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Biomedical subjects

J Garduño-Espinosa

Publications and source records attributed to J Garduño-Espinosa.

At least 19 recordsLinked to original sources
PubMed2004

Local research ethics committees of the Mexican Institute of Social Security: results of a national survey.

OBJECTIVE: To identify the structure, composition and work of the local research ethics committees (LRECs) of the Mexican Institute of Social Security (IMSS) in Mexico. DESIGN: A descriptive cross-sectional study was performed that included all LRECs of the IMSS. METHODS: A total of 335 questionnaires coded in advance were posted to each LREC secretary. The requested information was from January to December 2001. RESULTS: The response rate was 100%. Two hundred and thirty-eight (71%) LRECs were reported as 'active' during the evaluation period. Although almost all LRECs were composed of diverse professionals, physicians dominated the LRECs' membership. The rejection rate for research projects was lower than 1 per 1000, and less than half of the LRECs held meetings to issue a report of projects' evaluation. CONCLUSIONS: LRECs need to foster good ethical research; implementation of an audit system to examine their work might help improve LRECs' performance and accountability.

Committee Membership↗
PubMed2002

Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey.

BACKGROUND: Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice. MATERIAL AND METHODS: The cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned. RESULTS: Most anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T25 was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use. CONCLUSION: Vecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice.

Journal Article↗
PubMed1999

[Descriptive epidemiology of malignant tumors in children].

The object of this study is to present the descriptive epidemiology of cancer in children at the world and national levels. The international and national literature published on cancer in children was comprehensively reviewed, with emphasis on reports treating epidemiological aspects of time, place and person. For practical reasons and with the aim of integrating the information, only the more relevant publications were included. Incidence and child mortality were analyzed. Overall incidence is between 100 and 150 (annual rates = cases x 10(6) children). Specific incidence varies according to the type of cancer, the region and the country. The Latin American pattern of neoplasms is constituted by leukemias, lymphomas, and central nervous system tumors (CNST); in the Northamerican/European pattern the CNST appear in second place and in the African pattern, lymphomas show predominance. Incidence is higher among the younger than 5 year olds, from urban environments, and there is a 1% annual increase of cancer in Northamerican children. Child mortality has diminished remarkably, mainly in developed countries, whereas in developing or underdeveloped countries, incidence remains stable or shows a slight fall. The incidence of cancer in children is greater in developed countries, but in underdeveloped countries it may be underestimated. These countries have not managed to reduce the incidence of child mortality caused by cancer, as have the United States or Great Britain. Further studies on the epidemiology of cancer in children are necessary, since many data remain unknown.

Adolescent↗
PubMed1997

[Diagnostic tests for amniotic infection: review of the literature].

The diagnosis of intraamniotic infection (IAI) is not difficult when clinical manifestations are present, but there are patients with subclinical infections, in these cases the examination of the amniotic fluid is the most important diagnostic procedure. We made a critical review of the medical literature of diagnostic tests of IAI, according to the analysis criterion of the medical articles of the Department of Clinical Epidemiology of the McMaster University. The articles were identified looking for in the MEDLINE-CD ROOM and INDEX MEDICUS from 1991 to 1995. We identified 19 articles, none of them complied with all of the analysis criterion, none of the studies were blinded nor independently compared with a gold standard test and only five articles studied a full spectrum of patients. The articles with better methodologic design were those that studied the interleukin-6 role as diagnostic test for IAI; they showed a sensibility between 75 to 89% and a specificity of 97 to 100%; nevertheless it is still necessary to standardize the cut-off point of the interleukin-6 levels.

Amniotic Fluid↗
PubMed1997

Infection of pregnant women with hepatitis B and C viruses and risks for vertical transmission.

