Abstract Background: In Mexico, 29% of mortality resulting from SARS-CoV-2 was associated with one or more comorbidities. Diabetes mellitus was one of the most frequently increasing in-hospital mortality. Objective: This study was aimed at determining the impact of nosocomial infections in diabetic patients diagnosed with COVID-19. Materials and methods: An analysis of 930 patients with SARS-CoV-2 was performed, grouping data from April 2020 to December 2021. Survival, hospital stay, causative agents, antimicrobial resistance, and comorbidities were the variables of interest. Results: About 30% of patients had diabetes mellitus, which presented a greater number of concomitant comorbidities such as arterial hypertension in 50%, and chronic kidney disease in 13%. The survival function was higher in patients without diabetes mellitus. Conclusions: The association between nosocomial infections and diabetes mellitus increased hospital length of stay and mortality, which is why multidisciplinary teams are important to carry out prevention programs and establish hospital sanitation measures.

Abstract Objectives To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. Methods Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p < 0.05 was considered significant. Results A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p = 0.001) as well as the multiple spaces involvement, (p = 0.001) the presence of air corpuscles, (p = 0.001) compromise of the retropharyngeal space (p = 0.001) and age greater than 55 years (p = 0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p = 0.001, 95% CI 0.856-0.984). Conclusions The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. Level of evidence: IV. Observational analytical crosssectional cross sectional study 1 old genders 1st st 201 31th th 2021 https//7414519.shinyapps.io/ClinicalRiskScore/. https7414519shinyappsioClinicalRiskScore httpsshinyappsioClinicalRiskScore https //7 414 5 19.shinyapps.io/ClinicalRiskScore/ . 7 19 shinyapps io ClinicalRiskScore (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/) outcomes 005 0 05 0.0 significant 21 obtained 12 56.8% 568 56 8 (56.8% men 23.5% 235 23 (23.5% 0.001 0001 001 involvement corpuscles 0.001. account 97 65 95 0.8560.984. 08560984 0.856 0.984 856 984 0.856-0.984) evidence IV 20 202 7414519 https//7414519.shinyapps.io/ClinicalRiskScore/ shinyappsioClinicalRiskScore // 41 19shinyappsioClinicalRiskScore 19.shinyapps.io/ClinicalRiskScore (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/ 00 0. 2 56.8 (56.8 23.5 (23.5 0.00 000 9 6 8560 0.8560.984 0856098 0856 0.85 0984 0.98 85 98 0.856-0.984 741451 https//7414519.shinyapps.io/ClinicalRiskScore / 4 (https://7-414-5-19.shinyapps.io/ClinicalRiskScore 56. (56. 23. (23. 0.8560.98 085609 085 0.8 098 0.9 0.856-0.98 74145 (56 (23 0.8560.9 08560 08 09 0.856-0.9 7414 (5 (2 0.8560. 0.856-0. 741 ( 0.8560 0.856-0 74 0.856-

Resumen La tuberculosis extrapulmonar es aquella tuberculosis diagnosticada clínicamente y confirmada por estudios bacteriológicos que afecta a tejidos y órganos fuera del parénquima pulmonar. México es el tercer lugar en América Latina en incidencia de tuberculosis pulmonar y extrapulmonar. Los métodos de cultivo siguen siendo el método de referencia para el diagnóstico de tuberculosis extrapulmonar, ya que identifican la especie y la sensibilidad a los fármacos.

Abstract Extrapulmonary tuberculosis is defined as that case of tuberculosis clinically diagnosed and confirmed by bacteriological studies that affects tissues and organs outside the lung parenchyma. Mexico is in third place among Latin American countries in terms of the incidence of pulmonary and extrapulmonary tuberculosis. Culture methods are still the gold standard for the diagnosis of extrapulmonary tuberculosis since they identify the species and susceptibility to drugs.

