Carlos Enrique Cabrera-Pivaral

L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis

BACKGROUND & AIMS A growing number of randomized clinical trials suggest that glutamine (Gln) supplementation may be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the aim of this study was to investigate whether the provision of Gln-enriched TPN after surgical and medical treatment of secondary peritonitis improves infectious morbidity. METHODS Thirty-three patients with secondary peritonitis were randomly assigned to receive either standard (n=16) TPN or L-alanyl-L-glutamine-supplemented (n=17) TPN, after medical and surgical treatment of the infectious focus. The two TPN formulae were isonitrogenous and isocaloric, which commenced the morning after surgery and ran continuously for 10 consecutive days. The control group received standard TPN, while the treatment group was given L-alanyl-L-glutamine, 0.40 g/kg/d (Dipeptiven, Fresenius Kabi, Bad Homburg, Germany). Infectious morbidity, nitrogen balance, leukocytes, lymphocytes, subpopulations CD(4) and CD(8), Immunoglobulin A (IgA), total proteins, albumin, hospital and intensive care unit (ICU) stays, and mortality were evaluated. Statistical analysis included one-way ANOVA, the unpaired Students t-test, the Mann-Whitney U-test, chi(2) test, or Fishers exact test. RESULTS Patients in both groups were comparable prior to the operation. Nitrogen balance and the levels of albumin and IgA were significantly better than those in the control group. Also, a significant reduction in the infectious morbidity was found in the Gln-treated group. Lymphocyte counts as well as subpopulations CD(4) and CD(8), and proteins showed a propensity to improvement and a tendency to reduced rates of mortality were observed when comparing the groups. Hospital and ICU stays were similar. CONCLUSION L-alanyl-L-glutamine-supplemented TPN improved the infectious morbidity of patients with secondary peritonitis. Gln supplementation to parenteral nutrition may be an alternative for enhancing host defenses and improving infectious morbidity.

Efectos de una intervención educativa sobre los niveles plasmáticos de LDL-colesterol en diabéticos tipo 2

Objective. To prove the benefit of an educational intervention for controlling LDL cholesterol levels in LDL cholesterol. Material and Methods. A quasi-experimental study was conducted; diabetic patients were randomly allocated to an experimental and a control group. The experimental group consisted of 25 patients and the control group of 24 patients. The educational intervention was organized through a reflection-action process. LDL cholesterol levels were measured at baseline and monthly during the nine months of the study. The groups were controlled for age and sex. Statistical analysis included Wilcoxon’s test for ordinal variables. Results. The intervention group had a mean value of LDL cholesterol of 148.4 +/-21.3, compared to 185 +/-24.1 in the control group (p≤0.05). Conclusions. The participative educational intervention contributed to improving the levels of LDL cholesterol, by promoting a lifestyle change in type-2 diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Impact of participatory education on body mass index and blood glucose in obese type-2 diabetics

Exogenous obesity increases morbidity and mortality risk and has been associated with nutritional habits, which in turn can be affected by health education. Health education aims to promote patient participation in achieving behavior change and healthy lifestyles. The objective of this study is to show the advantages of participatory education in the modification of body mass index (BMI) in obese type-2 diabetics. A quasi-experimental study was performed with random allocation of two patient groups. The educational intervention was organized through a reflection-action process. BMI was measured at baseline and then monthly for 9 months during the intervention. The groups were analyzed by age and sex. Statistical analysis used the Student t test, with the mean difference for related groups. The control group showed a mean BMI of 33.89 + 1.96 and a final BMI of 33.2 +/- 2.15 (t:22.4; p:0.16). The experimental group had an initial value of 33.63 +/- 2.12 and a final BMI of 31.54 +/- 1.71; statistical difference: (t:11.55; p:0.003). The participatory educational intervention thus helped improve the BMI in obese type-2 diabetics.

