Implications of BRCA1 and BRCA2 Mutations in Mexico

BRCA 1 or BRCA 2 mutations have played a role in understanding its risk for several different cancer like breast, ovarian, prostate, and pancreatic cancer Knowing that biology is king, and its determination plays a role in prognosis for patients with cancer. Several recommendations have been made focusing on which population should have BRCA mutational status determined. This determination could help seek targeted therapy that could have a beneficial impact on cancer patients. Having this said, efforts have been made to determine if our Mexican population has the same prognosis when BRCA mutation is present when compared to global reports. As well as researching founder mutations that could help understand our Mexican population. This chapter seeks to describe and analysis this current scenario in Mexican population with BRCA mutation

Cumplimiento de intervenciones de enfermería para el mantenimiento del catéter venoso central en pacientes pediátricos

Introducción: El catéter venoso central es necesario en los cuidados pediátricos, sin embargo, es una causa importante de bacteriemia nosocomial con 25% de mortandad. El profesional de enfermería es responsable del mantenimiento del catéter venoso central con el propósito de evitar complicaciones locales y sistémicas como la endocarditis y la bacteriemia relacionadas al tratamiento endovenoso.Objetivo: Describir las intervenciones de enfermería para el mantenimiento del catéter venoso central en pacientes pediátricos de un hospital especializado.Metodología: Diseño observacional, descriptivo, transversal, muestra conformada por 85 profesionales de enfermería que otorgaron cuidados directos a niños hospitalizados y recibieron capacitación, muestreo no probabilístico, el instrumento utilizado fue una lista de verificación de mantenimiento del catéter venoso central. Se recolectaron datos con la técnica de observación. El estudio cumple con los aspectos éticos de la ley general de salud en materia de investigación.Resultados: Las intervenciones de enfermería se realizaron con un cumplimiento global de 90.1%, se enfatiza que 70.6% efectuaron lavado de manos antes de manipular el dispositivo. La limpieza y mantenimiento del sitio de inserción la realizaron 98.8%, desinfectaron puertos y conexiones, identificaron lúmenes 92.9%.Conclusión: Los profesionales de enfermería realizan las intervenciones para el mantenimiento del catéter venoso central con un cumplimiento bueno. Sin embargo, las intervenciones con menor cumplimiento que requieren mejora son la higiene de manos, los tiempos para cambios de equipo y soluciones, la desinfección de puertos y conexiones; esenciales para disminuir las infecciones del torrente sanguíneo. Además de estudios futuros acerca de los factores profesionales e institucionales asociados al cumplimiento

Adjuvant endocrine therapy for premenopausal women with breast cancer: Patient adherence and physician prescribing practices in Mexico

Background: In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians’ prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice. Methods: Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1–5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians’ adherence to standard-of-care prescription. Results: In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying (p = 0.042), worrying about long-term ET use (p = 0.031), and experiencing >7 ET-related symptoms (p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy. Conclusions: Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians’ knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc

Alirocumab and cardiovascular outcomes after acute coronary syndrome

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Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

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