L Balderas-Peña

Calidad de Vida en Mujeres Mexicanas con Cáncer de Mama en Diferentes Etapas Clínicas y su Asociación con Características Socio-Demográficas, Estados Co-Mórbidos y Características del Proceso de Atención en el Instituto Mexicano del Seguro Social

INTRODUCTION Quality of life is the most studied PRO (patient reported outcome) in cancer patients. With early diagnosis and better treatments in breast cancer, this entity has been transformed in a chronic disease with longer survival. The joint effects of diseases and treatment on quality of life are each day more important to consider in survival patients. OBJECTIVE To evaluate quality of life, socioeconomic factors, co-morbidities, and the attendance process impact on quality of life in breast cancer women with different clinical stages attending at the Instituto Mexicano del Seguro Social using the EORCT QLQ-C30 RESULTS The scores of EORTC QLQ-C30 (v3) were: Global health status / QoL: 73.47 (± 20.81), physical functioning 76.98 (± 20.85), role functioning 76.60 (± 27.57), emotional functioning 64.53 (± 26.81), cognitive functioning 74.47 (± 26.02), social functioning 84.96 (± 23.20), fatigue 31.94 (± 25.45), nausea and vomiting 19.49 (± 26.93), pain 28.95 (± 27.27), dyspnea 15.29 (± 24.62), insomnia 35.13 (± 32.10), appetite lost 18.04 (± 28.75), 18.04 (± 28.75), constipation 19.20 (± 32.11), diarrhea 12.9 (± 24.25), financial difficulties 40.57 (± 37.26). The scores with EORTC QLQ-BR23 were: body image 74.84 (± 31.69), sexual functioning 13.73 (± 22.55), sexual enjoyment 32.86 (± 36.17), future perspectives 51.69 (± 38.00), systemic therapy side effects 30.82 (± 20.71), breast symptoms 22.85 (± 23.49), arm symptoms 27.53 (± 24.75), upset by hair loss 43.80 (± 44.01). CONCLUSIONS Clinical stage in breast cancer is associated with differences in the scores from fatigue, nausea and vomiting and financial difficulties according to the evolution of the disease and the physical detriment associated. Socio-demographic features were related role functioning, fatigue and pain in single women with higher scores.

Enfermedades metabólicas maternas asociadas a sobrepeso y obesidad pregestacional en mujeres mexicanas que cursan con embarazo de alto riesgo

INTRODUCTION Pre-pregnancy obesity has been proposed as a risk factor related to gestational diabetes and hypertensive disorders during pregnancy. OBJECTIVES Identify pregnancy related diseases associated with pre-pregnancy obesity as a risk factor ina high risk preganancy patient population. METHODS 600 patients whose pre-pregnancy obesity had been assessed as a high risk factor were included in the study. The means, standard deviation, median, interquartile intervals, Pearson and Spearman correlation and logistic regression to estimate risk with the odds ratio and 95% confidence intervals were calculated. RESULTS The mean pre-pregnancy body mass index was 29.59 ± 6.42 kg/m2. The mean for recommended pregnancy weight gain was 2.31 ± 1.03 kg, but the mean of real weight gain was 8.91 ± 6.84 kg. A significant correlation between pre-pregnancy obesity and family history of diabetes mellitus (p=0.000), systemic hypertension (p=0.003), cardiac diseases (p=0.000), dyslipidemia (p=0.000) and obesity (p=0.000) was identified. Pre-pregnancy obesity was identified as a risk factor for the development of gestational diabetes (OR: 1.95; IC95%: 1.39 to 2.76; p=0.000) in this kind of patient. DISCUSSION AND CONCLUSION 75% of high risk pregnancy women in a high specialty hospital in West Mexico are overweight or obese when they become pregnant. These are risk factors in the development of gestational diabetes.

Evaluación de la Calidad de Vida en Pacientes con Linfoma no Hodgkin y Cáncer Colo-Rectal en Diferentes Etapas Clínicas Atendidos en el Instituto Mexicano del Seguro Social

