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Introduction Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL. Patients and methods Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test. Results In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p = 0.005), mood disorder (p = 0.004), anxiety disorder (p = 0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p = 0.01). Major depressive disorder (p = 0.004), social phobia (p = 0.03), PTSD (p = 0.02), and Generalized Anxiety Disorder (p Conclusions IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.

Resumen: Introducción y objetivos: Durante el curso clínico de la enfermedad inflamatoria intestinal (EII) diversas causas pueden comprometer la función renal, hepática y medular e incrementar el riesgo de osteoporosis, infecciones y neoplasias. El objetivo de este estudio es describir el seguimiento que llevan los pacientes mexicanos con EII respecto a su esquema de vacunación, riesgos asociados a tratamiento y cáncer. Material y métodos: Estudio transversal, retrospectivo. Se encuestó a 100 pacientes con diagnóstico histopatológico de EII entre febrero y junio de 2017 acerca del seguimiento de esquema de vacunación, riesgos asociados al tratamiento y cáncer. Se realizó el análisis estadístico en SPSS v. 24. Resultados: Se estudiaron 100 pacientes con EII (el 90% con colitis ulcerosa crónica idiopática, y el 10% con enfermedad de Crohn; el 60% eran mujeres y el 40%, hombres): el 75% negaron poseer un carnet de vacunación; el 71.4% de las mujeres se habían realizado al menos una citometría cervical en su vida, el 28.6% no se la realizan de forma anual; el 24% utilizan protector solar diariamente; el 18.2% con más de 10 años de evolución de una colitis ulcerosa crónica idiopática tiene una colonoscopia anual; anualmente se registra función renal en el 57.1%, biometría hemática en el 92.9%, función hepática en el 78.6% y el 34.8% no tienen densitometría ósea en el expediente. Conclusiones: Estos resultados son un foco rojo que indica la necesidad de reforzar el papel del primer nivel de atención respecto al seguimiento vacunal y la necesidad de mejorar la educación al paciente con relación a la EII. Abstract: Introduction and aims: During the clinical course of inflammatory bowel disease, different causes can compromise kidney, liver, and bone marrow function and increase the risk for osteoporosis, infections, and neoplasias. The aim of the present study was to describe the follow-up of Mexican patients with inflammatory bowel disease in relation to their vaccination regimen, treatment-associated risks, and cancer screening. Materials and methods: A retrospective cross-sectional study was conducted within the time frame of February and June 2017. One hundred patients that had a histopathologic diagnosis of inflammatory bowel disease were surveyed about their follow-up vaccination regimen, treatment-associated risks, and cancer screening. SPSS v24 software was employed for the statistical analysis. Results: One hundred patients with inflammatory bowel disease were studied (90% with ulcerative colitis and 10% with Crohn's disease; 60% women, 40% men): 75% stated that they had no vaccination regimen. A total of 71.4% of the women had at least one Pap smear in their lives and 28.6% did not have them done annually. Twenty-four percent of the patients wore sun block daily. A total of 18.2% of the patients with more than a 10-year progression of ulcerative colitis had an annual colonoscopy. Yearly kidney function was registered in 57.1% of the patients, 92.9% had a yearly complete blood count, and 78.6% had yearly liver function tests. A total of 34.8% of patients had no bone densitometry in their case records. Conclusions: These results are a red flag suggesting the need to reinforce the role of the primary healthcare providers in relation to vaccination follow-up and the need to improve the education of the patient in relation to inflammatory bowel disease. Palabras clave: Enfermedad inflamatoria intestinal, Seguimiento integral, Colitis ulcerosa crónica idiopática (CUCI), Enfermedad de Crohn (EC), Cuidado integral, Keywords: Inflammatory bowel disease, Integrated follow-up, Ulcerative Colitis, Crohńs disease, Integrated care

