Biobanks: Experience of the School of Medicine and the “Dr. José Eleuterio González” University Hospital of the Universidad Autónoma de Nuevo León

Medical research has greatly beneited from molecular biology and increasingly relies on tools from the “omics” disciplines (mainly genomics, transcriptomics, proteomics and metabolomics). The availability of biological samples preserved with high quality standards is a sine qua non condition for such studies and their repositories are referred to as biobanks. Biobanks support the transportation, storage, preservation, and initial pathological and analytical examinations of biospecimens, as well as the protection of relevant information and the comparison of clinical and laboratory findings. A biobank facility is one of the most valuable tools the academic medicine organizations can offer to their researchers to improve the competitiveness of their current and future medical research. it acts as an essential bridge and an effective catalyst for research synergies between basic and clinical sciences, and it can be potentiated with efforts to raise funds for acquiring and maintaining cutting-edge analytical infrastructure to better serve its clinical, pharmaceutical and biotech clients.

Sensitization to indoor aeroallergens in children who attended the Allergy Service of the “Dr. José Eleuterio González” University Hospital of Monterrey, Mexico

Background: Indoor aeroallergens are the main cause of sensitization in children and represent a risk factor for the development of allergic diseases. Objective: Identify the major indoor aeroallergens most often sensitized to pediatric patients treated at the Allergy Service at the “Dr. José Eleuterio González” University Hospital of Monterrey Methods: We performed an observational and descriptive study where we reviewed reports of positive skin tests to the following common indoor aeroallergens: Dermatophagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus), Canis familiaris (C. familiaris), Felis domesticus (F. domesticus), Blattella germanica (B. germanica) and Periplaneta americana (P. americana), found in patients under 16 years with symptoms of allergy, during the period of 2011-2012. Results: We performed 439 skin tests to aeroallergens in pediatric patients. Of these, 57.6% were male and 42.4% were female. Mean age was 6.3 years. The age groups were under 3 years: 17.8%, 3-5 years: 35%, 6-12 years: 36%, and 13-16 years: 11.2%. The main diagnoses were: allergic rhinitis (71.8%), asthma (16.6%), and atopic dermatitis (4.3%). In 57.9% of the cases, they had at least one positive skin test to any aeroallergen. The rate of sensitization to speciic aeroallergens was: D. Pteronyssinus 49.0%, D. farinae 44.6%, B. germanica 13.9%, P. Americana 10.9%, F. domesticus 10.7%, and C. familiaris 5.9%. Conclusion: Indoor aeroallergen sensitization can occur early in life, although it was more frequent in the preschooler and elementary school group. Dust house mites were the most commom cause of allergic sensitization.

Impact of a fall prevention program in the Internal Medicine wards of a tertiary care university hospital

Objective: To determine whether a falls prevention program reduces the incidence of falls within a hospital. Materials and methods: Each patient admitted to the Internal Medicine ward was classiied into a risk category (high, medium, low) according to the scale of J.H. Downton, and then various general and speciic measures were applied by risk group. Interventions included appointments, teaching materials, and training of medical staff and family. Furthermore, a registration system was developed that allowed adverse event fe edback to the program and identiicat ion of the causes of the fall. The SPSS version 20.0 was used for the data analysis. Descriptive analysis was used for quantitative variables, and qualitative variables were expressed as proportions. To compare the rate of pre- and post-program implementation falls, x 2 was used, with a  = 0.05 determining a signiicant statistical value. Results: Since the implementation of the program, the rate of falls per 1000 days/patient decreased from 1.9 in 2007 to 0.67 in the period 2008-2013, representing a decrease of the rate of falls of up to 70%, with a statistically signiicant difference (P=.02). Conclusions: The implementation of a falls prevention program is an effective tool and reduces the rate and complications associated with them.

