eSalud en servicios de salud públicos en México: estudio de caso / E-Health in Public Health Services in Mexico: Case Study

El presente trabajo tiene el objetivo de explorar el desarrollo de las tecnologías de la información y comunicación (componentes de eSalud) en servicios de salud públicos de México, así como indagar sobre los facilitadores y barreras para su implementación. Se realizó un estudio de caso en el Instituto de Servicios de Salud del Estado de Aguascalientes utilizando un abordaje mixto de tipo concurrente y de predominancia cualitativa que incluyó observación no participante, entrevistas semiestructuradas y un cuestionario dirigido al personal médico. A través del estudio, se identifican diversas oportunidades de mejora en cuanto al acceso y desarrollo de las tecnologías de la información y comunicación; también se identifican diversas barreras para su implementación factibles de superarse. En cuanto a las limitaciones del estudio, se reconoce la exploración de perspectivas sólo desde la oferta de servicios. En lo que respecta a la originalidad, destaca la investigación integral de diferentes componentes de eSalud. Se concluye que es necesario fortalecer las políticas de las tecnologías de información y comunicación dirigidas al sector salud con el fin de optimizar su desarrollo e implementación

The purpose of this work is to explore the development of the Information and Communication Technologies (e-Health components) in public health services of Mexico, as well as to inquire into the enablers and barriers to its implementation. A case study was conducted at the Instituto de Servicios de Salud del Estado de Aguascalientes using a mixed approach of concurrent type and qualitative predominance that included non-participant observation, semi-structured interviews and a questionnaire addressed to medical staff. Through the study, diverse improvement opportunities for the access and development of the Information and Communication Technologies were identified; diverse barriers to its implementation were also. The study has the limitation of taking only the services offer perspectives. The originality of this study is the comprehensive research of e-Health components. It is concluded that it is necessary to strengthen the Information and Communication Technologies policies focused to the health sector in order to optimize its development and implementation

Tratamiento artroscópico de la epicondilitis lateral crónica. Resultados a corto plazo de tres casos / Arthroscopic treatment of chronic lateral epicondylitis. Short-term results of 3 cases

Resumen: Objetivo: Mostrar el resultado a corto plazo de la liberación artroscópica en pacientes que presentan epicondilitis crónica lateral. Material y métodos: Se realiza liberación artroscópica de tres pacientes con epicondilitis lateral. Seguimiento de seis meses. Se utiliza la escala de Clínica Mayo para valoración de resultados. Se lleva a cabo revisión y discusión de la literatura. Resultados: Dos pacientes del género femenino y uno del género masculino dedicados a las actividades cotidianas, no deportistas. El dolor fue el síntoma capital que afectó el puntaje de la escala de valoración. Estos puntajes mejoraron luego de la cirugía. Se logró retorno precoz a sus actividades cotidianas. No se reportaron complicaciones neurológicas. Discusión: El tratamiento artroscópico resultó una alternativa segura y eficaz para el tratamiento de la epicondilitis lateral en estos tres pacientes, el cual permite realizar simultáneamente exploración articular con fines diagnósticos y tratar patologías asociadas. Se requieren series más amplias y estudios comparativos a fin de establecer protocolos definitivos en nuestra casuística.

Abstract: Objective: To assess the outcome of arthroscopic release in three patients with chronical lateral epicondylitis. Material and methods: Arthroscopic release in three patients with lateral epicondylitis is performed. Mayo Clinic scale for evaluation of results is used. A review and discussion of the literature is made. Results: Three patients, two female and one male, the common activities was principal labors, not athletes. Patients had significant pain. It was the principal symptom that affect the score of the rating scale. These scores improved after surgery. It was achieved early return to normal daily activities. No neurological complications were reported. Discussion: Arthroscopic treatment was an alternative safe and effective for treating chronical lateral epicondilitis in this three cases. It allows simultaneous joint exploration for diagnostic purposes and to treat associated pathologies. Broader Series and studies are necessary in order to establish definitive protocols in our cases.

