Phase Angle in Head and Neck Cancer: A Sex-Differential Analysis from Biological and Clinical Behavior to Health-Related Quality of Life

Head and neck cancer (H&NC) is a diverse category of tumors related to malignancies in the common aerodigestive pathway, with high metabolic rate, poor nutritional and treatment outcomes, and elevated mortality despite the best standard treatment. Herein, we focus on determining how the phase angle (PA) differs across sex as a predictor of poor prognosis, low quality-of-life (QoL) scores, and mortality in patients with head and neck cancer. This follow-up study presents a sex-differential analysis in a prospective cohort of 139 head and neck cancer patients categorized by sex as male (n = 107) and female (n = 32). Patients were compared in terms of nutritional, biochemical, and quality-of-life indicators between low and normal PA in women (<3.9° (n = 14, 43.75%) and ≥3.9°) and men (<4.5° (n = 62, 57.9%) and ≥4.5°). Our results show that most patients were in locally advanced clinical stages (women: n = 21 (65.7%); men: n = 67 (62.6%)) and that patients with low PA had a lower punctuation in parameters such as handgrip strength, four-meter walking speed, albumin, C-reactive protein (CRP), and CRP/albumin ratio (CAR), as well as the worst QoL scores in functional and symptomatic scales in both the male and female groups. A comparison between sexes revealed significant disparities; malnourishment and tumor cachexia related to an inflammatory state was more evident in the women's group.

Components of frailty, sarcopenia and their association with vitamin D deficiency. Cross-sectional, analytical study

INTRODUCTION

In older adults, the association of frailty and sarcopenia with vitamin D deficiency is well known, but the association of the components of frailty syndrome has been poorly studied.

OBJECTIVE

To determine the association of the components of frailty and sarcopenia with vitamin D insufficiency in older adults.

METHODS

Adults were studied, in whom age, education, marital status, history of fractures, hospitalizations, anthropometric indicators, sarcopenia, Charlson index, polypharmacy, Fried's frailty phenotype, and plasma vitamin D were recorded; figures < 30 ng/mL were considered indicative of vitamin D insufficiency. Descriptive and inferential statistics were used for statistical analysis. The association was determined by binary logistic regression.

RESULTS

One-hundred and seventy-five adults with a mean age of 71.7 ± 6.7 years (95% CI = 60-90 years) were studied. Binary logistic regression showed that the variables associated with vitamin D deficiency were exhaustion (OR = 2.6, 95% CI = 1.0-6.5, p = 0.03), frailty (OR = 9.2, 95% CI = 2.5-34.1, p = 0.001) and pre-frailty (OR = 4.6, 95% CI = 2.1-10.0, p < 0.001).

CONCLUSION

The frail and pre-frail phenotypes, as well as exhaustion, are associated with vitamin D insufficiency.

Phase Angle and Nutritional Status: The Impact on Survival and Health-Related Quality of Life in Locally Advanced Uterine Cervical Cancer

The phase angle, an indicator of muscle mass status and membrane cell integrity, has been associated with low survival, poorer clinical outcomes, and worse quality of life among cancer patients, but information on women with uterine cervical cancer (UCCa) is scarce. In this prospective study, we used a bioelectrical impedance analyzer to obtain the PA of 65 women with UCCa. We compared the health-related quality of life and inflammatory and nutritional indicators between low PA and normal PA. The mean age was 52 ± 13. The low PA and normal PA groups differed in terms of the C-reactive protein (15.8 ± 19.6 versus 6.82 ± 5.02, p = 0.022), glucose (125.39 ± 88.19 versus 88.78 ± 23.08, p = 0.021), albumin (3.9 ± 0.39 versus 4.37 ± 0.30, p = 0.000), EORTC QLQ-C30 loss of appetite symptom scale score (33.33 (0.0-100.00) versus 0.0 (0.0-0.0), p = 0.005), and EORTC QLQ-CX24 menopausal symptoms scale score (0.0 (0.0-33.33) versus 0.0 (0.0-100.0), p = 0.03). The main finding of the present study is the interaction between PA and obesity as critical cofactors in the UCCa adeno and adenosquamous histologic variants, to a greater extent than cervical squamous cell carcinoma.

Gender and age-related variations in human immunodeficiency virus infection trends at the Mexican Institute of Social Security: 2003-2017

INTRODUCTION

Diagnosing and treating human immunodeficiency virus carriers has led to the identification of a higher prevalence of said infection and, therefore, of a higher risk of transmission of the virus.

OBJECTIVE

To find out the trend of new cases of human immunodeficiency virus infection carriers at the Instituto Mexicano del Seguro Social (IMSS) in Mexico within the 2003-2017 period.

METHODS

Patients affiliated to the IMSS were analyzed. Data from 42,181 newly-diagnosed cases were collected, with variations related to gender and age being observed. Age-standardized rates per 100,000 population were obtained.

RESULTS

The highest mean annual percentage change in males was documented in adolescents (13.0, 95% CI = 9.9, 16.1). Heterogeneous trends were recorded for women, with a significant overall decrease (-2.2, 95% CI = -3.4, -1.0), but growing trends were also observed in some groups.

CONCLUSIONS

Our results suggest that the human immunodeficiency epidemic in patients cared for at the Instituto Mexicano del Seguro Social is concentrated in males, with a growing trend particularly in adolescents.

Phase Angle, a Cornerstone of Outcome in Head and Neck Cancer

In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects were divided into normal- and low-phase-angle (PA) groups and followed up for at least two years. Mean ages were 67.2 and 59.3 years for low and normal PA, respectively. Patients with PA < 4.42° had significant differences in age, anthropometric and biochemical indicators of malnutrition, and inflammatory status compared to patients with PA > 4.42°. Statistical differences were found in the functional and symptom scales, with lower functional scores and higher symptom scores in patients with low PA. Median survival was 19.8 months for those with PA < 4.42° versus 34.4 months for those with PA > 4.42° (p < 0.001).The relative risk of death was related to low PA (2.6; p < 0.001). The percentage of living patients (41.7%) is almost the same as the percentage of deceased subjects (43.1%; p = 0.002), with high death rates in patients with PA < 4.42°. Phase angle was the most crucial predictor of survival and a risk factor for death in the studied cases.

