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Objective To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation and its clinical outcome. Methods We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 hours. Results Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. Conclusions Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.

The use of tubular retractors in minimally invasive spine surgery has been described extensively in the literature. However, there are only select reports discussing their use specifically in a transoral approach for upper cervical pathologies such as an epidural abscess and a dystrophic os odontoideum.We report the first use of a transtubular transoral approach in a rare case of an adult presenting with severe neck pain with progressing neurologic signs secondary to atlantoaxial Pott’s disease. Debridement and partial odontoidectomy performed using this approach allowed less trauma to surrounding soft tissues without sacrificing an excellent visualisation of the operative field. A halo vest was applied to provide temporary stability. The patient transitioned out of his halo vest after 6 months while completing medical therapy after a year without need for further intervention. The transtubular transoral approach is a suitable alternative to the conventional approach in patients with atlantoaxial Pott’s disease.

Objective: To identify the relationship between red blood cell distribution width (RDW, %), interleukin-6 (IL-6) (pg/ml), high sensitivity-c-reactive protein (hs-CRP) (mg/l), in-hospital mortality and disease severity among patients with heart failure (HF). Methods: Prospective cohort. We included adults diagnosed with acute non-ischemic HF in 2015. The dependent variables were in-hospital mortality (yes or no) and disease severity. The latter was assessed with the Get With The Guidelines-HF score. We used hierarchical regression models to describe the pattern of association between biomarkers, mortality, and severity. We used the Youden index to identify the best cut-off for mortality prediction. Results: We included 167 patients; the mean age was 72.61 (SD: 11.06). The majority of patients presented with New York Heart Association classification II (40.12%) or III (43.11%). After adjusting for age and gender, all biomarkers were associated with mortality. After adding comorbidities, only IL-6 was associated. The final model with all clinical variables showed no effect from any biomarker. The best cut-off for RDW, hs-CRP and IL-6 for mortality were 14.8, 68.7 and 52.9, respectively. IL-6 presented the highest sensitivity (100%), specificity (75.35%) and area under the curve (0.91). Conclusions: No biomarker is independent from the most important clinical variables; therefore it should not be used for management modifications. Resumo: Objetivo: Identificar a relação entre a amplitude de distribuição dos eritrócitos (ADE, %), IL-6 (pg/nl), hs-PCR (mg/l), mortalidade intra-hospitalar e gravidade da doença em doentes com insuficiência cardíaca (IC). Métodos: Coorte prospetiva. Incluímos adultos com IC aguda de etiologia não isquémica durante o ano de 2015. As variáveis dependentes foram a mortalidade intra-hospitalar (sim ou não) e a gravidade da doença. A última foi avaliada com o score de Get With Guidelines-HF (GWTG-HF). Utilizámos modelos de regressão hierarquizados para descrever o padrão de associação entre os biomarcadores, mortalidade e gravidade. Utilizámos o índice Youden para identificar o melhor cut-off na previsão da mortalidade. Resultados: Foram incluidos 167 doentes. A idade média foi de 72,61 (MS: 11,6). A maioria dos doentes estava em Classe II (40,12%) ou III NYHA (43,11%). Após ajuste para idade e género, todos os biomarcadores se associaram à mortalidade. Após adicionar as comorbilidades, só a IL-6 se associou com mortalidade. O modelo final com todas as variáveis clínicas incluidas não mostrou qualquer efeito de qualquer dos biomarcadores estudados. Os melhor cut-off de ADE, hs-PCR e IL-6 para mortalidade foi de 14,8, 68,7 e 52,9 respetivamente. A IL-6 apresentou a sensibilidade mais elevada (100%), especificidade (75,35%) e área sob a curva (0,91). Conclusões: Nenhum dos biomarcadores analisados se revelou independente das variáveis clínicas mais importantes, pelo que os biomarcadores estudados não devem ser utilizados como orientação clínica.

Key Points Stem cell transplant improves long-term survival in T/NK CAEBV, though mortality remains high.Development of T/NK lymphoma showed a trend with increased mortality., Visual Abstract, Chronic active Epstein-Barr virus (EBV) disease (CAEBV) is characterized by high levels of EBV predominantly in T and/or natural killer cells with lymphoproliferation, organ failure due to infiltration of tissues with virus-infected cells, hemophagocytic lymphohistiocytosis, and/or lymphoma. The disease is more common in Asia than in the United States and Europe. Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only curative therapy for CAEBV, its efficacy and the best treatment modality to reduce disease severity prior to HSCT is unknown. Here, we retrospectively assessed an international cohort of 57 patients outside of Asia. Treatment of the disease varied widely, although most patients ultimately proceeded to HSCT. Though patients undergoing HSCT had better survival than those who did not (55% vs 25%, P < .01), there was still a high rate of death in both groups. Mortality was largely not affected by age, ethnicity, cell-type involvement, or disease complications, but development of lymphoma showed a trend with increased mortality (56% vs 35%, P = .1). The overwhelming majority (75%) of patients who died after HSCT succumbed to relapsed disease. CAEBV remains challenging to treat when advanced disease is present. Outcomes would likely improve with better disease control strategies, earlier referral for HSCT, and close follow-up after HSCT including aggressive management of rising EBV DNA levels in the blood.