Frequency of metabolic syndrome in women treated at the Menopause Clinic of the “Dr. José Eleuterio González” University Hospital of the UANL in Northeastern Mexico

Objectives: To determine the frequency of metabolic syndrome (MS) in patients with menopause, and to compare the incidence of MS between surgical and natural menopause. Methods: This was an observational, longitudinal, descriptive, retrospective, unblinded study of cases seen at the Menopause Clinic of the University Hospital “Dr. José eleuterio González” of the Universidad Autónoma de Nuevo León from March 2009 to December 2011. The frequency of MS was determined based on Adult Treatment Panel III (ATPIII) classiication. Results: at the end of the study, 391 patients were evaluated. The mean age was 50.1 years. We found a frequency of MS of 38.1%, the risk factor most often found was low HDL cholesterol (62.5%), followed by obesity (46.5%), hypercholesterolemia (42.3%), hyperglycemia (11.5%), and hypertension (7.7%). The incidence of natural and surgical menopause was 37.6% vs. 39.2% respectively; however, the result was not statistically signiicant (p = 0.093). Conclusions: Patients with menopause are at increased risk of developing MS. it is important to detect MS early in this of patients, when they have one risk factor to avoid complications which may trigger the syndrome. We recommend screening for MS during perimenopause, in order to detect and try to delay it in a timely manner and recommend primary prevention (diet and exercise), or secondary prevention in cases with one or more risk factors.

Frequency of metabolic syndrome in women treated at the Menopause Clinic of the “Dr. José Eleuterio González” University Hospital of the UANL in Northeastern Mexico

Objectives: To determine the frequency of metabolic syndrome (MS) in patients with menopause, and to compare the incidence of MS between surgical and natural menopause. Methods: This was an observational, longitudinal, descriptive, retrospective, unblinded study of cases seen at the Menopause Clinic of the University Hospital “Dr. José eleuterio González” of the Universidad Autónoma de Nuevo León from March 2009 to December 2011. The frequency of MS was determined based on Adult Treatment Panel III (ATPIII) classiication. Results: at the end of the study, 391 patients were evaluated. The mean age was 50.1 years. We found a frequency of MS of 38.1%, the risk factor most often found was low HDL-cholesterol (62.5%), followed by obesity (46.5%), hypercholesterolemia (42.3%), hyperglycemia (11.5%), and hypertension (7.7%). The incidence of natural and surgical menopause was 37.6% vs. 39.2% respectively; however, the result was not statistically signiicant (p = 0.093). Conclusions: Patients with menopause are at increased risk of developing MS. it is important to detect MS early in this of patients, when they have one risk factor to avoid complications which may trigger the syndrome. We recommend screening for MS during perimenopause, in order to detect and try to delay it in a timely manner and recommend primary prevention (diet and exercise), or secondary prevention in cases with one or more risk factors.

Prevalence of colonizing bacteria and their association with primary bacteremias in hemodialysis of a university hospital

to be from 2.5 to 5.5 cases per 1,000 catheter-day. the clinical impact is relevant and increases the cost of the HD Unit. Methods: The present study is the irst of 2 phases. It was conducted from January to December of 2012, and included all patients and nurses who were in the HD Unit. The prevalence of Gramnegative bacilli (GNB) and methicillin-resistant Staphylococcus aureus (MrSA) colonizing the nasal passages and the skin is described. Also, phenotypic association was sought by genus, species and sensitivities between colonizing bacterial strains and blood cultures with GNB and MRSA. Results: the study included 70 patients and 10 nurses. the prevalence of nasal colonization in patients by GNB was 9% and 6% in the pericatheter, and no nursing GNB colonization was discovered. The prevalence of MRSA nasal colonization was 19% and 6% in the pericatheter for patients and in the nurses the nasal colonization was 50% and 10% in the hands. We identiied 29 cases of primary bacteremia. The primary bacteremia rate is 1.5 per 1,000 catheter-day or 0.4 episodes per patient per year. Conclusion: We demonstrated a high prevalence of MrSA colonization in patients and nurses in the HD Unit. No relationship was found between primary bacteremia by GNB and patients and nurses’ bacteria colonization by the phenotypic comparison.