Adipocytokines and Insulin Resistance: Their Role as Benign Breast Disease and Breast Cancer Risk Factors in a High-Prevalence Overweight-Obesity Group of Women over 40 Years Old

Insulin levels, adipocytokines, and inflammatory mediators trigger benign breast disease (BBD) and breast cancer (BC). The relationship between serum adipocytokines levels, overweight-obesity, metabolic disturbs, and BC is unclear. Methods: To analyze the serum levels of the adipocytokines, insulin, and the HOMA IR in women without breast disease, with BBD or BC, and the role of these as risk factors for benign breast disease or breast cancer. Results: Adipsin values > 0.91 and visfatin levels > 1.18 ng/mL represent a risk factor to develop BBD in NBD lean women (OR = 18; and OR = 12). Data in overweight-obese women groups confirm the observation due to insulin levels > 2.6 mU/mL and HOMA IR > 0.78, with OR = 60.2 and 18, respectively; adipsin OR = 26.4, visfatin OR = 12. Breast cancer risk showed a similar behavior: Adipsin risk, adjusted by insulin and visfatin OR = 56 or HOMA IR and visfatin OR = 22.7. Conclusion: Adipose tissue is crucial for premalignant and malignant tissue transformation in women with overweight-obesity. The adipocyte−breast epithelium interaction could trigger a malignant transformation in a continuum, starting with BBD as premalignant disease, especially in overweight-obese women.

Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished As a Function of Sarcopenia and Obesity

BACKGROUND

Health-related quality of life (QoL) is a measure that allows us to know the patient's perception of well-being and how it is affected by their disease and treatments. In cancer patients, sarcopenia has been associated with low scores on various instruments used to assess the QoL; however, little information is available on the effects of sarcopenia and sarcopenic obesity on the QoL of patients with head and neck cancer (H&NC).

METHODS

In this cross-sectional study with 71 H&NC patients aged between 40 and 80 years, we describe the scores on the instruments EORTC QLQ C-30 and EORTC QLQ-H&N35 according to the sarcopenia phenotype (NSG, nonsarcopenic group; SG, sarcopenic group; and SOG, sarcopenic obesity group), hand-grip strength, gait speed, total lymphocyte count, albumin, cholesterol and C-reactive protein, and the relationships between these variables.

RESULTS

The prevalence of sarcopenia and sarcopenic obesity was 48% and 28%, respectively. The QoL analysis showed that NSG had higher scores on the physical functioning scale [NSG 93 (83-100); SG 73 (52-88); SOG 83 (53-93), P = .009] and lower scores on the fatigue scale [NSG 11 (0-22); S 39 (30-67); SOG 44 (14-56); P = .004]. The NSG had a higher hand-grip strength (31.1 kg) than SG (24.1 kg, P = .007) and SOG (26.3 kg, P = .001), and a lower C-reactive protein. The SG and SOG showed no differences between them.

CONCLUSIONS

Patients with sarcopenia or sarcopenic obesity have lower physical performance and a higher level of fatigue than nonsarcopenic patients. This loss of function can maintain or worsen sarcopenia due to the patient's self-restraint in physical exertion that encourages an increase in muscle tissue.

[Breast benign disease and breast cancer risk. Overweight-obesity, biochemical, anthropometry]

BACKGROUND

The immunologic, metabolic and anthropometric disturbances of overweight-obesity phenomena are risk factors to breast cancer (BC), particularly in proliferative benign breast disease women (PBBD).

OBJECTIVE

To describe the adipocytokine levels, metabolic alteration and anthropometric characteristics in PBBD and its role as risk estimator to BC in a population with high overweight-obesity prevalence.

MATERIAL AND METHODS

A cross-sectional study. We realized nutritional diagnosis, anthropometry, and we calculated the waist-height rate (WHR); serum measurement of adipocytokines, insulin and glucose and, HOMA IR determination in 27 PBBD and 27 BC women. We calculated mean, standard deviation, Pearson and Spearman correlation coefficients, Odds Ratio (OR) and confidence intervals through logistic regression as risk estimators of BC; p < 0.05 values were considered significant.

RESULTS

Mean age in the PBBD group was minor than BC group, the humeral diameter was greater in BC group women. We did not find differences in anthropometry or adipocytokine levels; in both groups, the predominant somatotype was the endo-mesomorphic. We found higher insulin levels in BC group and a higher percentage of women with WHR > 0.5 too. The WHR > 0.5 + age over 50 were considered risk estimators to develop breast cancer in PBBD women group.

CONCLUSION

The WHR >0.5 in women with PBBD over 50 years old could be considered an anthropometric risk estimator to develop BC.

Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies

AIM OF THE STUDY

We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016.

METHODS

A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models.

RESULTS

The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94).

CONCLUSIONS

Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.

Protein supplement use and prevalence of microalbuminuria in gym members

BACKGROUND

Protein supplement use is common in bodybuilders because protein supplements are thought to increase muscle mass by preventing protein catabolism during exercise routines. Information on the consequences of protein supplement use is scarce and contradictory. Therefore, the identification of a kidney damage marker, such as microalbuminuria, could be transcendent in preventing probable organ compromise in healthy persons. The aim of this study is to determine the presence of microalbuminuria in gym members and whether there is an associated risk with protein supplement use.

METHODS

An analytic, descriptive, cross-sectional study was conducted. It included gym members whose clinical and nutritional histories were taken, identifying protein supplement use. Microalbuminuria was then determined through a random urine sample. Descriptive and inferential statistics were used for the data analysis. The objective was to determine the presence of microalbuminuria in gym members and whether there is an associated risk with protein supplement use.

RESULTS

A total of 107 gym members, 71 men and 36 women, that met the inclusion criteria of the study were analyzed. Their mean age was 35±13 years, and the prevalence of microalbuminuria was 9.34%. There was active protein supplement use in 58% of the study participants, with a mean consumption duration of 16±22 months. No association with the presence of microalbuminuria was found (P=0.35).

CONCLUSIONS

The prevalence of microalbuminuria in gym members was higher than that of the general healthy population and was not associated with protein supplement use.

Expected years of life lost through road traffic injuries in Mexico

Background: Road traffic injuries (RTIs) are a leading cause of premature mortality, mainly in low- and middle-income countries

Objective: To estimate the 2014 burden of RTIs in Mexico calculating years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to evaluate sex, age, and region-related differences in premature mortality.

Methods: Mortality data were obtained from the National Institute of Statistics and Geography and 14,637 deaths of individuals 15 years of age and older were analyzed. The YLL and ASYLL were computed.

Results: The overall burden of RTIs was 332,922 YLL and 82.4% of the deaths occurred in males. Males from 25 to 34 years of age and females from 15 to 24 years of age showed the highest age-adjusted YLL rates (933 and 158 YLL per 100,000 inhabitants, respectively). The national ASYLL rate was 416 per 100,000 inhabitants and the highest state-stratified mortality rates were observed in Tabasco (851), Sinaloa (709), Durango (656), Zacatecas (642), and Baja California Sur (570).

