Primary melanoma of the nasal mucosa: case presentation and systematic review of the literature

Introducción: Los melanomas de mucosa nasosinusales, representa una de las patologías de menor proporción en las tumoraciones de nariz y senos paranasales y como consecuencia diagnósticos tardíos. Reporte de caso: paciente masculino de la sexta década de la vida, que inicio con cuadro de obstrucción nasal y epistaxis leve, fue enviado para su valoración nuestro hospital de tercer nivel, donde se sometió a biopsia, presentando el resultado histopatológico de melanoma de mucosa nasal. Conclusión: las lesiones se presentaron principalmente como epistaxis y obstrucción nasal, involucraron a la cavidad nasal y senos paranasales y el lado izquierdo fue el más común involucrado. Los estadios de la enfermedad avanzada y metástasis a distancia se presentaron con gran frecuencia y en general con una pobre supervivencia a 5 años.Background: Mucosal melanoma represents one of the pathologies with a lower proportion among tumors of the nose and paranasal sinuses and as a consequence late diagnoses. Objective: To present the case of a male patient in the sixth decade of life with nasal mucosal melanoma and a systematic review of studies reported from 2016 to 2021. Results: The systematic search was carried out from January 2016 to December 2021 in PubMed, Google Scholar and Elsevier; 147 articles that meet the 19 criteria were located. Conclusion: The injury was prevalent in women, there was a higher prevalence in the seventh and eighth decades. The main lesions were epistaxis and nasal obstruction, involved the nasal cavity and paranasal sinuses and the left side was the most common involved. There was high frequency of advanced disease stages and distant metastases and generally with poor 5-year survival

Mediación de conflictos, competencia no difundida en médicos en formación: revisión

Human beings are social beings by nature, and disagreements and conflicts are common situations inherent in their different social activities. This review aims to describe the origin of conflicts and the mediation techniques in healthcare. It is well known that conflict resolution skills are needed to be learned, and such skills are considered within the changing priorities of healthcare students. Disagreement and conflict are inevitable between members of clinical care teams, as well as with patients and their families during healthcare. Despite the importance of these skills, they have not been established as an educational need in healthcare professionals’ curricula, even though physicians are required to negotiate and resolve conflicts on an ongoing basis in healthcare settings. Our role as educators is to analyze the changing empirical professional context, and provide our students with the relevant tools with the greatest chance of success for their professional development in their daily activities. We invite you to read, analyze and criticize this proposal, which we consider very important to be included in the undergraduate and graduate curricula of the different fields of healthcare professionals, i.e. specialist physicians, nursing staff and all those professionals who work with the common goal of providing quality healthcare.El ser humano es un ser social por naturaleza, y los desacuerdos y conflictos son situaciones comunes e inherentes a sus diferentes actividades sociales. En esta revisión se pretende describir el origen de los conflictos y las técnicas de mediación en la atención sanitaria. Se sabe de la necesidad de aprender las habilidades para la solución de conflictos, y se reconocen dentro de las prioridades cambiantes de los educandos del profesional sanitario. El desacuerdo y el conflicto son inevitables entre los miembros de los equipos clínicos, así como con los pacientes y sus familias durante el curso de la atención sanitaria. A pesar de la importancia que representa esta competencia, no se ha establecido como una necesidad educacional en los planes de estudio de los profesionales de la salud, no obstante de que los médicos requieren negociar y resolver conflictos de manera continua en los entornos sanitarios. Nuestra función como educadores es la de analizar el contexto profesional empírico cambiante y otorgar a los educandos las herramientas pertinentes para su desarrollo profesional con la mayor posibilidad de éxito en sus actividades cotidianas. Los invitamos a leer, analizar y criticar esta propuesta, que consideramos muy importante para que sea contemplada en los planes de estudio desde el pregrado y posgrado de las diferentes ramas de los profesionales de la salud, que incluyen tanto a médicos de las diferentes especialidades, el personal de enfermería y todos aquellos profesionales que trabajamos con el objetivo común de brindar asistencia sanitaria de calidad

Pensamiento suicida en médicos residentes con la escala de Plutchik en dos instituciones de salud en Ciudad Obregón, Sonora, México

