Epidemiología descriptiva y cambios en la frecuencia de tumores astrocíticos en el Instituto Nacional de Neurología y Neurocirugía de México / Descriptive epidemiology and frequency variations of astrocytic tumors in the National Institute of Neurology and Neurosurgery of Mexico

Resumen: Objetivo: Determinar distribución, localización y cambios de la frecuencia de tumores astrocíticos (TA) en un instituto mexicano de neurología. Material y métodos: Se revisaron los registros institucionales de TA de cinco décadas. Se compararon las relaciones TA/egresos quirúrgicos (EQ) y TA/total de tumores del sistema nervioso central (TSNC) de 1995 a 2014. Resultados: Se analizaron 2 287 TA (1 356 en hombres y 931 en mujeres). El glioma más común fue el glioblastoma multiforme (GBM), que estuvo presente en adultos jóvenes con una frecuencia mayor a la reportada en otros estudios. La relación TA/EQ y TA/TNSC fue similar entre 1995 y 2014. Conclusiones: En general, la frecuencia de TA atendidos en el Instituto es similar a la reportada internacionalmente. No obstante, los casos de TA en el subgrupo de adultos jóvenes con GBM son más frecuentes (40%) que las incidencias reportadas en otros estudios (menores al 5%). No se encontró variación significativa en la frecuencia de TA durante las últimas dos décadas.

Abstract: Objective: To determine distribution, localization and frequency variations of astrocytic tumors (AT) in a Mexican Institute of neurology. Materials and methods: Institutional registries of AT from five decades were analyzed. AT/Surgical discharges (SD) and AT/Central Nervous System Tumors (CNST) from 1995 to 2014 were compared. Results: Two thousand two hundred and eighty-seven AT (1 356 men and 931 women) were analyzed. The most common glioma was glioblastoma multiforme (GBM), found in young adults with a higher frequency to that reported in other studies. Relation of AT/SD, as well as, relation of AT/CNST was similar between 1995 and 2014. Conclusions: In general, the frequency of AT attended at the Institute is similar to that found worldwide, being only higher the number of GBM in younger adults. There was not significant variation in the frequency of AT during the time studied.

Análisis cienciométrico de la producción científica del Instituto Nacional de Cancerología / National Cancer Institute scientific production scientometric analysis

Resumen Introducción: La cienciometría permite analizar la productividad e impacto de las publicaciones científicas mediante técnicas bibliométricas y computacionales. Objetivo: Proponer una metodología multidimensional para obtener el perfil cienciométrico del Instituto Nacional de Cancerología (INCan), México, y compararlo respecto a otras instituciones nacionales de salud. Método: Con el programa LabSOM y la metodología ViBlioSOM, basada en redes neuronales artificiales, se analizó la producción científica del INCan indexada en la Web of Science entre 2007 y 2017. Se obtuvo el perfil cienciométrico multidimensional del Instituto y se comparó con el de otras instituciones nacionales de salud. Resultados: En productividad, el INCan ocupa el cuarto lugar de las 10 instituciones mexicanas de salud pública indexadas en la Web of Science.; en el ranking de impacto normalizado, el sexto lugar. Aun cuando de 1323 artículos, 683 (51.62 %) no recibieron citas, 11 artículos de excelencia (0.83 %) lograron 24 % de 11 932 citas y, consecuentemente, el impacto normalizado del INCan evidenció una productividad media por arriba de la media mundial. Conclusión: El análisis multidimensional con la red neuronal propuesta permite obtener un perfil cienciométrico institucional absoluto y relativo más fidedigno e integral que el derivado de conteos de variables aisladas.

Abstract Introduction: Scientometrics analyzes scientific publications through bibliometric and computational techniques, whereby productivity and impact indicators are generated. Objective: To propose a multidimensional methodology in order to obtain the scientometric profile of the National Cancer Institute (INCan), Mexico, and rank it with regard to other national health institutions. Method: Using the LabSOM software and the ViBlioSOM methodology based on artificial neural networks, the INCan scientific production indexed in the Web of Science from 2007 to 2017 was analyzed. The multidimensional scientometric profile of the Institute was obtained and compared with that of other national health institutions. Results: In terms of productivity, INCan ranks fourth among the 10 Mexican public health institutions indexed in the Web of Science; in the normalized impact ranking, it ranks sixth. Although out of 1323 articles 683 (51.62 %) did not receive citations, 11 articles classified as excellent (0.83 %) obtained 24 % of 11,932 citations and, consequently, INCan normalized impact rate showed a mean productivity higher than the world mean. Conclusion: Multidimensional analysis with the proposed neural network enables obtaining a more reliable and comprehensive absolute and relative institutional scientiometric profile than that derived from measuring isolated variables.

Brazilian Academy of Neurology (2006 - 2016) / Academia Brasileira de Neurologia (2006 - 2016)

ABSTRACT Brazil is a heterogeneous country with continental dimensions. The different characteristics of cultural, socioeconomic, and demographic status of the population drive different strategies for neurological care. This knowledge helps the understanding of the current scenario with the consequent possibility of preparing for future challenges. We used data from annual internal forms of the Brazilian Academy of Neurology (BAN) since 2006 and the survey for all BAN members (3,240) in 2016. The geographic distribution of BAN members in Brazil follows the demographic concentration of the population. Participation of members from big cities was the most prevalent, 18.7% of participants were young neurologists, and 36.7% of neurologists had more than of 20 years of neurological practice. The improvement of knowledge of neurological practice in Brazil will be useful for BAN leadership in planning future actions. The BAN must make an effort to aggregate a greater number of neurologists, offering updating support contributing to health policies to disseminate neurological care in Brazil.