Conclusions: RTIs contributed to the premature mortality rate in the study population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life.

Clinical markers associated with acute laboratory-confirmed Dengue infection: results of a national epidemiological surveillance system

OBJECTIVE

To evaluate the association of several clinical markers with acute laboratory-positive Dengue Virus infection.

METHODS

A hospital-based case-control study was conducted in the state of Colima, Mexico, by using information from the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica [SINAVE]) for Dengue. Data from 2 732 cases and 2 775 frequency-matched controls were analyzed. Odds Ratio (OR) and the 95 % Confidence Interval (CI), estimated by means of logistic regression models, were used.

RESULTS

The presence of skin rash (OR=1,7; 95 % CI 1,5-2,1), persisting vomiting (OR=1,8; 95 % CI 1,5-2,3) and increased capillary fragility (petechiae, ecchymosis, hematoma or positive tourniquet test; OR=1,8; 95 % CI 1,2-2,6) were associated with laboratory-positive infection.

CONCLUSIONS

Three clinical markers were significantly associated with an increased risk of acute laboratory-confirmed dengue infection. These findings would support accurate and timely diagnosis of dengue in laboratory-limited settings.

Persistent Arthralgia and Related Risks Factors: A Cohort Study at 12 Months from Laboratory-Confirmed Chikungunya Infection

AIM OF THE STUDY

To assess the cumulative incidence and clinical markers associated with persistent arthralgia (PA) at 12 months from acute chikungunya virus (CHIKV) infection.

METHODS

A multicenter retrospective cohort study was conducted in the state of Colima, Mexico, and 217 serologically confirmed cases of CHIKV infection were enrolled. Participants aged 15 years and older were interviewed on 6 months basis from acute illness onset and the main binary outcome was self-reported PA at 12 months. To assess clinical markers associated with PA we used a generalized linear model. The 2-item Patient Health Questionnaire (PHQ-2) was used to screen for depressive symptoms among PA-positive individuals.

RESULTS

The cumulative incidence of PA was 31.8%. In the generalized linear model, individuals ≥40 years of age (risk ratio (RR) = 1.68; 95% confidence interval (CI), 1.10-2.55) and those with 8 or more arthralgia sites (RR = 2.91, 95% CI 1.87-4.53) at acute disease had a significantly increased risk of PA at 12 months from CHIKV infection. Self-reported arthralgia (any site) at 3 months post-infection, a sub-chronic clinical marker, was also associated with a significantly increased risk of long-term articular manifestations (RR = 7.06, 95% CI 2.97-16.81). Depressive symptoms (PHQ-2 score ≥3) were reported by 33.3% of PA-positive participants.

CONCLUSIONS

Our findings suggest that chronic CHKV-related articular manifestations were a frequent event in the study sample and the impact on functional status was potential. These results may be useful in health care settings in the risk-stratification of PA after CHIKV infection.

[Frequency of successful aging and frailty. Associated risk factors]

OBJECTIVE

To determine the frequency of successful aging (SA) and its relationship with frailty in an elderly population.

MATERIAL AND METHODS

An analytical cross-sectional study of subjects ≥60 years of age seen as outpatients in a general hospital. Successful aging was defined as scores of ≥ 90 in the Barthel index and ≤ 2 in the Pfeiffer test. Frailty was determined using the Fried criteria.

RESULTS

The study included 400 subjects (272 women and 128 men), with a mean age of 71.6±8.2 years. The SA frequency was 40.4%. frail status was statistically higher in non-successful aging subjects than in SA subjects (161.7 versus 7.9%; P<.001). Women were more frequently frail, while being a pensioner/retired and married were associated less frequently with frailty.

CONCLUSIONS

Successful aging is associated with a lower level of frailty.

[Frequency of metabolic syndrome and risk factors in adults with and without diabetes mellitus and arterial hypertension]

OBJECTIVE

Determinate the frequency and the risk factors for Metabolic Syndrome in adults with diabetes mellitus, Hypertension and without Diabetes- Hypertension.

MATERIALS AND METHODS

We realized a cross-sectional study in patients of both sexes and older than 20 years of the "Hospital General de Zona 1 IMSS" in Colima, Mexico. The variables studied were: age, BMI, waist circumference, cigarette smoking, and family history of diabetes and hypertension, and biochemical parameters, such as glucose, HDL cholesterol and triglycerides.

RESULTS

A total of 417 persons were enrolled (170 men and 247 women), with an age average of 53.2 ± 13.4 years (age range, 20 to 86 years). The global frequency of the metabolic syndrome was 52.3 % (56 % in women and 46.4 % in men). While the MS frequency was 50 % in DM2, 42 % in hypertension, 80 % in DM2+hypertension and 28.2 % without DM2 and hypertension. The cigarette smoking frequency was 27.8 %, and it was an important risk factor for the totally of patients with MS, in DM2 and in DM2+hypertension.

CONCLUSIONS

The frequency of MS in adults was 52.3 %, women were the most affected, and cigarette smoking was the most important risk factor.

Performance of the PSI and CURB-65 scoring systems in predicting 30-day mortality in healthcare-associated pneumonia

INTRODUCTION

Healthcare-associated pneumonia (HCAP) is the leading cause of infection in a hospital setting and is associated with a high mortality rate. This study aimed to evaluate the performance of the pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age≥65 (CURB-65) systems in predicting 30-day mortality in HCAP in adult patients.

PATIENTS AND METHODS

A cross-sectional study took place and data from 109 non-immunocompromised individuals aged>18 years were analyzed. The clinical diagnosis of HCAP included the presence of radiographic infiltrates in patients≥48hours after hospital admission. The PSI and CURB-65 scores were calculated and performance measures were estimated. Summary statistics were used to describe the study sample. The PSI and CURB-65 scores were calculated based on 20 and 5 criteria, respectively, and the performance indicators of the screening tools were estimated.

RESULTS

The overall 30-day mortality was 59.6%. At every given threshold, PSI sensitivity was higher, but showed a lower specificity than the CURB-65, and the highest Youden index (0.392) was observed at cut-off V in the PSI. The area under the ROC curve was 0.737 (95% CI: 0.646-0.827) and 0.698 (95% CI: 0.600-0.797) using the PSI and CURB-65 systems, respectively (P=.323).