PURPOSE Subtypes of depression have been under studied in women during the peripartum period and the year after childbirth and delivery. Due to heterogeneity of depression, researchers have attempted to identify phenotypes of maternal and postpartum depression based on key symptoms that may represent underlying genes and biological etiology (Leuchter et al. Dialog Clinic Neurosci 16(4):525, 2014). METHODS The current study collected self-report data from 587 women and utilized exploratory and confirmatory factor analyses (CFA) to identify subtypes of depression symptoms across two measures. RESULTS Findings of the study showed that: (1) using the Beck Depression Inventory (BDI-II) and the Postpartum Depression Screening Scale (PDSS), a five-factor solution best fit the data in our sample of mothers with infants aged 4-14 months. The factors included: anxiety/thought disorder; cognitive depression; suicide; somatic/neurovegetative; and sleep [χ2 (454, N = 587) = 1102.61, p

The objective of the study is to determine the personal, behavioral and psychological variables associated with somatization and the number of diseases in each gender from a sample of Mexican general population. They answered a questionnaire of behavioral and psychological variables including somatization and the sum of 16 different diseases and any additional one, finally the body mass index (BMI) was measured. A total of 164 participants (women = 90, men = 74) were included. We observed that women had more somatization and number of diseases than men and that more variables (mainly psychological) were associated with somatization and with the number of diseases in women than in men. Among the variables most negatively correlated in women with both variables were sleep quality (

Aims Overweight and obesity are affected by factors such as dietary transgressions and lack of exercise, as well as less obvious factors such as shift work and sedentary working. (i) To explore the associations between overweight and obesity (O/O) with working conditions such as type of job position, and work shifts; (ii) to know the associations between O/O with lifestyles (physical activity, eating habits, and tobacco and alcohol consumption). Methods and results A cross-sectional, population-based design was used based on the Spanish National Health Survey. The final sample consisted of 9097 workers aged between 18 and 65. The influence of the explanatory variables on the outcome variable (body mass index) was examined using logistic regression. The prevalence of O/O increased by 4% for every additional year of age (P Conclusion Age, men, engaging in moderate or low levels of physical activity, being an ex-smoker, working during the night or rotating shifts, holding a non-sedentary job position, having a low to moderate consumption of pasta, potatoes, and rice, a moderate consumption of bread and cereals, as well as dairy products, vegetables, sugary foods, and fast food, have been significantly associated with a higher prevalence of O/O. No relationships were identified between the consumption of alcohol, fruit, eggs, pulses, and sugary soft drinks.

Background. Fracture risk assessment tool (FRAX) index was developed for estimating of the 10-year risk of major or hip osteoporotic fracture. To date, there is insufficient information regarding the correlation between FRAX and serum bone turnover markers (BTMs), such as soluble ligand of receptor activator of nuclear factor-κB (sRANKL), osteoprotegerin (OPG), and other molecules related with secondary osteoporosis in rheumatoid arthritis (RA). Therefore, this study is aimed at assessing the correlation between the FRAX and serum levels of sRANKL, OPG, sRANKL/OPG ratio, Dickkopf-1 (DKK-1), and sclerostin (SOST) in RA. Methods. Cross-sectional study included 156 postmenopausal women with RA. Bone mineral density (BMD) was measured at lumbar spine (L1-L4) and total hip using dual-energy X-ray absorptiometry (DXA). RA patients were divided into (A) RA + osteoporosis and (B) RA without osteoporosis. FRAX scores were calculated including the total hip BMD. Serum sRANKL, OPG, DKK-1, and SOST levels were measured by ELISA. Pearson tests were used for assessing the correlation between serum levels of these molecules and FRAX scores in RA. Results. The RA + osteoporosis group had elevated sRANKL levels ( p = 0.005 ), higher sRANKL/OPG ratio ( p = 0.017 ), decreased DKK-1 ( p = 0.028 ), and lower SOST levels ( p < 0.001 ). Low total hip BMD correlated with high sRANKL ( p = 0.001 ) and sRANKL/OPG ratio ( p = 0.005 ). Total hip and lumbar spine BMD correlated with DKK-1 ( p = 0.009 and p = 0.05 , respectively) and SOST levels ( p < 0.001 and p < 0.001 , respectively). Higher sRANKL levels and sRANKL/OPG ratio correlated with estimated 10-year risk of a major osteoporotic fractures ( p = 0.003 and p = 0.003 , respectively) and hip fracture ( p = 0.002 and p = 0.006 , respectively). High serum SOST levels were associated with a low estimated 10-year risk of a major osteoporotic fracture ( p = 0.003 ) and hip fracture ( p = 0.009 ). Conclusion. High sRANKL levels and sRANKL/OPG ratio can be useful to detect a subgroup of RA patients who has an increased 10-year risk of major and hip osteoporotic fractures.

The prevalence and contribution of BRCA1/2 (BRCA) pathogenic variants (PVs) to the cancer burden in Latin America are not well understood. This study aims to address this disparity. BRCA analyses were performed on prospectively enrolled Latin American Clinical Cancer Genomics Community Research Network participants via a combination of methods: a Hispanic Mutation Panel (HISPANEL) on MassARRAY; semiconductor sequencing; and copy number variant (CNV) detection. BRCA PV probability was calculated using BRCAPRO. Among 1,627 participants (95.2% with cancer), we detected 236 (14.5%) BRCA PVs; 160 BRCA1 (31% CNVs); 76 BRCA2 PV frequency varied by country: 26% Brazil, 9% Colombia, 13% Peru, and 17% Mexico. Recurrent PVs (seen ≥3 times), some region-specific, represented 42.8% (101/236) of PVs. There was no ClinVar entry for 14% (17/125) of unique PVs, and 57% (111/196) of unique VUS. The area under the ROC curve for BRCAPRO was 0.76. In summary, we implemented a low-cost BRCA testing strategy and documented a significant burden of non-ClinVar reported BRCA PVs among Latin Americans. There are recurrent, population-specific PVs and CNVs, and we note that the BRCAPRO mutation probability model performs adequately. This study helps address the gap in our understanding of BRCA-associated cancer in Latin America.

