Mexican Public Hospital Research Articles

Mpox: Fifty-Nine Consecutive Cases from a Mexican Public Hospital; Just the Tip of the STIs Iceberg.

Monkeypox (Mpox) is a zoonotic viral infection endemic to Africa, which has caused a global outbreak since April 2022. The global Mpox outbreak is related to Clade IIb. The disease has primarily affected men who have sex with men. Skin lesions are concentrated in the genital area, with lymphadenopathy as well as concurrent sexually transmitted infections (STIs). This is an observational study of adult patients with a recent development of skin lesions and systemic symptoms, which could not be explained by other diseases present. Fifty-nine PCR-positive patients with prominent skin lesions in the genital area (77.9%), inguinal lymphadenopathy (49.1%), and fever (83.0%) were included. Twenty-five (42.3%) were known to be living with human immunodeficiency virus (HIV), and 14 of the HIV-naïve subjects (51.9%) were found to be positive during workup, totaling 39 (66.1%) patients with HIV. Eighteen patients (30.5%) had concurrent syphilis infections. It is worrisome that Mpox is present in large metropolitan areas of Mexico, but the underlying growth of cases of HIV infection and other STIs has not been well studied and should be evaluated in all at-risk adults and their contacts.

Study of perinatal transmission of SARS-CoV-2 in a Mexican public hospital

ObjectivesCOVID-19 is a viral transmissible disease and there is limited evidence on vertical transmission and prevalence of SARS-CoV-2 during pregnancy, birth, and the postnatal period. This descriptive cross-sectional study aimed to evaluate the possible perinatal transmission of SARS-CoV-2 in mothers and neonates in a Mexican population. MethodsA total of 133 nasopharyngeal swab samples from mothers, 131 swab samples from neonates, and 140 colostrum samples were obtained, and the presence of SARS-CoV-2 was determined by qPCR. ResultsOne in eight asymptomatic 38–39 weeks’ pregnant women were positive for the presence of SARS-CoV-2 in nasopharyngeal swabs taken just before delivery; and one in 12 nasopharyngeal swabs collected from neonates immediately after delivery without breast feeding were also positive. It was also determined that one in 47 colostrum/milk samples were positive for the test. In addition, there was no association between positive results and any collected metadata of mothers or newborns. ConclusionsAsymptomatic women carried the SARS-CoV-2 virus during delivery, with perinatal transmission of SARS-CoV-2 to newborns. Since neonates were sampled immediately after birth, the detection of positive cases might be due to infection by the virus in utero.

Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital.

This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry's recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

Genetic Algorithm for Scheduling Optimization Considering Heterogeneous Containers: A Real-World Case Study

In this paper, we develop and apply a genetic algorithm to solve surgery scheduling cases in a Mexican Public Hospital. Here, one of the most challenging issues is to process containers with heterogeneous capacity. Many scheduling problems do not share this restriction; because of this reason, we developed and implemented a strategy for the processing of heterogeneous containers in the genetic algorithm. The final product was named “genetic algorithm for scheduling optimization” (GAfSO). The results of GAfSO were tested with real data of a local hospital. Said hospital assigns different operational time to the operating rooms throughout the week. Also, the computational complexity of GAfSO is analyzed. Results show that GAfSO can assign the corresponding capacity to the operating rooms while optimizing their use.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital

In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus.The median age of patients was 25.3 years (range 13–49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Normal/Modern: Reconstructive Surgery in a Mexican Public Hospital

ABSTRACTA growing corpus of anthropological scholarship demonstrates how science and medicine in Mexico are imbued by national concerns with modernization. Drawing on ethnographic research in a public hospital located in the south of Mexico City, I unpack one manifestation of this dynamic, which is the conjugation of the normal and the modern in Mexican reconstructive surgery. The aspiration toward normality underlies everyday clinic practices and relationships in this field, including why parents want surgery for their children and how doctors see their patients and their responsibilities toward them. It is also central to the professional ethic of reconstructive surgeons. I argue that the realities of health care provision in Mexico coalesced with this ethic to produce reconstructive surgeons as political subjects. They aimed to modernize craniofacial surgery in Mexico and so make the bodies of craniofacial patients normal.

Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care.

BackgroundThe majority of births in Mexico take place in a health facility and are attended by a skilled birth attendant, yet maternal mortality has not declined to anticipated levels. Coverage estimates of skilled attendance and other maternal and newborn interventions often rely on women’s self-report through a population-based survey, the accuracy of which is not well established.MethodsWe used a facility-based design to validate women’s report of skilled birth attendance, as well as other key elements of maternal, newborn intrapartum, and immediate postnatal care. Women’s reports of labor and delivery care were collected by exit interview prior to hospital discharge and were compared against direct observation by a trained third party in a Mexican public hospital (n = 597). For each indicator, validity was assessed at the individual level using the area under the receiver operating curve (AUC) and at the population level using the inflation factor (IF).ResultsFive of 47 indicators met both validation criteria (AUC > 0.60 and 0.75 < IF < 1.25): urine sample screen, injection or IV medication received during labor, before the birth of the baby (i.e., uterotonic for either induction or augmentation of labor), episiotomy, excessive bleeding, and receipt of blood products. An additional 9 indicators met criteria for the AUC and 18 met criteria for the IF. A skilled attendant indicator had high sensitivity (90.1 %: 95 % CI: 87.1–92.5 %), low specificity (14.0 %: 95 % CI: 5.8–26.7 %) and was suitable for population-level estimation only.ConclusionWomen are able to give valid reports on some aspects of the content of care, although questions regarding the indication for interventions are less likely to be known. Questions that include technical terms or refer to specific time periods tended to have lower response levels. A key aspect of efforts to improve maternal and newborn health requires valid measurement of women’s access to maternal and newborn health interventions and the quality of such services. Additional work on improving measurement of population coverage indicators is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1047-0) contains supplementary material, which is available to authorized users.

Abstract P1-11-05: Chemotherapy-induced alopecia prevention and effects on quality of life among women with breast cancer: A study of a scalp-cooling system used in a Mexican public hospital

Abstract Background: Hair loss is one of the side effects associated with chemotherapy treatments. It causes emotional disturbances and constantly reminds the patient of the disease. This study analyzed the effectiveness of scalp-cooling system for prevention of alopecia in breast cancer patients and its impact on quality of life (QOL) in this population. Methods: The aim of this study was to examine the efficacy and safety of a scalp-cooling system to prevent chemotherapy-induced alopecia and its impact on quality of life (QOL) in this population. 110 breast cancer patients receiving neo or adjuvant were included in a nonrandomized pilot study. The Dignicap system consists of a refrigerator unit and a control unit integrated into a mobile cabinet and connected to a tight-fitting cooling cap. Women accepting the scalp-cooling system were compared for alopecia against those who refused group of 100 patients similarly treated. Hair loss in the 210 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy and photo documentation. Concomitantly, tolerance and side-effects were also recorded in 110 accepting patients. The effects of alopecia on various aspects of QOL in breast cancer patients including anxiety and distress, body image, sexuality, self-esteem, social functioning, global QOL was assessed by two questionnaires (EORTC QLQ-C30 and EORTC-QLQ-BR23) Results: Nurses' ratings indicated that hair loss frequency was constantly lower, at each cycle of chemotherapy, in study patients with scalp-cooling system ( n = 110) than in those without (n = 100).Differences between the two groups were statistically significant at cycles 1 and 4 ( P &amp;lt; 0.047). Scalp cooling was generally very well tolerated; only four of 110 patients discontinued use of the cold cap due to discomfort. Alopecia was considered among the most distressing problems and a trend towards higher well-being was found in successfully scalp-cooled patients, as indicated by a general better health-related quality of life, whereas unsuccessfully scalp-cooled patients reported lowest well-being. Conclusions: This study demonstrates that scalp cooling was an effective and safe method of protection against hair loss caused by chemotherapy and contributes to the well-being of the patients. Its routine use as part of neo or adjuvant chemotherapy should be seriously considered and should be clinically evaluated in a randomized trial and in studies using other chemotherapy regimens to determine optimal temperatures and durations of cooling for maximal efficacy. Citation Format: Campos-Gomez S, Claudis-Morales N, Campos-Gómez KA, Olivares-Mendoza B, García-Garcés M, Rojas-Cruz L. Chemotherapy-induced alopecia prevention and effects on quality of life among women with breast cancer: A study of a scalp-cooling system used in a Mexican public hospital. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-11-05.