CONCLUSION

Our findings suggest that the performance of the PSI and CURB-65 is reasonable for predicting 30-day mortality in adult HCAP patients and may be used in healthcare settings.

Persistent arthralgia and related risks factors in laboratory-confirmed cases of Chikungunya virus infection in Mexico

Objective.

To estimate the cumulative incidence of persistent arthralgia at 6 months from acute Chikungunya virus (CHIKV) infection and to evaluate the association of clinical markers with the risk of long-term arthralgia.

Methods.

This multicenter retrospective cohort study was conducted in the Mexican state of Colima. A total of 136 individuals aged 15 years and older with serologically confirmed CHIKV infection were enrolled. Participants were interviewed at 6 months from the onset of symptoms, and self-reported persistent arthralgia (PA) was the main binary outcome. A self-report numeric rating scale (NRS) ranging from 0 to 10 was used to estimate the severity of articular pain.

Results.

The cumulative incidence of PA was 41.9%. Severe pain (NRS ≥ 7) presented in 36.8% of participants with PA. In multiple analysis, individuals aged 40 years and older (risk ratio (RR) = 1.60; 95% confidence interval (CI), 1.03-2.48) and those with articular pain at 3 months post-infection (RR = 3.95; 95% CI, 1.95-8.01) had a significantly increased risk of PA at 6 months from CHIKV infection.

Conclusions.

To the best of our knowledge, this is first report of a CHIKV-associated longterm outcome in Mexico, where the incidence of the infection has been high. This is also the first study in Latin America evaluating several factors associated with the risk of PA. Our findings may be useful in health care settings to stratify the risk of chronic arthralgia secondary to CHIKV infection and to identify patients who would benefit clinically from early medical intervention.

Seroprevalence of Trypanosoma cruzi (TC) and risk factors in Colima, Mexico

INTRODUCTION

The present study was conducted to estimate the incidence of seropositivity to anti-Trypanosoma cruzi antibodies and analyze potential risk factors in Colima, on the western coast of Mexico.

METHODOLOGY

Longitudinal studies of 209 subjects with negative serology in 1999 for anti-Trypanosoma cruzi antibodies by hemagglutination inhibition test were tested again in 2005. At the same time, 716 children under six years of age were surveyed serologically (total n = 925); the history of Trypanosoma cruzi infection was determined by the same hemagglutination inhibition test. The variables analyzed were age, sex, living in triatomine-infested places, type of community, quality of housing, presence of pets, and number of inhabitants per house.

RESULTS

Trypanosoma cruzi seropositivity in the period of six years was 22/925 cases, with a point prevalence of 2.73% and an adjusted rate of 7.3/1,000 person-years. The variable living in triatomine-infested areas showed association with seropositivity anti-Trypanosoma cruzi antibodies (RR: 5.5; 95% CI: 1.28-23.5). The remaining variables showed no significant association.

CONCLUSIONS

This study confirms the active transmission of Chagas disease in Mexico´s western-central region, which merits greater epidemiological surveillance and vector control, particularly in localities infested with triatomines.

Patient satisfaction and quality of life following laparoscopic Nissen fundoplication

BACKGROUND

Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life.

OBJECTIVES

To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication.

PATIENTS AND METHODS

A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale.

RESULTS

No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent.

CONCLUSIONS

The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled.

[Psychomotor skills assessment in basic procedures of laparoscopic surgery in undergraduate medical students at the School of Medicine of the University of Colima]

BACKGROUND

The changes in recent decades in the training of medical student seem to agree that the educational model for professional skills is most appropriate. The virtual simulator translates skills acquired the operating room, in the Faculty of Medicine of the University of Colima noticed the need to prepare the students of pregrade transferring surgical trainees' skills in basic laparoscopic activities that require a simple cognitive effort.

OBJECTIVE

The hypothesis in this study was to evaluate the acquisition of skills in laparoscopic simulator in students of pregrade.

METHODS

Educational research, analytical comparison, which was conducted within the activities of the program of Problem Based Learning in the program of Education and Surgical Technique, Faculty of Medicine of the University of Colima.

RESULTS

All participants in the simulator achieved a significantly better during the task one after three repetitions (p= 0.001). The evaluation of final students calcification, we observed significant differences in means being lower during the initial assessment (8.60 ± 0.76) compared to the end (8.96 ± 0.58) p= 0.001.

CONCLUSIONS

The acquisition of skills in the simulator is longer but at the end is better than the acquisition of skills from the traditional method, showing that leads to the acquisition of skills that promote the transfer of skills to the surgical environment.

Effect of chronic administration of forskolin on glycemia and oxidative stress in rats with and without experimental diabetes

Forskolin is a diterpene derived from the plant Coleus forskohlii. Forskolin activates adenylate cyclase, which increases intracellular cAMP levels. The antioxidant and antiinflammatory action of forskolin is due to inhibition of macrophage activation with a subsequent reduction in thromboxane B2 and superoxide levels. These characteristics have made forskolin an effective medication for heart disease, hypertension, diabetes, and asthma. Here, we evaluated the effects of chronic forskolin administration on blood glucose and oxidative stress in 19 male Wistar rats with streptozotocin-induced diabetes compared to 8 healthy male Wistar rats. Rats were treated with forskolin, delivered daily for 8 weeks. Glucose was assessed by measuring fasting blood glucose in diabetic rats and with an oral glucose tolerance test (OGTT) in healthy rats. Oxidative stress was assessed by measuring 8-hydroxydeoxyguanosine (8‑OHdG) in 24-h urine samples. In diabetic rats, without forskolin, fasting blood glucose was significantly higher at the end than at the beginning of the experiment (8 weeks). In both healthy and diabetic rats, forskolin treatment lowered the fasting glucose at the end of the experiment but no effect was found on oral glucose tolerance. The 8-OHdG levels tended to be less elevated in forskolin-treated than in untreated group. Our results showed that chronic administration of forskolin decreased fasting blood glucose levels; however, the reductions of 8-OHdG were not statistically significant.

Effects of chronic caffeine administration on blood glucose levels and on glucose tolerance in healthy and diabetic rats

OBJECTIVE

To analyse the effect of chronic caffeine use on risk reduction and prognosis of diabetes mellitus.

METHODS

In this 60-day study, five groups of 11 healthy male Wistar rats were selected to receive one of four doses (37.5, 56.2, 75.0 or 93.0 mg/kg per day) of caffeine orally or no caffeine (control). The effect of caffeine on glycaemia and glucose tolerance was evaluated. After 15 days, each group was treated with 60 mg/kg of streptozotocine to induce diabetes mellitus, and glycaemia and glucose tolerance were assessed for a further 45 days.