Abstract Background: Deep neck abscesses can cause life-threatening complications. They are diagnosed by physical examination, and contrasted tomography as the gold standard. There are no studies about the association of Moore’s sign with infections of the retropharyngeal space. Objective: To determine the usefulness of Moore’s sign in the diagnosis of deep retropharyngeal abscess. Method: Observational, analytical, cross-sectional, study of patients with deep neck abscess, from May 1, 2019, to August 30, 2021, with report of Moore’s sign. Results: 87 patients were included, 49 (56.3%) males (p = 0.45). Of those who developed complications, 77.8% had a negative Moore’s sign (p = 0.001). Of those admitted to the ICU, 72% had a negative Moore’s sign (p = 0.001). The sensitivity of the absence of the sign with retropharyngeal involvement was 95.4%, and the specificity was 86.3%. By logistic regression, it was found that those with retropharyngeal involvement are 467 times more likely to present a negative sign (p < 0.05). Conclusions: The presence of abscess in the retropharynx is associated with complications and a worse prognosis. The evaluation of Moore’s sign can be a useful tool to suspect compromise of this space.

Resumen Antecedentes: Los abscesos profundos de cuello pueden ocasionar complicaciones letales. Se diagnostican por exploración física, y la tomografía contrastada es el método de referencia. No existen estudios de asociación del signo de Moore con infecciones del espacio retrofaríngeo. Objetivo: Determinar la utilidad del signo de Moore en el diagnóstico de absceso profundo en el espacio retrofaríngeo. Método: Estudio observacional, transversal y analítico, de pacientes con absceso profundo de cuello, del 1 de mayo de 2019 al 30 de agosto de 2021, con reporte de signo de Moore. Resultados: Se incluyeron 87 pacientes, de los cuales 49 (56.3%) eran de sexo masculino (p = 0.45). De los que desarrollaron complicaciones, el 77.8%, tenían el signo de Moore negativo (p = 0.001). De los que ingresaron a la unidad de cuidados intensivos, el 72% tenían negativo el signo de Moore (p = 0.001). La sensibilidad de la ausencia del signo con afección del espacio retrofaríngeo fue del 95.4%, y la especificidad del 86.3%. Por regresión logística se encontró que aquellos con afección del espacio retrofaríngeo tienen 467 veces más posibilidades de presentar signo negativo (p < 0.05). Conclusiones: La presencia de un absceso en el espacio retrofaríngeo se asocia a complicaciones y peor pronóstico. La evaluación del signo de Moore puede ser una herramienta útil para sospechar compromiso de ese espacio.

Abstract Objective: To identify and describe the risk factors that increase susceptibility in older adults to infection by SARS-CoV-2 (Covid-19). Material and methods: Descriptive, cross-sectional study in adults over 60 years, patients with a positive result (RT-PCR) were analysed to detect SARS-CoV-2. The study was carried out from May 17 to July 21, 2020. A multiple logistic regression model was used to analyse the risk factors of the study population. Results: 102 older adults were included with a mean age of 82.5 ± 8.8 years, 55 (54%) were positive and 47 (46%) were negative. When analysing the risk factors related to higher mortality coupled with Covid-19 infection, the statistically significant variable was frailty, with an OR of 11.6 in frail adults compared to robust individuals (p-value = 0.024.) Conclusion: In the vulnerable population, risk factors must be identified and treated, but above all, such factors must be prevented in advance; early detection, isolation, effective treatment must be carried out as well as follow-up of contacts and prevention of the spread of the new virus to reduce mortality in vulnerable groups.

Resumen Objetivo: Evaluar la eficacia y la seguridad de la angioterapia dual (endo-coil más N-butil-cianoacrilato) guiada por ultrasonido endoscópico) frente a N-butil-cianoacrilato solo en la profilaxis secundaria de várices gásctricas. Método: Estudio prospectivo de no inferioridad comparando dos técnicas de erradicación de várices gástricas. Se evalúan el éxito técnico y clínico, la oclusión y la erradicación de GOV, el resangrado, la reintervención, el período libre de GOV, las complicaciones y la mortalidad. Análisis estadístico mediante prueba de χ2 para variables categóricas y t de Student para las numéricas, con nivel de significancia de 0.05. Resultados: Fueron 68 pacientes (edad promedio 55.5 ± 10 años, mujeres 44 (64.7%) e índice de masa corporal promedio 25.7 ± 3.5 kg/m2). La causa más frecuente fue esteatohepatitis alcohólica (58%). La terapia dual tuvo mayor éxito técnico (100% vs. 94.3%) y clínico (100% vs. 85%), y la obliteración fue más rápida (100 vs. 79.2%); este grupo solo requirió una sesión. El tamaño de las GOV fue de 24 ± 14 mm y se colocaron uno o dos endo-coils. La mediana de seguimiento fue de 221 días. La tasa de libres de reintervención fue alta (100% vs. 94%; p = 0.9). Conclusiones: La angioterapia dual guiada por ultrasonido y la inyección de cianoacrilato son efectivas para la erradicación de las GOV, sin diferencias en las tasas de eventos adversos.

