Search

Vitamin D plays a major role in bone health and probably also in multiple extraskeletal acute and chronic diseases. Although supplementation with calcifediol, a vitamin D metabolite, has demonstrated efficacy and safety in short-term clinical trials, its effects after long-term monthly administration have been studied less extensively. This report describes the results of a 1-year, phase III-IV, double-blind, randomized, controlled, parallel, multicenter superiority clinical trial to assess the efficacy and safety of monthly calcifediol 0.266 mg versus cholecalciferol 25,000 IU (0.625 mg) in postmenopausal women with vitamin D deficiency (25(OH)D

La Retórica Cultural es un instrumento eficaz para el estudio de la transferibilidad de textos literarios y del lenguaje poético a la publicidad audiovisual actual, dentro del ámbito de la cultura y del imaginario conceptual. Se analizan, a este efecto, cuatro textos poéticos canónicos realizando una crítica transferencial.

Introducción: Los métodos de evaluación aplicados al área de la salud continúan siendo tradicionales, donde se evalúan conocimientos sin captar habilidades, actitudes y aptitudes. Es necesario buscar una estrategia para evaluar la competencia profesional en los médicos internos de pregrado (MIP) por medio de un examen clínico objetivo estructurado (ECOE) Objetivo: Evaluar las competencias profesionales de los médicos internos de pregrado que egresan de su rotación por medicina familiar. Material y métodos: Estudio cuasiexperimental, prospectivo, longitudinal realizado a los médicos internos de pregrado que cursaron medicina familiar en la Unidad de Medicina Familiar No. 80 en los bimestres: Enero-Febrero, Marzo-Abril y Julio-Agosto del 2020. Se llevó a cabo una evaluación diagnóstica y de acuerdo al resultado se estableció un programa académico y se realizó una evaluación posterior de las competencias profesionales, mediante un examen clínico objetivo estructurado. Se utilizó estadística descriptiva, para comparación de medias: t de student, significancia p

Vitamin D has shown to play a role in multiple diseases due to its skeletal and extraskeletal actions. Furthermore, vitamin D deficiency has become a worldwide health issue. Few supplementation guidelines mention calcifediol treatment, despite being the direct precursor of calcitriol and the biomarker of vitamin D status. This 1-year, phase III-IV, double-blind, randomized, controlled, multicenter clinical trial assessed the efficacy and safety of calcifediol 0.266 mg soft capsules in vitamin D-deficient postmenopausal women, compared to cholecalciferol. Results reported here are from a prespecified interim analysis, for the evaluation of the study's primary endpoint: the percentage of patients with serum 25-hydroxyvitamin D (25(OH)D) levels above 30 ng/ml after 4 months. A total of 303 patients were enrolled, of whom 298 were included in the intention-to-treat (ITT) population. Patients with baseline levels of serum 25(OH)D

Resumen Introduccion y objetivos La estenosis aortica degenerativa es la valvulopatia mas frecuente. Aun no esta claro como identificar a los pacientes asintomaticos con fraccion de eyeccion del ventriculo izquierdo normal y alta probabilidad de eventos que por ello pudieran beneficiarse de una intervencion valvular precoz. En este estudio se describe un protocolo de hemodinamica de esfuerzo para los pacientes asintomaticos con estenosis aortica moderada o grave para evaluar su valor pronostico para esta poblacion. Metodos Estudio prospectivo unicentrico de una poblacion de pacientes con estenosis aortica moderada o grave asintomaticos. Los pacientes realizaron una ergoespirometria para confirmar la ausencia de sintomas en esfuerzo. Despues los pacientes se sometieron a un cateterismo cardiaco derecho basal y de esfuerzo. Se definio evento como muerte o necesidad de reemplazo de valvula aortica quirurgico o percutaneo basado en las guias clinicas. Resultados Se sometio a 33 pacientes a cateterismo cardiaco derecho basal y de esfuerzo. El area valvular aortica media fue de 1,08 cm2 y el gradiente aortico medio, 39 mmHg. La presion arterial pulmonar media fue de 21 mmHg, con una presion de oclusion en la arteria pulmonar de 14 mmHg y un gasto cardiaco de 5,6 l/min. La presion pulmonar media en ejercicio maximo fue de 34 mmHg. Tras un seguimiento medio de 27 meses, 8 pacientes sufrieron un evento (24%). No hubo diferencias en las variables basales, el area valvular aortica o los parametros de ergoespirometria. Los pacientes con evento no tuvieron mayores presiones pulmonares o presiones de llenado en ejercicio maximo, pero el grupo con eventos mostro menor saturacion de oxigeno en la arteria pulmonar en esfuerzo (mediana, el 48 frente al 57%; p = 0,03). Conclusiones El cateterismo cardiaco de esfuerzo es seguro y factible en esta poblacion. La saturacion de oxigeno en la arteria pulmonar en esfuerzo podria identificar a un grupo de pacientes con un aumento del riesgo de eventos adversos graves.

