the age of diagnosis, a lower score on the PELD score and the Child-Pugh for the group with Kasai were statistically significant. Patients who died had a PELD score statistically higher (median 20) than those who lived (median 13), p = 0.004. The factor directly related with the mortality was the history of KP with an OR of 0.17 (95 % CI 0.04-0.71, p = 0.016). Conclusions: The prognosis of children with BA remains gloomy because they are diagnosed in late stages. The most important factor associated with mortality in these patients is to perform KP.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S270-S283.
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    ABSTRACT: In the interest of encouraging the promotion of research done by physicians of the Instituto Mexicano del Seguro Social, in this supplement we publish articles written by residents of different specialties related to critical themes on pediatrics. These residents are guided by affiliated physicians from the Hospital de Pediatría del Centro Médico Nacional Siglo XXI.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S228-S229.
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    ABSTRACT: Background: In the current medical practice, central venous catheters (CVC) are very useful; however, their use involves certain risks, which increase morbidity and mortality, especially in newborns. The aim of this study was to describe both the frequency of complications and survival of CVC placed in newborns hospitalized in a third level neonatal intensive care unit (NICU). Methods: A descriptive, observational and prospective study was carried-out in the NICU from the Hospital de Pediatría, Centro Médico Nacional Siglo XXI. Demographic, perinatal and CVC variables were recorded. Results: We included 152 CVCs, which were inserted in 123 newborns. For the CVC insertion, the puncture technique [percutaneous and subclavian] was used in 56.6 % (n = 86). There was at least one complication in 48.7 %.(n = 74). The most frequent complications were colonization 32.4 % (n = 24) and CVC-related bacteremia in 27 % (n = 20). Survival probability for CVC was 93.4 % at 10 days and 91.4 % at 17 days. Kaplan-Meier survival analysis demonstrated significantly lower survival probability for non-central catheters. Conclusions: Most of CVC complications occurred within the first two weeks after these CVC were installed. Infectious complications were the most frequent.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S300-S309.
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    ABSTRACT: Background: Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery. Methods: During a year a nested case-control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia. Results: 188 patients underwent heart surgery (15 % developed pneumonia). Ninety-seven patients were submitted to open-heart surgery: 24 cases and 73 controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. The average time of surgery, extracorporial bypass, aortic cross-clamp, and mechanical ventilation were greater in control patients. The frequency of open sternotomy, reintubation, and surgical wound infections was greater in case patients. Conclusions: Some of the events related to heart surgery and their subsequent management are associated significantly to the development of hospital-acquired pneumonia.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S316-S323.
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    ABSTRACT: Background: Annually, 5000 children younger than 20 years of age and 200 younger than two-years require treatment for chronic kidney disease (CKD). The objective was to estimate the incidence rate of infectious complications in children requiring renal replacement therapy. Methods: Retrospective cohort. Patients with a minimum of three months of follow-up in programs of peritoneal dialysis and hemodyalisis were included. The incidence rate for infections associated to replacement therapy was calculated. Results: 67 patients were analysed. In 88 %, initial therapy for CKD was peritoneal dialysis. A total of 52 episodes of peritonitis occured, with an incidence rate of 0.63 episodes/patient-year. Thirty children (48 %) never had an episode of peritonits during the folow-up. At six months, 90 % of the children had the same peritoneal dialysis catheter, decreasing to 84, 74 and 50 % at 12, 18 and 24 months, respectively. Forty-five children were on hemodialysis, 82 % preceded by peritoneal dialysis. Dialysis treatment time in 25 % of them was longer than 19 months. Twenty-two episodes of catheter-related bacteremia occurred, with an incidence rate of 1 episode/1000 catheter-days or 2.5/1000 hemodyalisis sesions. Twenty-nine patients received a transplant (43 %); two of them died. Median waiting time to transplant was 15 months. Conclusions: Incidence rate of infectious complications was similar to the rates reported in the literature by other centers. At 20 months, half of the patients had at least one infectious complication.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S246-S252.
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    ABSTRACT: Background: Survival of children with pineal region tumors has increased significantly in the last decade; these tumors have an insidious outcome associated with endocrine disorders with high morbidity and mortality, especially after gross resection. The objective was to report the survival, outcome, morbidity and mortality according to type of surgery, histology and treatment in children with pineal region tumors. Methods: This retrospective study included all patients of 17 years or less with diagnosis of pineal region tumor, who went over a period of 10 years to a children's hospital. A histopathological review was made, and the extent of resection was determined. The survival was also estimated. Results: Forty-six patients were included, out of which 36 had complete medical records and adequate pathologic material. Gross resection was performed in 24 (66.6 %), and biopsy in 12 (33.3 %); 23 (88 %) patients died; hydroelectrolytic imbalance was the cause of 14 deaths (60 %) and the other nine (39.1 %) were secondary to tumor progression. Ten-years survivals among patients treated with gross resection and biopsy were 52 and 75 %, respectively (p = 0.7). Endocrine alterations were observed in 13 patients (36.1 %); in 10 of these (76.9 %) the total resection was performed. Conclusions: Pineal region tumors in children can be treated with diagnostic biopsy, followed by adjuvant treatment consisting of chemotherapy and radiotherapy.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S240-S245.