Abstract Objective: To evaluate efficacy and safety between dual angiotherapy (endocoil plus N-butyl-cyanoacrylate) guided by endoscopic ultrasound) versus N-butyl-cyanoacrylate in the secondary prophylaxis of gastroesophageal varices (GOV). Method: Prospective non-inferiority study comparing two gastric variceal eradication techniques. We evaluated technical and clinical success, GOV occlusion and eradication, rebleeding, reoperation, GOV-free period, complications, and mortality. Chi square for categorical variables and Student's t for numerical variables with a significance level of 0.05. Results: There were 68 patients (average age 55.5 ± 10 years, women 44 (64.7%) and average body mass index 25.7 ± 3.5 kg/m2). The most frequent cause was alcoholic steatohepatitis (58%). Dual therapy had greater technical (100% vs. 94.3%) and clinical (100% vs. 85%) success. Obliteration was faster (100 vs. 79.2%). This group only required one session. The GOV size was 24 ± 14 mm and 1-2 endocoils were placed. The median follow-up was 221 days. The reoperation-free rate was high (100% vs. 94%; p = 0.9). Conclusions: Dual angiotherapy guided by endoscopic ultrasound and cyanoacrylate injection are effective for the eradication of GOV without differences in adverse event rates.

Abstract Background: Gynecological brachytherapy has evolved from the concept of punctual prescription (Manchester) to treatment volumes. Objective: To analyze the dosimetric result between the prescription at point A and high-risk clinical target volume (HR-CTV). Methods: Both plans were performed in 28 patients with stage IB2-IVA cervical cancer (112 applications), the dose used was 4 fractions of 5.62 Gy. Results: The mean D90 (dose to 90% volume) and its standard deviation for HR-CTV: 92.1 ± 2.7 Gy, was lower (p < 0.008) than at points A (103.4 ± 21.6 Gy). HR-CTV coverage: 97.8 ± 7.3% was higher (p < 0.000000000043) than with points A (86.6 ± 14.7%). The bladder D2 cc was: 83.8 ± 22.4 Gy vs. ICRU 38 bladder point (66.1 ± 7.6 Gy) (p < 0.0057), demonstrating the underestimation of the dose in the punctual planning. The D2 cc of the rectum was: 73.6 ± 12.7 Gy vs. ICRU 38 straight point (75.1 ± 11.9 Gy) (p < 0.4857), not differing significantly. Conclusions: 3D brachytherapy provides greater dose coverage for HR-CTV compared to the traditional system, with an underestimation of the dose received in the bladder in the punctual system.

Resumen Introducción: La braquiterapia ginecológica ha evolucionado desde el concepto de prescripción puntual (Mánchester) a volúmenes de tratamiento. Objetivo: Analizar el resultado dosimétrico entre la prescripción a puntos A y volumen blanco clínico de alto riesgo (CTV-HR). Métodos: Se realizaron ambas planeaciones en 28 pacientes con cáncer cervicouterino estadio IB2-IVA (112 aplicaciones), la dosis utilizada fue cuatro fracciones de 5.62 Gy Resultados: La dosis media al 90% del CTV-HR y desviación estándar: 92.1 ± 2.7 Gy fue más baja (p < 0.008) que a puntos A (103.4 ± 21.6 Gy). La cobertura al CTV-HR: 97.8 ± 7.3% fue mayor (p < 0.000000000043) que con puntos A (86.6 ± 14.7%). La D2 cc de vejiga fue: 83.8 ± 22.4 Gy vs. punto vejiga ICRU 38 (66.1 ± 7.6 Gy) (p < 0.0057), demostrando la subestimación de la dosis en la planeación puntual. La D2 cc de recto fue: 73.6 ± 12.7 Gy vs. punto recto ICRU 38 (75.1 ± 11.9 Gy) (p < 0.4857), no difiriendo significativamente. Conclusiones: La braquiterapia 3D proporciona una mayor cobertura de dosis al CTV-HR comparándolo con el sistema tradicional, existiendo una subestimación de la dosis recibida en vejiga en el sistema puntual.

