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AbstractObjective Vector-borne diseases are a growing burden worldwide. In particular, the risks of allergic reactions to bites are associated with growing arthropod populations in contact with the public. The diversity of allergic reactions associated with host and arthropod factors difficult disease diagnosis, prognosis and prevention. Therefore, arthropod-associated allergies are underdiagnosed and require better surveillance of arthropod populations and disease diagnosis and management.Methods To face these challenges, in this study, we describe five cases to illustrate arthropod-associated allergies with different symptomatology, including alpha-gal syndrome (AGS) associated with anti-alpha-gal IgE antibody titres. Information on symptoms in response to arthropod bites was collected from patients and medical doctors.Results The five cases included patients bitten by a robber fly and different tick species. Cases were in Spain or U.S.A. Two cases were diagnosed with AGS and one case was diagnosed with anaphylaxis in response to tick bite with high anti-alpha-gal IgE levels. The symptoms in response to arthropod bites vary between different cases.Conclusion Allergic reactions and symptoms in response to arthropod bites vary in association with host and arthropod factors. Herein we propose recommendations to control allergic symptoms, associated disease risk factors and the way forward to advance in the prevention and control of arthropod-associated allergies.

Total skin electron irradiation (tsei) is one of the most widely used techniques in the treatment of mycosis fungoides (mf). The objective of this work is to carry out the dosimetric characterization of the translational method using a mobile platform at constant speed for tsei, being a longitudinal prospective study design, making use of descriptive statistics with a quantitative approach. The dosimetric and geometric characteristics were established according to the Varian 21 iX linear accelerator for clinical use, treatment method and conditions of the translational platform (tp) with two degrees of freedom (speed and height), using a 1 cm thick lucite, thus degrading the energy and obtaining the maximum dose at a depth of 4.8 mm and a photon contamination of 0.74%, which are within the parameters established by the American Association of Physicists in Medicine (aapm) in report No. 23.1 In Mexico, the translational technique with tsei has not been implemented for mf cancer procedures, and due to the physical limitations of the patients, there is no homogeneous dose distribution on the skin surface with the Stanford and rotational technique

Radiotherapy Quality Management Systems (qms) and Quality Assurance (qa) Programs have been proposed as an effective tool to ensure consistency between medical prescription and safe delivery of treatment to patients with minimal exposure to staff. In recent years in Mexico, there has been an increase in the acquisition of modern medical linear accelerators for the delivery of highly sophisticated radiotherapy treatments with specific qa requirements. This makes it necessary to review the current regulatory framework on Quality Management, to know if regulatory requirements are sufficient for the establishment, implementation and development of Comprehensive Quality Systems (qs) in radiotherapy centres. The objective of this work is to review the current national regulations in radiotherapy qms, in particular those referring to standard procedures, human and physical infrastructure, and the implementation of qs in the practice of health care institutions. Results show a first approach to the implementation of quality management systems and quality assurance programs in radiotherapy centres.

Small cities with less than 200,000 inhabitants do not usually suffer from chronic congestion problems. However, private vehicles are used excessively, making it necessary to implement measures to encourage further use of public transport and pedestrian mobility to make it more sustainable. Bypasses improve level of service (LOS) by removing cars from the city center, leading to significant reductions in overall travel time. Most studies so far have been conducted in large cities suffering chronic congestion problems, so the aim of this research is to analyze the effects of bypasses in small and non-congested cities through the construction of a traffic model in Badajoz (Spain), starting with the allocation of the origin-destination travel matrix derived from surveys and traffic counts conducted at the southern and eastern accesses. The traffic model describes the mobility in potentially-capturable future southern traffic relationships and allows insights into different alternatives in the construction of a new high LOS road. This research concludes that small cities with no chronic congestion problems should plan bypasses as close as possible to the city, since they are the most economical, produce greater traffic capture, greater time savings, and eliminate the largest number of CO2 emissions from the urban center. The more distant alternatives have a higher LOS, however, these are longer and more expensive solutions that also capture less traffic and thus eliminate less CO2 emissions.

The current trend in vehicles is to integrate a wide number of antennae and sensors operating at a variety of frequencies for sensing and communications. The integration of these antennae and sensors in the vehicle platform is complex because of the way in which the antenna radiation patterns interact with the vehicle structure and other antennae/sensors. Consequently, there is a need to study the radiation pattern of each antenna or, alternatively, the currents induced on the surface of the vehicle to optimize the integration of multiple antennae. The novel concept of differential imaging represents one method by which it is possible to obtain the surface current distribution without introducing any perturbing probe. The aim of this study was to develop and confirm the assumptions that underpin differential imaging by means of full-wave electromagnetic simulation, thereby providing additional verification of the concept. The simulation environment and parameters were selected to replicate the conditions in which real measurements were taken in previous studies. The simulations were performed using Ansys HFSS simulation software. The results confirm that the approximations are valid, and the differential currents are representative of the induced surface currents generated by a monopole positioned on the top of a vehicle.