Effects of behavior-modifying education in the metabolic profile of the Type 2 diabetes mellitus patient

To demonstrate the advantages of behavior-modifying education in the metabolic profile of the type-2 diabetes mellitus patient. A quasi-experimental study was performed with a control group. The experimental group was made up of 25 type-2 diabetic patients and the control group consisted of 24. The type of education carried out was a behavior modification. Baseline measurements and subsequent monthly measurements of serum glucose, total cholesterol and triglycerides were carried out during 9 months after the intervention. The groups were controlled according to age and sex. The statistical analysis was performed using the Students and Wilcoxons test to determine the difference. The experimental group in comparison with the control group in the measurement after the intervention achieved a mean difference in serum glucose of 64.2 mg/dl (p=0.001), in the cholesterol of 31.6 (p=0.008), and in the triglycerides of 50.8 (p=0.006). The behavior-modifying education is a better option than traditional intervention for metabolic control in type-2 diabetes mellitus patients.

Mortalidad por homicidios en México: tendencias, variaciones socio-geográficas y factores asociados

This study seeks to analyze the trend of homicide rates (total and by firearm) in Mexico between 1990 and 2009 and identify the variables that best explain the geographical variations of these rates in the 2008-2009 two-year period. Homicide rates, adjusted for age, were calculated for both sexes between 1990 and 2009 and for each state in 2008-2009. Factors associated with the interstate variations in the homicide rates were identified using multiple linear regression analysis. Results show that the homicide rate in Mexico decreased between 1990 and 2007, but doubled over the last two years (from 7.6 to 16.6 per 100,000). In 2009, the male homicide rate was almost 9 times higher than the female rate and about two-thirds of homicides involved firearms. Multivariate analysis reveals that impunity, drug trafficking, alcohol and drug consumption and school dropout in basic education - in that order - are key factors for understanding the geographical variations in homicide rates in Mexico in 2008-2009. Findings suggest that to reduce the number of homicide victims and spatial variations in the rate, it is necessary not only to fight the drug cartels, but above all to implement structural reforms in the criminal justice system and reduce the socioeconomic disparities among states.

Impacto de la violencia homicida en la esperanza de vida masculina de México

OBJECTIVE To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998-2000 and 2008-2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. METHODS Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. RESULTS In the years between the 1998-2000 and 2008-2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008-2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20-44. YLEL due to homicide among those aged 15-44 increased between the two three-year periods. CONCLUSIONS The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75.

Exclusión Social e Inequidad en Salud en México: Un Análisis Socio-espacial

Objetivo Determinar la relacion existente entre exclusion social e inequidad en salud a nivel estatal y municipal en Mexico en anos recientes. Metodos Se calcularon tasas estandarizadas de mortalidad relacionadas con enfermedades trasmisibles en la infancia, el embarazo y el parto asi como producto de causas que podrian considerarse potencialmente evitables; estas tasas se calcularon por estados, por estados agrupados en cuartiles segun nivel de marginacion y por municipios agrupados segun grado de marginacion. Para medir la inequidad, se utilizaron indicadores como la razon de tasa, el coeficiente de Gini y el indice de inequidades en salud (INIQUIS) Resultados Se observa un claro exceso de mortalidad en los Estados agrupados en el Cuartil IV (mayor marginacion) en relacion con el Cuartil I (menor marginacion) y a la inversa, los recursos y servicios disponibles en el Cuartil I son mayores que los existentes en el Cuartil IV. El Coeficiente de Gini alcanza su valor mas alto en la tasa de mortalidad por anemias nutricionales (0,44). El exceso de mortalidad es evidente en los municipios considerados como de muy alta marginacion; el INIQUIS mas elevado se observa en los Estados ubicados en el Cuartil IV, sobre todo Chiapas, Oaxaca y Guerrero. Conclusiones Existe en Mexico una notoria inequidad en salud, asociada a los altos niveles de exclusion social; para modificar esta situacion se necesitan profundos cambios estructurales que impulsen el desarrollo social, y permitan reducir las desventajas injustas a las que estan expuestos importantes nucleos poblacionales del pais.

Evaluación de dos estrategias de educación nutricional vía radio en Guadalajara, México

Modifying knowledge and attitudes through persuasive communication in health via radio has produced encouraging results for public health planners. This studys objective was to measure the effect of an educational strategy on knowledge and attitudes towards nutrition in two marginalized communities in Guadalajara, Mexico. Two communities were randomly selected. In each community a group of individuals was invited to be exposed to radio broadcasts. Using a coded and structured instrument, knowledge and attitudes towards the contents of nutritional education for health were measured before and after the intervention in both groups. Group A (n = 37) was organized and exposed to the dynamics of the radio forum throughout the 4 months during which the project lasted. Group B (n = 33) was not organized, and listened to the radio program according to its own cultural dynamics. Median knowledge and attitudes (KA) for group A was 56.8 in the pre-test and 74.1 in the post-test (W: p = -0.05). In group B the KA results were 53.0 and 59.2, respectively (W: p = -0.05). The results emphasize the advantages of the radio forum as a health communications strategy for human nutrition.