Background: Denosumab is a monoclonal antibody approved for the treatment of postmenopausal osteoporosis. The withdrawal of denosumab produces an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). Objective: The objective of this study is to study the clinical, biochemical, and densitometric characteristics in a large series of postmenopausal women who suffered MVF after denosumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Patients and methods: Fifty-six patients (54 women) who suffered MVF after receiving denosumab at least for three consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodelling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by magnetic resonance imaging MRI, X-ray, or both at dorsal and lumbar spine. Results: Fifty-six patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically significant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the presence of a greater number of VF (P = .04). Conclusions: We present the series with the largest number of patients collected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, there was an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.

Background and Aims Bone fragility fractures (bone fractures) are extremely frequent in haemodialysis (HD) patients. Serum phosphate (P) has been suggested as a risk factor for bone fracture, nonetheless, evidence is poor. The aim of this study was to assess the association between incidence of bone fractures and serum phosphate (P), calcium (Ca) and parathyroid hormone (PTH) in patients from the COSMOS study. Method COSMOS is an observational, prospective, open cohort study with 3 years of follow-up including 6797 haemodialysis patients from 227 centres randomly selected from 20 European countries. At baseline, demographics, comorbidities, treatments, serum biochemical parameters of the previous six months and bone fractures of the previous 12 months were collected. Every 6 months, all these variables, outcomes, and incident bone fractures, were collected. Patients who had at least one bone fracture during follow-up were compared with those who had not. Multivariate binary logistic regression and Poisson regression were used to assess the association between incidence of bone fractures and serum P, Ca and PTH. Time to fracture (and possible re-fracture) was also evaluated using Cox regression and Cox regression for recurrent events. All the results were adjusted by 23 variables including Ca, P, PTH, albumin and haemoglobin (full adjusted model). Results Analysis included 6274 patients who had follow-up data and non-missing information regarding bone fractures at baseline and during follow-up; 252 patients (4.0%), suffered at least one incident bone fracture. The fractured patients were older (68.1±12.9 vs. 63.8±14.5 years, p Multivariate binary logistic regression showed that “well known risk factors for bone fracture”, such as a previous bone fracture (OR: 7.78[95%CI:4.83-12.55], p 800 pg/mL (OR: 1.60[95%CI: 1.01-2.55], p=0.047), were associated with a higher incidence of follow-up bone fractures. In addition to the “well known bone risk factors for fracture”, serum P > 6.1 mg/dL (OR: 1.50[95% CI: 1.07-2.11], p=0.02) and serum Ca > 9.7 mg/dL (OR: 1.42[95%CI: 1.01-2.03], p=0.043), were also associated with a higher incidence of bone fractures in the full-adjusted model. These findings were partly consistent with Poisson regression for serum P >6.1 mg/dL (IRR: 1.46[95% CI: 1.00-2.13], p=0.0085) and serum Ca > 9.7 mg/dL (IRR: 1.49[95%CI: 1.06-2.08], p=0.0047), but not for PTH. In addition, Cox regression analysis showed association between bone fractures and serum P >6.1 mg/dl (HR: 1.61 [95%CI: 1.16-2.24], p=0.0049) and 1.60 [95%CI: 1.14-2.24] (p=0.0066) for simple and recurrent events respectively, but no association was found with serum Ca and PTH in the 2 full-adjusted models for the Cox regression analyses. Conclusion In COSMOS, a large haemodialysis patient’s cohort with 3 years follow up, serum P was the only biochemical parameter that remained as a significant risk factor for bone fractures after 4 statistic approaches. Thus, for the first time, in a large scale well controlled study, high serum P has been identified as a new independent potential risk factor for incident bone fractures in haemodialysis patients.