Background: Benign prostatic hyperplasia (BPH), a common urological disease in aging men, frequently produces lower urinary tract symptoms (LUTS). Clinical studies have shown that terazosin relaxes the smooth muscle of the prostate and bladder, facilitates bladder emptying, improves LUTS, increases maximum urinary flow, and reduces the residual volume of urine. D-004, a lipid extract of the fruit of the Cuban royal palm ( Roystonea regia ), presents a similar efficacy to Saw palmetto. Clinical studies have demonstrated its efficacy and safety in short- and medium-term trials in patients with BPH. The objective of this study was to compare the efficacy and tolerability of D-004 with terazosin for 6 months on LUTS in patients with BPH. Methods: The present phase III study had an open, randomized, comparative design, with two parallel groups who received D-004 (320 mg/day) or terazosin (5 mg/day) for 6 months. The study included men at least 50 years of age, with evidence of the LUTS of moderate intensity according to the International Symptoms of the Prostate (IPSS). The effects on the IPSS Scale was the primary efficacy variable. The effects on the size of the prostate and the residual volume were secondary variables. The subjective self-perception of symptom relief at trial completion was a collateral outcome. Analysis was done by intention-to-treat. Results: The study included 100 men with a diagnosis of BPH, confirmed by digital rectal examination and ultrasonography, and moderate LUTS (IPSS score >7,

Objetivo. Determinar la prevalencia de sobrepeso y obesidad en adultos mayores en la Unidad de Medicina Familiar (UMF) del Instituto de Seguridad Social del Estado de Tabasco (ISSET) y su correlación con la presión arterial. Material y métodos: Se realizó un estudio observacional, retrospectivo, analítico, transversal en 7322 adultos de 60 años o más. Se obtuvieron las mediciones de peso, talla, presiones arteriales sistólica, diastólica y media, además de diagnósticos registrados en los expedientes clínicos. Se utilizaron estadísticas descriptivas de tendencia central y se calculó el coefiiente de correlación de Pearson (r) para el índice de masa corporal con las mediciones de presión arterial y se consideraron signifiativas aquellas con una p

Objetivo: Determinar si el aprendizaje de la Anatomía Humana en los alumnos del primer año grupos “A” y “C” de Médico Cirujano 2004 – 2005 tiene relación con el estado de su salud; de la Universidad Juárez Autónoma de Tabasco. Materiales y método: Se realizó un análisis de la información que se captó, así como un estudio retrospectivo a través de expedientes del Centro Clínico de la DACS en los alumnos del primer año “A” y “C” de la Licenciatura de Médico Cirujano del período Agosto 2004 a Julio 2005. Resultados: Los estudiantes presentan principalmente problemas de origen biopsicosocial, de tipo familiar, con antecedentes de familias disfuncionales y violencia intrafamiliar, que influyó negativamente en el aprendizaje de la asignatura. En México, el desarrollo y los factores que alteran el bienestar en los jóvenes son múltiples, variados e interrelacionados,resaltándose mayormente la influencia social y cultural. La familia desempeña un papel primordial debido a la fuerte relación ya sea positiva o negativa sobre la salud y educación en los jóvenes. Conclusión: La salud del alumno que aspira a la Lic. De Médico Cirujano debe ser valorado eficazmente en la División Académica de Ciencias de la Salud a través del expediente personal recabando detalladamente sus datos, que evalúe y trate al alumno de algún trastorno con la finalidad de orientar, detectar oportunamente los riesgos y/o factores coordinando apoyos con el servicio psicopedagógico; para establecer el seguimiento de los resultados obtenidos en la asignatura.

