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RESUMEN Objetivo: Demostrar el coste-efectividad de la cura en ambiente húmedo (CAH) sobre la cura tradicional (CT) en pacientes hospitalizados con úlceras por presión (UPP) de categorías I y II. Metodología: Estudio longitudinal comparativo, aleatorizado, abierto, dividido en dos grupos, tratados y seguidos durante 4 semanas. El tamaño de la muestra se calculó con base en el metaanálisis de Heyer. Creamos un árbol de decisión para comparar el coste-efectividad de cada cura. Los datos se recopilaron directamente de los formularios de informes de casos de pacientes y los costes se extrajeron de los registros hospitalarios. Realizamos análisis de sensibilidad y costeefectividad incrementales. Resultados: El análisis mostró un dominio de la CAH sobre la CT (223,00€/0,84 vs. 298,00€/0,51), ya que fue más rentable al final del estudio. La hospitalización fue más corta en la CAH y la curación se logró en menos días que con la CT, lo que tiene un impacto en los costes relacionados con los tiempos de atención de enfermería, gasto de recursos materiales y días de hospitalización de los pacientes. Conclusiones: La CAH es más coste-efectiva que la CT cuando se aplica a pacientes hospitalizados con UPP de categorías I y II.

Background. Human milk is essential for establishing the newborn’s gut microbiota, which can have an impact on future health. Several studies indicate that Non-nutritive Sweeteners (NNS) can modify the intestinal microbiota, promoting metabolic dysfunction in humans and rodents; however, the influence of NNS on human milk microbiota is unknown. This study aimed to assess changes in the relative abundance of several of bacterial groups in colostrum of women who consumed NNS during pregnancy. Methods. This cross-sectional, pilot study included 39 women that gave birth to a live, healthy newborn in the General Hospital of Mexico. We assessed mothers’ diet and NNS consumption by validated questionnaires and the relative abundance of Bifidobacteriaceae, Lactobacillaceae, Lachnospiraceae, Roseburia, Eubacteriales, and Bacteroidales in colostrum samples by real-time PCR.Results. Twenty-six women (66%) showed a low NNS consumption (Lactobacillaceae relative abundance significantly decreased in the high NNS consumption group compared to the low NNS group (12.36±11.29 vs. 4.41±2.84, respectively; P<.001). NNS consumption associated with lower gestational age determined by the Capurro method or Ultrasound/Last Menstrual Period (r=-0.320, P= .025; and r=-0.355, P= .018, respectively).Conclusion. NNS consumption during pregnancy is associated with decreased Lactobacillaceae abundance in colostrum and lower gestational age. The effects of NNS consumption during pregnancy on breast milk microbiota and gestational age should be further investigated.Study registration: This study was registered in ClinicalTrials, number NCT03912038.

Background: A diet containing non-caloric sweeteners (NCS) could reduce calorie intake; conversely, some animal studies suggest that NCS consumption may increase functional gastrointestinal disorder symptoms (FGDs). This study aimed to compare the effect of consuming a diet containing NCS (c-NCS) versus a non-caloric sweetener-free diet (NCS-f) on FGDs. Methods: We conducted a randomized, controlled, parallel-group study using two different diets for five weeks: the c-NCS diet contained 50–100 mg/day NCS, whereas the NCS-f diet had less than 10 mg/day NCS. At the beginning of the study (PreTx) and at the end (PostTx), we assessed FGDs, dietary intake, and NCS consumption. Results: The percentage of participants with diarrhea (PreTx = 19% vs. PstTx = 56%; p = 0.02), post-prandial discomfort (PreTx = 9% vs. PstTx = 39%; p = 0.02), constipation (PreTx = 30% vs. PostTx = 56%; p < 0.01), and burning (PreTx = 13% vs. PostTx = 33%; p < 0.01) increased in the c-NCS diet group. Conversely, abdominal pain (PreTx = 15% vs. PostTx = 3%; p = 0.04), post-prandial discomfort (PreTx = 26% vs. PostTx = 6%; p = 0.02), burning (PreTx = 15% vs. PostTx = 0%; p = 0.02), early satiety (PreTx = 18% vs. PostTx = 3%; p < 0.01), and epigastric pain (PreTx = 38% vs. PostTx = 3%; p < 0.01) decreased in the NCS-f diet group. Conclusion: A c-NCS diet is associated with increased FGDs, including diarrhea, post-prandial discomfort, constipation, and burning or retrosternal pain. The NCS-f diet also decreased FGDs, as well as abdominal pain, post-prandial discomfort, burning or retrosternal pain, early satiety, and epigastric pain.

Background Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. Methods We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. Results The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40–94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were − 3.02 (1.23) at the lumbar spine and − 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. Conclusions This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.