Infarto talámico bilateral secundario a oclusión de la arteria de Percherón / Bilateral thalamic infarct secondary to Percheron's artery occlusion

Resumen: La arteria de Percherón es una variante vascular que se caracteriza por una arteria tálamo-perforante dominante originada en el segmento P1 de la arteria cerebral posterior y se bifurca para irrigar a ambos tálamos en su porción paramedial. Su obstrucción se traduce en infartos talámicos bilaterales en el sitio paramedial. Se comunica el caso de un paciente de 85 años de edad con alteraciones en el estado de conciencia, con poca interacción con el medio y parálisis vertical de la mirada, al que se le realizó una resonancia magnética que evidenció infartos talámicos bilaterales. Las lesiones talámicas bilaterales son poco frecuentes. Los infartos talámicos representan 11% de los eventos vasculares y los bilaterales de 22 a 35% de los eventos vasculares talámicos; generalmente son de origen embólico y en raras ocasiones se asocian con hipoperfusión. La tríada típica incluye alteraciones del estado de conciencia, alteraciones de la memoria y parálisis vertical de la mirada. Aunque es una enfermedad infrecuente, es importante considerar la realización de estudios de imagen en pacientes con alteraciones del estado de conciencia que permitan descartar infartos talámicos como parte del diagnóstico diferencial.

Abstract: The Percheron's artery is a vascular variant characterized by the presence of a dominant thalamic-perforating artery originated in the P1 segment of the posterior cerebral artery; it forks to irrigate both thalamus in its paramedial portion. Its obstruction results in bilateral thalamic infarcts in the paramedial site. This paper reports the case of an 85-year-old man evaluated for alterations in the state of consciousness, associated with little interaction with the environment and vertical paralysis of the gaze. MRI evidenced bilateral thalamic stroke. The presentation of bilateral thalamic lesions is rare. The thalamic infarcts represent 11% of the vascular events, and the bilateral events 22 to 35% of the thalamic vascular events; they usually have an embolic origin and they are rarely associated with hypoperfusion. The typical triad includes alterations of the state of consciousness, alterations of the memory and vertical paralysis of the gaze. Although this is an infrequent disease, it is important to consider the performance of imaging studies in patients with alterations of the state of consciousness that allow to discard thalamic infarctions as part of the differential diagnosis.

Antiproliferative Effect of Portlandia Extracts and Their Fractions on Breast Cancer Cells.

Aim: Rubiaceae is one of the largest families of plants and it includes the Jamaican genus Portlandia. This family has been used in several ethnomedicinal practices. Thus, in this study we investigated whether extracts of two species of Portlandia affect In vitro proliferation of breast cancer cells. Study Design: Metastatic (MDA-MB-231 and HeLa) cells were incubated in the absence or in the presence of Portlandia extracts. A human non-metastatic (MCF-10A) and normal (ATCC PCS-600-010) epithelial cell lines were used as control. Methodology: At the end of the study all cell lines were incubated with Portlandia extracts (-and its subfractions-) and then analyzed on proliferation, thymidine incorporation and mitogenic and survival signaling pathways on metastatic and non-metastatic cells. Results: It was found that Portlandia methanol extract inhibited proliferation of MDA-MB- 231 in a dose-dependent manner attenuating the phosphorylation of Erk1/2 and Akt1 without affecting the proliferation of MCF-10A cells. [3H] thymidine incorporation was also decreased by Portlandia methanol extract. This study suggests that Portlandia extracts selectively affected the proliferation of metastatic breast cancer cells through the modulation of Erk1/2 and Akt1 activities that play a critical role during cell survival and proliferation. Conclusion: Portlandia leaf extracts contain active compounds, which strongly repress cancer cell proliferation in a dose-dependent manner and selectively down-regulate phosphorylation of both Erk1/2 and Akt1 activities.