Introduction and aims: During the clinical course of inflammatory bowel disease, different causes can compromise kidney, liver, and bone marrow function and increase the risk for osteoporosis, infections, and neoplasias. The aim of the present study was to describe the follow-up of Mexican patients with inflammatory bowel disease in relation to their vaccination regimen, treatment-associated risks, and cancer screening. Materials and methods: A retrospective cross-sectional study was conducted within the time frame of February and June 2017. One hundred patients that had a histopathologic diagnosis of inflammatory bowel disease were surveyed about their follow-up vaccination regimen, treatment-associated risks, and cancer screening. SPSS v24 software was employed for the statistical analysis. Results: One hundred patients with inflammatory bowel disease were studied (90% with ulcerative colitis and 10% with Crohn's disease; 60% women, 40% men): 75% stated that they had no vaccination regimen. A total of 71.4% of the women had at least one Pap smear in their lives and 28.6% did not have them done annually. Twenty-four percent of the patients wore sun block daily. A total of 18.2% of the patients with more than a 10-year progression of ulcerative colitis had an annual colonoscopy. Yearly kidney function was registered in 57.1% of the patients, 92.9% had a yearly complete blood count, and 78.6% had yearly liver function tests. A total of 34.8% of patients had no bone densitometry in their case records. Conclusions: These results are a red flag suggesting the need to reinforce the role of the primary healthcare providers in relation to vaccination follow-up and the need to improve the education of the patient in relation to inflammatory bowel disease. Resumen: Introducción y objetivos: Durante el curso clínico de la enfermedad inflamatoria intestinal (EII) diversas causas pueden comprometer la función renal, hepática y medular e incrementar el riesgo de osteoporosis, infecciones y neoplasias. El objetivo de este estudio es describir el seguimiento que llevan los pacientes mexicanos con EII respecto a su esquema de vacunación, riesgos asociados a tratamiento y cáncer. Material y métodos: Estudio transversal, retrospectivo. Se encuestó a 100 pacientes con diagnóstico histopatológico de EII entre febrero y junio de 2017 acerca del seguimiento de esquema de vacunación, riesgos asociados al tratamiento y cáncer. Se realizó el análisis estadístico en SPSS v. 24. Resultados: Se estudiaron 100 pacientes con EII (el 90% con colitis ulcerosa crónica idiopática, y el 10% con enfermedad de Crohn; el 60% eran mujeres y el 40%, hombres): el 75% negaron poseer un carnet de vacunación; el 71.4% de las mujeres se habían realizado al menos una citometría cervical en su vida, el 28.6% no se la realizan de forma anual; el 24% utilizan protector solar diariamente; el 18.2% con más de 10 años de evolución de una colitis ulcerosa crónica idiopática tiene una colonoscopia anual; anualmente se registra función renal en el 57.1%, biometría hemática en el 92.9%, función hepática en el 78.6% y el 34.8% no tienen densitometría ósea en el expediente. Conclusiones: Estos resultados son un foco rojo que indica la necesidad de reforzar el papel del primer nivel de atención respecto al seguimiento vacunal y la necesidad de mejorar la educación al paciente con relación a la EII. Keywords: Inflammatory bowel disease, Integrated follow-up, Ulcerative Colitis, Crohn's disease, Integral care, Palabras clave: Enfermedad inflamatoria intestinal, Seguimiento integral, Colitis ulcerosa crónica idiopática (CUCI), Enfermedad de Crohn (EC), Cuidado integral

INTRODUCCIÓN: El nacimiento de un recién nacido prematuro representa una emergencia nutricional, por lo que contar con nutrición parenteral (NP) de disponibilidad inmediata o estandarizada es una práctica fundamental para garantizar un aporte adecuado de macro y micronutrientes. El presente trabajo resume y compara los componentes de la NP personalizada y estandarizada, reportando un caso clínico donde esta última se utilizó con éxito.PRESENTACIÓN DE CASO: Recién nacida prematura de 30.5 semanas de gestación, quien inició con NP estandarizada a las 2 horas de vida a través de un catéter venoso umbilical. Tuvo una adecuada evolución nutricional hasta la semana 42 de vida corregida, en la cual presentó un peso localizado en el percentil 10 de acuerdo a Integrowth-21.CONCLUSIONES: Considerar a la prematurez como una emergencia nutricional que requiere inicio temprano de NP con aportes óptimos es una práctica que debe fomentarse en todas las unidades de cuidados intensivos neonatales. La NP estandarizada es hasta ahora la forma más asequible para lograr que, tras interrumpir el flujo placentario, el recién nacido prematuro reciba de forma oportuna el requerimiento nutricional requerido.