Pregnant women infected with hepatitis B and C viruses pose a risk for infecting their newborn infants by vertical transmission. We studied 6,253 pregnant women aged 12-49 years for infection with hepatitis B (HBV) and C (HCV) viruses. Infection was diagnosed by measuring IgG antibodies against HBc, HBs, HBe, as well as IgM-HBc and HCV viral antigens with commercially available immunoassay kits. HBV infection was detected in 113 cases (1.8%), and prevalence was significantly higher (2.4%) in a group of women with a high-risk pregnancy who were attending a perinatology hospital than in healthy pregnant women (1.67%, p < 0.05). Infection with HBV was significantly higher in women older than 30 years old (p < 0.05). HBsAg was found in blood, colostrum and vaginal exudate of two pregnant women; HBsAg was detected in the gastric aspirate but not in the blood of the two newborn infants. HBeAg and IgM-HBc were not detected in any of the samples. DNA-HBV was detected in serum of seven women, and DNA-HBV was detected in the gastric aspirate of only one of the newborns. HCV infection was diagnosed in three out of 111 women with markers for HBV infection (2.7%), and in 6 out of 1,000 women without these markers (0.6%). Anti-HCV antibodies were found in the serum of six of their infants during up to six months of age. Infants were monitored for one year and none of them developed any sign of hepatic disease. These results suggest that special attention should be paid to women older than 30 years and with a high-risk pregnancy, as they are at a higher risk of HBV and HCV infections.

Adult↗
PubMed1997

Validation of a Spanish version of the Childhood Health Assessment Questionnaire.

OBJECTIVE: To determine the reliability and validity of a Spanish version of the Childhood Health Assessment Questionnaire (CHAQ). METHODS: Fifty-five patients with juvenile rheumatoid arthritis (JRA) [35 girls, 20 boys; mean age at onset (+/- SD) 11 +/- 3.3 yrs, mean disease duration 3.3 +/- 2.2 yrs] were included in an observational and cross sectional study that evaluated translation validity, cross sectional construct validity, and test-retest reliability of the Spanish version of the CHAQ. The questionnaire was administered to either patients or one of their parents, and results were correlated with the Steinbrocker functional class, the Juvenile Arthritis Functional Assessment Scale (JAFAS), and disease activity. RESULTS: The mean CHAQ score (mean 0.77, range 0.01-2.25) was found to correlate at different levels with Steinbrocker functional class (r = 0.62, p < 0.0001), JAFAS (r = 0.65, p < 0.0001), and disease activity score (r = 0.40, p < 0.0001). Test-retest and interobserver agreement had good correlations. CONCLUSION: The Spanish version of the CHAQ we studied is a reliable and valid tool for assessment of health status in Spanish speaking children with JRA.

Adolescent↗
PubMed1993

Chest expansion in healthy adolescents and patients with the seronegative enthesopathy and arthropathy syndrome or juvenile ankylosing spondylitis.

OBJECTIVE: To determine chest expansion measurements in healthy children and those with juvenile spondyloarthropathies. METHODS: Chest expansion, as defined by the difference between maximal inspiration and maximal expiration was measured in 157 healthy adolescents (112 boys and 45 girls) aged 11 to 15 years, 20 patients with the seronegative enthesopathy and arthropathy (SEA) syndrome and 15 with juvenile ankylosing spondylitis (AS). RESULTS: The median and mean chest expansion (+/- 2 SD) were 5.0 cm and 5.6 cm (+/- 3.52) for the whole group of healthy adolescents, 6.0 cm and 5.9 cm (+/- 3.64) for boys and 5.0 cm and 4.8 cm (+/- 2.69) for girls. The frequency distribution of the values was leptokurtic and skewed to the right and did not follow the normal pattern; nearly 90% of the measurements fell within the interval from 3 to 9 cm. Of all variables analyzed (age, height, weight, sex and health/disease status), only height correlated with chest expansion (r = 0.20, p = 0.01). Even so, the effect of all these variables explained only 13% of the total variance of the measurements. Interobserver and intraobserver intraclass correlation coefficients were moderate (0.58 and 0.67, respectively). Mean values and cumulative frequency distribution in asymptomatic and symptomatic SEA syndrome and patients with juvenile AS were similar to those from healthy adolescents. CONCLUSION: Measuring chest expansion does not seem to be a useful method for the rare cases of early involvement of the chest joints in SEA syndrome and juvenile AS.