Contexto demográfico, desigualdad social e inequidad en salud de la niñez en México

Objetivos Caracterizar demograficamente el presente y futuro de la poblacion infantil en Mexico; relacionar condiciones demograficas y equidad social en la ninez y delinear los desafios que estas representan para la poblacion infantil mexicana en los proximos anos. Metodos A partir de las proyecciones de poblacion existentes se analizo el escenario presente y futuro de la poblacion infantil en Mexico. Se calcularon tasas de mortalidad por causas evitables en la infancia, por estados, por estados agrupados en cuartiles segun nivel de marginacion y por municipios agrupados segun grado de marginacion. Para medir la inequidad, se utilizo el coeficiente de Gini Resultados Aunque disminuira a futuro, el numero absoluto de ninos en Mexico seguira siendo elevado hacia 2025; el mayor numero de ninos reside en los estados con mayor marginacion social. Existe un claro exceso de mortalidad evitable en dichos estados en relacion con los de menor marginacion. El Coeficiente de Gini alcanza su valor mas alto en la tasa de mortalidad por infecciones respiratorias agudas (0,34). El exceso de mortalidad evitable es evidente en los municipios de alta y muy alta marginacion. Conclusiones Coexisten en Mexico demandas relacionadas con el envejecimiento demografico, pero tambien con el notable peso que mantendra en los proximos anos la poblacion infantil; es notoria la inequidad en salud en la ninez, asociada a los altos niveles de marginacion social; para modificar esta situacion se necesitan profundos cambios estructurales que permitan reducir las desventajas injustas a las que estan expuestos importantes nucleos poblacionales del pais.

Valoracion de la aptitud clinica en medicos de familia para la atencion integral de la hepatitis viral

Hemos realizado un estudio descriptivo transversal del consumo de cinco antibióticos de uso sistémico en atención primaria y su tendencia durante el periodo 2003–2006 en la provincia de Segovia. La población asignada osciló entre 135.435 habitantes en 2003 y 141.589 en 2006. Los datos fueron obtenidos del Sistema de Análisis y Evaluación de la Prescripción Farmacéutica de la Junta de Castilla y León. La medida del consumo fue la Dosis Habitante Dı́a (DHD), de acuerdo con la WHO anatomic therapeutic chemical classification. Los 57 principios activos se clasificaron en seis grupos (penicilinas de amplio espectro, penicilinas con inhibidores de betalactamasa, cefalosporinas, macrólidos, quinolonas y otros antibióticos); se eligió como marcadores de los cinco primeros amoxicilina, amoxicilina-ácido clavulánico, cefuroxima, claritromicina y ciprofloxacino. El consumo total presenta una tendencia al alza, con un total de 73,37 DHD y una variación interanual del 7,05%. Por grupos terapéuticos, el mayor consumo correspondió a las penicilinas con inhibidores de betalactamasa, con 23,49 DHD (el 32% del total), seguido de penicilinas de amplio espectro con 22,18 DHD (30,2%), otros antibióticos con 7,73 DHD (10,5%), macrólidos con 7,2 DHD (9,8%), quinolonas con 6,74 DHD (9,18%) y cefalosporinas con 5,76 DHD (7,85%). Amoxicilina-clavulánico fue el antibiótico más consumido (23,49 DHD, el 100% de su grupo), seguido por amoxicilina (22,14 DHD, 99,8%). Ambos antibióticos y el ciprofloxacino presentan tendencia al alza (figura 1). El promedio de consumo total fue de 18,28 DHD, similar al observado en el estudio ESAC para España, pero inferior al de otra provincia colindante y de similares caracterı́sticas. En conclusión, las penicilinas (con inhibidores de betalactamasa y de amplio espectro) son los antibióticos más consumidos en la provincia de Segovia, con una tendencia al alza. Sin embargo, se considera que el consumo total es moderado, y se aconseja mantener una estrecha vigilancia de la tendencia interanual.