RESULTS

In nondiabetic rats, caffeine had no effect on blood glucose. Compared with controls, the fasting blood glucose levels declined significantly in two caffeine-treated groups (93.0 mg/kg per day and 56.2 mg/kg per day) during the first 15 days following diabetes induction. Glucose tolerance was significantly improved 120 min after glucose loading in all caffeine-treated groups. The mean ± SE half-maximal effective concentration of caffeine was 35.79 ± 2.44 mg/dl.

CONCLUSIONS

Blood glucose levels decreased, and glucose tolerance improved, in diabetic rats administered increasing doses of caffeine.

Causes of accidents in children aged 0–14 years and risk factors related to the family environment

A case-control study to determine the causes of accidents in children aged 0-14 years and to analyse family environment risk factors was carried out. The variables analysed in the children were age, gender, mechanism and type of accidental injury, number of siblings, birth order of the injured child, history of sibling injury and family type. Variables analysed in the parents were mother's age, history of alcoholism, maternal and paternal education level, time mother spent at home with the child, presence or absence of parents at the time of the accident and parents' occupations. The most important risk factors were gender, time mother spends at home, level of maternal education, paternal alcoholism, birth order, more than five siblings and previous injury to a sibling.

H-reflex and clinical examination in the diagnosis of diabetic polyneuropathy

OBJECTIVES

To determine among adult patients with type-2 diabetes mellitus the proportion diagnosed with diabetic polyneuropathy (DPN) by clinical evaluation and by the Hoffmann reflex (H-reflex). In addition, the predictive value of the H-reflex in the diagnosis of DPN was evaluated.

METHODS

Studies were carried out on 150 adult patients referred for neuropathy screening. Diagnostic criteria for DPN were at least two abnormalities in clinical neurophysiological examinations and electrophysiological testing (H-reflex and nerve conduction velocity). Logistic regression analysis was performed to identify unique contributions of study characteristics to positive versus negative outcomes.

RESULTS

H-reflex was absent in 39.3% (59/150) and latency was prolonged in 43.3% (65/150) of patients. Ulnar nerve motor branch nerve conduction showed prolonged latency in 9.3% (14/150) of patients. Logistic regression analysis indicated that the H-reflex was significantly associated with positive outcomes.

CONCLUSION

The H-reflex could have a predictive value in DPN, providing more quantitative information regarding diagnosis than conventional nerve conduction studies.

[Evaluation of alignment on knees through a software]

INTRODUCTION

Diseases of the musculoskeletal system are often accompanied by postural deformity or malalignment. Genu varo or genu valgo can be found in the knees. It is necessary to have a diagnostic support test for diagnosis as well as for follow-up of cases since these diseases are frequently progressive and over time have serious repercussions on patient quality of life. Objective. To evaluate a software program that processes digitalized photographs as a diagnostic test for measuring the mechanical axis in patients with genu varo and genu valgo.

MATERIALS AND METHODS

The mechanical axis in both knees was measured by means of radiography (golden standard) and by means of a software program (proposed diagnostic test) in one hundred patients. Mechanical axis was considered to be abnormal when the angle was equal to or greater than four degrees. Sensitivity, specificity, positive predictive value, and negative predictive value were determined. Interobserver variation was evaluated with kappa statistics.

RESULTS

In relation to right knee genu varo, sensitivity, specificity, positive predictive value, and negative predictivie value were 0.84, 0.87, 0.84, and 0.87, respectively, and for the left knee values were 0.86, 0.87, 0.84, and 0.89, respectively. For genu valgo in the right knee, sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.98, 0.95, and 0.92, respectively, and in the left knee were 0.88, 0.95, 0.88, and 0.95, respectively. Kappa value was 0.9 in the right knee and 0.8 in the left knee.

CONCLUSION

The software program (diagnostic test) was useful for diagnosing genu varo or genu valgo, representing a safe and low-cost study.

Comparison of transumbilical approach versus infraumbilical incision for the repair of umbilical hernia in adults

BACKGROUND

Surgical management of umbilical hernias is proposed in the vast majority of cases. The typical approaches make a semilunar incision above the umbilicus. The aim of this study is evaluate the surgical approach with two different incisions, the transumbilical approach and the infra-umbilical approach.

METHODS

Included in the study were 82 consecutive patients with diagnosis of umbilical hernia. Variables related to demographic characteristics, surgical operation, and cosmetic results were evaluated. Patients were randomized into two groups; transumbilical or infra-umbilical approach. Statistical analysis was carried out to evaluate complications, recurrences and aspects of the surgical scar.

RESULTS

The study included group A (42 patients) and group B (40 patients). The most frequent symptom was pain in both groups. Complications were similar in both groups with four (9.5%) in group A and eight (19%) in group B (RR 0.53, 95% CI 0.17-1.61, p = 0.24). Cosmetic results were classified as good in the vast majority of patients in group A (p 0.001). No recurrences or mortality have been reported so far in both studied groups.

CONCLUSION

We described an uncommon technique of incision with the aim of improving cosmetic results. Our results are in concordance with randomized clinical trials with the same technique with no recurrence or mortality to date. Cosmetic results in our patients using the transumbilical approach were clearly superior.

[Association between neuropathy and peripheral vascular insufficiency in patients with diabetes mellitus type 2]

INTRODUCTION

Diabetes mellitus (DM) can present complications of neuropathy and peripheral arterial disease with high risk for developing foot ulcers and consequent amputations.

OBJECTIVE

To identify the association between peripheral vascular disease, and neuropathy in type 2 Diabetes mellitus patients from the Hospital General de Zona No. 1 IMSS in Colima, Mexico.

MATERIAL AND METHODS

Cross-sectional study of 80 patients with diabetes mellitus evaluated by means of the Edinburgh Claudication Questionnaire, Michigan Neuropathy Screening Instrument, ankle-arm index, Motor Nerve Conduction Velocity and H-reflex.

RESULTS

51 women and 29 men were studied. Mean age was 53.9 +/- 9.6 years, mean diabetes mellitus progression was 8 +/- 6.6 years and mean glucose level was 283 +/- 110 mg/mL. Neuropathy presented in 65 patients (81.2%). Ankle/arm index revealed 19% of patients presented with moderate peripheral vascular insufficiency. Motor Nerve Conduction Velocity was abnormal in 40% of patients and H-reflex was absent in 70%.