Objective. Anxiety and depression have a negative influence in the quality of life. The aim of the study was to determinate the levels of sensitivity and specificity of the Anxiety and Hospital Depression Scale (HADS) and compare the quality of life in patients with inflammatory bowel disease (IBD) and depression or anxiety. Methods. This study included 104 patients with diagnosis of IBD. Each patient received psychiatric intervention with SCID-I (Structured Clinical Interview for DSMIV Axis I Disorders) instrument as a gold standard to stablish the cut-off points of HADS. Quality of life was also evaluated with IBDQ-32. Demographic and clinical variables were collected. Results. Most of the patients reported a high quality of life (73.1%, n = 76 ), while 25.0% ( n = 26 ) express a moderate quality of life. The ROC curves for both psychiatric entities showed an adequate discriminative capacity of the HADS-anxiety dimension ( AUC = 0.84 , 95 % CI = 0.76 -0.92) with a limited discriminability of the HADS-depression dimension ( AUC = 0.58 , 95 % CI = 0.46 -0.70) using the proposed scoring of 8 as a cut-off point. Conclusions. Anxiety and depression impact negatively in the quality of life in Mexican patients with IBD. The Mexican version of HADS had acceptable internal consistency and external validity, with moderate sensitivity and specificity for clearly identifying clinical cases of anxiety and depression in patients with IBD.

Background. Incidence of inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is increasing worldwide; nevertheless, it is still unknown if this is the case in Mexico. Thus, the aim of this study was to analyze the distribution and trends of hospital discharges (HD) (for the period between 2004 and 2015) and deaths (for the period between 2004 and 2013) reported for UC and CD in Mexico. Methods. Quantitative cross-sectional study was performed. Secondary data sources analysis was performed through Dynamic Cubes of the General Direction of Health Information; variables were categorized by diagnosis, age, sex, and state. The Mann–Whitney U test was used to analyze the differences between the first and last years that were studied. Statistical analysis was performed in SPSS v.24. Results. The number of HD increased by 98.9% between 2004 and 2015 (IBD: p=0.033, CD: p=0.009, UC: p=0.051); it was more frequent, for both sexes and diagnoses, between 15 and 44 years, with a second peak for men with UC (between 45 and 64 years). Deaths increased by 96.2% from 2004 to 2011 (IBD: p=0.056, CD: p=0.064, UC: p=0.04). UC is three times more frequent than CD. Mexico City has the highest number of HD (4,179; 22.7%) while the state of Veracruz has the highest number of deaths (273; 38.2%). Conclusions. HD for IBD in Mexico is increasing significantly; the number of deaths increased until 2011, but from then on, they are apparently decreasing. IBD affects Mexican people without any gender predominance, often affecting patients between 15 and 44 years of age. UC is three times more frequent than CD.

Resumen Introduccion La Escala de Ansiedad y Depresion Hospitalaria (HADS) es un instrumento autoadministrable para pacientes ambulatorios cuyo comportamiento difiere segun la poblacion clinica a la que se aplica. En Mexico no esta validada en pacientes con enfermedad inflamatoria intestinal (EII). Objetivos Validar la HADS en la poblacion mexicana con EII. Metodos Se incluyeron 112 pacientes del Instituto Nacional de Ciencias Medicas y Nutricion «Salvador Zubiran» con EII a los cuales se les aplico la HADS y se valoraron algunas caracteristicas demograficas y clinicas del padecimiento. Se realizo un analisis factorial exploratorio y obtencion de la congruencia factorial para determinar la validez de constructo de la HADS y la confiabilidad se evaluo mediante el alfa de Cronbach. Resultados El resultado de la rotacion varimax de los 14 items de la HADS explico el 50,1% de la varianza, teniendo 2 factores principales. Diez items mostraron altas cargas factoriales para las dimensiones originalmente propuestas. La consistencia interna de la HADS fue alta (alfa = 0,88) con altos valores en los coeficientes de congruencia. Conclusiones La HADS es un instrumento valido para detectar posibles casos de ansiedad y depresion en pacientes mexicanos con EII. La validacion de este instrumento permite su utilizacion rutinaria para la evaluacion integral del paciente y su referencia oportuna a salud mental.