Introduction: Functional constipation (FC) is very prevalent in older adults, especially in women, but its relationship with frailty is not fully understood. The aims were to assess FC prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life (QoL) in older people. Methods: This epidemiological study included 384 individuals aged over 70 years recruited from the community, a hospital, and a nursing home and stratified into robust, pre-frail, and frail groups (Fried criteria). The following criteria were evaluated: frailty, FC (Rome III criteria), stool consistency (Bristol Stool Chart), comorbidities (Charlson), dependency (Barthel), QoL (EQ5D), and clinical and sociodemographic data. Defined by symptom aggregation were 2 main clinical subtypes as follows: slow colonic transit time (CTT) and functional defecation disorder (FDD). Results: Mean age was 79.11 ± 6.43 years. Overall FC prevalence was 26.8%, higher in women (32.4% women vs. 21.8% men; p = 0.019) and highest in frail patients (41.7% frail vs. 33.9% pre-frail vs. 24.2% robust; p < 0.001). Straining and hard stools (Bristol 1–2) were the most prevalent symptoms (89.3 and 75.7%, respectively). Frailty and benzodiazepine intake were independently associated with FC. Patients with FC obtained poorer QoL scores in the EQ5D (perceived health 66.09 ± 17.8 FC patients vs. 56.4 ± 19.03 non-FC patients; p < 0.05). The FDD subtype became significantly more prevalent as frailty increased (6.5, 25.8, and 67.7% for robust, pre-frail, and frail patients, respectively); the slow CTT subtype was significantly more frequent in robust patients (38.5% robust vs. 30.5% pre-frail vs. 23.1% frail), p = 0.002. Discussion/Conclusion: FC prevalence in older adults was high, especially in women, and was associated with frailty and poor QoL. Clinical subtypes as related to frailty phenotypes reflect specific pathophysiological aspects and should lead to more specific diagnoses and improved treatment.

El presente trabajo evidencia una revisión sistemática de la literatura de diferentes artículos acerca del Trastorno por Déficit de Atención e Hiperactividad, el cual afecta a millones de niños y adolescentes en edad escolar de 6 a 17 años. Objetivo. Identificar las metodologías trabajadas en estudiantes que presentan el Trastorno de Déficit deAtención e Hiperactividad y sus niveles de relación entre pares y el rendimiento en sus clases. Materiales y métodos. El proceso de búsqueda se realizó a partir de las bases de datos: PsycInfo, Dianet, MedLine, Redalyc, Scielo y PubMed, Revistas Neurológicas, Revistas Sicológicas, con palabras claves en inglés y español y determinados criterios de inclusión y exclusión. Resultados. Se utilizaron 18 artículos para el análisis de texto completo y 18 artículos para la revisión sistemática, los cuales evidenciaron diversos aspectos relacionados con estudiantes que presentan el Trastorno de Déficit de Atención e Hiperactividad. Conclusión. La investigación realizada podrá ser de utilidad para investigadores, docentes y profesionales del área de la salud y la educación que trabajen con niños y adolescentes con Trastorno de déficit de atención e hiperactividad.

Ovarian cancer (OC) represents a serious health problem worldwide. In Mexico, most OC patients are detected at late stages, consequently making OC one of the leading causes of death in women after reaching puberty. Personalized medicine (PM) provides an individualized therapeutic opportunity for treating each patient relying on “omic” tools to match the correct drug with the specific pathogenic genomic signature. PM can help predict the best therapeutic option for each affected woman suffering from OC. In recent years, Mexico has made contributions to the PM of OC; however, it still has a long way to go for its full implementation in the country’s health system. World J Oncol. 2021;12(4):85-92 doi: https://doi.org/10.14740/wjon1383

Food addiction (FA) is a construct that has gained interest in recent years but its relevance in Mexican population is still unexplored. The present study has the aims of explore FA in a community of Mexican population, as well as identifying the risk patterns associated with it, in relation to the different etiological factors that have been described such as impulsivity, emotional regulation and eating styles. Furthermore, to identify a predictive model of FA severity. The sample consisted of 160 female and male university students of Pachuca city in Mexico, who volunteered to participate in the study. Assessment included multidimensional measures for FA, eating disorder severity, eating disorder styles, emotional regulation and impulsivity. A screening of FA-probable was registered for 13.8% of the sample, while 8.1% met criteria for FA-present. The FA-present group differed from FA-absent in the impulsivity levels and in emotional eating style. Patients with FA-present differed from FA-probable in the impulsivity levels. Differences between FA-probable versus FA-absent were found in the restrained eating style. Path analysis evidenced that FA severity was directly associated with older age, worse eating style profile and higher impulsivity levels, and indirectly related with the ED symptom levels. Our findings suggest that it is possible to establish a specific predictive model of the development of FA and its severity in Mexican population to implement adequate prevention and treatment strategies. Level III: evidence obtained from well-designed cohort or case–control analytic studies

Objective: To investigate factors associated with cognitive impairment (CI) in institutionalized Mexican older adults. Material and methods: Cross-sectional study of residents of three long-term care facilities in the metropolitan area of Monterrey, Mexico. A medical history, Mini-Mental State Examination (MMSE), Barthel index, geriatric depression scale, and a nutritional screening were performed. CI was defined as MMSE ≤24. Results: Of 280 octogenarian residents (72.1% females) 61.1 % had a MMSE ≤24. Older age (OR=1.047), functional dependence (OR=10.309), malnutrition (OR=2.202), urinary incontinence (OR=2.588), and history of fracture (OR=1.764) were directly associated to CI. While higher education level (OR=0.583) and the use of antihypertensives (OR=0.521), antihistamines (OR=0.322), antiprostatic hypertrophy (OR=0.219), and lipid-lowering drugs (OR=0.575) were inversely associated. Conclusions: The evaluation of cognitive performance and its associated factors is essential for institutionalized patients in order to implement a management program aimed at reducing the progression of CI and its possible complications.