BACKGROUND Prediabetes is an altered metabolic state of glucose; it does not present symptoms, it is considered an intermediate stage in the progression to diabetes; it is possible to detect it early to avoid or delay the disease. NutrIMSS strategy was implemented so that these patients achieve a healthy lifestyle. OBJECTIVE To evaluate the impact of an educational intervention based on the NutrIMSS strategy on somatometric and biochemical parameters in patients with prediabetes. METHOD Quasi-experimental study in the Family Medicine Unit No. 80 of Morelia, Michoacan, Mexico, in patients 20 to 59 years of age, with diagnosis of prediabetes (impaired fasting glucose 100-125 mg/dL). The educational intervention included three educational sessions, six consultations with nutrition and inclusion to the social security center, from March to August 2017. Initial anthropometric and biochemical measurements were taken and in the sixth month. The data were presented as median and interquartile range or mean ± standard deviation, and Student's t and Wilcoxon tests, with a significance value of p < 0.05. RESULTS 45 patients, 66.7% women. Previous and after the intervention parameters were, respectively: weight (kg), 79.9 (56.5-114) and 77.5 (54.6-110) (p = 0.001); body mass index (kg/m2), 30.89 (23.2-39.9) and 29.0 (21.5-39.1) (p < 0.001); glucose (mg/dL), 111 ± 6.3 and 95.8 ± 9.2 (p < 0.001); and total cholesterol (mg/dL): 171 (120-223) and 170 (90-205) (p = 0.01). CONCLUSIONS The educational intervention based on the NutrIMSS strategy has a positive impact on the metabolic control of patients with prediabetes.

ResumenObjetivo: desarrollar y validar un instrumento de evaluación del funcionamiento familiar. Métodos: estudio de validación, realizado en la Unidad de Medicina Familiar No. 80 del Instituto Mexicano del Seguro Social en Morelia, Michoacán, México; de marzo 2018 a agosto 2019. Fase 1. Redacción de reactivos mediante modelo McMaster; fase 2. Adecuación de la prueba mediante análisis cualitativo de reactivos: presentación del instrumento, claridad en la redacción, pertinencia de las variables con los indicadores, relevancia del contenido y factibilidad de la aplicación, aplicación de pruebas estadísticas; reducción de reactivos, pertinencia, rotación varimax y varianza; fase 3. Fiabilidad y validez de convergencia contra ff-sil. Resultados: fase 1. Construcción de un instrumento inicial de 107 reactivos con seis dominios. Fase 2. Tras prueba piloto en cien sujetos se eligieron 79 reactivos con pertinencia >90 y tras un análisis factorial con factor de reducción por diez jueces se creó un instrumento final de 35 reactivos con redistribución de los mismos por el método de rotación de varimax, se asignaron seis dominios: resolución de problemas (7 reactivos), comunicación (10 reactivos), roles (5 reactivos), involucramiento afectivo (2 reactivos), respuestas afectivas (8 reactivos) y control de conductas (3 reactivos); con una varianza total de 74.1. Fase 3. Instrumento final de 35 reactivos que categoriza las familias en: funcional (141-175 puntos), disfuncional leve (106-140 puntos), disfuncional moderada (71-105 puntos) y disfuncional severa (35-70 puntos). Instrumento final con alfa de Cronbach de 0.962 vs 0.905 del ff-sil. Conclusión: se construyó un instrumento de 35 reactivos confiable que mide el funcionamiento familiar.

