Mexican Hospitals Research Articles

An international and comparative study of perceived justice in Mexican, Puerto Rican and Spanish hospitals

Purpose– The purpose of this paper was to test a construct of perceived justice and its dimensions in negative service encounters across Mexican, Puerto Rican and Spanish hospitals. Also to compare similarities and differences of perceived justice in negative service encounters in these countries.Design/methodology/approach– Includes Mexicans, Puerto Ricans and Spaniards who have experienced service failures at hospital settings. A descriptive research design was followed and a self-administered questionnaire was applied to gather the data from respondents. The researchers applied convenience sampling, and a pre-screening of respondents was included to verify that respondents were appropriate to participate in the study. A total number of 937 usable questionnaires were obtained from the hospital settings.Findings– The empirical findings across three Spanish-speaking countries indicate that the construct of perceived justice in negative service encounters consists of merely 15 items, divided into three dimensions, namely, distributional, interactional and procedural.Research limitations/implications– The empirical findings provide satisfactory validity and reliability across three countries, but there are acknowledged research limitations. These offer an opportunity for further research to verify or falsify the validity, reliability and generalization of the current findings.Practical implications– Service providers may use the three-dimensional construct of perceived justice as a guide when developing, implementing and managing processes and procedures of service failures in negative service encounters.Originality/value– The current international study in Mexico, Puerto Rico and Spain complements and fortifies previous research and existing theory of perceived justice in negative service encounters, and possible actions of complaint handling as well as service recovery.

Oxidative Stress Induced in Nurses by Exposure to Preparation and Handling of Antineoplastic Drugs in Mexican Hospitals: A Multicentric Study

The impact of involuntary exposure to antineoplastic drugs (AD) was studied in a group of nurses in diverse hospitals in Mexico. The results were compared with a group of unexposed nurses. Anthropometric characteristics and the biochemical analysis were analyzed in both groups. Also, lipid peroxidation level (LPX), protein carbonyl content (PCC), and activity of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were evaluated in blood of study participants as oxidative stress (OS) biomarkers. The group of occupationally exposed (OE) nurses consisted of 30 individuals ranging in age from 25 to 35 years. The control group included 30 nurses who were not occupationally exposed to the preparation and handling of AD and whose anthropometric and biochemical characteristics were similar to those of the OE group. All biomarkers evaluated were significantly increased (P < 0.5) in OE nurses compared to the control group. Results show that the assessment of OS biomarkers is advisable in order to evaluate exposure to AD in nurses.

A multicenter study in Spanish, Mexican, and Cuban hospitals of attitude toward living kidney donation

Living kidney donation (LKD) is a treatment with good results, although it is not very widely used in Spanish-speaking countries. To analyze the attitude toward LKD among hospital personnel in healthcare centers in Spain and Latin America. Ten hospitals within the "International Collaborative Donor Project" were selected, from Spain, Mexico, and Cuba. A random sample was taken, which was stratified according to type of service and job category. Of the 2618 workers surveyed, 90% were in favor of related LKD, 6% were against it, and the remaining 4% were undecided. If the LKD was not related, then 32% were in favor. Other factors associated with a favorable attitude toward related LKD were: Working in Latin American hospitals (p<0.001); Working in clinical services (p=0.030); Having job stability (p=0.013); Having had personal experience of donation and transplantation (p=0.002); Being in favor of deceased donation (p<0.001); Considering the possibility of needing a transplant (p<0.001); Being in favor of living liver donation (p<0.001); Accepting a kidney from a living donor (p<0.001); Having spoken about donation and transplantation within family and partner (p<0.001); Having carried out pro-social activities (p<0.001); and Having no concern about the possible mutilation of the body after donation (p<0.001). Hospital personnel had a favorable attitude toward LKD donation, both in Spain and Latin America. This attitude was related with factors of knowledge about and general attitude toward organ donation and transplantation, family factors, religious factors, and fear about mutilation remaining after the donation.