Objetivo: Determinar el nivel de conocimiento sobre lactancia materna exclusiva en madres primíparas atendidas por teleconsulta del Instituto Nacional Materno Perinatal en año 2020 y sus factores asociados. Materiales y métodos: Estudio de enfoque cuantitativo, diseño descriptivo, observacional, transversal, prospectivo y analítico. la población se compuso de un total de 1000 madres primíparas atendidas por teleconsulta en el Instituto Nacional Materno Perinatal, tomando una muestra representativa de 240 participantes. Se empleo un instrumento confiable y valido para medir el conocimiento en lactancia materna exclusiva, se realizaron pruebas estadísticas de asociación y un modelo de regresión de Poisson bivariado y múltiple para obtener la razón de prevalencias crudas y ajustadas y sus intervalos de confianza al 95% para los factores asociados y las categorías de lactancia materna exclusiva. Resultados: se encontró un 75.7% de nivel de conocimiento sobre lactancia materna exclusiva alto, con IC95% de 69.5% - 81.1%. Se encontró una asociación estadísticamente significativa para las variables gestante añosa (RPa 1.21 IC95% 1.05 – 1.39) y grado de instrucción superior (RPa 1.22 IC95% 1.02 – 1.44) Conclusiones: un nivel de instrucción alto y la gestación añosa se identificaron como factores asociados a un nivel de conocimiento alto sobre lactancia materna exclusiva en madre primíparas atendidas por teleconsulta del Instituto Nacional Materno Perinatal en año 2020

INTRODUCTION Analgesics are widely used, but evidence regarding whether their use increases the risk of inflammatory bowel disease (IBD) flares or complications is unclear. Therefore, self-medication with analgesics in IBD is usually not recommended. The aim of this study was to explore the prevalence of self-medication with analgesics in a cohort of ulcerative colitis (UC) patients and to identify reasons and factors associated with self-medication. METHODS This cross-sectional study included consecutive unselected adult patients with UC. Participants were asked to complete an anonymous web-based survey with multiple-choice questions and closed responses. No clinical data were collected. RESULTS A total of 546 patients (61.2% women, mean age 39.9 years) completed the survey. The prevalence of self-medication with analgesics was 49.8% (272/546). Paracetamol (45.2%) and metamizole (21.2%) were the most frequently used drugs; frequencies of self-medication were

To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint. MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16–1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12–1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10–1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17–1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00–1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31–1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04–1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis. Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions. CRD42020176044. Date registration: April 28, 2020.

La equinococosis es una infección zoonótica causada por el cestodo del género Echinococcus, endémica en muchas regiones del Perú. Los quistes hidatídicos habitualmente se ubican en el hígado y pulmón, siendo infrecuente tanto su localización en otros órganos como la hidatidosis múltiple. La mayoría de ellos son asintomáticos y de hallazgo incidental, aunque también pueden ocurrir complicaciones, como su ruptura espontánea o traumática que tiene una mínima incidencia (3-17%), siendo insólito que se dé hacia el tórax. Se presenta el caso de un paciente con ruptura de quistes hidatídicos hepáticos hacia la cavidad pleural, por traumatismo tóraco-abdominal, que al constituir una presentación excepcional de la patología originó dificultades en su reconocimiento inicial teniéndose como diagnóstico diferencial un hemotórax masivo. Este finalmente fue superado por la revisión de imágenes tomográficas con las que se concluyó una hidatidosis hepática complicada.

Adipokines, especially chemerin, can interact with cytokines and other molecules in inflammation. To date, there is insufficient information regarding a possible correlation between functional disability and chemerin and other pro-inflammatory molecules in rheumatoid arthritis (RA). To identify the association of functional disability with serum chemerin and other pro-inflammatory molecules, including other adipokines, cytokines and E-selectin, in patients with RA. Cross-sectional study. Assessment: disease activity (DAS28-ESR) and functional disability (HAQ-DI). We compared the adipokines (chemerin, leptin, adiponectin, resistin, and visfatin), cytokines (TNF-α, IL-6, IL-1β, and IL-18) and E-selectin levels between RA with functional disability and RA non-disabled patients. Of 82 patients with RA, 43 (52%) had functional disability. The RA with functional disability group had higher chemerin (140 vs. 112 ng/mL, p = 0.007) than the non-disabled RA group. Chemerin correlated with the HAQ-DI (rho = 0.27, p = 0.02) and DAS28-ESR (rho = 0.21, p = 0.05). Severe activity correlated with IL-6 (rho = 0.33, p = 0.003) and E-selectin (rho = 0.23, p = 0.03) but not with disability. No other pro-inflammatory molecules correlated with HAQ-DI. High chemerin levels were associated with functional disability in RA, whereas no other molecules correlated with loss of function. These results encourage further studies assessing new roles of chemerin as a marker of impairment in RA.