INTRODUCTION In Mexico during 2008, were reported 127,604 new cancer cases, 6,347 of them were colorectal cancer cases and 4,276 non-Hodgkin lymphoma (NHL) cases. OBJECTIVE To evaluate health related quality of life in non-Hodgkin lymphoma and colorectal cancer cases in different clinical stages, attended in a High Specialty Medical facility at the Instituto Mexicano del Seguro Social, during a 13 month period. RESULTS 162 patients were included, 56.8% (n=92) with NHL and 43.2% (n=70) with colorectal cancer. The scores obtained in the NHL group were: Global health status/QoL: 67.75 (± 27.55), physical functioning 69.64 (± 29.98), role functioning 71.38 (± 33.73), emotional functioning 69.7 (± 26.57), cognitive functioning 75.36 (± 28.01), social functioning 79.35 (± 29.38), fatigue 35.27 (± 28.27), nausea and vomiting 13.41 (± 21.85), pain 28.08 (± 30.25), dyspnea 19.20 (± 32.11), insomnia 30.80 (± 38.03), appetite lost 26.45 (± 36.16), constipation 19.20 (± 32.11), diarrhea 12.32 (± 26.48), financial difficulties 26.09 (± 35.57). In colorectal cancer patients the scores were: Global health status/QoL: 68.21 (± 24.46), physical functioning 67.38 (± 30.45), role functioning 65.48 (± 35.70), emotional functioning 66.43 (± 26.84), cognitive functioning 78.57 (± 26.49), social functioning 75.24 (± 31.05), fatigue 37.78 (± 31.62), nausea and vomiting 20.00 (± 28.32), pain 37.38 (± 34.45), dyspnea 11.90 (± 26.64), insomnia 28.09 (± 35.73), appetite lost 23.81 (± 36.40), constipation 19.05 (± 32.88), diarrhea 20.95 (± 31.17), financial difficulties 34.76 (± 38.67). CONCLUSIONS With these basal results is important a follow-up with special attention to the treatment and attendance processes, in patients with this neoplasms and their impact on the quality of life.

Obesity, Thrombotic Risk, and Inflammation in Cancer

Neoplasms exhibits a high incidence and mortality rates due to their complex and commonly overlapping clinical, biochemical, and morphologic profiles influenced by acquired or inherited molecular abnormalities, cell of origin, and level of differentiation. Obesity appears related to ~20% of cancers including endometrial, esophageal, colorectal, postmenopausal breast, prostate, and renal. Several factors other than obesity, i.e., insulin, insulin-like growth factor, sexual hormones, and adipokines may play a potential role in neoplasia. Cancer-associated hypercoagulable and thrombotic states are influenced by abnormalities in the vascular wall and susceptibility to invasion, interference in blood flow and increase in circulating tissue factor and thrombin, activation of cell growth factors, the presence of a central catheter, chemotherapies, neoplasm type, and surgery. In cancer, thromboembolic complications are the second most frequent cause of death with pulmonary thromboembolism in ~50% of cases postmortem. Thrombosis worsens prognosis as demonstrated with a survival rate as low as 12% per year vs 36% in nonthrombic patients. Deep vein thrombosis is the most frequent thromboembolic complication in cancer. It is usually detected at diagnosis and within the first 3 months of chemotherapy. The underlining mechanisms of this association should be further studied to identify patients at higher risk and develop adequate prevention, diagnostic, and treatment measures. The D-dimer test can be successfully used to assess the fibrinolytic phase of coagulation and as such is routinely used in suspected cases of deep vein thrombosis and pulmonary thromboembolism. In addition, significant advances have been made in understanding the composition and functional capabilities of the gut microbiota in the inflammatory process, obesity, and its roles in cancer; however, the intricate balance that exists within the microbiota may not only affect the host directly, it can also disrupt the entire microbial community. CONCLUSIONS Cancer is a prothrombotic and inflammatory state in which the activation of coagulation is related to tumor growth, angiogenesis, and metastasis. It is important to identify the relationship between body mass index with these processes and clarify their importance in cancer prognosis. Future research should answer the question if manipulation of resident microbial communities could potentially improve prognosis and treatment outcome.

Impact of Early Microbiologic Culture in the Economic Burden of Care for Patients With Infected Diabetic Foot Ulcers At A Model Of Secondary Level Imss' Hospitals in Mexico

1 Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social; 2 Unidad Médica de Alta Especialidad Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social; 3 Departamento de Morfología, División de Disciplinas Básicas para la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; 4 Programa de Posgrado de la Maestría en Administración de Negocios, Centro Universitario de Ciencias Económico Administrativas, Universidad de Guadalajara; 5 Unidad de Investigación Social Epidemiológica y en Servicios de Salud, Delegación Estatal Jalisco, Instituto Mexicano del Seguro Social; 6 Admisión Médica Continua, Hospital General de Zona No. 42, Delegación Estatal Jalisco, Instituto Mexicano del Seguro Social; 7 Laboratorio de Biología Molecular, Departamento de Farmacobiología, División de Ciencias Básicas, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara; 8 División de Educación e Investigación en Salud, Hospital General Regional No. 46, Delegación Estatal Jalisco, Instituto Mexicano del Seguro Social.

Health Related Quality of Life and Patient Satisfaction in Colorectal Cancer Patients Treated Through Radical Surgery in Curative Intent in a Colo-Proctology Clinical Department

1 UMAE Hospital de Especialidades Centro Medico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 2 UMAE Hospital de Gineco-Obstetricia Centro Medico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 3 UMAE HE Centro Medico Nacional de Occidente Instituto Mexicano del Seguro Social, Guadalajara, Mexico, 4 Universidad de Guadalajara, Guadalajara, Jalisco, Mexico, 5 Delegacion Jalisco IMSS, Guadalajara, Jalisco, Mexico