Ratio of hemocomponents in massive transfusion and mortality of trauma patients in a university hospital

Background: Nowadays, there are very few studies about massive transfusion in our country. This situation generates the necessity to the elevation of possible new strategies to diminish mortality and its adverse effects. Material and methods: All massive transfusions were evaluated in a retrospective way from October 2010 to October 2012. All diagnosis groups were recorded and the patients were divided into three groups depending on the ratio between packed red blood cells (PRBC) and fresh frozen plasma (FFP) units (ratios ≤2, >2, and without FFP). Their mortality and/or survival were evaluated 30 days after as well as all the factors associated with the event. Results: A total of 69 patients were included (37 trauma patients, 28 gunshot wounds and 4 with lacerated wounds); the groups (ratios ≤2, >2, and no plasma at all) were distributed as follows: 30, 30 and 9 patients each, with an overall mortality rate of 60.8% within 30 days. A lower survival rate (12%) in the no plasma group (P=.015) was found and systolic blood pressure during transfusion had a mean of 67.7 mmHg (P=.012) in this group. Fresh frozen plasma units were 136 and 249 for >2 and ≤2 ratios respectively (P<.01); 85.5% of all patients developed metabolic acidosis during the transfusion, and the number of days in the hospital after the event had a mean of 24.5 days in all patients. Conclusions: High rates of massive transfusion mortality are still being reported in our ield. The use of transfusion strategies contribute to elevate the survival rate in patients with massive transfusion treatment

Nutritional screening and prevalence of hospital malnutrition risk. University Hospital of the UANL, Monterrey

Introduction: Hospital malnutrition risk has prevalence values of 20%-50%, and it is a major health problem in the health institutions worldwide. Objective: To assess the accomplishment of nutritional screening and the prevalence of hospital malnutrition risk in a University Hospital. Materials and methods: A retrospective analysis was carried out with nutritional screening, using primary data from six clinical areas obtained in the period between July 2012 and December 2013. According to previous results in Mexican health institutions and considering a mean malnutrition risk prevalence of 50%, it was calculated that a sample size of 3200 subjects was required for the assessment of valid risk values. Patients with values ≥3 on the Nutritional Risk Screening (NRS, 2002) were classiied as carriers of nutritional risk. Results: A total of 5611 patients (38% of all patients admitted) were studied. The rate of screening declined from 55% in 2012 to 31% in 2013. During the whole period, 3034 patients were classiied with risk of malnutrition (54% prevalence). Conclusions: The prevalence of hospital malnutrition risk was high. The accomplishment of the nutritional screening was deicient, and declined between 2012 and 2013. The lack of nutritional screening does not meet the vital care requirements of hospitalized patients and prevents the timely treatment of those at malnutrition risk.

Terminal interruption of relux source technique in the treatment of active venous ulcers

Introduction: The treatment for venous ulcers in most cases is unsatisfactory, with recurrences and poor healing. Objective: to evaluate adjuvant therapy in the treatment of active venous ulcers. Methods: We analyzed 20 patients with active venous ulcers attending the general Surgery outpatient clinic at the “Dr. José eleuterio gonzález” University Hospital from October 2012 to January 2013. they were randomly divided into 2 groups: group A (11 patients) underwent compression therapy and group B (9 patients) underwent compression therapy plus removal of the vein that gives terminal relux to the ulcer, guided by ultrasound (microphlebectomy). Patients were evaluated weekly (8 weeks). At each assessment, photographs and lesion measurements were taken and pain was evaluated using the visual analog scale. Results: No significant differences were found between the study groups in terms of age, weight, height, body mass index (BMi), ankle-brachial index, and baseline measurement of the ulcer (p>0.05). Group B showed a greater reduction in ulcer size and a statistically signiicant lower score on the visual analog pain scale (p<0.05) from the second and third week of treatment, respectively. Conclusions: the results obtained in patients with surgical procedure (group B) are consistent with the reported eficacy of chronic venous ulcer treatment with saphenectomy (conventional surgery), the difference is that in this study we used a minimally invasive procedure (microphlebectomy).