Intertextualidad, interdiscursividad y retórica cultural

Resumen Objetivos Valorar si la fuerza de agarre y la dificultad para realizar actividades cotidianas podrían ser predictores de caídas y fracturas osteoporóticas. Material y métodos Se seleccionaron aleatoriamente 624 hombres y mujeres mayores de 50 años, que fueron seguidos durante 8 años para conocer la incidencia de caídas y fracturas osteoporóticas no vertebrales. Al inicio se midió la fuerza de agarre en manos y se cumplimentó un cuestionario con variables clínicas, factores de riesgo relacionados con la osteoporosis y cuestiones relativas a la dificultad o incapacidad para realizar actividades cotidianas. Resultados La fuerza de agarre en manos no se asoció con la incidencia de caídas y fracturas. Sin embargo, la imposibilidad o dificultad de “estar sentado más de 1 hora en silla dura”, “quitarse los calcetines o las medias” e “inclinarse desde una silla para coger un objeto del suelo” se asoció con caídas: 1,83 (1,16-2,89); 1,85 (1,14-3,00) y 1,68 (1,04-2,70), respectivamente. Del mismo modo, la imposibilidad o dificultad de “llevar durante 10 metros un objeto de 10 kilos” y “levantar una caja con 6 botellas y ponerlas sobre una mesa” se asoció con fractura: 2,82 (1,21-6,59) y 2,54 (1,12-5,81) respectivamente. Conclusiones No se encontró asociación entre la fuerza de agarre e incidencia de caídas y fracturas osteporóticas, pero sí con dificultad o incapacidad para realizar actividades cotidianas. Las relacionadas con mayor fuerza se asociaron con fractura, mientras que las relacionadas con capacidad funcional se asociaron con caídas. Realizar cuestionarios sencillos podría ayudar a predecir eventos antes de que ocurran.

Objetivo: identificar la relación entre obesidad y depresión infantil en escolares de 8 a 12 años de edad de la unidad de medicina familiar (umf) no. 80, Instituto Mexicano del Seguro Social (imss), Morelia, Michoacán. Métodos: estudio prospectivo, transversal y observacional, se estudiaron 165 niños, de ambos sexos, con obesidad y peso normal a los cuales se les aplicó la Children’s Depression Scale (cds). Las diferencias en las medias se analizaron con la prueba t de Student para muestras independientes; χ2 y regresión logística se utilizaron para establecer asociación y riesgo, respectivamente. Resultados: de los 165 niños, 78 (47.3%) eran obesos y 87 (52.7%) no obesos; 91 (55.2%) niñas y 74 (44.8%) niños; del total, 34 (20.6%) tuvieron depresión; de estos últimos 22 (64.7%) eran obesos y 12 (35.3%) no obesos; 25 (70.5%) eran mujeres y nueve (26.5.4%) hombres. La obesidad materna se asoció con la obesidad infantil (χ2=11.733, p

Overweight and obesity are a public health problem, which continues to increase in recent decades and is associated with chronic diseases. NutrIMSS is a strategy of the Mexican Institute of Social Security (IMSS) that promotes a healthy lifestyle and provides education to patients on proper nutrition, water consumption and practice of physical activity.

Background Family history of type 2 diabetes mellitus (T2DM) is one of risk factors for that in future a subject can develop diabetes. Insulin resistance (IR) is important in the pathogenesis of T2DM. There is evidence that oxidative stress plays an important role in the etiology and/or progression of diabetes. Myeloperoxidase (MPO) participates in developing of inflammation. The objective was to investigate if MPO is associated with IR and inflammation in individuals with first-degree relatives of T2DM. Methods Cross-sectional study in 84 overweight individuals with family history of T2DM divided in two groups according to IR, group with IR (homeostasis model assessment [HOMA] ≥2.5; n=43) and control group (CG; HOMA

Momoyo Kaijima es profesora en la Facultad de Arte y Diseño de la Universidad de Tsukuba en la Prefectura de Ibaraki y profesora visitante en la ETH de Zürich, en Royal Academy of Fine Arts, en Rice School of Architecture y en Harvard GSD. A lo largo de los años, Atelier Bow Wow ha colaborado con Krešimir Rogina, arquitecto de Zagreb y socio de la firma internacional Penezic&Rogina, en la realización del Grožnjan International Summer School of Architecture, siendo Rogina el nexo indispensable para propiciar la visita de Kaijima a Valencia.