Adolescent↗
PubMed1993

[Residence close to high-tension electric power lines and its association with leukemia in children].

INTRODUCTION: There are different risk factors which have been related to the presence of leukemia in children. In the past years one of these factors has become relevant, the risk of living in an area near to high electric voltage lines, generators of electromagnetic fields of low frequency (EMF), which can cause development of leukemia in children. OBJECTIVE: To learn whether living in an area close to EMF generator sources, electric transformers, high electric voltage distribution or transmission lines and electric substations, is a risk factor in the development of leukemia in children living in Mexico City. MATERIAL AND METHODS: A projective study of case-control was accomplished. The cases were obtained from hospitals of the third level. The diagnosis of leukemia in its different varieties was confirmed through biopsy of bone marrow. The controls were selected in the same hospital from inpatients and outpatients with different problems, except neoplasia. A total sample of 81 cases and 77 controls was analyzed. The residence of the controls and cases were visited using a questionnaire coded with the different study variables. To diminish the memory bias in relation to EMF, the subjects were shown different pictures pointing out the different sources of exposures, which were asked. Having obtained the information, different odds ratios (OR) were calculated for the different associations, as well as the confidence intervals at 95% and an unconditioned logistic regression was accomplished to know the adjusted OR. RESULTS: There were no differences between the cases and controls according to the relative who gave the information, the current age of children, the parents's age, the social class and the parent's occupation. It was found that all the generating sources of EMF, which were involved in the study, had and OR above 1. Being the highest, the ones living near the distribution or transmission wires of high voltage with an OR of 2.63 (1.26-5.36) and 2.5 (0.97-6.67) respectively. When the distance of exposure was controlled, the highest OR was for distribution lines (OR 2.12; 0.79-5.85). When the analysis was applied to persons who have moved from the residence, it was found that the OR was above 1 in all the associations, the highest being the distribution wires and with the distance the highest was the electric substations. Furthermore, the multivariate analysis showed that the risk continued only for the distribution wires. CONCLUSIONS: The EMF exposure was found positive, however this is not very precise, that is why it is necessary to carry out other studies to confirm the existence of the association and correct possible biases which could appear during the research.

Case-Control Studies↗
PubMed1993

[The use of thoracic radiography in a third-level-care pediatric hospital].

OBJECTIVES: 1. To describe the frequency in which the thorax radiography is requested in a third-level pediatric hospital, 2. To identify the frequency of detected abnormalities in such a study by the radiology service, 3. To describe the frequency and the characteristics form the information considered as useful in a clinical way, not only in the radiography application but in the radiologic report and the clinical file as well, 4. To identify the frequency in which the thorax radiography result is associated with diagnosis changes and/or therapeutic ones. DESIGN OF THE INVESTIGATION: Descriptive survey. STUDY UNITS: 371 thorax X-rays completed during December 1990 and January 1991. PRIMARY RESULTS: The thorax radiographies were 32% of the entire radiological study during the survey; 335 of the latter ones (90%) were requested for inpatients. The hospital services which had the highest request for such a study were the Intensive Care Unit (n = 149, 40%) and Medical Pediatrics (n = 116, 31%). The most frequent diagnosis leading to the application was pneumonia (n = 55, 15%) and solid neoplasia (n = 51, 14%). Three-hundred forty eight of the applications had diagnostic impression given by the physician in charge(94%); whereas only 127 (34%) mentioned clinical data. The radiology report was attached to the file in 162 (44%) of the cases. It was found that form the patients who had a radiology report and the thorax radiography as an initial study (n = 95), 48 (50%) suffered from abnormalities. The results of the study were transcribed in the file in 58 cases (16%); the physician's interpretation was written down in 229 cases (62%) and in 84 studies (23%) there was no reference to the results of the study (P < 0.0001). Changes in the therapeutic plan of 93 cases (50%) were identified from the studies with official report by the radiologist, other radiology studies were requested in 65 of the patients (35%), after the interpretation of such study. CONCLUSIONS: Abnormalities in 50% were identified from the total thorax radiographies requested as the patient entered. The study application mentioned as a whole (94%) the diagnostic impression which led to the application, but only in 127 cases (34%) were supporting clinical data written down. The radiology report was attached to the file in less than half the cases (44%). In 63% of the cases the supporting reason of the study was written down whereas in 23% there was no reference to the result at all.