Objective: To evaluate the incidence and factors associated with suicidal ideation in a sample of resident physicians from two institutions. Materials and methods: A descriptive, observational, prospective and cross-sectional study was carried out to estimate the suicidal ideation and associated factors with the Plutchik Suicide Risk Scale among resident physicians from two hospitals between September and October 2022. Descriptive statistics were used with measures of central tendency and dispersion, as well as relative and absolute frequencies. In addition, Pearson’s chi-square goodness of fit test and Kruskal-Wallis H test were used to examine the differences between specialties, and Tukey’s Honest Significant Difference test to determine which specialty was different. Results: A total of 225 surveys were answered, out of which 20 were eliminated due to inadequate completion, leaving 205 complete surveys for analysis. The average age was 28.66 years (SD ± 2.360) and 71.2 % were females. Concerning the specialties, pediatrics was found in 28.8 % of the respondents and anesthesiology in 20.5 %. A significant association between specialties with a value of p = 0.0000 and academic degrees with p = 0.003 (p ≤ 0.05) was evidenced. Differences regarding suicidal ideation were found by specialty: Kruskal-Wallis H test showed a value of p = 0.000 and Tukey’s Honest Significant Difference test revealed that the specialty of gynecology was the different one.Conclusions: According to the results of the study sample, approximately one fourth of the resident physicians had suicidal ideation. Its prevalence in this sample showed no significant difference with respect to its incidence in Latin America. An association between suicidal ideation, medical specialties and academic degree was found. As for the comparison between specialties, gynecology was the one with the highest suicidal ideation rate. This work had some limitations; for example, the groups were very heterogeneous, a probabilistic selection technique was not used, and the statistical tests were nonparametric.Objetivo: Evaluar la incidencia y factores asociados al pensamiento suicida en una muestra de médicos residentes de dos instituciones. Materiales y métodos: Se realizó un estudio de tipo descriptivo, observacional, prospectivo y transversal, entre los meses de septiembre a octubre del 2022, para estimar el pensamiento suicida en los médicos residentes de dos hospitales con la escala de Plutchik, además de buscar factores asociados. Se aplicó la estadística descriptiva con medidas de tendencia central y de dispersión, frecuencias relativas y absolutas; las pruebas ji al cuadrado de Pearson y de bondad de ajuste, así como la prueba de Kruskal-Wallis se emplearon para examinar las diferencias entre especialidades, y la prueba post-hoc de Tukey para evaluar la especialidad diferente. Resultados: Se respondió un total de 225 encuestas, de las cuales se eliminaron 20 por inadecuado diligenciamiento, y quedaron 205. El promedio de edad fue de 28,66 años (DS ± 2,360) y el 71,2 % correspondió al sexo femenino. En cuanto a las especialidades, se encontró a pediatría con el 28,8 % y a anestesiología con el 20,5 %. Se evidenció asociación significativa entre especialidades, con un valor de p = 0,0000, y grado académico de p = 0,003 (p ≤ 0,05). Según la especialidad, se encontraron diferencias en cuanto al pensamiento suicida; la prueba de Kruskal-Wallis mostró un valor de p = 0,000 y la prueba post-hoc de Tukey reveló que la especialidad de ginecología fue la diferente. Conclusiones: De acuerdo con los resultados de la muestra, alrededor de una cuarta parte de los médicos residentes manifiesta pensamiento suicida. La prevalencia en dicha muestra no presenta diferencia significativa con respecto a la incidencia a nivel latinoamericano. Se encontró una asociación entre ideas suicidas, especialidades médicas y grado académico. En cuanto a comparación entre las especialidades, ginecología fue la que mostró mayor ideación suicida. Este trabajo presenta algunas limitaciones, por ejemplo, existe una gran heterogeneidad de grupos, no se empleó una técnica de selección probabilística y las pruebas estadísticas empleadas fueron no paramétricas

Pólipos linfangiomatosos de las amígdalas palatinas en la infancia: Reporte de un caso y revisión

Background: Lymphangiomatous polyps of the palatine tonsils are rare benign lesions. This entity originates from the lymphoid stroma intermixed with parenchyma, being different from papillary hyperplasia, representing approximately 1.9% of tonsillar neoplasms. Objective: To present a case report and systematic review of the pediatric cases published in the literature. The report case: A systematic review was carried out following the PRISMA guidelines of the reports in PubMed, Elsevier, Google Scholar from 2010 to 2021. 18 articles were found of which 8 females and 10 males were found, the mean age was 14 years, in 15 lesions were unilateral. All cases reported the presence of lymphatic vessels in the histopathological exam. Conclusion: There is variability with age with a similar distribution between genders, being rare there is heterogeneity in its denomination.Introducción: Los pólipos linfangiomatosos de las amígdalas palatinas son lesiones benignas raras. Esta entidad se origina en el estroma linfoide mezclándose con el parénquima, siendo diferente a la hiperplasia papilar y representa aproximadamente el 1,9% de las neoplasias de amígdalas. Objetivo: Presentar un caso clínico y una búsqueda sistemática de los casos pediátricos publicados en la literatura. Reporte de caso: se ha realizado una revisión sistemática siguiendo las pautas PRISMA de los reportes en PubMed, Elsevier, Google Académico de 2010 a 2021. Se localizaron 18 artículos en los que se encontró 8 mujeres y 10 hombres, la edad promedio fue de 14 años, en 15 las lesiones eran unilaterales. Todos los casos reportaron en los hallazgos histopatológicos la presencia de vasos linfáticos. Conclusión: Existe variabilidad entre la edad con distribución similar entre sexos; al ser una entidad infrecuente hay heterogeneidad en su denominación