Objetivo: Determinar los factores principales que influyen en la satisfacción del usuario de la consulta externa del Centro Médico ISSET. Material y métodos: Se realizo una investigación observacional descriptiva transversal a una muestra de 600 pacientes mayores de 18 años que en forma aleatoria se seleccionaron en los 20 consultorios de medicina familiar, turnos matutino y vespertino, en la segunda semana del mes de junio 2003. Resultados: Los usuarios que acuden a la consulta externa el 71.60% son de zona suburbana, las personas con mas demanda de atención son de 26 a 40 años (43.3%), del sexo femenino 72.40%, los casados 69.90%, tres hijos o más 53%, de nivel primaria 32.80% y empleados 49.40%. El tiempo que esperaron para el 53.6% fue mayor de 30 minutos, para el 74.2% no hubo interrupciones durante la consulta. Expediente presente: 78.2%, para el 86.5% el médico estaba en el consultorio. El 95.6% opinaron que las instalaciones físicas son agradables, el 84.4% recibieron buena orientación del médico, el 42.20% no regresan por largos tiempos de espera y el 35.70% regresarían porque no les queda de otra. Conclusiones: Con este trabajo se destaca la importancia que tiene la “satisfacción del usuario” como un aspecto que debe evaluarse sistemáticamente con el fin de utilizarla cuando sea pertinente y esto se obtiene con la entrevista de los usuarios sobre la atención Médica recibida y obtener información que permita la toma de decisiones para elaborar una estrategia que se acerque a las expectativas y necesidades de los prestadores directos y a los usuarios mismos.

Objetivo: Identificar la influencia del grupo de autoayuda en el control de la Diabetes Mellitus del CAAPS No. 1. Material y Métodos: Se realizó el estudio en el CAAPS (Centro Avanzado de Atención Primaria para la Salud) No. 1, de Tierra Colorada, de la Jurisdicción de Centro, donde se encuestaron a 36 pacientes registrados en el Club de Diabéticos, todos los usuarios son diabéticos tipo 2, donde se les aplicó una encuesta explorando 3 dimensiones, identificando los estilos de vida saludable, adicciones como tabaquismo, alcoholismo y drogadicción y el conocimiento que tienen estos usuarios sobre su enfermedad previa autorización de los pacientes encuestados. Resultados: Para los estilos de vida saludables, los hábitos alimenticios disminuyeron notablemente desde el momento de su ingreso en cuanto a los malos de 36.11% a 5.56%, hábitos regulares de 30.56% a 47.22% y los hábitos buenos aumentaron de 16.67% a 63.89%. Para el sedentarismo, los usuarios que realizan ejercicio semanalmente antes de ingresar al club el nunca realizar ejercicio un 55.6%, antes de ingresar al club, y en el momento de realizar el estudio un 44.4%. Para las adicciones ningún usuario tuvo drogadicción ni al inicio ni en el momento del estudio, los usuarios que tenían el hábito de fumar, fué de un 19.44% y los que no lo hacían un 80.56%, para el mismo hábito estando en el club actualmente 13.89% y no lo hacen un 86.11%, disminuyendo de 19.44% a 13.89%. En cuanto a la calificación del examen obtenido el 55.6% para la calificación de 10. Conclusiones: Por los resultados obtenidos, en este club de autoayuda se lleva en forma adecuada y satisfactoria, alcanzando un buen impacto entre los usuarios de este club. Además reconocen su enfermedad, utilizando diversas acciones para concientizar y formar en los usuarios el sentido de responsabilidad de su enfermedad, para que todo esto repercuta de manera favorable en los factores de riesgo

Objetivo. Conocer el nivel de satisfacción en la atención odontológica de las clínicas Odontológicas Periféricas de la UJAT, según las dimensiones de calidad de Donabedian Avendis. Método. Estudio exploratorio, descriptivo, transversal. Mediante la aplicación de un instrumento de recolección de datos previamente validado y piloteado para recabar la información necesaria. Se consideró una muestra de 200 usuarios que acudieron en lapso de 3 meses a la Clínica Juchiman 1. Se concentró la información en una base de datos para su análisis estadístico con el apoyo del programa para análisis estadístico SPSS. Resultados. El rango de edad que más sobresale fue de 15 a 35 años con un 51.5 %. El 64 % de los usuarios son pacientes asiduos y el 36 % usuarios de primera vez. El tiempo de espera en recepción que más se presentó fue de 0 a 15 minutos con un promedio de 43 % de los encuestados; la espera para atención del Cirujano Dentista es de 0 a 15 minutos con un porcentaje del 61.5 % de los usuarios. La higiene de los servicios sanitarios arroja un 30.5 % de aceptación y el 25.5 % están en desacuerdo .Las condiciones mecánicas de las unidades dentales las perciben adecuadas el 33 % de los encuestados, en segundo lugar el 29 % de los usuarios se encuentran en desacuerdo. La confianza que le inspiró el dentista al usuario fue de 52.5 % de acuerdo y el 33.5 % totalmente de acuerdo. La amabilidad del cirujano dentista fue el 51.5 % de acuerdo y en segundo lugar totalmente de acuerdo con un 35.5 % de aceptación. Las sugerencias de procesos que percibe requiere cambio en la clínica odontológica dio como resultado e un 22 % de promedio, el de “Función y manejo de las unidades dentales”, seguido de la “Falta de material dental” un 15.5 %. En promedio el 61.5 % de los encuestados están satisfechos con el resultado de su tratamiento; las expectativas en el tratamiento dan un 67 % de aceptación. Conclusiones. Se puede concluir que los usuarios del servicio dental de esta clínica, muestran un grado aceptable de los servicios de la clínica, sin embargo, están lejos de ser un servicio que satisfaga las necesidades de todos ellos, se sugiere mantener al personal administrativo en sus puestos y solucionar los inconvenientes inmediatamente, mantener un mínimo de material disponible para evitar la interrupción del tratamiento dental del usuario, colocar un buzón de sugerencias.