El presente estudio tuvo como objetivo describir los resultados materno-perinatales de gestantes con infección por SARS-CoV-2 identificadas antes del parto, en un hospital nivel III del Perú. Se evaluaron variables sociodemográficas, complicaciones obstétricas y morbilidades neonatales en los nacimientos ocurridos entre el 1 de abril y el 30 de junio de 2020, en el Instituto Nacional Materno Perinatal del Perú. Se registraron 43 recién nacidos, 93% de las madres fueron asintomáticas. Las complicaciones obstétricas más frecuentes fueron rotura prematura de membranas (18,6%) y preeclampsia (11,6%). El 65,1% de nacimientos fue por parto vaginal, solo uno de los recién nacidos presentó resultado positivo a la prueba de reacción en cadena de polimerasa con transcriptasa inversa (RT-PCR) para COVID-19, las comorbilidades de los recién nacidos fueron prematuridad (11,3%), bajo peso al nacer (9,3%), cuatro ingresaron a cuidados intermedios y dos a cuidados intensivos. Se concluye que el 2,4% de los recién nacidos hijos de madres con COVID-19 presentó prueba molecular positiva de RT-PCR, el 14% de recién nacidos presentó morbilidad como prematuridad, bajo peso al nacer, sepsis y neumonía que requirió ventilación. La morbilidad neonatal se encontró en recién nacidos cuya prueba de RT-PCR fue negativa para COVID-19.

Measuring quality of care (QoC) from a patient’s perspective is becoming increasingly important in inflammatory bowel disease. The objective of this study was to determine whether patients’ evaluations of QoC correlate with better inflammatory bowel disease outcomes. A survey including patients’ characteristics, a decalogue of QoC indicators, and self-reported disease outcomes was completed by Spanish patients with inflammatory bowel disease. A QoC index (QoCI) was constructed with the sum of the “yes” answers in the decalogue. We evaluated the correlation of QoCI with outcomes. A sub-analysis comparing patients with high QoCI vs those with low QoCI was performed (QoCI = 10 or ≤ 7). Seven hundred and eighty-eight questionnaires were analyzed. Mean age of participants was 43.4 years (63% women). Mean QoCI was 8.1 (± 2.4). The QoCI correlated significantly with activity of the disease, number of flares, emergency/unscheduled visits, and disease control. Patients scoring in the first QoCI quartile reported a decreased rate of moderate/severe disease (34.8% vs 55.3%, p < 0.001), fewer numbers of flares (p < 0.001), and fewer emergency/unscheduled visits (p < 0.001) compared with those in the lower QoCI quartile. The high QoC group also reported better disease control. Patient-evaluated QoC correlates with better outcomes. Evaluation of QoC by patients may be useful to detect inadequate care and improve inflammatory bowel disease outcomes.

Background: The Wnt/β catenin pathway promotes bone mineralization stimulating proliferation, differentiation, and survival of osteoblasts; it also inhibits osteoclast differentiation and osteocyte...

Adipogenesis regulation is crucial for mature adipocyte function. In obesity, a major driver of type 2 diabetes (T2D), this process is disrupted and remains poorly characterized. Here we identified altered DNA methylation profiles in diabetic obese patients, during three adipocytes differentiation stages. We isolated mesenchymal cells from visceral adipose tissue of obese patients with and without T2D to analyse DNA methylation profiles at 0, 3, and 18 days of ex vivo differentiation and documented their impact on gene expression. Methylation and gene expression were analysed with EPIC and Clarion S arrays, respectively. Patients with T2D had epigenetic alterations in all the analysed stages, and these were mainly observed in genes important in adipogenesis, insulin resistance, cell death programming, and immune effector processes. Importantly, at 3 days, we found six-fold more methylated CpG alterations than in the other stages. This is the first study to document epigenetic markers that persist through all three adipogenesis stages and their impact on gene expression, which could be a cellular metabolic memory involved in T2D. Our data provided evidence that, throughout the adipogenesis process, alterations occur in methylation that might impact mature adipocyte function, cause tissue malfunction, and potentially, lead to the development of T2D.

Background: Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH. Methods and Results: Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7–9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up. Conclusion: In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.

Introduction: Genetic variants could aid in predicting antidiabetic drug response by associating them with markers of glucose control, such as glycated hemoglobin (HbA1c). However, pharmacogenetic implementation for antidiabetics is still under development, as the list of actionable markers is being populated and validated. This study explores potential associations between genetic variants and plasma levels of HbA1c in 100 patients under treatment with metformin. Methods: HbA1c was measured in a clinical chemistry analyzer (Roche), genotyping was performed in an Illumina-GSA array and data were analyzed using PLINK. Association and prediction models were developed using R and a 10-fold cross-validation approach. Results: We identified genetic variants on SLC47A1, SLC28A1, ABCG2, TBC1D4, and ARID5B that can explain up to 55% of the interindividual variability of HbA1c plasma levels in diabetic patients under treatment. Variants on SLC47A1, SLC28A1, and ABCG2 likely impact the pharmacokinetics (PK) of metformin, while the role of the two latter can be related to insulin resistance and regulation of adipogenesis. Conclusions: Our results confirm previous genetic associations and point to previously unassociated gene variants for metformin PK and glucose control.