Objetivo: analizar el control prenatal en adolescentes embarazadas de acuerdo con los lineamientos de la Guía de Práctica Clínica (gpc). Métodos: estudio observacional, retrospectivo y transversal, mediante revisión de 92 expedientes clínicos de embarazadas adolescentes adscritas a la unidad de medicina familiar (umf) no. 80 en Morelia, Michoacán, México, de enero de 2014 a enero de 2015. La edad promedio de las adolescentes fue de 17.4 ±2 años (ic 14-19 años), se excluyeron expedientes incompletos. Para evaluar el apego al control prenatal, se utilizó la Cédula Única de Evaluación del Proceso de Atención Materna Integral para Atención Primaria, se consideró un apego adecuado mayor a 80%. Los resultados se muestran en frecuencias (porcentajes). Resultados: se encontró que 50% de las adolescentes embarazadas no trabajaba o estudiaba. Predominó el inicio del control prenatal en el segundo trimestre del embarazo. El apego a la gpc del control prenatal fue de 69.19%. La prueba inmunológica de embarazo se realizó en 18.1%, la confirmación del embarazo en el módulo de vigilancia prenatal fue de 79.8%. Las embarazadas remisas, reintegradas a atención médica constituyeron 48.9%; se otorgó a 88.3% cita prioritaria; y se envió al módulo de Enfermera Materno-Infantil a 36.2%. La detección oportuna de infecciones genitourinarias fue de 58% y el tratamiento oportuno de éstas fue de 45.7%. Conclusiones: el apego a la gpc no es adecuado; se identificaron deficiencias en la confirmación del embarazo, en el número de embarazadas remisas que se reintegraron a la atención médica y en la detección y tratamiento oportuno de las infecciones genitourinarias.

Los ámbitos de la comunicación, la sociedad y el arte han evolucionado como consecuencia de los cambios culturales y del progreso de las nuevas tecnologías. Sin embargo, en la cultura audiovisual dominante hoy, la Retórica clásica sigue vigente y ha sabido adaptarse a los nuevos modelos de comunicación que integran elementos visuales, lingüísticos y acústicos que pueden ser analizados y entendidos a través de la Retórica Cultural.Palabras clave: cultura audiovisual, Retórica Cultural, tropos, publicidad, discurso audiovisualAbstract: Communication, Society, and Art evolve as a consequence of cultural change and new technologies’ development. However, in current audiovisual mainstream Culture, Classical Rhetoric is still useful. It adapts itself to new communicative models incorporating visual, linguistic, and acoustic elements, which can be studied and understood through Cultural Rhetoric.Keywords: Audiovisual Culture, Cultural Rhetoric, tropes, advertising, Audiovisual discourse

Objetivo: evaluar la satisfacción de los pacientes del módulo Diabetimss y su asociación al control glucémico en la unidad de medicina familiar (umf) no. 80, Morelia, Michoacán, México, de noviembre de 2014 a octubre de 2015. Métodos: estudio transversal y descriptivo. Se incluyeron pacientes con diabetes tipo 2 sin complicaciones que permanecieron en el programa Diabetimss por un año, que acudieron a 12 consultas (médico familiar y nutriólogo) y 12 sesiones educativas (enfermería) orientadas a lograr cambios en el estilo de vida, alcanzar metas de control y prevenir complicaciones; se excluyeron sujetos que no contestaron las encuestas de satisfacción y que no tenían en su expediente el registro de los niveles de glucosa. Resultados: se incluyeron 94 pacientes de 57.07 ±10.48 años de edad, 54% mujer y 46% hombre, glucosa: 120.05 ±28.69 mg/dl, 65% en control glucémico (≤130 mg/dl) y 35% en descontrol (>130 mg/dl). El nivel de satisfacción en el módulo Diabetimss fue: en consulta médica, buena-excelente (83%); en enfermería, buena (96.8%) y en nutrición, mala (65.9%). La asociación entre satisfacción y control glucémico no fue significativa con la atención de la consulta médica (p=0.199), enfermería (p=0.948) o nutrición (p=0.240). Conclusión: la satisfacción en el módulo de Diabetimss es adecuada con el personal médico y de enfermería e inadecuada con el personal de nutrición, sin encontrar asociación entre el nivel de satisfacción y el control glucémico.