Level of acceptance of solid organ xenotransplantation among personnel in Spanish, Mexican, and Cuban hospitals

Xenotransplantation is still a long way from becoming a clinical reality. However, in an emergency situation, it could be used as a bridge for replacing vital organs until the arrival of a human organ. To analyze the attitude toward xenotransplantation among hospital personnel from several hospitals in Spain and Latin America. A random sample stratified according to the type of hospital and job category (n = 2618) in 10 hospitals in three different countries: Spain (n = 821), Mexico (n = 1595), and Cuba (n = 202). A validated questionnaire (PCID-XenoTx Rios) was self-administered and completed anonymously by the respondents. If the results of xenotransplantation were similar to those achieved using human donor organs, 61% (n = 1591) of the respondents would be in favor, while 9% (n = 234) would be against and 30% (n = 793) would be unsure. The analysis of the variables affecting attitude toward xenotransplantation revealed that attitude varied according to the country of reference and was more favorable among personnel in Cuban hospitals (70% a favor) than in Spanish (57%) and Mexican ones (62%; P = 0.000). However, these differences are mainly determined by job category with the physicians having the most favorable attitude. The ancillary staff, in contrast, had the least favorable attitude (76 vs. 51% respectively; P = 0.000). Of the remaining variables, attitude is significantly related to variables connected to human donation: attitude toward the different kinds of human organ donation (deceased [P < 0.001] and living [P < 0.001]), the possibility of needing a transplant oneself in the future (P < 0.001), and attitude toward donating the organs of a deceased family member (P = 0.004). A third of healthcare personnel from several hospitals are not in favor of xenotransplantation. It is necessary to provide more information about the matter, especially in hospitals where there is a preclinical xenotransplantation program or where there is access to one, such as in the hospitals in this study.

The effect of knowledge-centered culture and social interaction on organizational innovation: the mediating effect of knowledge management

The effect of organizational resources in technological innovation has been widely studied. However, the effect of these resources in organizational innovation is a subject that still requires greater scrutiny. Relying on the resource-based view of the firm, we hypothesize that the knowledge-centered culture and the social interaction are factors (resources) that affect the organizational innovation, but that this effect is mediated by the knowledge management. Using a transversal study with a sample of Mexican public hospitals through its high and medium level managers perception we found support for the hypotheses. Results of the research confirm the importance of a knowledge-centered culture, social interaction, and knowledge management as predictors of organizational innovation. This study also buttresses the critical role of knowledge management as a mediating variable in the influence of a variety of factors on the development of organizational capabilities.

Dermoscopy of non-pigmented eccrine poromas: study of Mexican cases

Background:Eccrine poroma is a benign neoplasm that can mimick a malignant neoplasm dermoscopically. The characteristic vascular pattern of this tumor has not been established.Objective:To evaluate dermoscopic features of non-pigmented eccrine poroma in Mexican patients.Method:We retrospectively studied histologically proven cases of eccrine poroma from three Mexican hospitals analyzed by four dermoscopists.Results:Thirteen cases were studied. A polymorphous vascular pattern was found in most cases. Four presented with irregular linear and branched vessels with semi-elliptical, or semicircular endings (“chalice-form” and “cherry-blossoms” vessels). Structureless pink-white areas were the most common other dermoscopic finding.Conclusions:“Chalice-form” and “cherry-blossom” vessels have not been reported in other benign or malignant neoplasms and can be a useful clue to the diagnosis of non-pigmented eccrine poroma. Due to the variability of dermoscopic patterns of eccrine poroma further studies are required to establish the specificity of our findings.

Fluoxetine for motor recovery after acute intracerebral hemorrhage (FMRICH): study protocol for a randomized, double-blind, placebo-controlled, multicenter trial