Ustekinumab (UST) is a monoclonal antibody against IL-12/23 approved in Spain (2017) to treat moderate / severe Crohn's disease.To evaluate the effectiveness and safety in real clinical practice in patients treated with UST in our center.This is a prospective observational study including patients who started UST from 08/01/2017 to 02/28/2019 with follow-up up to that date. We analyze response and remission in weeks 16, 24 and 52, using "Crohn's Disease Activity Index" (response if 100 point decrease and remission if150) and Physician's Global Assessment.We included 61 patients with a median duration of Crohn's disease of 14,6 years (0-36). The 83,6% of patients without steroids and 73,8% without associated immunosuppressors. Previously all patients had received anti-TNF and 14,8%, in addition, vedolizumab. We observed a good correlation between Crohn's Disease Activity Index and Physician's Global Assessment (r = 0,89, p.001). In week 16 (n = 45) 75,6% response (57,8% remission), in week 24 (n = 35) 69,9% response (45,7% remission) and in week 52 (n = 12) 75% response (58.3% remission). There were no statistically significant differences in the response/remission rates at week 16 or 24 depending on the reason for the onset of UST or the number of previous biologics. In 2 patients it was withdrawn due to toxicity (arthralgia / myalgia).UST is an effective and safe treatment in real clinical practice with high rates of clinical remission at week 16, 24 and 52 regardless of the order of biological used and the reason for starting UST.

This research aimed to show that using different cutoff points for women and men in nutritional assessment through the Mini Nutritional Assessment (MNA) and different anthropometric variables, improves the diagnostic accuracy of malnutrition among people over 65 years. A cross-sectional study was carried out in a sample of 240 patients of 65 to 104 years in Córdoba (Spain) between 2013 and 2015. Excluded were those with disabling diseases that prevented informed consent. We assessed Nutritional status using the MNA and the Chang Method (Gold Standard). Global cut points per sex were determined for each independent variable using Receiver Operating Characteristic curves, choosing the best of each according to the highest Youden´s index (J). None of the variables studied showed high precision in the diagnosis of malnutrition in the elderly. Different cutoff points were found for all variables by sex, as well as variations in their validity indexes. The number of lymphocytes was more accurate in women (J = 0.58), being the muscular circumference of the arm the best in men (J = 0.8). Regarding MNA, the Long Form version showed higher sensitivity (S) in women (S = 76%) and short versions in men (S = 71% and 59%) at different cutoff points. The introduction of the sex variable seems determinant to achieve a more accurate diagnostic of malnutrition, avoiding biases derivate from a global study without considering its effect in the development of diseases.

BackgroundTo date, the association of serum macrophage migration inhibitory factor (MIF) and serum adipokines with lupus nephritis is controversial.ObjectiveTo assess the utility of serum MIF, leptin, adiponectin and resistin levels as markers of proteinuria and renal dysfunction in lupus nephritis.MethodsCross-sectional study including 196 systemic lupus erythematosus (SLE) patients and 52 healthy controls (HCs). Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Renal SLE involvement was investigated by renal-SLEDAI. MIF, adiponectin, leptin and resistin levels were quantified by ELISA. We assessed the correlations of quantitative variables by Spearman correlation (rs). Multivariable linear regression adjusted the variables associated with the severity of proteinuria.ResultsSLE patients had higher MIF (p = 0.02) and adiponectin (p n = 43) had higher adiponectin (19.0 vs 13.3 μg/mL,p = 0.002) and resistin (10.7 vs 8.9 ng/mL,p = 0.01) than patients with non-renal SLE (n = 153). Proteinuria correlated with high adiponectin (rs = 0.19,p rs = 0.26,p rs = 0.27,p = 0.04). Resistin correlated with increased creatinine (rs = 0.18,p = 0.02). High renal-SLEDAI correlated with adiponectin (rs = 0.21,p = 0.004). Multiple linear regression showed that elevated adiponectin (p = 0.02), younger age (p = 0.04) and low MIF (p = 0.02) were associated with the severity of proteinuria. Low MIF and high adiponectin levels interacted to explain the association with the severity of proteinuria (R2 = 0.41).ConclusionsHigh adiponectin combined with low MIF concentrations int+eract to explain the severity of proteinuria in renal SLE. These findings highlight the relevance of adiponectin, resistin and MIF as markers of LN.

To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. Women with stage I–III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.

BACKGROUND Few studies have examined self-medication with corticosteroids among patients with ulcerative colitis (UC). AIMS To assess the frequency of self-medication with oral corticosteroids in UC patients, and associated factors and reasons. METHODS An anonymous, voluntary, web-based survey was administered to adults with UC recruited via a Spanish patient association (ACCU) and hospital gastroenterology departments. Information was provided by patients; no clinical data were collected. Descriptive statistics and comparisons of frequencies are displayed. RESULTS Among 546 respondents (mean age 39.9 years, median duration of UC since diagnosis 7 years,) 36 (6.6%) reported self-medication with oral corticosteroids during the past year (once: 23 patients; 2-3 times: 10 patients; >3 times: 3 patients). Self-medication was more common among patients managed in general gastroenterology vs. inflammatory bowel disease clinics [23 (9.0%) vs. 11 (2.9%), P = 0.019], patients with no regular follow-up [4 (22.2%) vs. 32 (6.1%), P = 0.026] and patients with more flares (P < 0.001). Patients who stored steroids from previous flares (17.9% vs. 6.0%, P < 0.001) or who lived with a partner taking steroids (9.3% vs. 1.1%, P = 0.038) were more likely to self-medicate than other patients. Common reasons for self-medicating included the need for quick symptom relief (55.6%), fear of worsening (47.2%) and difficulty in getting an appointment (25.0%). Only seven patients (19.4%) informed their physician when they started self-medicating and only four (11.1%) declared they would not start corticosteroids again. CONCLUSION Self-medication with oral corticosteroids is not a common practice among patients with UC in Spain, but several areas of improvement exist.

Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization’s World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77–3.67) and lesbian/gay and bisexual students (AORs range 2.22–5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25–3.82). Gender differences varied across sexual identity and disorder. These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.