RESUMO O Brasil é um país heterogêneo com dimensões continentais. As diferentes características culturais, do padrão socioeconômico e demográfico da população direcionam diferentes estratégias de atenção neurológica. Este conhecimento ajuda a entender o cenário atual para consequente preparação para os desafios futuros. Utilizamos informações dos relatórios anuais de Academia Brasileira de Neurologia (ABN) desde 2006, além de dados de uma pesquisa para os membros da ABNr ealizada em 2016. A distribuição geográfica dos membros da ABN no Brasil segue a concentração demográfica da população. A participação na pesquisa dos membros das grandes cidades foi a mais prevalente. 18,7% eram neurologistas jovens e 36,7% tinham mais de 20 anos de prática neurológica. O aperfeiçoamento do conhecimento da prática neurológica no Brasil será útil para a liderança da ABN planejar ações futuras. A ABN deve se esforçar para agregar um maior número de neurologistas, oferecendo constante atualização e apoio profissional contribuindo para políticas de saúde para disseminar o conceito de doenças neurológicas no Brasil.

Historical distribution of central nervous system tumors in the Mexican National Institute of Neurology and Neurosurgery / Distribución histórica de neoplasias del sistema nervioso central en el Instituto Nacional de Neurología y Neurocirugía de México

Abstract Objective: To determine the frequency of central nervous system (CNS) tumors in the first fifty years of the National Institute of Neurology and Neurosurgery of Mexico Manuel Velasco Suárez (Instituto Nacional de Neurología y Neurocirugía de México, INNN) from 1965 to 2014. Materials and methods: A total of 16 116 institutional records of CNS tumors were analyzed. The frequency and distribution of CNS tumors were evaluated by tumor type, patient age and patient gender. The annual relationship between CNS tumors and surgical discharges (SD) over the last 20 years was estimated. Results: The frequencies of most CNS tumors were consistent with those found worldwide, and the most common tumors were neuroepithelial tumors (33%), particularly astrocytic tumors (67%); meningeal tumors (26%); and pituitary tumors (20%). The incidence of pituitary tumors in these data was twice as high as that reported in other regions of the world, and the relationship between CNS tumors and SD was consistent over time (0.22-0.39). Conclusion: This study summarizes the largest sample of CNS tumor cases analyzed in Mexico and provides an important reference of the frequency of this tumor type in the country. This work will serve as a basis for conducting studies evaluating factors associated with the presence of CNS tumors and for identifying adequate public health interventions.

Resumen Objetivo: Determinar la frecuencia de neoplasias del sistema nervioso central (NSNC) en los primeros 50 años del Instituto Nacional de Neurología y Neurocirugía de México (INNN). Material y métodos: Se analizaron 16 116 registros institucionales de las NSNC, atendidas en el INNN de 1965 a 2014; se estimó su frecuencia y distribución por tipo de neoplasia, edad y género, y se determinó la relación anual de NSNC y egresos quirúrgicos (EQ) en un período de 20 años. Resultados: Las frecuencias de la mayoría de NSNC fueron consistentes con las encontradas a nivel mundial. Las más frecuentes fueron las neuroepiteliales (33%), entre las cuales destacaron las astrocíticas (67%); meníngeas (26%), e hipofisiarias (20%). El número de neoplasias hipofisiarias en esta serie fue dos veces mayor al reportado en otras regiones del mundo y la relación NSNC/EQ fue similar a través del tiempo (0.22-0.39). Conclusión: Ésta es la mayor serie de casos de NSNC analizados en México y proporciona un referente importante sobre la frecuencia de este tipo de neoplasias en el país. Este trabajo servirá de base para llevar a cabo estudios de los factores asociados a la presencia de NSNC e identificar intervenciones de salud pública adecuadas.

Cancer incidence and mortality in children in the Mexican Social Security Institute (1996-2013) / Incidencia y mortalidad por cáncer en niños atendidos en el Instituto Mexicano del Seguro Social (1996-2013)

Abstract Objective: To identify the cancer incidence and mortality in Mexican Social Security Institute beneficiary (MSSI-B) children during 1996-2013. Materials and methods: Both cancer cases (n=4 728) and deaths (n=2 378) were analyzed in MSSI-B children who were registered in five states of the Mexican Republic. The incidence and mortality trends and the incidences (rate x 1 000 000 children / year) of the type of cancer, age, sex, and place of residence were obtained. Results: For both indicators (incidence and mortality), there was a downward trend for the period of 1996-2001 and a stable trend for 2002-2013. This occurred in the overall mortality and incidence trends of the Estado de México and Chiapas and in the leukemia and the acute lymphoid subgroups. The annual overall incidence was 128 cases per 1 000 000 children. Leukemia, lymphomas, and central nervous system tumors were the principal cancer groups. Conclusions: Cancer mortality for the period of 2002-2013 did not diminish. Interinstitutional and/or international research should be designed to improve the care of these children.