This case report presents fluoconazole efficacy to reduce hypercalcaemia and increased urinary calcium excretion in a patient with nephrocalcinosis after a long history of recurrent renal stones caused by a loss-of-function mutation of the CYP24A1 gene. The CYP24A1 gene codes for a key enzyme in the vitamin D endocrine system that protects against vitamin D toxicity by degrading the circulating excess of both 1,25-dihydroxyvitamin D, the hormonal form of vitamin D, and its precursor, 25-hydroxyvitamin D. In order to expedite the identification of this rare disorder and improve therapies to avoid its progression to nephrocalcinosis, this editorial updates the current knowledge on the frequency of CYP24A1-inactivating mutations, the features of their early clinical presentation and progression, and the pathophysiology of vitamin D activation in health and in granulomatous disorders that may help improve current treatment.

Background. Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients. Methods. A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected. Results. The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0–10.0) and RR = 4.8 (1.7–13.4), respectively]. Conclusions. Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD.

Primary immunodeficiencies have a low prevalence, but their severity and high risk of mortality require a clinical approach based in diagnostic instruments that allow their early detection.To validate the PRIDE scale to determine a high level of suspicion for primary immunodeficiency diseases in Mexican population.Seventy five patients with suspicion of primary immunodeficiencies (13.9 ±11.8 years-old) were evaluated with the PRIDE scale by specialists in Allergy and Immunology in this cross-sectional study, and their results were compared with the confirmed diagnosis of primary immunodeficiency.Kappa concordance coefficient with clinical diagnosis was 0.872, with an standard error of 0.072; CI 95% [0.73-1.013]. The scale showed sensitivity 98.3%, specificity 86.6%, positive predictive value 96.7%, negative predictive value 92.8%, positive odds ratio 7.3358 and negative odds ratio 0.0196.PRIDE scale was concordant with the diagnosis of primary immunodeficiency in the majority of patients with a previous confirmed diagnosis. The characteristics of diagnostic accuracy provide reliability to this instrument in the scrutiny of patients with probable immunodeficiency.

para determinar si hay variacion en la adecuacion Darwiniana de dos poblaciones. La poblacion de Yotoco presenta dos fenotipos claramente diferenciables por el color (Rosa y Blanco), mientras que en Centenario se encontro solamente el fenotipo Blanco; las flores pueden presentar o no nectar independiente de su fenotipo. Las ofertas florales de R. granadensis se encuentran en el callo del labelo y el nectario de ducto que contiene el espolon o sinsepalo, recubierto por un epitelio glandular compuesto por osmoforos y nectarios. R. granadensis es polinizada por Eulaema sp. que la visita en busca de alimento, es autoincompatible, xenogama obligada y dependiente del polinizador. Mediante simulaciones con matrices demograficas de transicion a 50 anos y 500 repeticiones se encontro que ambas poblaciones y fenotipos tienden a la extincion en un plazo de 25 anos. No se encontraron diferencias entre la adecuacion Darwiniana, de los fenotipos de estudio por lo que no se puede probar la existencia de seleccion fenotipica sobre los caracteres florales. La variacion de la especie puede deberse a la deriva genica o la seleccion dependiente de la frecuencia y la ecologia cognitiva del polinizador.

Asthma has been linked to family disfunctioning and poor control of the disease. This study was conducted to analyze the interactions between the level of intermittent asthma control, family functioning and respiratory function and between quality of life of asthmatic patients and their caregivers. 7 to 15 years old children with intermittent asthma were included. Asthma Control Test Questionnaire, Pediatric Asthma Quality of Life Questionnaire (PAQLQ) test, and flowmetry were applied to children and Pediatric Asthma Caregiver´s Quatily of Life Questionnaire (PAQCLQ) and the Family Functioning Perception Test (FF-SIL) were applied to their parents. The most affected areas of family functioning in dysfunctional families were adaptability and permeability. A medium to high strength of association was founded between the emotional function of parents and the emotional function of children, R2=0.552. The most remarkable associations were among parents’ limitation of activities and parents' emotional function (r=0.837), parents’ limitation of activities and child's emotional function (r=0.722), parents' emotional role and limitation of activities (r=0.837), parents’ emotional role and emotional functioning of children with asthma (r=0.743) and the limitation of activities of children with asthma and the emotional function of children with asthma (r=0.870). No direct associations were founded among respiratory function, disease control and family functioning in Mexican children with intermittent asthma and emotional function of parents and children were associated in both groups.