Esophageal duplication cysts are asymptomatic gastrointestinal anomalies that are infrequently seen, usually diagnosed as a secondary finding. In adults, they can be associated with gastroesophageal reflux disease (GERD) and are usually detected with a radiologic study. We report the case of a 55-year-old woman with a 2-year history of pyrosis, regurgitation, coughing fits, and dysphagia. An esophagogastroduodenoscopy (EGD) was done, detecting a subepithelial lesion at the gastroesophageal junction with a type I hiatal hernia; endoscopic ultrasound and a CT scan were performed, showing a distal esophageal mass that generated a narrowing of the esophageal diameter with proximal dilation. An esophageal duplication cyst was diagnosed. Excision of the mass, hiatoplasty, and gastric fundoplication were auspiciously achieved by an abdominal transhiatal approach. A year after the procedure, the patient is asymptomatic and without complications. If a patient presents with epigastric pain and GERD-like symptoms, with no benefit from medical treatment, an esophageal duplication cyst must be a differential diagnosis. This can be confirmed with a CT scan and endoscopic ultrasound, with surgery being the best treatment for this disease

El riesgo de muerte súbita en la cardiomiopatía hipertrófica está relacionado a la presencia de arritmias ventriculares en la gran mayoría de los casos. Es y será un reto para la Cardiología moderna encontrar los mejores esquemas para valorar la probabilidad de complicaciones arrítmicas, siendo por ahora el enfoque multifactorial la mejor estrategia para evitar el implante innecesario de dispositivos como los cardiodesfibriladores. Si bien, el electrocardiograma (ECG) sigue siendo una excelente herramienta para el diagnóstico, incluso en fases sin expresión ecocardiográfica, no tiene un rol claro en la estratificación de riesgo. Sin embargo, la asociación de cambios en el ECG y otros hallazgos como la presencia de preexcitación y/o QT largo, así como variantes de presentación tipo cardiomiopatía hipertrófica apical, permitirían identificar a pacientes con alta probabilidad de muerte súbita. Desde hace unos años la resonancia cardíaca y la cuantificación de la fibrosis intramiocárdica (mecanismo básico de las arritmias ventriculares) tienen un rol cada vez más importante en la evaluación de estos pacientes. En especial, la población pediátrica debe tener una visión individualizada por el mal pronóstico a edades tempranas y por el rol incierto de diferentes herramientas para la valoración del riesgo y tratamiento

BACKGROUND AND PURPOSE: Stroke assistance is facing changes and new challenges since COVID-19 became pandemic. A variation on the patient influx might be one of the greater concerns, due to fewer people coming to emergency departments or coming too late. However, no data quantifying this have been published until now. The aim was to analyse the impact of the COVID-19 epidemic outbreak on hospital stroke admissions and their characteristics in our region. METHODS: The data of every patient admitted to any hospital of our healthcare system with a diagnosis of ischaemic stroke between 30 December 2019 and 19 April 2020 were reviewed. Demographic and clinical data were recorded and compared between periods before and after the setting of the state of emergency secondary to the COVID-19 outbreak. RESULTS: In total, 354 patients with ischaemic stroke were admitted in our study period. There was a weekly average of 27.5 cases before the setting of the state of emergency against 12 afterwards (P

Explore the pathogenesis, unique features, and various prophylactic as well as therapeutic surgical techniques used in the two most common types of hereditary colorectal cancer Lynch syndrome (LS) and familial adenomatous polyposis (FAP). In LS patients, it is important to determine the genetic risk panel before undergoing surgery. In practice, 22% of surgeons prefer to perform a subtotal colectomy at diagnosis of LS, and more than a half recommend a subtotal colectomy at diagnosis of CRC. In FAP patients, most surgeons would choose proctocolectomy + ileal pouch-anal anastomosis (IPAA) rather than total colectomy + ileorectal anastomosis (IRA), as the remaining rectum might harbor disease and will require surveillance. The role of laparoscopy and robotics has been introduced in the management of these operations over the past few years. Different surgical techniques are used as prophylactic or therapeutic measures in patients with LS and FAP. The main question is to determine how extensive the surgery should be, rather than deciding on the need or on the timing of intervention. Regardless of the surgical technique options, all decisions need to be individualized and best undertaken with the patient, patient’s family, and a multi-disciplinary team.

Background Although important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients. Methods A before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals. Results The DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-valuep-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c. Conclusions MIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.

Background The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. Methods In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. Results Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. Conclusions Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.

Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence-based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.

Metabolic Syndrome (MetS) has been related to pulmonary diseases but its relationship with lung age has not been sufficiently studied. In addition, anthropometric variables have been associated with pulmonary dysfunction, highlighting the waist-to-height ratio (WHtR). The aim was to evaluate the relationship between MetS and: lung age, anthropometric variables and the alteration of lung function. A cross-sectional study was carried out in 1901 workers, evaluating lung function through lung age (Morris & Temple equation) and spirometric values. The diagnosis of MetS was based on the harmonized criteria. We measured anthropometric variables (WHtR, waist circumference, body mass index, waist to hip ratio), blood pressure and biochemical variables (glucose, cholesterol total, HDL, triglycerides). Workers suffering from MetS showed an accelerated lung aging (59.4 ± 18.7 years vs 49 ± 18.4 years). The WHtR ≥ 0.55 was significantly related to an increase in lung age (β = 6.393, p