Resumen Objetivo: Mostrar la incidencia y mortalidad por cáncer en niños derechohabientes del Instituto Mexicano del Seguro Social (DH-IMSS) (periodo 1996-2013). Material y métodos: Se analizaron los casos (n=4 728) y las muertes (n=2 378) por cáncer en niños DH-IMSS registrados en cinco estados de la República mexicana. Se obtuvo la tendencia de la incidencia y mortalidad y la incidencia por tipo de cáncer, edad, sexo y lugar de residencia. Resultados: Para ambos indicadores (incidencia y mortalidad) hubo tendencia a la disminución para el periodo 1996-2001 y estabilidad para 2002-2013; esto sucedió para la tendencia global, para el Estado de México y Chiapas, para las leucemias y para el subgrupo de las linfoide agudas. La incidencia global fue de 128 x 1 000 000 niños/año; las leucemias, tumores del sistema nervioso central y linfomas fueron los principales grupos de cáncer. Conclusiones: La mortalidad por cáncer para el periodo 2002-2013 no ha disminuido; deben diseñarse investigaciones interinstitucionales e internacionales para mejorar la atención médica de estos niños.

Cancer mortality in the Mexican Social Security Institute, 1989-2013 / Mortalidad por cáncer en el Instituto Mexicano del Seguro Social, 1989-2013

Abstract Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. Materials and Methods: A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. Results: The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. Conclusion: The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Resumen Objetivo: Analizar la frecuencia de las defunciones por cáncer en la población derechohabiente (DH) del Instituto Mexicano del Seguro Social, así como la tendencia temporal en el riesgo de muerte por esta causa de 1989 a 2013. Material y métodos: Se realizó análisis descriptivo del comportamiento de la mortalidad por cáncer en población derechohabiente del IMSS. Las tasas de mortalidad ajustadas por edad y sexo se obtuvieron con el método directo utilizando la población mundial estándar de la OMS. Los cambios en el riesgo de morir por cáncer a través del tiempo se evaluaron mediante regresión de Poisson. Resultados: El número absoluto de defunciones por cáncer se duplicó de1989 a 2013 debido a un aumento y al envejecimiento de la población derechohabiente. El riesgo de muerte en los DH disminuyó para la mayoría de los diferentes tipos de cáncer, excepto para el cáncer de colon y recto. Conclusión: El riesgo de morir por cáncer en DH del IMSS muestra una discreta disminución, posiblemente debido a la mejora en la detección y tratamiento oportuno.

Análisis de la mortalidad por leucemia aguda pediátrica en el Instituto Nacional de Cancerología / Analysis of mortality in pediatric acute leukemia at the National Cancer Institute

Introducción. La mortalidad por leucemia aguda pediátrica es un indicador trazador del acceso y efectividad de la atención en salud; su análisis permite identificar los factores involucrados en el proceso de la enfermedad que pueden influir en la condición final de los niños. Objetivo. Describir la experiencia operativa y los resultados obtenidos en los comités de análisis institucional de la mortalidad por leucemia aguda pediátrica. Materiales y métodos. Se hizo un análisis descriptivo de las muertes por leucemia linfoide o mieloide aguda ocurridas en niños menores de 15 años en el Instituto Nacional de Cancerología, 2008-2010. Se llevó a cabo el análisis de “evitabilidad” (sic.) con el modelo de las tres demoras propuesto por Thaddeus y Maine. Resultados. Se analizaron 24 defunciones. El 87,5 % fueron a causa de leucemia linfoide aguda. La mediana de edad fue de 10,5 años. Se encontró que la demora 3 (obtener el tratamiento adecuado y oportuno) ocurrió en el 83 % de los casos analizados y que los traslados durante el tratamiento fue la limitación más común (66,7 %). El 83,3 % de las muertes se consideraron no evitables dadas las condiciones clínicas de la enfermedad. Conclusiones. Es la primera experiencia en el análisis de mortalidad por un evento crónico en la población pediátrica del Instituto Nacional de Cancerología y en el país. Aunque las demoras identificadas no condicionaron de forma directa la mortalidad, sí constituyen la base para establecer acciones de mejoría que influyan en la calidad de la atención de los niños con cáncer.

Introduction. Mortality rate for childhood acute leukemia is an indicator of access to and efficacy of health services. Analysis of this indicator allows the identification of factors contributing to the development of the illness and the final condition of affected children. Objective. The operative experience results were described from data obtained by committee of analysis of institutional mortality by childhood acute leukaemia. Materials and methods. Formal reports of deaths in children under 15 due to acute lymphoblastic or myeloid leukemia were provided to the National Cancer Institute of Colombia. A descriptive analysis of these reports from the period 2008-2010 was undertaken by the National Cancer Institute. Avoidability analysis was performed using the 1994 “three delays” model of Thaddeus and Maine. Results. Of 24 deaths analyzed, 21 were caused by acute lymphoblastic leukemia. The median age was 10.5 years. The delay 3 (get adequate and timely treatment) was identified in 83% of the cases and transfers during treatment were the most common limitation (66.7%). 83.3% of deaths were deemed unavoidable given the clinical conditions of the patients. Conclusions. Even though the delays identified did not affect mortality in a direct way, they did nonetheless constitute the basis for improvements to the quality of attention to children with cancer.