Adolescent↗
PubMed1993

[Risk factors associated with the development of leukemia in children].

INTRODUCTION: Leukemia is the most frequent neoplasia in children; in our country it is the main cause of medical attention in children with cancer. The are different risk factors associated with the development of this kind of cancer. OBJECTIVE: To identify which of the already known factors described in the literature associated with the development of leukemia are most frequent in the pediatric population of Mexico City. MATERIAL AND METHODS: A protective case-control study was carried out using prevalent and incident cases. In two third level hospitals of Mexico City, a total of 81 children who had been diagnosed as suffering from different kind of leukemia, confirmed by biopsy of bone marrow, were select and studied. The control were 154 children from two different sources: 77 of them came from the same hospital where the cases received medical care, the selection criteria was not to have any kind of neoplasia; and 77 came from the same community where those diagnosed children cases lived, the selection criteria for this group was that they were healthy children. Both cases and community controls were visited at home and interview to complete precoded questionnaire with the different variables of the study. The information from the hospital controls was obtained during the time they stayed in the hospital. Odds ratio (OR's) for the different associations were calculated, as well as its confidence intervals at 95% (IC) accord to Cornfield and unconditioned logistic regression was carried out to control confounding variables. RESULTS: OR greater than 1 was found in those with familiar cancer background 1.93 (1.2-3.63); the mother being exposed to X-ray during pregnancy 1.89 (0.84-4.22); previous abortions before the child with leukemia was born 2.44 (1-06-5.68); being born from full term birth 2.42 (0.47-16.65); being born with weight greater that 3500 g 2.21 (1.04-4.33); being exposed to fertilizers 4.73 (1.04-24.14) and insecticides 1.93 (1.05-3.56). OR smaller than 1 was found in those who have been in a hospital because of an infectious disease during the first year of life 0.57 (0.17-1.74); to have suffered from chicken pox 0.59 (0.32-1.08). No association to parent's age or job was found. Multivariated analysis shows that the exposure to insecticide is the most important risk factor associated with the development of leukemia in children. CONCLUSIONS: We obtained positive associations to different risk factors described in the literature, having found that exposure to fertilizers is the most important risk factor and finding no association with the parent's occupation. This leads to the need of carrying out further studies to investigate, in more detail, the occupation of the father to confirm whether or not this is a risk factor.

Case-Control Studies↗
PubMed1993

[Granulocytopenia and fever in children with leukemia as indicator of quality of medical care].

OBJECTIVES: 1. To identify the quality degree of medical care in patients with acute leukaemia who had fever and granulocytopenia during the hospitalization period. 2. To establish the relationship between the medical care process and the results in this concern. DESIGN: Retrospective survey. STUDY AREA: Children's Hospital of the Mexican Institute of Social Security. STUDY SUBJECTS: Twenty three patients with acute leukaemia were studied. Also, hospitalization episode of these patients, in which they suffered fever and granulocytopenia, was randomly selected. MAIN MEASUREMENTS: Compliance of diagnostic and therapeutic process was measured during hospitalization, according to the protocolized recommendations made by consensus of the hospital expert group. In order to identify the quality degree of medical care, it was taken into account the protocol compliance besides the results observed in the patients. Results were assessed based on patients' survival to fever and granulocytopenia episode, as well as on fever's duration. The correlation was calculated by using Spearman's coefficient. RESULTS: The medical care quality of the hospital was "adequate" (85% on average). Compliance degree, including the total process was 71%; with diagnostic process 63%, and with therapeutic process 76%. The results observed in the patients were considered as "adequate" (89%). By evaluating individual cases, the medical care quality was considered excellent or adequate in 17 patients (74%) regular in five (22%) and poor in one (4%). Diagnostic process was adequate in 6 patients (26%) regular in 12 (53%) poor in three (13%) and very bad in two (8%). On the other hand, therapeutic process was excellent in 14 patients (60%) regular in one (4%) poor in six (26%) and very bad in two (9%). Results observed in 13 cases were excellent (57%) adequate in eight (35%) regular in one (4%) and very bad in one (4%). The relationship between process and result was 0.41 (P < 0.05) between diagnostic process and result 0.14 and, between therapeutic process and result 0.34. CONCLUSIONS: The medical care quality rendered to patients with leukaemia, who suffered a granulocytopenia episode and fever, was considered as adequate. Therapeutic recommendations were followed accurately, meanwhile, diagnostic process had a lower adherence. A positive relationship between process and result was observed.