Sistema de bajo costo y alto rendimiento para bioensayos farmacológicos in vitro de tejido vivo / Low-Cost and High-Throughput System for Pharmacological Bioassays of Living Tissue in vitro

La potencialidad terapéutica de fármacos se averigua mediante estudios bioquímicos y celulares que nos hablan de sus acciones sobre vías de señalización y receptores. Sin embargo, en algunas enfermedades -por ejemplo, enfermedades neurológicas conocidas como "desórdenes del movimiento"-, los bioensayos realizados miden las acciones farmacológicas mediante valoraciones conductuales en modelos animales de las mismas. No se han logrado bioensayos que correlacionen la acción terapéutica de fármacos sobre la actividad del tejido vivo. Se puede medir la actividad de decenas de neuronas mediante imagenología de calcio en tejido vivo. Ciertos parámetros de esta actividad neuronal registrada in vitro reflejan su estado patológico, así como la acción terapéutica de fármacos determinados. No hay un sistema integrado orientado a estos bioensayos, por lo que se combinan diferentes equipos comerciales de manera independiente con costo final de alrededor de 100,000 USD. Presentamos un prototipo de un sistema integral encaminado a realizar este tipo de bioensayos: microscopía de epifluorescencia con calidad suficiente para adquirir y medir cuantitativamente la actividad celular del tejido vivo registrada in vitro pero de costo 10 veces menor -alrededor de 10,000 USD-. Se pueden realizar satisfactoriamente bioensayos funcionales de uso potencial en la industria farmacéutica, investigación y docencia.

The therapeutic potential of drugs is determined by biochemical and cellular studies that inform us about their actions on signaling pathways and receptors. However, in some diseases -for example, neurological diseases such as "movement disorders"-, bioassays measure the pharmacological actions by evaluating behavior in animal models of the diseases. There are no bioassays that correlate drug therapeutic actions on living tissue. The neural activity of several neurons can be measured by using calcium imaging on living tissue. Certain parameters of the recorded neuronal activity in vitro reflect the pathological state and the therapeutic actions of specific drugs. There is no integrated system oriented to these bioassays, so different commercial equipment has to be integrated independently with costs about 100,000 USD. We present a prototype of an integral system aimed to perform bioassays in vitro: epifluorescence microscopy with enough quality for the acquisition and quantitative assessment of cell activity recorded in the living tissue with costs around 10 times less -about 10,000 USD-. It allows successfully functional bioassays of potential use in the pharmaceutical industry, research an education.

Interacciones tróficas de las seis especies de peces más abundantes en la pesquería artesanal en dos bahías del Pacífico Central Mexicano

Trophic interactions of the six most abundant fish species in the artisanal fishery in two bays, central Mexican Pacific. We surveyed the trophic components in six species of Bahía de Navidad and Bahía de Chamela: Microlepidotus brevipinnis, Caranx caballus, Haemulon flaviguttatum, Lutjanus guttatus, L. argentiventris and Mulloidichthys dentatus. Two main seasonal periods were considered: 1) North Equatorial Counter Current NECC period influence (T1) and 2) California Current CC period influence (T2). In Bahía de Navidad 78 prey taxa were identified in the stomachs. From July to December (T1), 64 prey taxa were found, and from January to June (T2), 45 prey items. In Bahía de Chamela 93 prey items were identified; 74 during T1 and 60 during T2. The highest prey number was found in the stomachs of M. dentatus during T1 in Bahía de Navidad and the lowest prey number (7) was recorded in H. flaviguttatum in Bahía de Navidad in the same period. Crustaceans were the most frequently recorded prey items, followed by fishes, mollusks, polychaetes, and echinoderms in both seasonal periods and sites. The six fish species studied are considered as specialist feeders due the low values of the niche breadth index. There was little similarity among the diets. Rev. Biol. Trop. 58 (1): 383-397. Epub 2010 March 01.