Citations to papers from Brazilian institutions: a more effective indicator to assess productivity and the impact of research in graduate programs

A recent assessment of 4400 postgraduate courses in Brazil by CAPES (a federal government agency dedicated to the improvement of the quality of and research at the postgraduate level) stimulated a large amount of manifestations in the press, scientific journals and scientific congresses. This gigantic effort to classify 16,400 scientific journals in order to provide indicators for assessment proved to be puzzling and methodologically erroneous in terms of gauging the institutions from a metric point of view. A simple algorithm is proposed here to weigh the scientometric indicators that should be considered in the assessment of a scientific institution. I conclude here that the simple gauge of the total number of citations accounts for both the productivity of scientists and the impact of articles. The effort spent in this exercise is relatively small, and the sources of information are fully accessible. As an exercise to estimate the value of the methodology, 12 institutions of physics (10 from Brazil, one from the USA and one from Italy) have been evaluated.

Análisis bibliométrico de las publicaciones sobre enfermedades infecciosas en Colombia, 2000-2009 / Bibliometric analysis of publications on infectious diseases in Colombia, 2000-2009

Objetivo Analizar la producción científica en el área de las enfermedades infecciosas en Colombia durante el periodo de 2000-2009. Material y métodos Se realizó una búsqueda bibliográfica en las revistas de categoría A del Publindex de Colciencias. Las revistas fueron: Biomédica, Salud Pública de la Universidad Nacional, Colombia Médica, Ciencias Pecuarias, Iatreia, MVZ Córdoba, Medicina de la Universidad Nacional e Infectio. Resultados Se encontraron un total de 2 963 publicaciones, 2 744 (92,6 por ciento) publicaciones nacionales y 219 (7,4 por ciento) publicaciones de origen extranjero; De las cuales 863 (29,1 por ciento) fueron sobre enfermedades infecciosas, 817 (94,7 por ciento) publicaciones de origen nacional y 46 (5,3 por ciento) publicaciones extranjeras. Las publicaciones nacionales en enfermedades infecciosas, se distribuyeron de la siguiente manera: parasitología 268 (32,8 por ciento), bacteriología y resistencia antimicrobiana 267 (32,7 por ciento), virología 210 (25,7 por ciento), micología 46 (5,6 por ciento) y otros artículos relacionados con las enfermedades infecciosas 26 (3,2 por ciento). La distribución regional de las publicaciones fue: Cundinamarca 239 (29,3 por ciento), Antioquia 211 (25,8 por ciento) Valle del Cauca 60 (7,3 por ciento), Costa Caribe 52 (6,4 por ciento), Santanderes 38 (4,6 por ciento), eje cafetero 31 (3,8 por ciento) y sur del país 13 (1,6 por ciento). Conclusiones Este es el primer trabajo que analiza las publicaciones en enfermedades infecciosas en Colombia. Existe un desequilibrio regional en los indicadores bibliométricos en Colombia. La universidad pública soporta el 90 por ciento de la investigación del área de infectología en Colombia.

Objective Analysing scientific production in the area of infectious diseases in Colombia, 2000-2009. Material and methods A literature search was made in category A journals in Colciencias' Publindex. The journals were: Biomédica, Revista de Salud Pública (Universidad Nacional), Colombia Médica, Ciencias Pecuarias, Latreia, MVZ Córdoba, Revista de Medicina (Universidad Nacional) and Infectio. Results 2,963 publications were found; 2,744 (92.6 percent) were national publications and 219 (7.4 percent) were foreign submissions, of which 863 (29.1 percent) were on infectious diseases, 817 (94.7 percent) having been submitted nationally and 46 (5.3 percent) submitted by foreigners. National publications on infectious diseases were distributed as follows: 268 on parasitology (32.8 percent), bacteriology and antimicrobial resistance accounted for 267 (32.7 percent), virology 210 (25.7 percent), mycology 46 (5.6 percent) and other items related to infectious diseases accounted for 26 (3.2 percent). The regional distribution of publications was: Cundinamarca 239 (29.3 percent), Antioquia 211 (25.8 percent), Valle del Cauca 60 (7.3 percent), Caribbean coast 52 (6.4 percent), the Santanders 38 (4.6 percent), the coffee-growing area 31 (3.8 percent) and southern Colombia 13 (1.6 percent). Conclusions This is the first study which has analysed publications on infectious diseases in Colombia. There was regional imbalance concerning bibliometric indicators in Colombia; public universities accounted for 90 percent of research being carried out in the area of infectious diseases in Colombia.