DISCUSSION

Grade 2 motor-sensitive polyneuropathy was found in 70-80% of patients and moderate peripheral vascular insufficiency in 19%. It can thus be inferred that the complication of diabetic neuropathy appears before that of peripheral vessel damage.

A280V polymorphism in the histamine H3 receptor as a risk factor for migraine

BACKGROUND AND AIMS

Activation of histamine H3 receptors blocks the release of peptides responsible for headache. Our objective was to investigate the association between the genotypes of A280V polymorphism in the H3 receptor and migraine risk.

METHODS

We evaluated the frequency of the genotypes of A280V, polymorphism A280V and allelic variants of H3 receptor in 147 migraine patients and 186 healthy controls using a PCR-RLFP method.

RESULTS

V allele frequency was 6.46% and 2.68% for the cases and controls, respectively (p = 0.02) (OR 2.67; 95% CI 1.20-5.93). The frequency of V/V + V/A genotypes was 12.92% in migraine patients, significantly higher when compared to the 3.22% frequency in the control group (p = 0.001) (OR 4.45; 95% CI 1.7-11.46).

CONCLUSIONS

The results of this study suggest that V-allele genotypes in the H3 receptor gene are related to migraine risk in the Mexican population. We propose the hypothesis that the V-allele genotypes in the H3 receptor gene increase the population of inactive receptors, enhancing the inhibition of the negative feedback mechanism on the H3 receptor and increasing histamine release, which correlates with migraine attacks in susceptible patients. The case-control study reinforces the role of histamine in migraine pathogenesis.

[The frequency of risk factors associated with obesity and being overweight in university students from Colima, Mexico]

OBJECTIVE

Determining risk factor frequency regarding obesity and being overweight in university students.

METHODS

A cross-sectional analytic study was carried out on 821 students from the University of Colima. Some variables analysed were age, gender, alcoholism, smoking and weight-control drug use.

RESULTS

821 students were included (380 male, 441 female), 20.9±2.5 average age. 27.8 % of males were overweight and 14.7 % suffered from obesity; this was 17 % and 5.2 % in females, respectively. Smoking (2.1 OR; 1.4-3.8 95 % CI; p=0.01) and alcoholism (2.1 OR; 1.2-3.6 95 % CI; p=0.003) were associated with being overweight and being obese. Weight-control drug use was a protective factor in both genders (0.4 OR; 0.2-0.8 95 % CI; p=0.01); diet control was only a protective factor in women (2.2. OR; 1.1-3.4 95 % CI; p=0.01).

CONCLUSIONS

31.6 % of university students were overweight and suffered from obesity. Smoking and alcoholism in males were associated with being overweight and suffering from obesity. Weight-control and diet-control drug use were protective factors.

[Comparison of three therapeutic exercises protocols to lumbar hyperlordosis improvement in asyntomatic youths]

INTRODUCTION

One of the causes of low back pain is lumbar hyperlordosis. There are different protocols of therapeutic exercises for its correction, which do not involve all of corporal segments. A modified protocol is proposed, which involves all such segments.

OBJECTIVE

To evaluate the efficacy of proposed protocol with two established protocols for correction of lumbar hyperlordosis.

MATERIALS AND METHODS

Simple-blind clinical trial on 42 students of the Faculty of Medicine at University of Colima. The three protocols: A) Pérez-Olmedo (proposed, n = 14), B) Williams (n = 15) and C) Jeffrey Saal (n = 13) were randomly assigned. Clinical and radiological evaluations were performed. Lumbar hyperlordosis was considered when Ferguson's angle was > or = 30 degrees, measured on lateral spine x-ray pictures. During two months they underwent supervised and directed exercise sessions. The improvement in lumbar hyperlordosis correction of each protocol was compared through paired Student t-test and ANOVA.

RESULTS

Average age was 18 +/- 0.9 years. Lumbar hyperlordosis frequency was 31% (n = 15). There was not significative difference on Ferguson's angle average comparation between three treatment groups. There was lumbar hyperlordosis improvement with following percentages: group A = 60%, Group B = 16% and group C = 0%.

CONCLUSION

Protocol of therapeutic exercises proposed (Pérez-Olmedo) could be an alternative to lumbar hyperlordosis improvement in asyntomatic youhts.

Forskolin compared with beclomethasone for prevention of asthma attacks: a single-blind clinical trial

This single-blind study compared the efficacy of oral forskolin versus inhaled beclomethasone for mild or moderately persistent adult asthma. Patients were randomly assigned to receive forskolin (one 10-mg capsule orally per day; n = 30) or beclomethasone (two 50 microg inhalations every 12 h; n = 30) for 2 months. No statistically significant improvement occurred in any lung function parameter in the forskolin-treated patients. Subjects in the beclomethasone-treated group presented a slight but statistically significant improvement in percentage forced expiratory volume in 1 s (FEV(1)), percentage forced expiratory flow in the middle (25 - 75%) expiratory phase (FEF(25 - 75%)) and percentage forced vital capacity (FVC) after 2 months of treatment, though the improvement in absolute values for FEV(1), FEF(25 - 75%), FVC and FEV(1):FVC did not reach statistical significance. There was no statistically significant difference between the forskolin and beclomethasone treatment groups for any lung function parameter at baseline or after treatment. None of the beclomethasone-treated patients had an asthma attack and one forskolin-treated patient had a mild asthma attack during the 2-month study period. More studies are needed in adult asthma patients to confirm whether forskolin may be a useful preventive treatment for mild or moderately persistent adult asthma.

[Clinical study of patients with cranial trauma]

OBJECTIVE

To identify clinical characteristics and prognosis in patients with cranial trauma.

METHODS

A longitudinal design was used to study 302 patients between the years 2003 and 2006. Variables were mechanism and type of lesion, localization, clinical condition, Glasgow Coma Scale and prognosis. Descriptive statistics, correlation analysis and odds ratio were applied.

RESULTS

Motor vehicle accidents were in the first place (47%). The Glasgow mean score was 13. Half of the patients presented with loss of consciousness and the most common symptom, in 34% of them, was cephalgia. There was a proportionately inverse correlation (r-53, < 0.00001) between the Glasgow score and the number of hospitalization days. A two percent mortality was equally distributed in the period studied. Odds ratio for the motorcycle as mechanism was 2.02 (95% CI, 0.8- 4.2) and the OR for the frontoparietal region was 2.6 (95% CI, 0.6-2.3).

CONCLUSIONS

The variables associated with unfavourable prognosis in cranial trauma were motorcycle accidents and damage to the frontoparietal region of the brain.