To compare the effects of platelet-rich plasma (PRP) injection versus placebo (saline injection) on pain and joint function in lateral epicondylitis in randomized placebo-controlled trials. Randomized controlled trials that evaluated pain (visual analog scale [VAS] and patient-rated tennis elbow evaluation [PRTEE]) and/or functional improvement (PRTEE; disability of the arm, shoulder, and hand [DASH]; and Roles–Maudsley score [RMS]) in patients diagnosed with lateral epicondylitis and compared PRP with placebo injections were considered. The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched from inception to October 2019. The assessment of bias was performed using the Cochrane Risk of Bias Tool version 1. The meta-analysis was conducted with a random effects model and generic inverse variance method. Five trials involving a total of 276 individuals were included. They used a parallel study design and saline solution as placebo. The mean age of participants was 48.0 ± 9.3 years. Follow-up varied from 2 months to 1 year. No significant changes were noted for pain (standardized mean difference [SMD], − 0.51 [95% confidence interval (CI), − 1.32 to − 0.30]) nor functional scores (SMD, − 0.07 [95% CI, − 0.46 to 0.33]) between PRP and placebo injections. The most frequent adverse reaction reported in two of the five studies was transient post-injection pain for a few days (from 16 to 20% in the PRP group and from 8 to 16% in the placebo group). PRP injection was not superior to placebo for relieving pain and joint functionality in chronic lateral epicondylitis. However, patients reported improvement after both interventions in such clinical parameters. Further randomized trials are required to determine whether PRP injection is clinically more effective than placebo (saline injection).

Introduction: Multiple studies have reported that breast reconstruction (BR) after mastectomy is paramount in the global treatment of breast cancer (BC). Despite this, BR rates in Mexico are very low (7-16%), which may be explained by the fact that BR is not completely covered by public institutions in our country. Even though BR rates can increase when pertinent information is offered to patients, little is known about the level of information among Mexican patients. We sought to assess the level of information that patients who underwent mastectomy had about BR in a Mexican referral BC center with public healthcare insurance where BR services are not covered, as well as its relationship with their decision-making and the main reasons why they would or would not want to have BR. Methods: A written questionnaire was applied to 110 women who underwent mastectomy to assess their knowledge and desire for BR, and the reasons for or against it. We then analyzed the differences in information perception between women who did or did not desire BR. Results: Mean age was 51 years (30-78). Most patients had lower education (61%), 29% had a monthly income 5 cm (66%), with a high proportion of locally advanced clinical stages (67%). Mean times since diagnosis and since mastectomy were 2.2 and 1.9 years, respectively. Two-thirds of patients wished to have BR. Only 28% looked for information about BR; 65% did not recall ever receiving any information about BR from their doctors; 76% said they were not advised by their providers to undergo BR; 83% never asked their doctors for information regarding BR; and 84% believed they did not have enough information about BR. Notably, 12% of patients received their families’ advice not to have a BR. Seven domains were significantly associated with the desire of having a BR. More patients who did not desire a BR than those who did, reported they did not receive or look for information, advice or counseling about their BR options (see table). The five main reasons to have BR were: 1) It would give me freedom to dress in any kind of clothes; 2) To make my breasts look symmetrical; 3) To look like I used to before the mastectomy); 4) To feel more confident; and 5) To feel more attractive. The five main reasons not to have BR were: 1) I am worried about its cost; 2) I do not know the BR options; 3) I do not have enough information about BR; 4) I am worried the cancer could return; and 5) I am afraid that BR complications can happen. Conclusion: This is the first study to evaluate the association between the information, advise and counseling patients receive about BR and their desire to undergo the procedure in an underserved setting such as the Mexican public healthcare system. The amount of information and counseling about BR significantly correlates with women's interest in this procedure. This lack of information about BR from providers might be mainly due to the lack of BR coverage in public services, which likely play a strong role on the low rates of BR in this country. For this reason, it is of utmost importance to ensure that a specific governmental or civil budget is directed to cover this procedure and, ultimately promote the delivery of BR-related information to all BC patients in a standardized manner. Table. Differences in BR interest according to BR knowledgeQuestionsWould you like to have a breast reconstruction? n(%)No (n=37)Yes (n=73)Total (n=110)PNone of my doctors informed me about breast reconstruction30 (81)41 (56)71 (65)0.01None of my doctors advised me to have a breast reconstruction33 (89)51 (70)84 (76)0.024I never asked my doctor for information about breast reconstruction36 (97)55 (70)91 (83)0.004My doctor did not explain there are many types of reconstruction35 (95)51 (70)85 (77)0.003I do not think I have enough information about breat reconstruction35 (95)57 (78)92 (84)0.027I have never approached an NGO or civil society organizations to get a breast reconstruction37 (100)65 (89)102 (93)0.037I have never discussed with my partner about having a breast reconstruction30 (81)36 (49)66 (60)0.001 Citation Format: Paulina Bajonero-Canonico, Melina Miaja-Avila, José Moral de la Rubia, Jorge A Saldaña-Rodríguez, David E Hinojosa-González, Cristel G De la O-Maldonado, Cynthia M Villarreal-Garza. Information gaps and perceived barriers to achieve breast reconstruction among patients with mastectomy in a public breast cancer center in Mexico [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-15.

La distrofia muscular de Duchenne (DMD) es la miopatía más común en niños, de herencia recesiva ligada al cromosoma X y causada por mutaciones en el gen DMD (Xp21.2). Se caracteriza por atrofia y debilidad muscular progresiva, con consecuentes complicaciones musculoesqueléticas, respiratorias y cardíacas, entre otras. Considerando la alta prevalenciade esta condición (prevalencia mundial 0.5 por cada 10 000 hombres) (1,2) y la importancia del manejo multidisciplinar para el diagnóstico oportuno y el manejo adecuado de los pacientes, se realiza un consenso interdisciplinario de expertos para proponer recomendaciones para el diagnóstico y seguimiento de los pacientes colombianos con DMD

The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.