An intelligent hospital device for health caring assistance of patients with motor disabilities

In this document we present an intelligence device which includes a monitor system for automatic movements of a robotic hospital bed based on posture classification and identification. This functionality has been developed in response to the requirements defined by the application of a diagnostic methodology [10]. Our diagnostic methodology applied on a Mexican public hospital allowed us to understand that the problem of mobility in elderly people and disabled people involves solutions like devices that attend these individuals to achieve movement without many complications. The movement of these patients can be performed routinely or sporadically during their stay in hospital. For patients who require certain routine application of this movement is designed an intelligent monitor system. This intelligent system allows medical experts to program the movements of the robotic bed considering the patient’s posture and time. We will show a methodology for bodies classification in real time. Our work considers the problem of human posture classification with few information (sensors), applying digital process to expand the original data of the sensors and so get more significant data for the classification, however, this is done with low-cost algorithms to ensure the real-time execution.

Safety and efficacy of scalp hypothermia to prevent chemotherapy-induced alopecia: A study of a scalp-cooling system used in breast cancer women in a Mexican public hospital.

e12021 Background: Hair loss is one of the side effects associated with chemotherapy treatments. It causes emotional disturbances and constantly reminds the patient of the disease. This study analyzed the effectiveness of scalp-cooling system for prevention of alopecia in breast cancer patients. Methods: The aim of this study was to examine the efficacy and safety of a scalp-cooling system to prevent chemotherapy-induced alopecia. 68 breast cancer patients receiving neo or adjuvant were included in a nonrandomized pilot study. The Dignicap system consists of a refrigerator unit and a control unit integrated into a mobile cabinet and connected to a tight-fitting cooling cap. Women accepting the scalp-cooling system were compared for alopecia against those who refused group of 68 patients similarly treated. Hair loss in the 136 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy and photo documentation. Concomitantly, tolerance and side-effects were also recorded in 68 accepting patients. Results: Nurses' ratings indicated that hair loss frequency was constantly lower, at each cycle of chemotherapy, in study patients with scalp-cooling system ( n = 68) than in those without (n = 68).Differences between the two groups were statistically significant at cycles 1 and 4 ( P < 0.05). Scalp cooling was generally very well tolerated; only three of 68 patients discontinued use of the cold cap due to discomfort and no scalp metastasis was observed among the 68 accepting patients followed up. Conclusions: This study demonstrates that scalp cooling was an effective and safe method of protection against hair loss caused by chemotherapy. Its routine use as part of neo or adjuvant chemotherapy, especially in cancers with low prevalences of scalp metastasis, should be seriously considered and should be clinically evaluated in a randomized trial and in studies using other chemotherapy regimens to determine optimal temperatures and durations of cooling for maximal efficacy.

PMD29 - Economic impact derived from the use of a catheter impregnated with Antibiotic in pediatric patients with hydrocephalus treated with external shunts in Mexico

Estimate the economic impact derived from the use of antibiotic-impregnated catheters vs. traditional, non-antibiotic-impregnated catheters for the treatment of hydrocephalus in pediatric patients with external shunts from a Mexican public hospital perspective (IMSS). An Excel-based decision tree was used to estimate the economic consequences of using an antibiotic-impregnated catheter (treatment group) vs. a catheter without antibiotic (control group) for target population. Given procedure volume variability in comparable hospitals, base-case scenario assumed 100 pediatric patients with hydrocephalus and only one potential infection after first catheter placement; the antibiotic-impregnated device was assumed as second-line treatment for both groups. Infection rates after catheter placement for considered alternatives were taken from published international meta-analyses (2.4% vs. 8.7% for treatment and control groups, respectively). Unitary costs were provided by internal resources (antibiotic-impregnated device) and by public bid results for base-case hospital (traditional catheter). Considered time horizon was <1 year, thus no annual discount rate for costs was necessary. Inflation-adjusted DRGs from IMSS´s high specialty hospitals were used as hospitalization (catheter placement) and catheter replacement costs. Results are shown in 2015-adjusted USD. Due to low reinfection rates documented in literature, posterior infections and mortality were not considered. The total cost of the catheter with antibiotic strategy resulted in $1,610,600, while the non-antibiotic catheter strategy in $1,542,200, resulting in additional $684 per patient treated with the antibiotic-impregnated device and $11,400 per avoided infection. The use of antibiotic-impregnated catheters appears to be a cost-effective alternative to treat hydrocephalus in pediatric patients in the Mexican setting. Local high-specialty hospitals should consider the adoption of this alternative as it yields less infections in target population.