BackgroundSpontaneous, nontraumatic intracerebral hemorrhage (ICH) is a subtype of stroke that causes a great amount of disability and economic and social burden. This is particularly true in developing countries where it accounts for between 20% and 50% of all strokes. Pharmacological and surgical interventions have been attempted to reduce the mortality and disability caused by ICH, with unsuccessful results. Recently, the use of fluoxetine in addition to physical rehabilitation has been proven useful to improve motor recovery following cerebral infarct. The purpose of this study is to test whether a 3-month treatment with fluoxetine enhances motor recovery in nondepressed patients with acute intracerebral hemorrhage.Methods/designOur study is a randomized, double-blind, placebo-controlled, multicenter clinical trial. We will recruit 86 patients with intracerebral hemorrhage of both sexes, aged >18 years, from four Mexican hospitals. The patients will receive either 20 mg of fluoxetine or a placebo once daily for 90 days. The primary outcome is the mean change in the Fugl-Meyer Motor Scale score between inclusion (day 0) and day 90. The secondary outcomes will be changes in the Barthel Index, the Modified Rankin scale and the National Institutes of Health stroke scale. The outcomes will be measured at day 42 ± 7days and at day 90, for a total of four visits with each subject (at screening and at 0, 42 and 90 days).DiscussionCurrent guidelines recommend early supported hospital discharge and home-based rehabilitation programs as the only cost-effective intervention to aid the recovery of patients with intracerebral hemorrhage. Nevertheless, such interventions are dependent on available resources and funding, which make them very difficult to implement in developing countries. We believe that the identification of a helpful pharmacological intervention to aid the motor recovery of these patients will constitute a breakthrough that will have a major impact in reducing the burden of disease caused by this subtype of stroke worldwide, especially in the developing world.Trial registrationCurrent Controlled Trials NCT01737541

Actitud de los profesionales hospitalarios no sanitarios españoles y latinoamericanos hacia la donación de hígado de vivo

IntroductionHospital professionals are an opinion group that influences the general population. ObjectiveTo analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes. Material and methodA random sample, stratified by department, was selected from non-medical staff in the “International Donor Collaborative Project”: there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire. ResultsThere were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001). ConclusionsAttitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors.

Factores organizativos y profesionales asociados con la prescripción correcta de glibenclamida para el manejo de la diabetes mellitus tipo 2

IntroductionIn México, there is a high proportion of patients with uncontrolled type 2 diabetes mellitus (DM2), as well as multiple problems in the quality of prescribing in first contact medical care, despite the recommendations of the regulations, evidence-based guidelines, and international reports. ObjectiveTo analyze the factors associated with good prescribing of treatment for DM2. Material and methodsSurvey research methods with a random multi-stage cluster sampling. Two surveys were conducted with patients and physicians to assess prescription patterns in hospitals and ambulatory care clinics. A set of bivariate logistic regressions were carried out to assess the association of the prescription patterns with organizational and medical factors, and multiple logistic regression models were finally fitted. ResultsA total of 267 physicians were evaluated, of whom 39,62% were classified as prescribing correctly. Among the principal factors associated with correct prescription were, physician experience, to have specialty training, years since graduation from the specialty, and to have a clinical practice in more than one setting. ConclusionsThe results show the need to develop educational interventions to address the factors identified with good patterns of prescription for diabetes in Mexican hospitals and ambulatory clinics.

Multivariate Analysis of the Factors Affecting Attitude Toward Living Liver Donation among Workers in Surgical Services in Spanish, Mexican, and Cuban Hospitals

IntroductionCurrent liver donation rates are insufficient to cover transplant needs. Therefore, it is essential to promote living liver donation (LLD) given the ever decreasing morbidity and mortality in the donor and the improving results in the recipient. LLD is becoming increasingly accepted. However, in the health care system, a percentage of the personnel are not in favor. ObjectiveTo analyze the attitude of personnel in surgical services in Spain and Latin-America hospitals toward LLD. Materials and methodsAs part of the “International Collaborative Donor Project,” a random sample was taken and stratified according to surgical service and job category in 10 hospitals; three in Spain, five in Mexico, and two in Cuba (n = 496). Attitude was evaluated using a validated survey that was completed anonymously and self-administered. ResultsEighty-six percent (n = 425) of respondents were in favor of related living liver donation, and 30% (n = 147) were in favor if it were not related. According to country, 88% of the Mexican respondents were in favor of living liver donation, 85% of the Cubans, and 82% of the Spanish (P > .05). In the multivariate analysis of the variables with most weight affecting attitude toward LLD, the following significant associations were found: (1) a favourable attitude toward living kidney donation (odds ratio [OR] = 91; P < .001); (2) acceptance of a donated living liver if one were needed (OR = 11; P < .001); and (3) family discussion about donation and transplantation (OR = 2.581; P = .037). ConclusionsAttitude toward related living liver donation was very favorable among hospital personnel in Spanish and Latin American surgical services.