Introduction The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument for outpatients, but its behaviour differs according to the clinical population to which it is applied. In Mexico it is not validated in patients with inflammatory bowel disease (IBD). Objectives To validate the HADS scale in the Mexican population with IBD. Methods 112 patients with IBD from the “Salvador Zubiran” National Institute of Medical Sciences and Nutrition were included, to whom the HADS was applied and some demographic and clinical characteristics of the disease were evaluated. An exploratory factor analysis was performed and factorial congruence was calculated to determine the construct validity of the HADS, while reliability was evaluated using Cronbach's alpha. Results The result of the varimax rotation of the 14 items of the HADS explained 50.1% of the variance, having two main factors. Ten items showed high factor loading for the dimensions originally proposed. The internal consistency of the HADS was high (alpha = 0.88) with high values for the congruence coefficients. Conclusions The HADS scale is a valid instrument to detect possible cases of Anxiety and Depression in Mexican patients with IBD. The validation of this instrument allows its routine use for the integral evaluation of the patient and their timely referral to mental health.

The most frequent extra-intestinal manifestation in ulcerative colitis (UC) around the world is joint involvement. There are no previous data in Latin America that is about this aspect of disease; hence, the aim of this study was to determine the frequency and factors associated to joint involvement in Mexican patients with UC. A total of 295 patients with histological diagnosis of UC were studied, divided into two groups: (1) 154 cases with at least one joint affection (arthralgia, peripheral, or axial arthropathy (sacroilitis (SI) or ankylosing spondylitis (AS))) and (2) 141 controls that had never presented any joint involvement during the clinical course of UC. Demographic, clinical, and laboratory variables were collected from the clinical records, at the time of presentation of the joint involvement for the cases and with the last information available for controls. A total of 52.2% of the patients had joint involvement, which was also the most frequent extra-intestinal manifestation (EIM). The frequency of peripheral arthralgia was 46.8% and of axial arthropathy was 5.4% (2.7% AS, 2.4% SI, and 0.3% both). The female gender (P = 0.01, OR = 3.061 95% CI: 1.311-7.15), elevated erythrocyte sedimentation rate (ESR) (P = 0.07, OR = 8.04 95% CI: 1.759-36.764), and moderate disease activity by Truelove and Witts criteria (P = 0.024, OR = 4.37 95% CI: 1.211-15.78) were factors associated at the time of presentation of the joint affection. Joint involvement is the most frequent EIM in Mexican patients with UC. The female gender, elevated ESR, and disease activity are factors associated with its presentation.

We evaluated the influence of six human activities (related variables) on the richness and abundance of large and medium-sized mammals in the southern portion of the Lacandon Rainforest, including protected and non-protected areas. The human activities measured have different influences on mammal richness and abundance. Our results show that some human activities (human density and anthropogenic land cover, and agriculture/cattle ranching) had no effect on large and medium-sized mammal populations, but community-based protection, such as medium levels of tourism and hunting, had a negative influence on richness and abundance. Those variables negatively influencing the mammal community were reported in one of the study sites. Data indicate both an opportunity for applied integral conservation actions that involve people and their activities, as well as an opportunity to support biodiversity conservation in agricultural landscapes by integrating human activities with protected areas and conservation.

Supplemental Digital Content is available in the text, Despite the worldwide increasing incidence and prevalence of Inflammatory Bowel Disease (IBD), our knowledge about it in Mexico is still limited. The aim of this study is to describe the incidence and prevalence of IBD as well as its clinical and socio-demographical characteristics in Mexico from a nation-wide perspective. Multicenter nation-wide cohort study that included 42 IBD clinics from all over the country that participated with electronically register of the new cases over 17 years as well as all known existing cases together with their clinical and socio-demographical characteristics from patients with IBD (ulcerative colitis [UC], Crohn disease [CD], and inflammatory bowel disease unclassified [IBDU]). The data collection was conducted between January and October 2017. Incidence, prevalence, and mean incidence over 2 decades were then calculated. Data base was analyzed using SPSS v24 program SPSS (version 24, IBM Corp., Armonk, NY, USA). A total of 2645 patients with IBD were registered. The crude incidence rates of IBD, UC, and CD, respectively, were 0.21, 0.16, and 0.04 cases per 100,000-person year. The highest incidence was registered in the year 2015, compared with to the previous years. The mean incidence of IBD has increased steadily from 0.05 to 0.21 per 100,000 person-years over the past 15 years (P = .06). The incidence of IBD new cases have increased significantly throughout the last 16 years, 5.9-fold for IBD, 5.3-fold for UC, and 9.5-fold for CD. The prevalence rates of IBD, UC, and CD, respectively, were 1.83, 1.45, and 0.34 cases per 100,000-person-year. This is the first study from a nation-wide perspective that demonstrated a significant increase of prevalence and incidence of IBD in Mexico in the last 15 years.