Anuario estadístico 2011 / Statistical Yearbook 2011

El presente anuario estadístico de periodicidad anual consta de siete capítulos, que incluye variables e indicadores más representativos de cada uno de ellos, el cual pretende satisfacer las exigencias informativas, en los aspectos que la institución trabaja, principalmente en el área de salud

Serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): análise dos pacientes atendidos no 1º ano do departamento (2004) / Low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): analysis of the patients examined on the first year of the department (2004)

Objetivo: Traçar o perfil dos pacientes portadores de baixa visão atendidos no serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Métodos: Realizou-se um estudo transversal no qual foram revisados 82 prontuários de pacientes com baixa visão, atendidos pelo Serviço Único de Saúde (SUS) no primeiro ano do departamento de Visão Subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira em 2004. Os dados analisados foram: sexo, faixa etária, etiologia, acuidade visual inicial e final (pós-refração) para longe e perto, com e sem auxílio óptico e recurso óptico indicado. Resultados: Dos 82 pacientes avaliados, 11 (13,4 por cento) foram excluídos do trabalho por não apresentarem visão subnormal. Dos 71 pacientes restantes, 32 (45 por cento) eram menores de 20 anos. Quanto ao sexo, não houve diferença estatisticamente significante (51 por cento eram mulheres e 49 por cento eram homens). A etiologia mais frequente em crianças e adolescentes foi o glaucoma congênito (15,6 por cento). Em pacientes de 20 a 39 anos prevaleceu a toxoplasmose ocular (21,1 por cento). Entre os pacientes de 40 a 59 anos, a retinose pigmentar foi a patologia mais frequente (19 por cento). Nos idosos, o glaucoma foi a patologia mais encontrada (40 por cento). Trinta e três pacientes (40,2 por cento) tinham acuidade visual entre 20/60 e 20/160. O sistema telescópico foi o único auxílio óptico indicado para longe (44 por cento) e os óculos foram os mais indicados para perto (54,5 por cento). Conclusão: Existe uma alta prevalência de baixa visão em crianças e adolescentes em países em desenvolvimento como o Brasil. Desta forma o oftalmologista precisa criar programas preventivos, melhorar as condições de atendimento e atentar para o diagnóstico precoce e o tratamento destes pacientes.

Purpose: To outline low vision (LV) patients profile of the low vision department of the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Methods: Transversal study of 82 medical charts from the low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira of the first year of the department - 2004, considering age, gender, etiology, distance and near visual acuity with and without optical aids and prescription assistance. Results: Of the 82 available patients, 11 (13.4 percent) were excluded of the study because they did not present low vision. Of the 71 patients, 32 (45 percent) were younger than 20 years old. Regarding the gender, there was not a significant difference (51 percent female and 49 percent male). The most frequent etiology in infants and adolescents was congenital glaucoma and in patients aged between 20-39 years was ocular toxoplasmosis (21.1 percent). In patients with 40-59 years old, pigmentary retinosis was the most frequently pathology (19 percent). In elderly people it was glaucoma (49 percent). Thirty-three patients (40.2 percent) had visual acuity between 20/60 and 20/160. The telescopic system was the only optical aid indicated for distance (44 percent) and glasses were the most indicated for near (54.5 percent). Conclusion: There is a high prevalence of low vision in infants and adolescents that live in developing countries like Brazil. Therefore, ophthalmologists need to be aware to promote early diagnosis and treatment to these patients, creating preventive programs and better assistance conditions.

Demografía del cáncer laríngeo en el Instituto Nacional de Cancerología / Demographic data of laryngeal cancer at the Instituto Nacional de Cancerología in Mexico City

Objetivo: Describir los datos demográficos de los pacientes atendidos con diagnóstico de cáncer laríngeo en el Instituto Nacional de Cancerología. Material y métodos: Se revisaron los expedientes de 500 pacientes atendidos entre 1986 y 2002. Resultados: Se encontraron 452 hombres (90.4 %) y 48 mujeres (9.6 %), en una relación hombre:mujer de 10.6:1. La media de edad fue de 62.37 años; predominaron los pacientes con edad entre 56 y 70 años. El tabaquismo y el alcoholismo estuvieron presentes en la mayoría. El síntoma cardinal de inicio fue disfonía en 458 (91.6 %). La media de evolución de la sintomatología fue de 11.6 meses. La localización del tumor más común fue la glotis (61.6 %). En 142 pacientes (28.4 %) se encontraron tumores tempranos (T1-T2) y en 354 (70.8 %), tumores tardíos (T3-T4). Clínicamente 165 pacientes (33.0 %) tuvieron adenopatías palpables desde el inicio (33.0 %) y 13 (2.6 %), metástasis al momento del diagnóstico. La histología en 483 (96.6 %) fue epidermoide; 325 recibieron tratamiento. Las recurrencias fueron locales en 146 (44.9 %), regionales en nueve (2.8 %) y a distancia en uno (0.3 %). En 169 pacientes (52 %) se logró un adecuado control del tumor primario. La media de supervivencia de los 325 pacientes fue 38 meses. Conclusiones: El cáncer laríngeo es una entidad potencialmente curable. Ante disfonía mayor de un mes de evolución se debe hacer diagnóstico diferencial de cáncer. El pronóstico en la supervivencia de los pacientes con diagnóstico de cáncer laríngeo está determinado por el estadio clínico inicial.