Resistance trends in gram-negative bacteria: surveillance results from two Mexican hospitals, 2005–2010

BackgroundHospital-acquired infections caused by multiresistant gram-negative bacteria are difficult to treat and cause high rates of morbidity and mortality. The analysis of antimicrobial resistance trends of gram-negative pathogens isolated from hospital-acquired infections is important for the development of antimicrobial stewardship programs. The information obtained from antimicrobial resistant programs from two hospitals from Mexico will be helpful in the selection of empiric therapy for hospital-acquired gram-negative infections.FindingsTwo thousand one hundred thirty two gram-negative bacteria collected between January 2005 and December 2010 from hospital-acquired infections occurring in two teaching hospitals in Mexico were evaluated. Escherichia coli was the most frequently isolated gram-negative bacteria, with >50% of strains resistant to ciprofloxacin and levofloxacin. Klebsiella spp. showed resistance rates similar to Escherichia coli for ceftazidime (33.1% vs 33.2%), but exhibited lower rates for levofloxacin (18.2% vs 56%). Of the samples collected for the third most common gram-negative bacteria, Pseudomonas aeruginosa, >12.8% were resistant to the carbapenems, imipenem and meropenem. The highest overall resistance was found in Acinetobacter spp. Enterobacter spp. showed high susceptibility to carbapenems.ConclusionsE. coli was the most common nosocomial gram-negative bacilli isolated in this study and was found to have the second-highest resistance to fluoroquinolones (>57.9%, after Acinetobacter spp. 81.2%). This finding represents a disturbing development in a common nosocomial and community pathogen.

Fungal and Bacterial Contamination on Indoor Surfaces of a Hospital in Mexico

: Background: Nosocomial infections acquired during hospitalization depend on the characteristics of the microorganisms, with a high risk of these being acquired when the environment is contaminated. Cross-transmission of microorganisms by contaminated surfaces and the hands of health care workers are considered to be the main route of the spread of nosocomial infections and in many Mexican hospitals, information about microbial and fungi contaminants on indoor surfaces is insufficient.Objectives: In this study, we explore the bacterial and fungal genera present on surfaces taken from; armrest beds, wash sinks, medical tables, and the hands of medical staff from emergency, intensive care unit, inhalation therapy, stomatology and pediatric areas.Materials and Methods: The present study was conducted in a hospital located in Xalapa City in Mexico; the samples were taken during a 6 month period from August to December, 2010. Surface swab specimens were collected from predefined surfaces with cotton tipped applicators, pre-moistened with sterile saline and inoculated on Sabouraud dextrose or selective Eosin-Methylene Blue agar plates and incubated for 1 to 7 days at 28°C or 37°C in three triplications in order to isolate bacterial and fungal contaminants.Results: We isolated and identified gram-negative bacteria and fungi and the results showed that the predominant bacteria were; Klebsiella spp. Pseudomonas spp. and E coli spp. The predominant genera of fungi were; Cladosporium spp. Microsporum canis., Aspergillus spp. and Penicillium spp.Conclusions: This study showed that all areas of the hospital have pathogenic fungi and bacteria, indicating that these are a potential source of cross-infection from the hands of health care workers to their patients. Implication for health policy/practice/research/medical education:Identification of bacterial and fungal contamination in indoor surfaces would be the key elements in order to evaluate the effectiveness of aseptic techniques that can be applied and contribute to better preventive measures against infectious diseases caused by nosocomial pathogens.Please cite this paper as:Garcia-Cruz CP, Najera Aguilar MJ, Arroyo-Helguera OE. Fungal and Bacterial Contamination on Indoor Surfaces of a Hospital in Mexico. Jundishapur J Microbiol. 2012;5(3):460-4. DOI: 10.5812/jjm.2625 Copyright ©2012 Kowsar Corp. All rights reserved.