Se analizaron los componentes tróficos de las seis especies de peces más importantes en la captura de la pesquería artesanal en las Bahía de Navidad y Chamela, ubicadas en la costa de Jalisco, México. Las especies estudiadas fueron Microlepidotus brevipinnis, Caranx caballus, Haemulon flaviguttatum, Lutjanus guttatus, Lutjanus argentiventris y Mulloidichthys dentatus. Se consideraron dos periodos de estudio de acuerdo a las pautas hidroclimáticas y los patrones de producción biológica en la zona: periodo de influencia de la Contracorriente Norecuatorial (T1), y periodo de influencia de la Corriente de California (T2). En Bahía de Navidad se identificaron 78 presas en total para las seis especies. En el periodo comprendido entre julio y diciembre (T1) se identificaron 64 presas y 45 de enero a junio (T2). En Bahía de Chamela se identificaron 93 presas, encontrando 74 presas en el periodo T1 y 60 presas para el periodo T2. El mayor número de presas se encontró en M. dentatus con 34 presas en el periodo T1 de Bahía de Chamela y el menor número fue en H. flaviguttatum en T1 de Bahía de Navidad con solo 7 presas. Los crustáceos fueron las presas de mayor presencia en la dieta, seguidos por peces, moluscos, poliquetos y equinodermos, en ambos periodos y sitios de muestreo. Las seis especies analizadas se consideran como especialistas, dados los bajos valores del índice de amplitud de nicho en ambos periodos y sitios de muestreo.

Development of SRS. php, a Simple Object Access Protocol-based library for data acquisition from integrated biological databases

Data integration has become an important task for biological database providers. The current model for data exchange among different sources simplifies the manner that distinct information is accessed by users. The evolution of data representation from HTML to XML enabled programs, instead of humans, to interact with biological databases. We present here SRS.php, a PHP library that can interact with the data integration Sequence Retrieval System (SRS). The library has been written using SOAP definitions, and permits the programmatic communication through webservices with the SRS. The interactions are possible by invoking the methods described in WSDL by exchanging XML messages. The current functions available in the library have been built to access specific data stored in any of the 90 different databases (such as UNIPROT, KEGG and GO) using the same query syntax format. The inclusion of the described functions in the source of scripts written in PHP enables them as webservice clients to the SRS server. The functions permit one to query the whole content of any SRS database, to list specific records in these databases, to get specific fields from the records, and to link any record among any pair of linked databases. The case study presented exemplifies the library usage to retrieve information regarding registries of a Plant Defense Mechanisms database. The Plant Defense Mechanisms database is currently being developed, and the proposal of SRS.php library usage is to enable the data acquisition for the further warehousing tasks related to its setup and maintenance.

Effects of sample re-sequencing and trimming on the quality and size of assembled consensus sequences

The production of nucleic acid sequences by automatic DNA sequencer machines is always associated with some base-calling errors. In order to produce a high-quality DNA sequence from a molecule of interest, researchers normally sequence the same sample many times. Considering base-calling errors as rare events, re-sequencing the same molecule and assembling the reads produced are frequently thought to be a good way to generate reliable sequences. However, a relevant question on this issue is: how many times the sample needs to be re-sequenced to minimize costs and achieve a high-fidelity sequence? We examined how both the number of re-sequenced reads and PHRED trimming parameters affect the accuracy and size of final consensus sequences. Hundreds of single-pool reaction pUC18 reads were generated and assembled into consensus sequences with CAP3 software. Using local alignment against the published pUC18 cloning vector sequence, the position and number of errors in the consensus were identified and stored in MySQL databases. Stringent PHRED trimming parameters proved to be efficient for the reduction of errors; however, this procedure also decreased consensus size. Moreover, re-sequencing did not have a clear effect on the removal of consensus errors, although it was able to slightly increase consensus.