Comparison of combined spinal and general anesthesia block and combined epidural and general anesthesia block in laparoscopic cholecystectomy

OBJECTIVE

Combined spinal and general anesthesia block (CSGAB) and combined epidural and general anesthesia block (CEGAB) in laparoscopic cholecystectomy were compared.

MATERIAL AND METHODS

Forty patients were randomly selected (ASA physical status I-II) to receive sevoflurane plus 10 to 15 mg of bupivacaine weighed at 0.5% and 20 microg of fentanyl (CSGAB) or sevoflurane plus 150 mg of ropivacaine and 1 microg/kg of fentanyl (CEGAB). Blood pressure, heart rate, oxygen and carbon dioxide saturation, drug doses and sevoflurane MAC (minimum alveolar concentration) were evaluated during surgery. Anesthesia recovery time and pain intensity and duration were evaluated during the first two postoperative hours. Frequency of incisional or referred pain, dyspnea, headache, cramping, nausea and vomiting were evaluated 24 hours after surgery. Statistical analysis was carried out using the Chi-square test and Student t test. Relative risk, absolute risk reduction and number needed to treat (NNT) for adverse reactions were determined.

RESULTS

Systolic and diastolic arterial pressures posterior to semi-Fowler's position were lower in the CSGAB group than in the CEGAB group. (94 +/- 16 vs. 110 +/- 18 mmHg; p < 0.01 and 59 +/- 8 vs. 69 +/- 12, mmHg; p < 0.01, respectively). Anesthesia recovery time (32 +/- 17 vs. 61 +/- 29 minutes; p < 0.01) and pain duration (26 +/- 42 vs. 83 +/- 46 minutes; p < 0.01) were shorter in the CSGAB group. NNT was 8 for postoperative pain, 8 for nausea, and 95 for vomiting.

CONCLUSIONS

CSGAB was more efficacious for rapid anesthesia recovery and had a shorter post-operative pain duration than CEGAB.

Prolonged cold ischemia: risk factor for acute rejection in renal grafting of cadaveric kidney transplantation

BACKGROUND

Exposure of renal grafting to prolonged cold ischemia time (CIT) and the association with acute rejection (AR) are known. However, there is no evidence in Mexico about this topic. Thus, the objective of this study was to evaluate prolonged CIT as a risk factor for AR in renal grafting of cadaveric kidney transplantation in a Mexican population.

METHODS

A cross-sectional study was carried out. Clinical files of patients undergoing renal grafting using cadaveric kidneys were reviewed from July 1994-June 2004. Prolonged CIT (=12 h) as a risk factor for AR was evaluated. Other related variables were also examined.

RESULTS

From 425 kidney transplantations, only 33 cases were cadaveric. Ten patients had AR. Prolonged CIT (OR 8.4; CI 1.5-44.2, p = 0.02) and azathioprine (AZA)-prednisone (PDN)-cyclosporine (CSA) combination (OR 9.1; CI 1.5-49.4, p = 0.02) were risk factors for AR. Anti-CD25 use (OR 0.6; CI 0.009-0.37, p = 0.001) and mycofenolate mofetil (MMF)-PDN-CSA combination (OR 0.1; CI 0.02-0.65, p = 0.02) were protective factors for AR.

CONCLUSIONS

In a Mexican population, prolonged CIT and AZA-PDN-CSA combination were risk factors for AR. Meanwhile, anti- CD25 use and MMF-PDN-CSA combination were protective factors for AR in cadaveric kidney transplantations.

[Taste sensitivity diminution in hyperglycemic type 2 diabetics patients]

OBJECTIVE

To determine the relationship between fasting blood glucose (FBG) values and gustatory sensitivity alterations in type 2 diabetic patients (DM2) without peripheral neuropathy (PNP).

METHODS

Assessment of the strength of association between FBG and detection and recognition taste thresholds for the four primary tastes measured by chemical gustometry were performed in 140 DM2 without PNP with evolution < 10 years.

RESULTS

FBG values above 7.77 mmol/L (140 mg/dL) induce in a dependent manner, the increase in the detection and recognition taste thresholds only to sweetness; whereas, values above 16.65 mmol/L (300 mg/dL) did not cause further decreasing in taste acuity to sweet flavor. Statistically significant differences where found for detection and recognition, taste thresholds for sucrose between well controlled (HbA1c < or = 7 %) normoglycemic and hyperglycemic diabetics, as well as between alarming uncontrolled (HbA1c > 10 %) normoglycemic and hyperglycemic patients.

CONCLUSIONS

Hyperglycemia induces a concentration-dependent impairment of sweet taste perception in DM2 patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose.

Prevalence of childhood sexual abuse among Mexican adolescents

BACKGROUND

To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students.

METHODS

A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse.

RESULTS

The prevalence of child sexual abuse was 18.7% (n = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling.

CONCLUSIONS

In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3-8.4%), although it was similar to that found in the Spanish child population (15-23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.

[Comparison of sublingual ketorolac vs. IV metamizole in the management of pain after same-day surgery]

BACKGROUND

Therapeutic pain is one of the most important outcome measures in surgery. Comparative studies investigating ketorolac efficiency in ambulatory surgery have generally been restricted to IV administration. We compared analgesic effectiveness of sublingual ketorolac and metamizole in short stay surgery.

METHODS

This was a randomized single-blind clinical trial. All patients received either a three-dose (30 mg) of sublingual ketorolac or 1 g of IV metamizole, respectively. We evaluated pain with a visual/analog scale (VAS). Side effects were also recorded. Statistical analysis included t-test or Mann-Whitney U test and Fisher exact test or chi(2). Absolute risk reduction (ARR), odds ratio (OR), confidence interval (CI), relative risk ratio (RRR) and numbers needed to treat (NNT) were also evaluated.

RESULTS

Rescue doses of analgesics were greater in patients receiving metamizole although the difference was not significant (p = 0.286). Mean VAS score was lower in the ketorolac group at 8 h after surgery, with no statistical difference (p = 0.06). ARR for severe pain score was almost 5% (OR = 1.78). Adverse effects did not show differences between groups (p = 0.642).

CONCLUSIONS

Ketorolac and metamizole have comparable effects and can be safely used in ambulatory settings.