Acute Cerebrovascular Disease in Pregnancy and Puerperium: Description of Cases from a Mexican Multicenter Registry (RENAMEVASC) (P01.035)

Objective: To describe CVD cases occurring during pregnancy or puerperium in Mexican hospitals. Background Pregnancy and puerperium are physiological conditions associated with a high risk of acute cerebrovascular disease (CVD). Comparative data on the association of pregnancy and puerperium among the different types of acute CVD is sparse. Design/Methods: We analyzed 2000 patients with different types of acute CVD included in a registry conducted in 25 referral hospitals. Research records of cases occurring during pregnancy or puerperium (the first 40 days after delivering) were selected. Results: We identified 45 (2.3%, 95% confidence interval: 1.7% to 3.0%) women with CVD associated with pregnancy or puerperium (mean age 26.3 years, range: 14-39): 20 (44%) in pregnant women and 25 (56%) during puerperium. A total of 26 (58%) cases corresponded to cerebral vein thrombosis (CVT), 10 (22%) to intracerebral hemorrhage (ICH) and 9 (20%) to acute ischemic stroke (AIS). No association with subarachnoid hemorrhage was identified. As compared with puerperium, pregnancy was more common among AIS (56% vs 44%, respectively) and ICH cases (90% vs 10%, respectively), but the inverse characteristic was observed in CVT cases (23% vs 77%, respectively). Ten (22%) patients presented preeclampsia/eclampsia: 7 (70%) in association with ICH, 2 (22%) with AIS and only one (4%) with CVT. The 30-day case fatality rate was 4%, (2 pregnant women: one with ICH and the other with CVT); however, the frequency of women with a modified Rankin scale >2 was 17%; more common among patients with ICH (60%), than in AIS (14%) and CVT (9%) cases. Conclusions: CVT is the main type of acute CVD occurring during pregnancy or puerperium. Preeclampsia/eclampsia was mainly associated with ICH, whereas CVT may be associated with a prothrombotic, non-hypertensive state. Mortality rate is low, but at expense of a significant proportion of disabled young women. Disclosure: Dr. Chiquete has nothing to disclose. Dr. Flores has nothing to disclose. Dr. Florez has nothing to disclose. Dr. Salas has nothing to disclose. Dr. Reyes-Melo has nothing to disclose. Dr. Villarreal-Careaga has nothing to disclose. Dr. Murillo-Bonilla has nothing to disclose. Dr. Leon-Jimenez has nothing to disclose. Dr. Ruiz-Sandoval has nothing to disclose. Dr. Gonzalez-Duarte has nothing to disclose. Dr. Garcia-Ramos has nothing to disclose. Dr. Cantu-Brito has nothing to disclose.

Prevalence and Characterization of Plasmid-Mediated Quinolone Resistance Genes in Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Isolates in Mexico

The objectives of this study were to investigate the prevalence of plasmid-mediated quinolone resistance genes in a collection of 226 extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolates and characterize the qnr-positive isolates. The rate of qnr-positive isolates was 21.6% (49/226), 49.5% for aac(6')-Ib-cr (112/226), and 1.7% for qepA1 (4/226). Those isolates carried qnr genes corresponding to types qnrB (71.4%), qnrS1 (24.4%), and qnrA1 (18.3%). The distribution among bacterial species was as follows: 55.8% (19/34) to Enterobacter cloacae, 50% (28/56) to Klebsiella pneumoniae, and 1.4% (2/136) to Escherichia coli. The characterization of qnr-positive isolates indicated the ESBL SHV-types as the most prevalent (81.6%), including the ESBLs SHV-12, SHV-5, and SHV-2a, followed by CTX-M-15 (44.9%) and TLA-1 (8.1%). In addition, for qnr-positive isolates, the prevalence of aac(6')-Ib-cr was 55.1%, but qepA was not identified. Alterations at codons Ser-83 and Asp-87 in GyrA and at codons Ser-80 in ParC were observed in 69% and 80% of the qnr-positive isolates, respectively. The analysis of the transconjugants revealed a cotransmission of bla(CTX-M-15) with qepA1 or aac(6')-Ib-cr and/or qnrA1 and bla(SHV-type) with qnrB5 and qnrB6 genes. To conclude, these findings indicate a high prevalence of qnr and aac(6')-Ib-cr among ESBL-producing isolates from Mexican hospitals and point to the wide spread of qnr-like determinants associated to ESBLs SHV- and CTX-M-type in Mexican clinical isolates.