Sex-biased gene flow in African Americans but not in American Caucasians

We have previously shown evidence of strong sex-biased genetic blending in the founding and ongoing history of the Brazilian population, with the African and Amerindian contribution being highest from maternal lineages (as measured by mitochondrial DNA) and the European contribution foremost from paternal lineages (estimated from Y-chromosome haplogroups). The same phenomenon has been observed in several other Latin American countries, suggesting that it might constitute a universal characteristic of the Iberian colonization of the Americas. However, it has also recently been detected in the Black population of the United States. We thus wondered if the same could be observed in American Caucasians. To answer that question, we retrieved 1387 hypervariable I Caucasian mitochondrial DNA sequences from the FBI population database and established their haplogroups and continental geographical sources. In sharp contrast with the situation of the Caucasian population of Latin American countries, only 3.1% of the American Caucasian sequences had African and/or Amerindian origin. To explain this discrepancy we propose that the finding of elevated genomic contributions from European males and Amerindian or African females depends not only on the occurrence of directional mating, but also on the [quot ]racial[quot ] categorization of the children born from these relations. In this respect, social practices in Latin America and in the United States diverge considerably; in the former socially significant [quot ]races[quot ] are normally designated according to physical appearance, while in the latter descent appears to be the most important factor.

Production of full-length cDNA sequences by sequencing and analysis of expressed sequence tags from Schistosoma mansoni

The number of sequences generated by genome projects has increased exponentially, but gene characterization has not followed at the same rate. Sequencing and analysis of full-length cDNAs is an important step in gene characterization that has been used nowadays by several research groups. In this work, we have selected Schistosoma mansoni clones for full-length sequencing, using an algorithm that investigates the presence of the initial methionine in the parasite sequence based on the positions of alignment start between two sequences. BLAST searches to produce such alignments have been performed using parasite expressed sequence tags produced by Minas Gerais Genome Network against sequences from the database Eukaryotic Cluster of Orthologous Groups (KOG). This procedure has allowed the selection of clones representing 398 proteins which have not been deposited as S. mansoni complete CDS in any public database. Dedicated sequencing of 96 of such clones with reads from both 5' and 3' ends has been performed. These reads have been assembled using PHRAP, resulting in the production of 33 full-length sequences that represent novel S. mansoni proteins. These results shall contribute to construct a more complete view of the biology of this important parasite.

A picture of gene sampling/expression in model organisms using ESTs and KOG proteins

The expressed sequence tag (EST) is an instrument of gene discovery. When available in large numbers, ESTs may be used to estimate gene expression. We analyzed gene expression by EST sampling, using the KOG database, which includes 24,154 proteins from Arabidopsis thaliana (Ath), 17,101 from Caenorhabditis elegans (Cel), 10,517 from Drosophila melanogaster (Dme), and 26,324 from Homo sapiens (Hsa), and 178,538 ESTs for Ath, 215,200 for Cel, 261,404 for Dme, and 1,941,556 for Hsa. BLAST similarity searches were performed to assign KOG annotation to all ESTs. We determined the amount of gene sampling or expression dedicated to each KOG functional category by each model organism. We found that the 25% most-expressed genes are frequently shared among these organisms. The KOG protein classification allowed the EST sampling calculation throughout the glycolysis pathway. We calculated the KOG cluster coverage and inferred that 50 to 80 K ESTs would efficiently cover 80-85% of the KOG database clusters in a transcriptome project. Since KOG is a database biased towards housekeeping genes, this is probably the number of ESTs needed to include the more commonly expressed genes in these organisms. We also examined a still unaddressed question: what is the minimum number of ESTs that should be produced in a transcriptome project?

Toxicidad y actividad inmunológica in vitro e in vitro del extracto metanólico de la especie vegetal Cordia sebestena / Toxicity and immunologic activity in vivo and in vitro of the metanolic extract of the vegetal species Cordia sebestena