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Tuberculosis Amigdalina con foco pulmonar primario: Reporte de un caso

La tuberculosis en una enfermedad infecciosa que afecta a varios órganos y tejidos del cuerpo, teniendo mayor tropismo por afección pulmonar, gastrointestinal y sistema nervioso central, e incluso tejido óseo, sin embargo se han reportado casos aislados de afección a otras estructuras en diferentes reportes de casos,  de la misma forma  en el que se presenta  un paciente que acudió con síntomas a nivel deltejido amigdalino y posteriormente se evidenció involucramiento pulmona,r considerándose a la  infección amigdalina del presente caso como una tuberculosis amigdalar secundaria con foco primario a nivel pulmonar. (Horiz Med 2015; 15(3): 61-63

Tuberculosis Amigdalina con foco pulmonar primario: Reporte de un caso

La tuberculosis en una enfermedad infecciosa que afecta a varios órganos y tejidos del cuerpo, teniendo mayor tropismo por afección pulmonar, gastrointestinal y sistema nervioso central, e incluso tejido óseo, sin embargo se han reportado casos aislados de afección a otras estructuras en diferentes reportes de casos,  de la misma forma  en el que se presenta  un paciente que acudió con síntomas a nivel deltejido amigdalino y posteriormente se evidenció involucramiento pulmona,r considerándose a la  infección amigdalina del presente caso como una tuberculosis amigdalar secundaria con foco primario a nivel pulmonar. (Horiz Med 2015; 15(3): 61-63

Tonsillar tuberculosis, with primary pulmonary focus: A Case Report

Tuberculosis is an infectious disease that affects various organs and tissues, with greater tropism for lung disease, gastrointestinal and central nervous system tissue and even bone. However isolated cases of affection to other structures have been reported, just like this patient who came with symptoms in the tonsils and subsequently, lung involvement became apparent. The tonsillar infection in this case was considered a secondary tuberculosis with primary focus in the lungs

Ganancia auditiva en timpanoplastía tipo I, Hospital de Especialidades Nº2 del Centro Médico Nacional del Noroeste "Lic. Luis Donaldo Colosio Murrieta"

Objetivo: Determinar si existe ganancia auditiva posterior a la realización de timpanoplastía tipo 1 en pacientes con otitis media crónica e hipoacusia conductiva.Material y Métodos: Este estudio se realizó en servicio de otorrinolaringología del Hospital de especialidades N°2, unidad médica de alta especialidad, centro médico nacional del noroeste en ciudad Obregón, Sonora. Se llevó a cabo un estudio de cohorte retrospectivo, analítico, longitudinal. Descripción general del estudio. Se revisó el expediente clínicos de los pacientes con diagnóstico de secuelas de otitis media crónica, posoperados de timpanoplastía tipo 1, atendidos en el servicio de esta institución de marzo 2011 a abril 2014. Se tomaron datos como edad, sexo, lugar de procedencia, si existieron complicaciones postquirúrgicas, nivel promedio de audición previo y posterior a intervención quirúrgica.Resultados: De un total de 237 expedientes revisados, se encontraron 51 expedientes completos, de los cuales 33 pacientes fueron femeninos (64.7%) el rango de edad fue de 9 a 71 años, con media de 36.7 años. el lado operado más frecuente fue el derecho en 33 pacientes (64.7%). No se documentó ninguna complicación en los expedientes revisados. La evaluación de la audiometría previa la cirugía, se observó algún grado de hipoacusia en 46 pacientes (90.19%) y normal en 5 pacientes (9.8%). Postquirúrgicamente se mostró audiometría normal en 38 pacientes (74.5%), y anormal en 13 pacientes (25.49%) con una p <.0001. Existe ganancia auditiva estadísticamente significativa con timpanoplastía tipo 1 en pacientes con secuelas de otitis media crónica en la unidad médica alta especialidad, cd. Obregón, Sonora.Conclusión: En la mayoría de nuestros pacientes la timpanoplastía tipo 1, presentaron mejoría en la audición. Estos resultados son similares a los que encontraron otros autores como shrestha y et al