Abstract Introduction: COVID-19 associated mortality in patients who require mechanical ventilation is unknown in the Mexican population. Objective: To describe the characteristics of Mexican patients with COVID-19 who required mechanical ventilation. Methods: Observational cohort study carried out in an intensive care unit from March 25 to July 17, 2020. Data were obtained from a prospective database and electronic medical records, and were analyzed with the chi-square test, Fisher’s exact test or Mann-Whitney’s U-test. Results: One hundred patients required mechanical ventilation; median age was 56 years, 31 % were females and 97 % were Latin American. Most common comorbidities were obesity (36 %), diabetes (26 %), hypertension (20 %), and chronic or end-stage kidney disease (10 %). At the end of the analysis, 11 patients remained in the ICU, 31 had been discharged alive and 58 (65.2 %) died; survivors were younger, had lower scores on severity and organ dysfunction scales, lower levels of C-reactive protein at ICU admission, were less likely to receive hemodialysis and vasopressors, and had longer hospital and ICU stays. Conclusions: This study adds information on the presentation and results of SARS-CoV-2-infected patients who require mechanical ventilation.

Resumen Introducción: La mortalidad por COVID-19 en quienes requieren ventilación mecánica se desconoce en la población mexicana. Objetivo: Describir las características de pacientes mexicanos con COVID-19 que requirieron ventilación mecánica. Métodos: Estudio de cohorte observacional en una unidad de terapia intensiva, del 25 de marzo al 17 de julio de 2020. Los datos se obtuvieron de una base de datos prospectiva y de registros clínicos electrónicos; fueron analizados con c2, prueba exacta de Fisher o prueba U de Mann-Whitney. Resultados: Cien pacientes recibieron ventilación mecánica, la edad media fue de 56 años, 31 % era del sexo femenino y 97 %, latinoamericano. Las comorbilidades más comunes fueron obesidad (36 %), diabetes (26 %), hipertensión (20 %) y enfermedad renal crónica o renal terminal (10 %). Al término del análisis, 11 pacientes permanecían en la UCI, 31 egresaron vivos y 58 (65.2 %) fallecieron; los sobrevivientes fueron más jóvenes, con menor puntuación en las escalas de gravedad y disfunción orgánica, menores niveles de proteína C reactiva al ingreso a la UCI, menor propensión a hemodiálisis y necesidad de vasopresores y con mayor estancia hospitalaria y en la UCI. Conclusiones: Este estudio agrega información sobre la presentación y resultados de pacientes con ventilación mecánica infectados con SARS-CoV-2.

Abstract Introduction: Image-guided 3D brachytherapy (IGBT) contemplates the volumetric definitions for the calculation of the dose to clinical target volume and the risk organs, such as bladder, rectum and sigmoid, but the value of contouring the bowel has not been proven. Objective: To determine the doses received at the D2cc (dosage in 2 cubic centimeters) bowel in IGBT. Methods: Retrospective study including 117 applications of intracavitary gynecological IGBT of high dose rate carried out in the General Hospital of Mexico, evaluating the bowel D2cc. Results: 117 applications of IGBT were made by computed tomography, 61 simultaneous arrangements (tandem and ovoids), and 56 vaginal cylinders. In the simultaneous arrangement group, the values of the bowel D2cc were in the range of 53 to 1153 cGy, mean 324 cGy; in the vaginal cylinder group, the range obtained was 36 to 549 cGy, with a mean of 224 cGy. Applying a multiple linear regression model, larger doses to the bowel were observed (86.4 cGy) in the simultaneous arrangement group compared to the vaginal cylinder group, with statistical significance. Conclusion: The bowel dosimetry shows higher doses in simultaneous arrangements, but studies are required that evaluate the dosimetry obtained with acute and late clinical toxicity.