Laryngeal amyloidosis: An uncommon cause of dysphonia

Introduction: Amyloidosis is used to describe a range of disorders deined by extracellular deposition of abnormal protein ibrils. The larynx is the most common site of localized amyloidosis in the head and neck region and constitutes less than 1% of benign laryngeal lesions. Hoarseness is the most common symptom. Objective: Prospective clinical evaluation of patients with localized laryngeal amyloidosis. Clinical cases: Presented are 4 cases of patients with localized laryngeal amyloidosis who were treated at the Otolaryngology and Head and Neck Surgery Department at the “Dr. José Eleuterio González” University Hospital in Monterrey, Mexico. Three patients underwent phonomicrosurgery by direct microlaryngoscopy with the removal of the amyloid implantation using a cold knife excision with great results. In each patient the major site of involvement was the supraglottis with a small focus on the false vocal cord. A medical work-up, including a complete blood count (CBC), a basic metabolic panel, urinalysis, liver function test, chest X-ray and physical examination were performed to rule out the presence of systemic disease; no amyloidosis or signs of systemic disease were found. Congo red staining conirms the diagnosis of amyloidosis in all surgical specimens. Conclusions: In laryngeal amyloidosis, the treatment should be directed toward the improvement of the voice and the maintenance of the airway.

Smoking, depression, and suicide risk in the nursing staff of a Third-Level Hospital

Objective: To determine the association between smoking, depression and suicide risk in the Nursing Staff of a University Hospital. Materials and method: this was a non-experimental, correlational cross-range study with observational analysis carried out between May 2012 and May 2013. We studied 232 nurses of the “Dr. José Eleuterio gonzález” University Hospital. two self-administered scales were applied, one for depression and one for suicide risk. Another hetero-applied scale of nicotine dependency was also used, and the subjects’ socio-demographic records were reviewed. Results: A total of 527,232 nurses were studied. A smoking prevalence of 22.8% (53 subjects), an operational depression prevalence of 15.1% (35 subjects), and a suicide risk of 5.1% (12 subjects) were found. Gender and age, speciically being male and young (mean age 29.2 years) were found to increase the risk of smoking. We also found that those nurses who had a partner and had a higher level of education smoked less compared to those who did not have a partner or had a lower degree of education. there were hospital departments where there was a higher prevalence of smoking, such as Internal Medicine and Shock trauma. No association between smoking and the presence of depression was found. Regarding depression, we found that those nurses who worked in the Department of Pensioners were more likely to develop operational depression than those working in any other department. We also found that the risk of presenting operational depression decreases as age increases. About suicide risk, a statistically signiicant association between smoking and suicide risk was found. We also found an association between operational depression and suicide risk.Conclusions: It is recommended to consider nicotine dependence as a fundamental part of psychopathology assessment because of its strong association with suicide risk. this study emphasizes the complexity of the issue of the comorbidity of smoking and psychopathology and the need to continue research lines.

Comparison of the eficacy and safety of 4 mg of ondansetron vs. 4 mg of nalbuphine for the treatment of neuraxial morphineinduced pruritus

Objective: To compare the eficacy and safety of 4 mg of ondansetron vs. 4 mg of nalbuphine for the treatment of neuraxial morphine-induced pruritus, in patients at the “Dr. José Eleuterio González” University Hospital from September 2012 to August 2013. Material and methods: A controlled, prospective, randomized study of 28 patients (14 per group) receiving neuraxial morphine analgesia was conducted, which was registered and approved by the ethics Committee of the Institution and patients agreed to participate in the study under informed consent. The results were segmented and contrasted (according to drug) by hypothesis testing; the association was determined by X2 with a 95% conidence interval (CI). Results: Pruritus was effectively resolved in both groups and no signiicant difference was found in the rest of the variables. An increase in the visual analogue scale (eVA) was observed at 6 and 12 hours for the ondansetron group, which was statistically signiicant (p≤0.05), however both groups had an eVA of less than 3. Conclusions: When comparing the eficacy and safety of ondansetron 4 mg vs. nalbuphine 4 mg for the treatment of neuraxial morphine induced pruritus, the only signiicant difference found was the mean eVA at 6 and 12 hours, favoring the ondansetron group. However, both groups scored less than 3 on the eVA. Therefore, we consider that both treatments are effective and safe in the treatment of pruritus caused by neuraxial morphine.