[Characterization of stroke patients attended at IMSS hospitals in Mexico City].

Background: Cerebrovascular disease (CD) is considered a problem of huge social, economic and public health implications worldwide in adults and elderly. In Mexico, the information concerning the provision of services to people and their characteristics is limited. The objective is to describe the characteristics of patients with CV who attended the hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City.

[Key recommendations of the clinical guidelines of arterial hypertension in primary care].

Background: Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making.

[Methodology for the development and update of practice guidelines: current state].

The current scenario of health services in Mexico reveals as a priority the implementation of strategies that allow us to better respond to the needs and expectations of individuals and society as a whole, through the provision of efficient and effective alternatives for the prevention, diagnosis and treatment of diseases. In this context, clinical practice guidelines constitute an element of management in the health care system, whose objective is to establish a national bechmark for encouraging clinical and management decision making, based on recommendations from the best available evidence, in order to contribute to the quality and effectiveness of health care. The purpose of this document is to show the methodology used for the development and updating of clinical practice guidelines that the Instituto Mexicano del Seguro Social has developed in line with the sectorial model in order to serve the user of these guidelines.

[Experience of the Mexican National Health System in the development of clinical practice guidelines].

Background: Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence.

Objective: The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico.

Material And Methods: The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination.

[General Strategies for Implementation of Clinical Practice Guidelines].

The need to use clinical practice guidelines (CPG) arises from the health conditions and problems that public health institutions in the country face. CPG are informative documents that help improve the quality of care processes and patient safety; having among its objectives, to reduce the variability of medical practice. The Instituto Mexicano del Seguro Social designed a strategic plan for the dissemination, implementation, monitoring and control of CPG to establish an applicable model in the medical units in the three levels of care at the Instituto.

[Clinical practice guideline on closed tibial plateau fractures in adulthood].

Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture.

[Clinical practice guideline. Traumatic urethral stenosis in males].

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial.

Modifying cancer patients' attitudes towards medical care received in the oncology service.

Background: Attitude changing involves a holistic change on individual biopsychosocial structure. That attitude is understood by behaviors, thoughts, feelings and higher mental processes involved with behavior. This attitude will be considered in two ways: favorable or unfavorable, through a part of the environment.

Survey on physicians' knowledge and attitudes towards clinical practice guidelines at the Mexican Institute of Social Security.

Objective: A survey was organized to determine the general level of knowledge and attitudes of medical personnel towards clinical practice guidelines (CPG).

Methods: A questionnaire modified from two validated instruments was used. Multi-stratified sampling was applied, and 1782 questionnaires were completed.

[A clinical guideline for diagnosis and treatment of hydrocele in childhood].

Objective: To develop a guideline available to the medical staff of the first and second level of care, which includes recommendations based on the best available evidence about diagnosis and management of hydrocele in the pediatric patient.

Methods: Clinical questions were formulated and structured. Standardized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of hydrocele in children.

[The clinical guidelines of practice project at the Instituto Mexicano del Seguro Social].

The advance in the knowledge and technology is growing quickly and greater quantity, so it is difficult for the health professional to access to whole information that is generated every day on diagnostic and therapeutic strategies more effective, so the clinic practice guidelines (CPG) is a resource to support the updating of the health professional and support them in making clinical decisions. The CPG is also a better support to the manager of health services in making decisions regarding the strategies that have performed for the patient and less risk to the individual and collective health. They also support the response capacity of the medical units and hospitals and guide the planning of services to the optimization of the resources.

[Lymphatic mapping and sentinel lymph node biopsy in patients with high risk squamous cell carcinoma of the skin].

Background: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors.

Objective: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC.

[Cost-effectiveness analysis of nuclear cardiology and its impact on total expense for diagnosis of coronary artery disease].

Background: Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies.

[Physiopathological alterations secondary to extracorporeal circulation in cardiac surgery].

Cardiopulmonary bypass (CPB) is one of the methods used in myocardial revascularization and can be associated with adverse events that are uncommon, but CPB induces high morbidity and mortality. Cardiac surgery and CPB activate a systemic inflammatory response characterized by tissular lesions, cells movements and blood flow toward the interstice where the harmful stimulus has begun, under the influence of the mediators. The systemic inflammatory response may be initiated during cardiac surgery by a number of processes, including blood contact with the foreign surface of the CPB apparatus, development of ischemia and reperfusion injury, and presence of endotoxemia.

[Left atrial dissection. Review].

The left atrial dissection is a rare complication occurring mainly after mitral surgery, thoracic trauma, myocardial infarction and infectious endocarditis. The clinical diagnosis can be confused with isolated prosthetic dysfunction, myocardial infarction. Its onset and, its form of presentation vary widely, concerning to the intensity and to the moment in which the symptoms appear.

[Mitral valve prolapse. A review].

Primary mitral valve prolapse (MVP) or the disease known as MVP, consists of mixomatous degeneration of the mitral valve with systolic displacement of a portion or all of one or both mitral leaflets beyond mitral annulus into left atrium during systole, associated or not with mitral insufficiency. Prevalence in Mexican population is <2%. MVP behavior is benign unless associated with mitral insufficiency (MI, moderate-to-severe) or complications, or is associated with other syndromes.

[Nosocomial infection surveillance: experience at a cardiology hospital in Mexico].

Objective: To describe the results of the Nosocomial Infection surveillance program at the Cardiology Hospital in Centro Médico Nacional Siglo XXI of the Mexican Social Security Institute.

Methodology: To inform of the epidemiologic follow-up results from January 2000 to July 2003. Global frequency, infection rates by infection site, hospital services, and frequency of most common microorganisms were estimated.