An observational cross-sectional study was conducted to assess calcium intake and vitamin D status by measurement of 25-hydroxyvitamin D (25(OH)D), in postmenopausal osteoporotic women (PMOW) treated and untreated for osteoporosis. To assess the influence of sunlight exposure on vitamin D status, the study group was categorized on the basis of sunlight exposure (above or below 2500 sunlight h/year). A group of 336 PMOW older than 65 years was identified (190 [56.5%] treated and 146 [43.5%] untreated for osteoporosis). The demographic and clinical data of the PMO women included history of prior fractures, pharmacological treatments and dietary calcium intake. BMD was measured by DEXA and 25(OH)D was determined by an HPLC method. Results: vitamin D serum levels were lower in the untreated group as compared with the treated group (58 +/- 27 vs. 67 +/- 27 nmol/l; p = 0.006). Prevalence of vitamin D deficiency (cut-off point set at

El objetivo del estudio fue analizar el riesgo de fractura calculado mediante la herramienta FRAX® y sus determinantes, en pacientes con trasplante renal remitidos a nuestra consulta para control de las repercusiones óseas. Se estudiaron 113 pacientes, 42 hombres y 71 mujeres portadores de trasplante renal funcionante a los que se les realizó una encuesta general. A todos los pacientes se les hizo una densitometría ósea en columna lumbar PA (L2 - L4) y cadera (cuello femoral y cadera total) con un densitómetro Hologic QDR 1000®. Con los datos recogidos de la encuesta se calculó el riesgo de fractura mediante la herramienta FRAX®. La edad media de los pacientes fue 57±9 años y un tiempo medio trasplantados de 4,6±4,4 años. El riesgo de presentar fractura osteoporótica mayor a los 10 años fue del 6,54±4,9% y de fractura de cadera de 2,06±2,67%. Cuando analizamos el riesgo según el sexo observamos como en las mujeres la probabilidad de presentar fractura osteoporótica mayor a los 10 años fue significativamente superior que en los hombres (7,6±5,2% vs 4,8±3,7%, p=0,001). El riesgo de fractura de cadera a los 10 años fue también ligeramente superior en las mujeres que en los hombres, pero no de forma significativa (2,3±2,8% vs1,6±2,4%).

A study was realized to detect the prevalence of sensitization to alergenic fungi in Mexican patients with respiratory allergies. Skin prick test was practiced to 299 patients with asthma (165) and allergic rhinitis (134) from Michoacan State and Jalisco-León, Gto. Alternaria (35,3%), Mucor (24,1%), Aspergillus (23,2%), Hormodendrium (23,2%), Helmintosporium (20,6%) and Candida (18,9%) were the fungi genera more frequently appeared during the test. The sensitization to fungal allergens was increased during the periods evaluated, for the patients from Michoacan varied from 19.23% (2004-2006) to 80.76% (2007-June 2009) and for the patients from Altos de Jalisco-Leon, Gto. the percentages detected were 48.88% and 51.11%, respectively. In adition, differences between the frequency of fungi genera caused positive skin prick test between both 2 regions (x= 154,226, gl = 10, p 0.001) were observed.

OBJECTIVE: To evaluate which of the anthropometric parameters that estimate overweight and obesity are the best predictors of insulin resistance (IR) in adults from Family Medicine Unit N° 80 of IMSS in Morelia, Michoacán, México. DESIGN: Descriptive cross-sectional study. SETTING: Family Medicine Unit N 80 of Mexican Social Security Institute in Morelia, Michoacán, Mexico. PARTICIPANTS: A random sample of 147 adults with overweight or obesity. MAIN MEASUREMENTS: Age and sex. Anthropometrics: weight, body mass index (BMI), waist and mid arm circumference, % corporal fat; Skin folds thickness: bicipital, tricipital, subscapularis, abdominal skin folds; analyses: glucose, lipid profile, insulin; clinical: diastolic and systolic pressure, cardiovascular risk and insulin resistance by HOMA ≥2.5. RESULTS: IR was found in 41.49% of patients. ROC curves were made and the cut off point of bicipital skin fold ≥4.50 mm, mid arm ≥27.50 cm were predictors of IR in 97.4%; BMI ≥25 kg/m(2) was a predictor of IR in 92.3%, and by linear regression these parameters were the better predictors of IR. CONCLUSIONS: A total of 41.49% of patients were identified with IR (HOMA ≥2.5). BMI, bicipital skins fold and mid arm were the better predictors of IR. Specific studies are needed to determine the optimum cut off point of different parameters for estimating overweight and obesity in each sector in México.