The appearance of new anti-tuberculosis drugs such as bedaquiline and delamanid makes it impossible not to remember that the first strictly controlled medical trials of tuberculosis treatment were published in two rigorously researched outstanding articles that can be qualified as historical. In 1948, streptomycin was formally studied as an efficacious anti-tuberculosis drug. In 1952, another trial compared streptomycin-paramino salicylic acid with isoniazid, by means of which the first bases of pharmacological tuberculosis treatment were established.La aparición de nuevos fármacos antituberculosos, como la bedaquilina y el delaminid, hace inevitable recordar que los primeros ensayos estrictamente controlados del tratamiento médico de la tuberculosis se publicaron en dos artículos de excelente y rigurosa investigación científica que pueden calificarse como históricos. En 1948 se estudió formalmente la estreptomicina como medicamento antituberculoso eficaz. En 1952, en otro ensayo se comparó estreptomicina-ácido paraaminosalicílico con isoniacida, con lo que se establecieron las primeras bases del tratamiento farmacológico de la tuberculosis.

Background In acute lymphoblastic leukemia (ALL), high ABCB1 gene expression has been associated with treatment resistance, which affects patient prognosis. Many preclinical reports and retrospective population studies have shown an anti-cancer effect of metformin. Therefore, the objective of this study was to assess the effect of metformin on the treatment regimen in patients with ALL who exhibited high levels of ABCB1 gene expression and to determine its impact on overall survival. Methods A total of 102 patients with ALL were recruited; one group (n = 26) received metformin, and the other received chemotherapy (n = 76). Measurement of ABCB1 transcript expression was performed using qRT-PCR prior to treatment initiation. Survival analysis was performed using Kaplan–Meier curves. The impact of both the type of treatment and the level of expression on the response (remission or relapse) was analyzed by calculating the odds ratio. Results The survival of patients with high ABCB1 expression was lower than those with low or absent ABCB1 gene expression (p = 0.030). In the individual analysis, we identified a benefit to adding metformin in the group of patients with high ABCB1 gene expression (p = 0.025). In the metformin user group, the drug acted as a protective factor against both therapeutic failure (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.0037–1.53) and early relapse (OR 0.05, 95% CI 0.0028–1.153). Conclusion The combined use of metformin with chemotherapy is effective in patients with elevated levels of ABCB1 gene expression. Trial registration NCT 03118128: NCT

Allergic rhinitis (AR) is considered to be a public health problem, therefore it is essential to test health education strategies such as nursing counseling (NC) aimed at population groups such as children with allergic rhinitis and their tutors. This study aimed to measure the health benefits of children with this disease for a year.Longitudinal, randomized, comparative study with a sample of 100 pediatric patients of both sexes, aged 6 to 12 years, with diagnosis of allergic rhinitis, with counseling (study group) and without counseling (control group). In both groups, an informed consent letter signed by both tutors was obtained, in addition to knowledge and assessment papers; the latter included a scale of symptomatology and Morisky Green (adherence to treatment). The children in the study group received intervention based on personalized education, didactic material, support of the multidisciplinary group if necessary (doctor, dermatologist and psychologist). The control group received usual care. In both groups, telephone follow-up was performed, which allowed the number of relapses to be identified in one year.The Wilcoxon rank-sum test (Mann-Whitney) was used to compare the results; the presence of relapses in the control group was statistically significant compared to the study group.It was found that the infant population that receives NC, has as a better benefit the control of the symptomatology and decrease of relapses per year.

El crecimiento mundial de la poblacion geriatrica es un fenomeno relacionado con mayor esperanza de vida que permite una diversidad de manifestaciones de la senectud. El envejecimiento conlleva un declive natural de funciones, entre ellas, disminucion del apetito que resulta en perdida de peso, pero que a veces tiene origenes patologicos. La anorexia nerviosa en el anciano es una entidad cuyo reconocimiento se ha omitido sistematicamente en la practica medica, debido a que el clinico la relaciona solamente con adolescentes y su identificacion en la vejez es esporadica con referencias anecdoticas en la literatura medica. La importancia del tema radica en que se desconoce la historia natural de este trastorno alimentario cronico y de baja mortalidad en el paciente mayor, por lo que debemos preguntarnos si existe la anorexia nerviosa en el anciano, y si es asi, si se trata de recaidas del problema del adolescente o es una aparicion tardia de la enfermedad.

Summary Background & aims People with the highest risk of iron deficiency are infants, teenagers and pregnant women. Iron deficiency has negative effects on physical and psychomotor development and has high impact on the productive life and on the development of a country. The aim of this study was to determine iron state in healthy six-month-old infant Mexican patients. Methods The analysis was held in 205 subjects in an observational and descriptive study. We included infants at term with good health, no acute or chronic diseases at least in the 4 previous weeks and with any type of feeding. We evaluated the birth weight, gain weight and iron status of infants at the age of six months. Laboratory studies included blood hemoglobin (Hb), mean cell volume (MCV), red blood cell distribution width (RDW), transferrin saturation (TS) and ferritin. Results Birth weight and gain weight were acceptable in 94.1%. Iron deficiency was detected in 44.9% and anaemia secondary due to iron deficiency was present in 19.5%. Multiple linear regression analysis showed that exclusive breast-fed correlated with iron deficiency (rp = −0.167, p Conclusions High prevalence of iron deficiency and secondary anaemia, two important public health problems, were present in children during the first months of life in the analyzed sample.