A study of the impact of the 21-gene breast cancer assay on the use of adjuvant chemotherapy in women with breast cancer in a Mexican public hospital.

The majority of breast cancer patients in Mexico are treated through the public health system and >80% receive adjuvant chemotherapy. The aim of this prospective study was to characterize the impact of the Oncotype DX assay on adjuvant therapy decision making and the confidence in those decisions amongst public sector physicians in Mexico. Ninety-eight consecutive patients with ER+, HER2-, stage I-IIIa, N0/N1-3 node-positive breast cancer from the Instituto Nacional de Cancerología were eligible for the study. The primary endpoint was the overall change in treatment recommendations after receiving the assay results. Of 96 patients, 48% received a chemohormonal therapy recommendation prior to testing. Following receipt of results, treatment decisions changed for 31/96 (32%) patients, including 17/62 (27%) node-negative patients and 14/34 (41%) node-positive patients. The proportion of patients with a chemotherapy-based recommendation decreased from 48% pre- to 34% post-assay (P=0.024). 92% of physicians agreed that they were more confident in their treatment recommendation after ordering the assay. These results suggest that use of the 21-gene assay in the Mexican public health system has a meaningful impact on adjuvant treatment recommendations that may reduce the overall use of chemotherapy.

The Impact Of Transformational Leadership In Burnout Of Nurses And Doctors In A Public Hospital Of Mexico

This study analyzes the relationship between supervisors’ leadership styles and subordinates’ experience of burnout. We tested relationships between transformational, transactional and non leadership styles and facets of burnout (i.e., emotional exhaustion, depersonalization and reduced personal accomplishment), using the Bass and Avolio and Maslach Models, while controlling for subordinates’ demographics and hierarchical level. We applied the MLQ and MBI questionnaires to a sample of 102 employees in a Mexican Public Hospital to Doctors and Nurses. Our Structural Equations Models determined that inverse significant correlations were found between the different leadership subscales and burnout, excepting with those of the Laissez Faire, being positive. The theoretical and empirical findings of previous studies of the Model of Bass and Avolio, as well as of the Model of Maslach were reaffirmed; the subscale of depersonalization was eliminated. The reliability coefficients Alpha of Cronbach were higher than, 70 in all the variables.

Bodies of risk: Constructing motherhood in a Mexican public hospital

This article addresses the connection between risk and motherhood at an urban obstetrics hospital in Mexico. It primarily aims to explore the ways that clinicians define risk as well as how they conflate risk with bad motherhood. It discusses how clinicians' perceptions of their patients' social lives shape their interactions and decisions about the women's health. The study was based on interviews and participant observation in June 2008 and June–July 2011 with 71 obstetrical patients, 30 physicians, 9 nurses, and 12 midwives in the city of Puebla. Results show that birth itself was defined as a risky event, clinicians conflated social factors with biological factors in their management of risk, and the patients were a priori classified as bad mothers. This article proposes a reproductive habitus to explain the connection between health institutions, class, responsibility, blame, and clinical decision-making to analyze how risk is managed and blame enacted upon women's bodies.