BACKGROUND: We undertook this study to describe the demographic data of patients with laryngeal cancer treated at the Instituto Nacional de Cancerología in Mexico City. METHODS: We retrospectively reviewed the clinical files from 1986 to 2002, revealing 500 patients. RESULTS: Included were 452 men (90.4%) and 48 women (9.6%) (M:F ratio--10.6:1). Average age of patients was 62.37 years. The highest incidence of patients was among those aged 56 to 70 years. Smoking and alcoholism were present in most patients from this series. The cardinal symptom of presentation was dysphonia in 458 patients (91.6%). The mean evolution time of symptomatology was 11.6 months. The most common localization of the tumor was the glottis (61.6%). One hundred forty two patients (28.4%) presented early-stage tumors (T1-T2) and 354 patients (70.8%) presented with late-stage tumors (T3-T4). Clinically, 165 patients (33.0%) presented adenopathies and 13 patients (2.6%) had metastases at the time of diagnosis; 483 patients (96.6%) presented with invasive epidermoid cancer. Of these, 325 patients received treatment. One hundred forty six patients (44.9%) presented local recurrence, in nine patients (2.8%) there was regional recurrence, and one patient (0.3%) recurred with a distant tumor. Adequate control of the primary tumor was achieved with the established treatment in 169 patients (52%). verage survival time of the 325 treated patients was 38 months. CONCLUSIONS: Cancer of the larynx is a potentially curable entity. In any patient with major dysphonia of >1 month evolution, a differential diagnosis of cancer must be made. The survival prognosis for patients with cancer of the larynx is determined by the initial clinical stage.

H-index in the Brazilian Academy of Sciences: comments and concerns

Bibliometric parameters have been used in order to evaluate a scientist's performance. The h-index has been gradually accepted as the most adequate parameter for this purpose. To have an idea of this index among Brazilian scientists, we performed an analysis of this parameter for the full members of the Brazilian Academy of Sciences (BAS). The h-index of 402 members listed in 10 distinct categories by the BAS was determined, cross-checked with the curriculum vitae of each of them listed at the Plataforma Lattes database (CVL) and compared with each other. Despite the large production, mostly in journals without impact factor, the h-indexes among the BAS members are comparatively low and show a large variation in all of the 10 categories, particularly in Biomedical and Physical sciences. The highest average of h-index values was found in Biomedical, Health and Chemical sciences; the lowest values were found in Human sciences where this index is meaningless. Several problems due to the trend that new and "fresh" publications need be constantly produced (the "bakery-effect") are discussed. This study points to the need of developing countries such as Brazil to invest in national scientific journals in order to make them gradually part of the mainstream journals. This would have a positive effect on bibliometric parameters of Brazilian researchers, including the h-index.

Índices bibliométricos estão sendo utilizados como ferramentas na avaliação do desempenho de cientistas, sendo o índice h o mais empregado atualmente. Com o propósito de tecer considerações sobre o índice h de cientistas brasileiros, foi realizada uma análise do mesmo entre os membros titulares da Academia Brasileira de Ciências (ABC). Foram calculados os valores do índice h para os 402 membros titulares separados nas 10 áreas do conhecimento distintas listadas pela ABC. Concomitantemente os trabalhos de cada pesquisador foram conferidos através da comparação com os currículos apresentados na Plataforma Lattes. Apesar da grande produção científica, a maioria em jornais sem fator de impacto, os índices h dos membros da ABC demonstram uma grande variação em todas as 10 áreas, particularmente nas Ciências Biomédicas e Físicas. As maiores médias do índice h foram encontradas nas Ciências Biomédicas, da Saúde e Químicas; os menores valores estão nas Ciências Humanas, onde este índice não reflete a produção dos respectivos pesquisadores, revelando-se inútil nesse caso. Devido a uma pressão por contínua publicação (the bakery-effect), diversos problemas relacionados são discutidos. A conclusão principal deste estudo corrobora a necessidade de países em desenvolvimento, como o Brasil, investirem em periódicos científicos nacionais, possibilitando a incorporação gradual dos mesmos nas principais listagens dos periódicos com fator de impacto, causando um efeito positivo sobre os índices dos pesquisadores atuantes no país.

Análisis de los premios a la investigación en gastroenterología: Experiencia en México / Critical analysis of awards in gastroenterology research: The Mexican experience

El impacto internacional de la investigación gastroenterológica mexicana es limitado. Se desconoce cuál ha sido el resultado final de los trabajos de mejor calidad a nivel nacional de acuerdo a la Asociación Mexicana de Gastroenterología (AMG). El objetivo de este trabajo fue analizar el patrón de publicación e impacto en las publicaciones periódicas internacionales de los trabajos premiados por la AMG. Se revisaron las memorias del congreso anual de la AMG, período 1998-2006. Se seleccionaron resúmenes donde se indicara premiación o presentación en sesión plenaria. Los trabajos identificados fueron buscados en bases de datos electrónicas, o bien se contactó alguno de los autores para solicitar la información relacionada. De aquellos trabajos publicados en revistas con factor de impacto se buscaron las citas relacionadas. Se localizaron 35 premios, 57.1% fueron en el área de gastroenterología y 34.3% en hepatología. Las instituciones con los premios son Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Instituciones de Educación Superior (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Hospital privado (2.9%). De estos se han publicado 19 (54.8%), la mayoría antes de un año (73.7%). Unicamente dos de los trabajos publicados tienen registradas <10 citas en revistas con factor de impacto. La mitad de los trabajos meritorios de premiación han sido publicados. La mayoría se publican en revistas de circulación nacional. El impacto de estos trabajos a nivel internacional es limitado.