El ha investigado la utilidad terapéutica de las plantas basado principalmente en el uso folklórico por su aplicación en un amplio rango de enfermedades. En el presente trabajo, se evaluó la toxicidad y la actividad inmunológica in vivo e in vitro del extracto metanílico de la Cordia sebetena. Cultivos de celuals mononucleares de sangre periférica humana, donde se investigó el efecto de la viabilidad (coloración supravital azul tripán), linfoproliferación (Timidina Tritiada) y concentraciones del Factor Estimulador de Colonias Granulocítico-Macrofágico (FEC-GM) en los sobrenadantes, empleando la técnica de ELISA de captura, así como la actividad quimiotáctica de celulas polimorfonucleares humanas a través de la técnica en gel de agarosa. Se estudio la toxicidad in vivo en hígado, vaso y riñón en ratones bajo tratamiento oral e intraperitoneal a través de estudios histológicos, niveles sanguíneos de leucocitos totales y plaquetas/mm3 y el efecto en la ingesta diaria y el peso corporal de dichos ratones. Los resultados indican que el extracto metanolico de Cordia sebestena es inocuo a las celulas ensayadas, estimula la producción del FEC-GM, y por ende a la formación de nuevas células linfoides comportándose como un quimioatractante celular, hallazgos que podrían, en parte, explicar los efectos farmacológicos atribuidos a esta especie vegetal

Mining microorganism EST databases in the quest for new proteins

Microorganisms with large genomes are commonly the subjects of single-round partial sequencing of cDNA, generating expressed sequence tags (ESTs). Usually there is a great distance between gene discovery by EST projects and submission of amino acid sequences to public databases. We analyzed the relationship between available ESTs and protein sequences and used the sequences available in the secondary database, clusters of orthologous groups (COG), to investigate ESTs from eight microorganisms of medical and/or economic relevance, selecting for candidate ESTs that may be further pursued for protein characterization. The organisms chosen were Paracoccidioides brasiliensis, Dictyostelium discoideum, Fusarium graminearum, Plasmodium yoelii, Magnaporthe grisea, Emericella nidulans, Chlamydomonas reinhardtii and Eimeria tenella, which have more than 10,000 ESTs available in dbEST. A total of 77,114 protein sequences from COG were used, corresponding to 3,201 distinct genes. At least 212 of these were capable of identifying candidate ESTs for further studies (E. tenella). This number was extended to over 700 candidate ESTs (C. reinhardtii, F. graminearum). Remarkably, even the organism that presents the highest number of ESTs corresponding to known proteins, P. yoelii, showed a considerable number of candidate ESTs for protein characterization (477). For some organisms, such as P. brasiliensis, M. grisea and F. graminearum, bioinformatics has allowed for automatic annotation of up to about 20 of the ESTs that did not correspond to proteins already characterized in the organism. In conclusion, 4093 ESTs from these eight organisms that are homologous to COG genes were selected as candidates for protein characterization

Evaluation of alternative reporter genes for the yeast two-hybrid system

The yeast two-hybrid system is a powerful tool for screening protein-protein interactions and has also been used for large-scale studies. We evaluated two protein-coding sequences as reporter genes for the yeast two-hybrid system, to determine if it was suitable as an alternative screening strategy. Aspergillus awamori glucoamylase activity results in clear haloes around colonies producing this enzyme after growth on starch plates and staining with iodine vapors. However, transcription activation by Gal4 on Gal-regulated promoters was insufficient for this type of phenotypic visualization. A modified gene of Aequoria victoria enhanced green fluorescent protein (EGFP) was tested to determine its suitability for interaction screenings with flow cytometry. When the EGFP reporter gene system was incorporated into the cells, Gal4 transcriptional activation produced sufficient fluorescence for detection with the flow cytometer, especially when there were strong interactions

Evaluación de un método simple y eficiente en el diagnóstico de tinea capitis: cepillo dental vs. pinsa cosmética / Evaluation of a simple and efficient method in diagnosing tinea capitis: toothbrush and eyebrow twezeers