289P - A Study of the Impact of the 21-Gene Breast Cancer Assay on the Use of Adjuvant Chemotherapy in Women With Breast Cancer in a Mexican Public Hospital

ABSTRACT Background The majority of early stage breast cancer patients in Mexico are treated through the public health system, and >80% are treated with chemotherapy (CT). The 21-gene assay (Oncotype DX®) is available in Mexico but has been utilized primarily within the private health system. There are no data that describe the potential impact of the assay on adjuvant treatment decision-making for public sector patients. The aim of this study is to characterize how assay results impact the decision-making process and confidence of public sector physicians in Mexico to determine adjuvant therapy. This is the first decision impact study of the Oncotype DX assay in Latin America. Methods At total of 98 consecutive patients with ER + , HER2-, stage I-IIIa, N0/N1-3 breast cancer from the Instituto Nacional de Cancerologia in Mexico City, Mexico, were enrolled in the study. Via consensus discussion in multidisciplinary team meetings, physicians completed pre- and post-assay questionnaires regarding adjuvant treatment recommendations for each enrolled patient. The primary endpoint was the overall change in physician treatment recommendations resulting from the addition of the Recurrence Score® result in the decision-making process. Results Pre- and post-assay results were available for 96 patients. Treatment decisions changed for 31/96 (32%: 95% CI 23%-43%) patients; 17/62 (27%; 95% CI 17%-40%) N0 and 14/34 (41%; 95% CI 25%-59%) N1-3 patients. Post-assay, 8/50 (16%) of patients initially recommended hormonal therapy (HT) were recommended chemohormonal therapy (CHT) or CT, and 21/46 (46%) of patients initially recommended CHT/CT were recommended HT alone. The proportion of patients recommended CT decreased from 48% pre- to 34% post-assay (p = 0.024), a decrease of 14% overall, 6% in N0, and 26% in N1-3 patients. Conclusions These results suggest that use of the 21-gene assay in the Mexican public health system has an impact on adjuvant treatment recommendations and may reduce the use of chemotherapy. Post-Assay Pre-Assay Adjuvant Therapy HT alone CT + HT CT alone Total HT alone 42 (44%) 7 (7%) 1 (1%) 50 (52%) CT + HT 21 (22%) 23 (24%) 2 (2%) 46 (48%) Total 63 (66%) 30 (31%) 3 (3%) 96 Disclosure C. Yoshizawa: Genomic Health- Employment and Stockholder. E. Burke: Genomic Health- Employment and Stockholder. C. Chao: Genomic Health- Employment and Stockholder. All other authors have declared no conflicts of interest.

Correlation between anxiety in labor and duration as well as outcome

Correlation between anxiety in labor and duration as well as outcome

Cost-effectiveness study of clomiphene citrate versus anastrozole for inducing ovulation in infertile adult patients in a public hospital, La Raza in Mexico City

Objective To evaluate the cost-effectiveness (CE) ratio of clomiphene citrate versus anastrozole in the induction of ovulation in infertile adult women attending a Mexican public hospital. Methods A CE study was conducted from a hospital perspective. A clinical pilot study was carried out at the La Raza hospital. Thirty patients with infertility due to anovulation were recruited and grouped as follows: group A was treated with clomiphene citrate and group B with anastrozole. Efficacy data and adverse events of both drugs were obtained from the above-described clinical pilot study with Mexican women patients and through a systematic review of published medical literature. Efficacy data were analysed using meta-analysis; direct and indirect costs were gathered and calculated by the micro-costing technique, and a 1-year time horizon was considered. The Monte Carlo Markov model was used, and quality-adjusted life years (QALYs) were used as the unit of effectiveness. Incremental and sensitivity analyses were performed and we investigated the effect of a 5% discount rate. Key findings The odds ratios from the meta-analysis were 0.86 for ovulation induction and 1.46 for pregnancy. The most cost-effective therapy was clomiphene citrate at US$405/QALY in comparison to US$457/QALY for anastrozole. The incremental cost was US$52/QALY. The result of the discount rate for the most cost-effective therapy projected for 5 years was US$1288. The sensitivity analysis did not show changes for the most cost-effective therapy when the effectiveness probabilities or the treatment costs were modified. Conclusion Conventional treatment with clomiphene citrate therapy has the highest cost-effectiveness for the population studied.

The costs of breast cancer in a Mexican public health institution

Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.