The impact of Mexican gastrointestinal research worldwide is limited and the outcome of the best research papers awarded by the Asociación Mexicana de Gastroenterología (AMG) is unknown. The objective of this study was to analyze the publication pattern of the research work, awarded by the AMG and their impact in international journals. The abstracts accepted for the annual meeting of the AMG from 1998 to 2006 were reviewed. Those presented in a plenary session or awarded were included. Their abstracts were searched in electronic databases. When not found, the main author was contacted by e-mail. In those papers published in a journal with an impact factor, the times it was cited were assessed. 35 abstracts were identified, mainly in gastroenterology (57.1%) and hepatology (34.3). Only in 5.7% (n=2) some of the authors were members of the governing board of AMG. The awarded institutions were Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Universities (Universidad Autónoma de Nuevo León, Universidad Nacional Autónoma de México and the Benemérita Universidad Autónoma de Puebla) (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Private hospital (2.9%). Most of the papers were published within a year (73.7%). Only 2 papers had more than 10 citations in another international journal with impact factor, with a median for all paper of 5 citations (045). Considering all institutions, the rate of publication is 48%. Only half of the awarded works were published and mainly in journals of local distribution. The impact of these studies worldwide is limited.

Comparison of scientists of the Brazilian Academy of Sciences and of the National Academy of Sciences of the USA on the basis of the h-index

A new scientometric indicator, the h-index, has been recently proposed (Hirsch JE. Proc Natl Acad Sci 2005; 102: 16569-16572). The index avoids some shortcomings of the calculation of the total number of citations as a parameter to evaluate scientific performance. Although it has become known only recently, it has had widespread acceptance. A comparison of the average h-index of members of the Brazilian Academy of Sciences (BAS) and of the National Academy of Sciences of the USA (NAS-USA) was carried out for 10 different areas of science. Although, as expected, the comparison was unfavorable to the members of the BAS, the imbalance was distinct in different areas. Since these two academies represent, to a significant extent, the science of top quality produced in each country, the comparison allows the identification of the areas in Brazil that are closer to the international stakeholders of scientific excellence. The areas of Physics and Mathematics stand out in this context. The heterogeneity of the h-index in the different areas, estimated by the median dispersion of the index, is significantly higher in the BAS than in the NAS-USA. No elements have been collected in the present study to provide an explanation for this fact.

¿Explicitan los autores de la Revista Médica de Chile sus fuentes de financiamiento? / Disclosure of financial sources and conflicts of interest among research articles published in Revista Médica de Chile

Background: Financial relationships between the industry and researchers have raised concerns about the existence of conflicts of interest that could influence the scientific validity of the studies. Aim: To determine the financial sources of research articles published in the Revista Médica de Chile during a five-year period. Material and Methods: Retrospective analysis of all articles classified as ôresearch articlesõ, published in this journal between years 2001-2005, identifying the funding source and the existence of a declaration of conflicts of interest by the authors. Results: Two hundred seventeen out of 519 research articles published in the period (42 percent) had an explicit financial source disclosed. Of these, 28 percent were funded by internal sources, 36 percent by Fondo Nacional de Desarrollo Científico y Tecnológico and 36 percent by other sources. Twenty-six studies (5 percent) received funding from the industry. In only five of these, the authors explicity declared the absence of conflict of interest. Among the studies that did not disclose any financial source, one third required some funding to be carried out. Conclusions: Forty two percent of research articles published in the last five years did not specify the financial source. Those that did specify a funding source were mainly supported by non-profit agencies including university centers and governmental funds. This is in contrast with international reports that evidence an important financial support from the industry. Only a minority of the authors sponsored by the industry declared absence of conflict of interest.

Articles with authors affiliated to Brazilian institutions published from 1994 to 2003 with 100 or more citations: I - the weight of international collaboration and the role of the networks

Articles with 100 citations or more in the scientific literature and with at least one author with Brazilian affiliation, were identified in the Thomson-ISI (Institute for Scientific Information) Web of Science bibliometric database, covering a 10-year period, from 1994 to 2003; 248 (0.23 percent) out of a total of 109,916 articles with Brazilian affiliation were identified. This study was primarily carried out to identify thematic nuclei of excellence in research that had major impact in the international literature (Meneghini and Packer 2006). The regional and institutional affiliation distributions of these articles follow approximately that of the total of Brazilian articles in the ISI database. However, some significant deviations are observed derived from the outstanding performance of a few groups responsible for the publication of the HC-ISI (Highly cited ISI) papers. The international collaboration and the network organization of work played a fundamental role in these results. It is evident that the role played by organizations in research networks as well as the international collaborations exerted strong influence in the impact of these articles, although with distinct amplitude in the different fields.

Foram identificados os artigos com um mínimo de 100 citações na literatura científica e com ao menos uma filiação brasileira, segundo a base bibliométrica Thomsom ISI, no período de 10 anos entre 1994 e 2003. Dos 109.916 artigos com filiação brasileira neste período, 248 apresentaram 100 ou mais citações, ou seja, 0,23 por cento do total. Este levantamento foi feito primordialmente para identificar núcleos temáticos de excelência em pesquisa que tiveram maior impacto na literatura internacional (veja Meneghini and Packer 2006). As distribuições regional e institucional das afiliações desses artigos mais citados seguem aproximadamente aquela do total de artigos brasileiros na base ISI. No entanto, notam-se alguns desvios significativos derivados de grupos destacados quanto à publicação de trabalhos muito citados. Ficou patente que o papel das organizações em rede de pesquisa e as colaborações internacionais tiveram uma grande influência no impacto desses artigos, mas com distinta amplitude nas diversas áreas.