Perceived managerial and leadership effectiveness within Mexican and British public sector hospitals: A cross‐nation comparative analysis

AbstractStephen M. Shortell, dean of the School of Public Health, distinguished professor of health policy and management, and professor of organization behavior in the Haas School of Business, University of California‐Berkeley, has argued that evidence‐based management needs to be married with evidence‐based medicine if sustainable improvement in the delivery, quality, cost, and outcomes of care are to be achieved. And this, he suggests, calls for an effective partnership between academics and practitioners to ensure that relevant practice‐grounded research is correctly translated for practicing healthcare managers to use in their day‐to‐day activities (Grazier, 2004). His call is particularly urgent due to the dearth of best evidence to support evidence‐based management in the field of medicine and healthcare.

Assessing quality of medical death certification: Concordance between gold standard diagnosis and underlying cause of death in selected Mexican hospitals

BackgroundIn Mexico, the vital registration system relies on information collected from death certificates to generate official mortality figures. Although the death certificate has high coverage across the country, there is little information regarding its validity. The objective of this study was to assess the concordance between the underlying cause of death in official statistics obtained from death certificates and a gold standard diagnosis of the same deaths derived from medical records of hospitals.MethodsThe study sample consisted of 1,589 deaths that occurred in 34 public hospitals in the Federal District and the state of Morelos, Mexico in 2009. Neonatal, child, and adult cases were selected for causes of death that included infectious diseases, noncommunicable diseases, and injuries. We compared the underlying cause of death, obtained from medical death certificates, against a gold standard diagnosis derived from a review of medical records developed by the Population Health Metrics Research Consortium. We used chance-corrected concordance and accuracy as metrics to evaluate the quality of performance of the death certificate.ResultsAnalysis considering only the underlying cause of death resulted in a median chance-corrected concordance between the cause of death in medical death certificates versus the gold standard of 54.3% (95% uncertainty interval [UI]: 52.2, 55.6) for neonates, 38.5% (37.0, 40.0) for children, and 66.5% (65.9, 66.9) for adults. The accuracy resulting from the same analysis was 0.756 (0.747, 0.769) for neonates, 0.683 (0.663, 0.701) for children, and 0.780 (0.774, 0.785) for adults. Median chance-corrected concordance and accuracy increased when considering the mention of any cause of death in the death certificate, not just the underlying cause. Concordance varied substantially depending on cause of death, and accuracy varied depending on the true cause-specific mortality fraction composition.ConclusionsAlthough we cannot generalize our conclusions to Mexico as a whole, the results demonstrate important problems with the quality of the main source of information for causes of death used by decision-makers in settings with highly technological vital registration systems. It is necessary to improve death certification procedures, especially in the case of child and neonatal deaths. This requires an important commitment from the health system and health institutions.

Errors in Managing Postsurgical Pediatric Pain in Mexico

ABSTRACTPostoperative pain is a subjective symptom that has been extensively studied in adults, but only minimally in children. In children, use of low analgesic doses and failure to document the pain and its management are common concerns. In newborns and infants pain is difficult to interpret. This was a double-blind, prospective, multicenter observational study conducted in four public Mexican hospitals to identify analgesic use. One hundred subjects were enrolled at each institution and monitored for 24 to 48 hours following surgery. Data were collected on 152 girls and 248 boys ranging in age from newborns to 14 years. Nearly 300 (290) underwent major procedures; 110 had short stay surgery. The most common analgesics used were paracetamol and dipyrone at low doses. Less frequently ibuprofen or another anti-inflammatory was used. Many children received no analgesic, including 30 newborns, and others received only one or two analgesic doses. Fifteen burn patients received ketorolac. The occurrence and characteristics of the pain were poorly documented in all four hospitals. Postoperative pain causes suffering and can prolong hospital stays. Graphic pain intensity scales exist to evaluate pain, but use of them was not documented in medial records. Nurses and doctors in training did not have the skills needed to evaluate pain. The study revealed errors in pain management and fear among staff in using high doses of common analgesics. The study results document patterns of care in most Mexican hospitals today and indicate a need for pain management training for Mexican doctors and nurses.

Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebrovascular Disease: The RENAMEVASC Study

Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that is usually not mentioned in multicenter registries on all-type acute stroke. We aimed to describe the experience on hospitalized patients with CVT in a Mexican multicenter registry on acute cerebrovascular disease. CVT patients were selected from the RENAMEVASC registry, which was conducted between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging, and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed. Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%), contraceptive use (18%), and pregnancy (12%) were the main risk factors in women. In 67% of men, CVT was registered as idiopathic, but thrombophilia assessment was suboptimal. Longitudinal superior sinus was the most frequent thrombosis location (78%). Extensive (>5 cm) venous infarction occurred in 36% of patients. Only 81% of patients received anticoagulation since the acute phase, and 3% needed decompressive craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic thromboembolism (8.5%) were the main in-hospital complications. The 30-day case fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards model, only age <40 years was associated with a mRS score of 0 to 2 (functional independence; rate ratio, 3.46; 95% CI, 1.34-8.92). The relative frequency of CVT and the associated in-hospital complications were higher than in other registries. Thrombophilia assessment and acute treatment was suboptimal. Young age is the main determinant of a good short-term outcome.

Extended-spectrum β-Lactamase-Producing Enterobacteriaceae Causing Nosocomial Infections in Mexico. A Retrospective and Multicenter Study

Background and Aims Extended-spectrum β-lactamase (ESBLs) production is still the most frequent mechanism of resistance to cephalosporins in gram-negative bacteria. The aim of the study was to identify the types of ESBL-producing Enterobacteriaceae clinical isolates causing nosocomial infections in Mexico. Methods ESBL production was performed using a disk diffusion method. The MIC for several antibiotics was performed by agar dilution on Mueller-Hinton. PFGE typing was carried out on all enterobacteria assayed. The β-lactamase pattern was obtained by IEF and bioassay. Genes of β-lactamases were amplified by PCR with specific primers and products were sequenced and analyzed using informatics programs. Plasmid isolation and conjugation experiments were carried out using standard methodologies. Results There were 134 isolates of Enterobacteriaceae included from a retrospective and multicenter study that included eight Mexican hospitals from 1999 to 2005. The most prevalent species were K. pneumoniae (56%), Enterobacter cloacae (29%), and Escherichia coli (15%). Molecular analysis identified the underlying endemic and polyclonal spread of enterobacterials in each hospital. The most frequent ESBLs identified were SHV-type (84%), TLA-1 (11%), and CTX-M-15 (5%). Successful matings were detected in 68.4% (71/104) isolates. Conclusions ESBL-producer K. pneumoniae remains the most frequent bacterial species obtained in nosocomial infections. The SHV-type and TLA-1 ESBLs were disseminated in most hospitals analyzed and CTX-M-15 was emerging in one of the studied hospitals. This work highlights the proper use of antibiotics to avoid the selection of these types of multiresistant bacteria.

Attitude Toward Living Liver Donation in Transplant Hospitals in Spain, Mexico and Cuba

Background Transplantation hospitals have played a key role in developing deceased organ donation and transplantation (ODT). To reduce the number of deaths on the transplant waiting list, it is essential to encourage living liver donation (LLD). Involvement of personnel in these hospitals is crucial. Purpose We analyzed the attitudes toward LLD among hospital personnel in Spain, Mexico, and Cuba. Materials and methods Data were obtained from 5 transplant hospitals in Spain, Mexico, and Cuba. The sample was stratified according to job category and type of service (n = 2273). A validated questionnaire about living donation was used as the instrument. Results Most respondents (82%) were in favor of related LLD. If the LLD was not related, acceptance fell to 21%. A total of 85% of physicians, 79% of nursing personnel, 74% of nursing assistants, and 83% of auxiliary staff were in favor ( p < .001). A favorable attitude toward LLD was associated ( P < .05) with age (37 ± 10 y vs 39 ± 10 y), a favorable attitude toward deceased donation, a belief that a possible transplant is needed, acceptance of LLD if necessary, a favorable attitude toward living kidney donation, family discussion about ODT, a partner's favorable attitude toward ODT, an intention to participate in prosocial activities, being a Catholic, and a belief that one's religion is in favor of ODT. Conclusions Personnel from Spanish, Mexican, and Cuban transplantation hospitals have favorable attitudes toward LLD. This suggests that there may be an increase in LLD in the future, provided that there is the necessary sociopolitical and economic support.