INTRODUCCIÓN. La magnitud del daño inducido por el tabaquismo está relacionada con el grado de adicción a la nicotina y frecuentemente esta adicción tiene sus inicios en la adolescencia. Este trabajo se realizó con el objetivo de estimar la prevalencia de tabaquismo y grado de adicción a la nicotina en adolescentes de una escuela urbana en México. MÉTODOS. Se estudiaron 314 adolescentes entre los 14 y 19 años, los cuales se entrevistaron con el auxilio de la Encuesta Nacional de Adicciones 2004 y el cuestionario Flagestrom; la primera para evaluar prevalencia de tabaquismo y la segunda, la dependencia a la nicotina. RESULTADOS. El grado de adicción a la nicotina fue leve en el 30 % de los adolescentes (94/314), moderado en el 2,9 % (9/314) y grave en un 0,03 % (1/314). Por otro lado, la prevalencia de tabaquismo fue del 33,1 % (104/314). Más de la mitad de los adolescentes encuestados fumaron alguna vez en su vida y el 88 % de los que fumaban comenzó a hacerlo antes de los 16 años de edad. CONCLUSIONES. La prevalencia de tabaquismo entre los adolescentes constituye un problema regional que sugiere la evaluación de las acciones de promoción de salud vigentes encaminadas a disminuir el consumo de cigarrillos y la expansión de esta y otras iniciativas de promoción de salud a sitios donde convivan adolescentes.INTRODUCTION. The magnitude of the damage induced by smoking is related to the degree of nicotine addiction. This addiction frequently starts in adolescence. This paper was aimed at estimating the prevalence of smoking and the degree of nicotine addiction in adolescents from an urban school in Mexico. METHODS. 314 adolescents aged 14-19 were interviewed with the assistance of the National School of Addictions 2004 and the Flagestrom questionnaire. The first was used to evaluate the prevalence of smoking and the second to determine nicotine dependence. RESULTS. The negree of nicotine addiction was mild in 30 % of the adolescents (94/314), moderate in 2.9 % (9/314) and severe in 0.03 % (1/314). On the other hand, the prevalence of smoking was 33.1 % (104/314). More than half of the surveyed adolescents smoked one in their life and 88 % of those who smoked began to do it before the age of 16. CONCLUSIONS. The prevalence of smoking among adolescents is a regional problem that suggests the evaluation of the health promotion actions directed to reduce the consumption of cigarettes and the expansion of this and other health promotion initiatives to places where adolescents live together.

Vitamin D status and secondary hyperparathyroidism: The importance of 25-hydroxyvitamin D cut-off levels.BackgroundSerum 25-hydroxyvitamin D is the best indicator of vitamin D status. However, some controversy remains regarding “normal” and “abnormal” values. This study's aim was to assess vitamin D status and prevalence of secondary hyperparathyroidism.MethodsA random sample of 326 subjects (164 women and 162 men, aged 68 ± 9; range, 54 to 89) participating in the European Vertebral Osteoporosis Study (EVOS) was used to assess vitamin D status and secondary hyperparathyroidism. Only those subjects who had never received any kind of treatment for osteoporosis were included in this analysis.ResultsSerum 25-hydroxyvitamin D levels were “deficient” (18 ng/mL) in 33% of subjects. The prevalence of secondary hyperparathyroidism (PTH>65 pg/mL) according to 25-hydroxyvitamin D levels was 33% (18 ng/mL), respectively. There were no cases of secondary hyperparathyroidism with 25-hydroxyvitamin D levels>40ng/mL. The independent predictors for PTH were 25-hydroxyvitamin D and serum creatinine in both sexes, but age was a predictor only in men.ConclusionThese remarkable findings demonstrate the importance of maintaining higher 25-hydroxyvitamin D levels to avoid stimulation of the parathyroid gland.