Adolescent↗
PubMed1993

[Usefulness of residuals in clinical research].

The simple linear regression analysis, multiple linear regression and logistic regression constitute powerful statistical analysis tools widely used in clinical research. These kinds of analyses are based upon mathematical models which at the same time are established on certain basic assumptions. The regression analysis assumptions are basically: a) that the model is really linear, b) that the distribution of data is normal (from a statistical point of view), c) that the variances of the employed data are homogeneous (homocedastics) and that the included data are independent. The regression diagnostic has become popular as a form to evaluate if the assumptions have been accomplished, one of its most important techniques is the residual analysis. A residual can be defined as the value which measures the distance between the regression line and the corresponding value of the variable "y". Among these kinds of residuals used to evaluate the assumptions of regression are: the crude residual, the standardized, of student and the jackknife. The most useful among them is the jackknife residual. The usefulness and limitations of the residuals in the evaluation of the regression analysis assumptions are described, basically referring to the identification and handling of extreme values (outliers).

Evaluation Studies as Topic↗
PubMed1992

[Acute infections, growth velocity and nutritional status in children from developing countries: a meta-analytic review].

Aiming to explore the direction of the cause-effect relationship between the changes in the nutritional status, the physical growth and the selected acute infections, we performed a meta-analysis. It was based on 12 publications selected out of 993 eligible. In 6 papers (50%) a direct relationship between infections and growth velocity was found; in 5 a negative association was reported. A positive association between malnutrition (Gómez's criteria) and infection was found in 4 (33%). Two more reported no association between growth (Z score) and infection. The most remarkable confounding variables were: previous episodes of infection, duration, birth weight and feeding mode. Most of the studies did not met the criteria for causality. Better designed studies are in order to address this question.

Acute Disease↗
PubMed1992

[Circumcision in the newborn child and risk of urinary tract infection during the first year of life. A meta-analysis].

To assess if neonatal circumcision may decrease the incidence of urinary tract infection (UTI), published papers on these topics were reviewed, to address their methodological shortcomings, and to analyze them in individual and grouped form. A systematic search of the papers on circumcision and UTI was conducted in Index Medicus (1975-1991) and MEDLINE (1988-1991). Six papers were included in the meta-analysis because all of them presented original data obtained from groups of patients. All of the elected articles were considered in individual and grouped form to calculate odds ratio (OR) and confidence interval at 95% (CI 95%). The number of patients included in each paper ranged from 112 to 219,775. Clustering of the articles enabled us to obtain a global sample number of 221,799 patients. In each individual article there was a higher risk of UTI in uncircumcised patients (OR from 10.82 to 156.42). Global risk obtained from the six clustered papers was of 13.05 with a CI 95% from 10.86 to 15.70. Uncircumcised males have low risk of UTI during their first year of life, but the risk may decrease even more with circumcision. This conclusion may not be considered as definitive because of the methodological shortcomings of the papers reviewed. Recommendation of routinely circumcision to all newborns in not justified with these data.

Circumcision, Male↗
PubMed1992

[The degree of agreement of the clinical and the histopathological diagnoses in a tertiary medical care pediatric hospital].

In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.

Biopsy↗