Articles with authors affiliated to Brazilian institutions published from 1994 to 2003 with 100 or more citations: II - identification of thematic nuclei of excellence in Brazilian science

Articles with 100 citations or more in the scientific literature and with at least one author with Brazilian affiliation, were identified in the Thomson-ISI (Institute for Scientific Information) Web of Science bibliometric database covering a 10-year period, from 1994 to 2003 (see Packer and Meneghini 2006); 248 (0.23 percent) out of a total of 109,916 articles with Brazilian affiliation were identified. This study was primarily carried out to identify thematic nuclei of excellence in research that had major impact in the international literature. Twelve of these nuclei in the fields of Biomedicine, Medicine, Biology, Physic, Chemistry and Astronomy were considered outstanding and their genesis and development were described. The weight of factors such as international collaboration and network organization are distinct in these areas and the reasons for that are discussed.

Foram identificados os artigos com um mínimo de 100 citações na literatura científica e com ao menos uma filiação brasileira, segundo Thomson-ISI (Institute for Scientific Information) Web of Science bibliometric database, no período de 10 anos entre 1994 e 2003 (veja Packer and Meneghini 2006). Este levantamento foi feito primordialmente para identificar núcleos temáticos de excelência em pesquisa que tiveram maior impacto na literatura internacional. Doze núcleos, nas áreas biomédica, médica, biológica, física, química e astronomia foram considerados proeminentes e suas gêneses e desenvolvimento foram descritos. Os pesos de fatores como colaboração internacional e organização de trabalho em rede são distintos em cada uma dessas áreas. São discutidas as razões para isso.

Factores asociados a mortalidad en cirugía mayor: análisis retrospectivo en un centro de referencia / Mortality associated factor in major surgery: retrospective analysis in a referral center

Background. There are very few studies that analyze surgical morbidity and mortality in the general population and the factors associated with those events. Objective. To determine factors associated to mortality in surgical procedures performed in a tertiary referral center in Mexico City. Methods. We retrospectively analyze surgical mortality in 4,157 consecutive surgical procedures performed in a one-year period from 1/1/2000 through 12/31/2000. Categorical variables were analyzed with the chi-square test and continuous variables with the t-Student test. Significance was defined as p < O.OB. Results. During the study period there were 76 postoperative deaths, representing a mortality rate of 1.82%. Mean patient's age in the entire cohort was 48.7 ± 17.6 years and for the patients who died in the postoperative period 57.8 ± 17.8 years (p < 0.05). Sixty-six percent of deaths were attributed to the primary or surgical disease. In 33.8% of postoperative deaths an adverse event was identified as responsible for the outcome. In 23% of cases there was a potentially preventable event, representing 0.3% of surgical procedures. Most patients (96.9%) had at least one co-morbid condition and 61.5% had two or more. Almost 80% of surgical deaths occurred in patients with ASA score III of TV and albumin levels below 3.5 g/dL. Most common cause of death was sepsis, reported in 35% of patients who died in the postoperative period. Conclusion. Surgical mortality in our series is low. In 0.3% of procedures it was detected a potentially preventable event. Postoperative deaths occurred in older patients with low albumin levels.

Introducción. Existen pocos estudios que analicen la mortalidad quirúrgica general y los factores asociados a la misma. Objetivo. Estudiar las causas y factores asociados a mortalidad quirúrgica en las intervenciones quirúrgicas realizadas en el INCMNSZ. Métodos. Se analizó en forma retrospectiva la mortalidad quirúrgica asociada a 4,157 procedimientos consecutivos realizados del 1/1/2000 al 31/12/2000. Los factores asociados a mortalidad fueron analizados mediante la prueba de chi-cuadrada para variables categóricas y t de Student para variables continuas. Se estableció como significativa a p < 0.05. Resultados. Durante ese periodo ocurrieron 76 muertes postoperatorias, lo que representa una mortalidad global de 1.82% para todos los procedimientos. El promedio de edad para los 4,157 procedimientos fue de 48.7 ± 17.6 años y para las muertes postoperatorias fue de 57.8 ± 17.8 años (p < 0.05). El 66.2% de las muertes se atribuyeron a la enfermedad de base o a la patología que motivó la cirugía. En 33.8% de las muertes se identificó algún evento diferente a la enfermedad primaria como responsable de la muerte. En 23% se identificó algún evento potencialmente prevenible, lo que representa 0.3% del total de eventos quirúrgicos. El 96.9% de los pacientes tenía al menos una comorbilidad y 61.5% cursaba con dos o más. El 78.5% de las muertes sucedió en pacientes ASA III-IV. El 80% de las muertes se asoció a niveles preoperatorios de albúmina por debajo de 3.5 g/dL. La causa de muerte más frecuentemente reportada fue sepsis en 35% de los eventos. Conclusión. La mortalidad postoperatoria en nuestra serie es baja. En 0.3% de los pacientes sometidos a cirugía se detectó algún evento potencialmente prevenible. Las muertes postoperatorias ocurrieron en pacientes más viejos y con niveles bajos de albúmina.