Resumen Introducción: La braquiterapia 3D guiada por imagen (BTGI) contempla definiciones volumétricas para cálculo de dosis a volumen blanco clínico y órganos de riesgo como vejiga, recto y sigmoides, pero no se encuentra definida la importancia de la dosimetría en intestino delgado. Objetivo: Determinar las dosis recibidas a la D2cc (dosis en 2 centímetros cúbicos) intestino delgado en BTGI. Métodos: Estudio retrospectivo, incluye 117 aplicaciones de BTGI ginecológica intracavitaria de alta tasa de dosis en el Hospital General de México evaluándose la D2cc intestino. Resultados: Se realizaron 117 aplicaciones de BTGI mediante tomografía computarizada, 61 arreglos simultáneos (sonda intrauterina y par de colpostatos) y 56 cilindros vaginales. En el grupo arreglo simultáneo, la D2cc intestino estuvo en el rango de 53 a 1,153 cGy, media 324 cGy; en el grupo de cilindro vaginal, el rango fue de 36 a 549 cGy, media 224 cGy. Aplicando un modelo de regresión lineal múltiple se observó en el grupo arreglo simultáneo, 86.4 cGy más de dosis sobre el intestino delgado en comparación con el grupo de cilindro vaginal, con significancia estadística. Conclusión: La dosimetría en intestino muestra dosis mayores en arreglos simultáneos, pero se requieren estudios que evalúen la dosimetría obtenida con la toxicidad clínica aguda y tardía.

Abstract Introduction: New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area. Objective: To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events. Method: Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days. Results: Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12–0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24–5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes. Conclusions: In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU.

Resumen Introducción: Nuevos hospitales están reemplazando a instalaciones antiguas. Existe poca información del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área nueva y equipada. Objetivo: Analizar el impacto del cambio de instalaciones de un ambiente compartido a camas individuales en la ocurrencia de eventos adversos en la UCI. Método: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 1 de marzo de 2014 al 28 de febrero de 2017 a la antigua UCI (aUCI) y del 17 de julio de 2017 al 17 de enero de 2019 a la nueva UCI (nUCI) de un hospital-escuela público. La tasa de eventos adversos se midió en eventos por 1000 días-paciente Resultados: En 1188 pacientes (aUCI, n = 681 versus nUCI, n = 507) se observó reducción en la tasa de paro cardiaco no previsto (razón de tasas 0.31, IC 95 % = 0.12-0.80) e incremento en la tasa de extubación no planeada (razón de tasas 2.49, IC 95 % = 1.24-5.01), estadísticamente significativos; los otros nueve eventos adversos monitoreados no mostraron cambios Conclusiones: Comparada con la aUCI, la mayor parte de eventos adversos monitoreados no se modificaron significativamente en los 18 meses de inicio de actividades de la nUCI.

Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.

Objetivo. Cuantificar el abasto en farmacia y el nivel de surtimiento de medicamentos en las unidades de especialidades médicas de enfermedades crónicas (UNEMES-EC) de México. Material y métodos. Los indicadores de abasto y surtimiento se midieron en 30 de 86 UNEMES-EC existentes en el país. El abasto de medicamentos se registró mediante una lista de cotejo que incluía 17 medicamentos básicos relacionados con la atención de diabetes mellitus, hipertensión y sobrepeso/obesidad. La información sobre surtimiento de recetas procede de un cuestionario aplicado directamente a 1 200 usuarios. Resultados. Sólo 13.3% de las unidades reportó abasto completo de medicamentos esenciales y dicho abasto fue más frecuente en aquellas unidades con servicio tercerizado de farmacia. Del total de pacientes entrevistados, 35% alguna vez tuvo que comprar medicamentos con recursos propios. Conclusión. Las UNEMES-EC deben mejorar su abasto de medicamentos y el surtimiento completo de recetas para evitar que sus usuarios incurran en gastos de bolsillo.