La tinea capitis es una patología frecuente en niños, y la toma de muestra, a fin de establecer un correcto diagnóstico, a veces representa un procedimiento incómodo y doloroso en los niños. Se plantea en este estudio comparar dos métodos para la toma de muestras; el método convencional, que consiste en la extracción de cabellos con pinza de cejas, y el cepillo de la lesión con un cepillo de dientes corriente. Se evaluaron un total de 20 pacientes provenientes de la consulta de micología del Instituto de Biomedicina del Hospital Vargas de Caracas, con clínica sugestiva y confirmada de tinea capitis. El grupo de pacientes estudiados tenían edades comprendidas entre 2 y 10 años. El tiempo de evolución fue aproximadamente de 60 días. De los pacientes estudiados, un 15 por ciento presentaban antecedentes de contacto con otros pacientes con tinea capitis y 10 por ciento habían tenido un episodio previo. Clínicamente, se presentaron con placas descamativas alopénicas y sólo uno de ellos presentó Kerión. Con respecto a los cultivos tomados con muestra de la pinza de cejas, 14 se contaminaron con otros hongos contaminantes (no dermatofitos) y bacterias y sólo 6 no presentaron contaminación, por lo que se pudo aislar el agente causal. En cambio, los cultivos obtenidos de las muestras provenientes del cepillo de dientes, 8 de ellos se contaminaron y 12 de ellos no presentaron contaminación (p<0,01). Se concluye que la toma de muestra con cepillo es tan efectiva como el método convencional. Las escamas son tan ricas en material fúngico como los cabellos. La toma de muestra con cepillo es un método seguro, poco doloroso, confiable y disminuye el riesgo de contaminación.

Resultados de un programa educativo para adultos con asma / Results of an educational program for adults with asthma

Antecedentes: el asma es un problema mundial de salud. La educación del paciente asmático se ha propuesto como una alternativa para disminuir la mortalidad causada por este padecimiento. Objetivo: demostrar que los programas educativos para pacientes asmáticos ayudan a reducir la gravedad de la enfermedad, el número de crisis y de hospitalizaciones, y fomentan un mayor apego terapéutico. Material y método: participaron 80 pacientes con asma, que se dividieron en dos grupos; el primero recibió el curso educativo y el segundo no. A todos los sujetos se les dio tratamiento de acuerdo con las guías internacionales que incluyen consulta mensual, flujómetro, cámara espaciadora y diario de síntomas; se les realizó una evaluación inicial y una final sobre conocimiento de la enfermedad. El curso consistió en un taller que abarcó el manejo de las crisis, el uso de medicamentos inhalados, la flujometría y las técnicas de relajación. Resultados: estudiamos a 76 pacientes, con una edad promedio de 34 años; 36 se asignaron al grupo 1 y 40 al 2. La evaluación inicial de ambos fue de 7.8, en tanto que la calificación final del grupo 1 fue de 9.3 y la del 2, de 8.4. El grupo 1 tuvo menor número de hospitalizaciones que el 2 (p-0.005), menor cantidad de consultas de urgencias (p-0.005) y una mejoría global superior a la del grupo 2, en el que sólo ocho pacientes se aliviaron. Una tercera parte del grupo 1 abandonó el tratamiento, mientras que esta cifra fue de 79 por ciento en el grupo 2 (p < 0.0005). Conclusiones: los programas educativos para pacientes asmáticos adultos disminuyen la gravedad de la enfermedad y el número de crisis y hospitalizaciones, además de incrementar el apego al tratamiento.

Neumonía de resolución lenta / Slow resolution pneumonia

Resumen: Se trata de una mujer de 46 años, preciamente sana, quien despues ed varios meses de evolución de una neumonida basal derecha y multiples tratamientos con antibioticos, todos sin respuesta, acudio a la consulta de infectiologia. Sus sintomas se iniciaros 4 meses antes, cuando consultó al médico por congestion nasal, rinorrea mucoporulenta, cefalea de predominio frontal, otalgia, tos húmeda con expectoración mucoporulenta escasa y voz nasal

Endarterectomía carotídea con anestesia local: estudio de 22 casos / Carotid endarterectomy under local anesthesia

Se presenta un estudio descriptivo de 22 casos de endarterectomia carotidea con anestesia local en la Fundacion Santa Fe de Bogota. Se analizan los resultados que muestran una baja morbilidad postoperatoria y ausencia de mortalidad relacionada con el procedimiento. En pacientes de alto riesgo quirurgico y anestesico, esta tecnica es de práctica sencilla y el tratamiento intra y postoperatorio no presenta mayores dificultades.