In this paper, the integration of directional antennas in a room-level received signal strength (RSS) fingerprinting-based indoor localization system (ILS) is studied. The sensor reader (SR), which is in charge of capturing the RSS to infer the tag position, can be attached to an omnidirectional or directional antenna. Unlike commonly-employed omnidirectional antennas, directional antennas can receive a stronger signal from the direction in which they are pointed, resulting in a different RSS distributions in space and, hence, more distinguishable fingerprints. A simulation tool and a system management software have been also developed to control the system and assist the initial antenna deployment, reducing time-consuming costs. A prototype was mounted in a real scenario, with a number of SRs with omnidirectional and directional antennas properly positioned. Different antenna configurations have been studied, evidencing a promising capability of directional antennas to enhance the performance of RSS fingerprinting-based ILS, reducing the number of required SRs and also increasing the localization success.

Background: Peripheral artery disease (PAD) impacts more than 200 million people worldwide. The understanding of the genetics of the disease and its clinical implications continue to evolve. This systematic review provides a comprehensive summary of all DNA variants that have been studied in association with the diagnosis and progression of PAD, with a meta-analysis of the ones replicated in the literature. Methods: A systematic review of all studies examining DNA variants associated with the diagnosis and progression of PAD was performed. Candidate gene and genome-wide association studies (GWAS) were included. A meta-analysis of 13 variants derived from earlier smaller candidate gene studies of the diagnosis of PAD was performed. The literature on the progression of PAD was limited, and a meta-analysis was not feasible because of the heterogeneity in the criteria used to characterize it. Results: A total of 231 DNA variants in 112 papers were studied for the association with the diagnosis of PAD. There were significant variations in the definition of PAD and the selection of controls in the various studies. GWAS have established 19 variants associated with the diagnosis of PAD that were replicated in several large patient cohorts. Only variants in intercellular adhesion molecule-1 (rs5498), IL-6 (rs1800795), and hepatic lipase (rs2070895) showed significant association with the diagnosis of PAD. However, these variants were not noted in the published GWAS. Conclusions: Genetic research in the diagnosis of PAD has significant heterogeneity, but recent GWAS have demonstrated variants consistently associated with the disease. More research focusing on the progression of PAD is needed to identify patients at risk of adverse events and develop strategies that would improve their outcomes.

Balloon rupture during angioplasty can with calcified or recalcitrant lesions. A 61-year-old woman presented with worsening arm and facial swelling. She had a history of left upper extremity thrombolysis and stenting of the innominate vein 6 years prior. Venography showed severe in-stent stenosis. After crossing the lesion, a 12-mm balloon was inflated, which ruptured at nominal pressure. The balloon became stuck and could not be moved over the wire even after retraction of the sheath. A limited surgical cutdown was performed, and the balloon and the wire were removed together. The ruptured balloon part was found to be everted and circumferentially wrapped around the wire, preventing the wire exchange. After cutting the everted portion of the balloon, the catheter was removed without losing wire access. A high-pressure balloon was subsequently used to treat the lesion successfully. Her symptoms had resolved on follow-up, and the stent remained patent after 6 months.

Introduction Psychiatric co-morbidity is common in Crohn’s disease (CD) and ulcerative colitis (UC). IBD-related surgery or hospitalizations represent major events in the natural history of disease. Whether there is a difference in risk of psychiatric co-morbidity following surgery in CD and UC has not been examined previously. Methods We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic, disease, and treatment related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety. Results Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression prior to surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC respectively. We found no difference in the risk of depression following surgery in CD and UC patients (adjusted OR 1.11, 95%CI 0.84 – 1.47). Female gender, co-morbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD-surgery; only female gender and co-morbidity predicted depression in UC. Only 12% of the CD cohort had ≥ 4 risk factors for depression, but among them nearly 44% were subsequently received a diagnosis code for depression. Conclusion IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety with a similar magnitude of risk in both diseases.