During the clinical course of inflammatory bowel disease, different causes can compromise kidney, liver, and bone marrow function and increase the risk for osteoporosis, infections, and neoplasias. The aim of the present study was to describe the follow-up of Mexican patients with inflammatory bowel disease in relation to their vaccination regimen, treatment-associated risks, and cancer screening.A retrospective cross-sectional study was conducted within the time frame of February and June 2017. One hundred patients that had a histopathologic diagnosis of inflammatory bowel disease were surveyed about their follow-up vaccination regimen, treatment-associated risks, and cancer screening. SPSS v24 software was employed for the statistical analysis.One hundred patients with inflammatory bowel disease were studied (90% with ulcerative colitis and 10% with Crohn's disease; 60% women, 40% men): 75% stated that they had no vaccination regimen. A total of 71.4% of the women had at least one Pap smear in their lives and 28.6% did not have them done annually. Twenty-four percent of the patients wore sun block daily. A total of 18.2% of the patients with more than a 10-year progression of ulcerative colitis had an annual colonoscopy. Yearly kidney function was registered in 57.1% of the patients, 92.9% had a yearly complete blood count, and 78.6% had yearly liver function tests. A total of 34.8% of patients had no bone densitometry in their case records.These results are a red flag suggesting the need to reinforce the role of the primary healthcare providers in relation to vaccination follow-up and the need to improve the education of the patient in relation to inflammatory bowel disease.

Background: Pouchitis is the most common complication of proctocolectomy with ileo-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). No previous study in Mexico has evaluated this issue; our aim was to evaluate its frequency, clinical characteristics and factors associated with its presence in Mexican patients with UC and IPAA. Methods: Retrospective-cohort study including 70 patients with histopathological diagnosis of UC and IPAA between 1983 and 2014 from inflammatory bowel disease clinic of a tertiary care center. The statistical analysis used descriptive statistics, chi-square and Fisher's exact test for categorical variables and Student's t test for numeric variables. Univariate analysis was performed to identify the factors associated. Results: Patients presenting with pouchitis accounted for 48.6%. From the 34 cases, 12 (35.3%) had inactive pouchitis; 7 (20.6%) active acute pouchitis; 15 (44.1%) chronic active pouchitis. On average, pouchitis occurred 5.37 years after IPPA. Factors probably associated with its occurrence were the presence of autoimmune concomitant diseases (ACDs; p = 0.06, OR 4.40, 95% CI 0.84-22.9) and extra-intestinal manifestations (EIMs; p = 0.05, OR 2.53, 95% CI 0.96-6.64), which was also probably associated with chronic active pouchitis (p = 0.06, OR 0.31, 95% CI 0.07-1.31). Conclusions: The frequency of pouchitis is high in Mexican UC patients after IPAA. ACDs and EIMs were probably associated with its development.

Hoy por hoy en la actualidad, hemos analizado que todo negocio sea grande o pequeño necesita de alguien que informe como se está llevando a cabo su negocio, es decir, dando a conocer reportes acerca de que si existe rentabilidad o perdida, para ello en el caso de La Hacienda "El Pedregal", hemos implementado una contabilidad agropecuaria ya que es tan importante como cualquier otra contabilidad. Al desarrollar esta contabilidad necesitábamos información acerca de la reseña histórica de la hacienda, es por eso que realizamos investigaciones de la ubicación del terreno, dentro de esto podemos mencionar cuantas hectáreas tiene el mismo, el tratamiento que se ha dado al terreno, los sembríos, la cantidad de animales que poseía la hacienda. Para continuar, nos enfocamos en los conceptos básicos de la contabilidad agrícola y los costos incurridos para la producción agrícola, para tener un conocimiento más profundo al momento de desarrollar la contabilidad, y sobre todo mencionamos las normas internacionales de contabilidad que es de suma importancia para respetar las leyes que tiene este país,… Luego, valoramos todos aquellos inventarios que encontramos en la hacienda el "Pedregal", y finalmente, desarrollamos la contabilidad con los datos obtenidos, la contabilidad que se está llevando a cabo es la del mes de marzo.