[Alternative method for measuring the mechanical axis of the knee]

OBJECTIVE

To identify the existence of significant differences in the degrees of mal-alignment of the mechanical axis of the knee between a traditional measuring method and an alternative method. MATERIALS AND METHODS. One hundred mechanical axes of the knee were determined in patients of both sexes. The degree of axis mal-alignment was obtained first using the traditional measuring method and subsequently using the alternative method. The results obtained from the two methods were then compared. The measurement variable control was standardised by positioning the patients in the same place during radiography when beginning mechanical axis determination. A wooden ruler on which each centimetre was indicated by a metal strip and numbered at every 10-centimeter interval was used to evaluate the degree of pelvic mal-alignment. The ruler was then used as a mechanical axis correction reference in accordance with the characteristics of each patient.

RESULTS

The following results were obtained from 100 mechanical axes evaluated by the traditional method and by the alternative method, respectively: varus deformity of the right pelvic segment was 21 degrees +/- 16 degreesuv. 7 ++/-6. degrees varus deformity of the left pelvic segment was 22 _+/-170 degreesvs. 8 ++/-50 degrees valgus deformity of the right pelvic segment was 21 - /-150 degreess. 8 + +/-; and valgus deformity of the left pelvic segment was 16 +/- 11 vs. 6 +/- 5 degrees.

CONCLUSIONS

Our results suggest that the proposed method provides more accurate mechanical axis measurement and that the correction is exponential: the greater the angle measured traditionally, the greater the correction with our proposed method.

Reduction of peritoneal adhesion to polypropylene mesh with the application of fibrin glue

PURPOSE

The purpose of our study was to evaluate the possibility of the reduction of peritoneal adhesions to a polypropylene mesh with fibrin glue.

METHODS

Forty Wistar rats were assigned to two treatment groups: Group 1) hernioplasty with polypropylene mesh plus fibrin glue sealant, and Group 2) hernioplasty with polypropylene mesh without fibrin glue sealant. The variables evaluated were: presence and density of adhesion, organs or abdominal structures adhered to the polypropylene mesh, inflammatory tissular reaction and cell recount.

RESULTS

Group 1 presented a statistically lower adhesion percentage than Group 2 (40% versus 100%, P = 0.0003). The mean areas of mesh patch surfaces covered with adhesions were statistically different between Groups 1 and 2 (0.67 +/- 0.65 cm2 versus 1.60 +/- 0.51 cm2; P = 0.00001). Twelve rats presented with adhesions in Group 1; eleven were adhesions to the epiploon and one to the colon. In Group 2 there were 16 adhesions to the epiploon, 2 to the colon, 1 to the small intestine and 1 to the stomach. Tissular reaction comparison showed a significant difference (21 +/- 4.9 versus 17 +/- 4.1; P = 0.006).

CONCLUSIONS

Fibrin glue sealant significantly reduced the frequency and severity of intra-abdominal adhesions.

Subcutaneous histamine versus topiramate in migraine prophylaxis: a double-blind study

BACKGROUND

Histamine has a selective affinity for H3 receptors and it may specifically inhibit the neurogenic edema response involved in migraine pathophysiology.

OBJECTIVE

To evaluate the therapeutic potential of subcutaneous administration of histamine in migraine prophylaxis, compared with oral administration of topiramate.

METHODS

Ninety patients with migraine were selected in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of histamine (1-10 ng twice a week) compared with oral administration of topiramate (100 mg daily dose). The variables studied were: headache intensity, frequency, duration, analgesic intake and Migraine Disability Assessment.

RESULTS

The data collected during the 12 weeks of treatment revealed that headache symptoms improved in both the histamine and topiramate groups, which was evident within the first month after the initiation of treatment, with statistically significant (p < 0.001) reductions in headache frequency (50%), Migraine Disability Assessment score (75%), intensity of pain (51%), duration of migraine attacks (45%), as well as in the use of rescue medication (52%).

CONCLUSION

The present study provides evidence of the efficacy of subcutaneously applied histamine and orally administered topiramate in migraine prophylaxis. Subcutaneously applied histamine may represent a novel and effective therapeutic alternative in resistant migraine patients.

Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy

OBJECTIVE

To evaluate the role a daily intake of 100 mg of ascorbic acid plays in urinary infection prophylaxis during pregnancy.

METHODS AND MATERIALS

A single-blind clinical trial was carried out on pregnant women randomly assigned to the following treatment groups - Group A: oral treatment with ferrous sulphate (200 mg per day), folic acid (5 mg per day) and ascorbic acid (100 mg per day) for 3 months, and Group B: oral treatment with ferrous sulphate (200 mg per day) and folic acid (5 mg per day) for 3 months. All patients were clinically evaluated, and a urine culture was carried out each month for a period of 3 months. The chi(2) and odds ratio were used to compare effects with and without ascorbic acid, and statistical significance was considered at p<0.05.

RESULTS

Global frequency of urinary infections was 25%. The presence of urinary infections in Group A (12.7%) was significantly lower than in Group B (29.1%), (p=0.03, OR =0.35, CI 95% =0.13-0.91).

CONCLUSIONS

Daily intake of 100 mg of ascorbic acid played an important role in the reduction of urinary infections, improving the health level of the gestating women. We recommend additional vitamin C intake for pregnant women in populations which have a high incidence of bacteriuria and urinary infections.

[Frequency of intestinal helminthiasis and its association with iron deficiency and malnutrition in children from western Mexico]

OBJECTIVE

To determine intestinal helminthiasis frequency and its association with malnutrition and iron deficiency.

MATERIAL AND METHODS

An analytical cross-over study was carried out on children in the municipality of Comala, Colima, Mexico. Coproparasitoscopic exams in series of three using the Kato-Katz technique were performed in all children. To evaluate the degree ofmalnutrition, the following anthropometric indices were determined: means and z-scores for weight/height, height/age, weight/age. Severe, moderate and minimal iron deficiency was considered when ferritin was: < or = 12 ng/ml, 12 to 18 ng/mL and 19 to 24 ng/mL, respectively.

RESULTS

243 children were studied with an average age of 65.3+/-8.7 months. 60.9% (n = 148) of the children showed a decrease in ferritin levels and 2.5% (n = 6) had anemia. 16% (n = 39) had trichuriasis, 6.9% (n = 17) ascariasis and 5.3% (n = 13) had both parasites. Trichiura infection was associated with declining health (OR 11.0, CI 3.9-30.8; p<0.001) and with iron deficiency, with cut-off points of <24 ng (OR 2.0, CI 1.0-3.9, p = 0.02) and <18 ng/ dL (OR 2.2, CI 1.2-4.2, p= 0.009). Ascaris infection was not associated with malnutrition or iron deficiency.

CONCLUSIONS

Trichiura infection was associated with declining health and slight and moderate degrees of iron deficiency.