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    ABSTRACT: Background: Isolated ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide. Prognostic factors associated with postoperative morbidity in patients with isolated VSD in the Hospital de Pediatría del Centro Médico Nacional Siglo XXI have not been identified. Methods: A retrospective cohort study was conducted from January 1, 2009 to December 31, 2013. Descriptive statistics and comparisons between groups were performed using chi-square test, Mann Whitney U test and linear regression. Relative risks (RR) and 95 % confidence intervals (95% CI) were calculated. Results: A total of 64 patients who underwent isolated VSD closure were included, 12.5 % (n = 8) had a history of pulmonary banding and 22 patients (34.3 %) had Down syndrome. The perimembranous and subaortic lesions occurred in 70 % of cases. Factors associated with an increased morbidity and a prolonged intensive care unit (ICU) stay were: lactate at the end of extracorporeal circulation (ECC) greater than 3 mmol/L (p = 0.02) and Down syndrome (p = 0.02), who had the highest incidence of postoperative complications (p = 0.02). Conclusions: A statistically significant association was found: the higher the preoperative functional class, the longer the hospital stay, the number of days at ICU and the hours of mechanical ventilation.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S324-S335.
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    ABSTRACT: Genetic counseling is an information process to help people in the understanding and adaptation to the medical, psychological and family implications of the genetic contribution in diseases. This counseling encompasses all sorts of patients. This represents a challenge in the daily work of the medical geneticist, because giving information in a meaningful way to the patient and his family implies an emotional and psychological burden. Generally we can see two outcomes in the medical practice of genetics, which converge after a diagnosis process: 1) we can face the inability to reach a diagnostic conclusion or 2) we can establish or confirm a diagnosis with certainty, which is the main piece in the genetic counseling. However, in all the situations the uncertainty is a fact, since in the case of those individuals who come in for genetic counseling before symptoms appear or those in prenatal cases, the absence of clinical manifestations and the impossibility to change the course of events lead to the appearance of helplessness and despair. In those cases without diagnostic conclusion, this situation represents a reason for uncertainty, and even in those patients with a diagnosis, certain factors can modify the circumstances in which genetic counseling occurs, such as unpredictability or lack of control. Therefore, it is important to consider the management of uncertainty as an inherent part throughout the process of care in medical genetics. The teaching of medical genetics should also consider the inclusion of topics related to this circumstance.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S230-S235.
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    ABSTRACT: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. The inclusion of molecular biology techniques in the diagnosis and prognostic stratification of these patients has allowed major treatment achievements in developed countries. One of the best studied gene rearrangements is E2A-PBX1, which predicts isolated central nervous system relapse in patients with ALL. However, further research on the search for new molecular markers related to prognosis of patients with childhood leukemia is required. Such studies need the integration of different disciplines, including epidemiology. Epidemiological studies are needed not only to accelerate the discovery of new molecular markers and new biological signals as to the etiology and pathophysiology of cancer, but also to evaluate the clinical impact of these findings in well-defined populations.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(Suppl 3):S236-S239.
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    ABSTRACT: Background: The aim of this study was to determine if the care of child patients on admission, coincides with perception of real urgency on the part of parents with that of the doctor and not because of perceived worry in the family (perceived emergencies). Methods: All the care given in the emergency department, from January 1st 2009 to December 31st 2010, was analyzed. A real urgency was determined by consensus on the conditions of the child. Sociodemographic of real urgency conditions were compared against those perceived. Results: 8,888 consultations were given, of which 2,024 (22.7 %) met criteria for real urgency. The main causes of real urgency were infectious diseases were followed by accidents and poisoning. Of real emergencies 17 (1 %) eventually required intensive management. Factors associated with real urgency were age, non-infectious disease, occurring between Monday to Friday, during the morning shift and in the winter months. Conclusions: The frequency of care for real urgency was low compared to that reported in other pediatric centers. Restructuring of pre-consultation services for the implementation of optimal patient classification before going to emergency helps greatly to optimize the use of the emergency department, deriving the patients in true need sooner.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(6):710-714.
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    ABSTRACT: Background: Nosocomial infections are a growing problem of great social and economic impact that affects hospitals. The aim of this study was to determine the prevalence of nosocomial infections in a secondary care hospital. Methods: A cross-sectional, observational study. Sample size was calculated for a proportion, hospitalized patients with more than 48 hours of stay were included; descriptive statistics and hypothesis testing was done using Fisher's exact test; SPSS software version 18 was used. Results: A prevalence of 9.52% was found, with an average age of 46.59 years; 64.3% of patients were female, 35.7% male. The prevalence was 16.27% in Internal Medicine department and 12.5% Surgery. Conclusions: 10 out of 100 hospitalized patients develop nosocomial infection, similar to that reported in the literature.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(6):686-690.
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    ABSTRACT: Cervical cancer (CC) is one of the best known malignancies. Currently, it is accepted that the etiological factor is persistent infection with high-risk human papillomavirus (HPV). Even before the identification of its etiological factors, methods such as Pap cytology and colposcopy were developed as tools for early diagnosis on CC and its precursor lesions. At the time when such tests were being developed, they were not fully accepted by the scientific community of the time; however, as time went by, the dissemination of knowledge, and more extensive application, these tests were finally included within the international guidelines. The implementation of programs with adequate coverage and quality allowed a significant reduction in the incidence and mortality of CC. However this did not occur widely, and CC is still a public health problem in developing countries. From the epidemiological and molecular viewpoint, knowledge on HPVs laid the foundations for the development of new prevention strategies based on vaccination and molecular detection of the causal agent, currently accepted as strategies for primary and secondary prevention. It is expected that the implementation of these strategies will have a greater impact on the control on CC and other malignancies associated with HPV infection.
    Revista medica del Instituto Mexicano del Seguro Social 10/2015; 53(6):670-677.