Endoscopic Biliary Darinage (EBD) versus Percutaneous Transhepatic Biliary Drainage (PTBD) for biliary drainage in patients with Perihilar Cholangiocarcinoma (PCCA): A systematic review and meta-analysis

Abstract Biliary drainage for Perihilar Cholangiocarcinoma (PCCA) can be performed either by endoscopic retrograde cholangiopancreatography or Percutaneous Transhepatic Biliary Drainage (PTBD). To date there is no consensus about which method is preferred. Taking that into account, the aim of this study is to compare Endoscopic Biliary Drainage (EBD) versus percutaneous transhepatic biliary drainage in patients with perihilar cholangiocarcinoma through a systematic review and metanalysis. A comprehensive search of multiple electronic databases was performed. Evaluated outcomes included technical success, clinical success, post drainage complications (cholangitis, pancreatitis, bleeding, and major complications), crossover, hospital length stay, and seeding metastases. Data extracted from the studies were used to calculate Mean Differences (MD). Seventeen studies were included, with a total of 2284 patients (EBD = 1239, PTBD = 1045). Considering resectable PCCA, the PTBD group demonstrated lower rates of crossover (RD = 0.29; 95% CI 0.07-0.51; p = 0.009 I2 = 90%), post-drainage complications (RD = 0.20; 95% CI 0.06-0.33; p < 0.0001; I2 = 78%), and post-drainage pancreatitis (RD = 0.10; 95% CI 0.05-0.16; p < 0.0001; I2 = 64%). The EBD group presented reduced length of hospital stay (RD = -2.89; 95% CI -3.35 - -2,43; p < 0.00001; I2 = 42%). Considering palliative PCCA, the PTBD group demonstrated a higher clinical success (RD = -0.19; 95% CI -0.27 - -0.11; p < 0.00001; I2 = 0%) and less post-drainage cholangitis (RD = 0.08; 95% CI 0.01-0.15; p = 0.02; I2 = 48%) when compared to the EBD group. There was no statistical difference between the groups regarding: technical success, post-drainage bleeding, major post-drainage complications, and seeding metastases.

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aims@#Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic. @*Methods@#A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. @*Results@#Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I2=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I2=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I2=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I2=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events. @*Conclusions@#EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis using Two Gallbladder Stents (Dual Gallbladder Stenting)

Background/Aims@#Endoscopic transpapillary gallbladder drainage (ETPGBD) is gaining popularity for the management of acute cholecystitis (AC) in high-risk patients. However, the stents placed during the procedure are not immune to obstruction. Here we describe a novel technique of stenting with two transpapillary stents and evaluate its technical feasibility, safety, and efficacy in AC. @*Methods@#A retrospective analysis of all patients undergoing ETPGBD using dual stents for AC at our institution between November 1, 2017 and August 31, 2020 was conducted. We abstracted patient data to evaluate technical and clinical success, adverse events, and long-term outcomes. Two stents were placed either during the index procedure or during an interval procedure performed 4–6 weeks after the index procedure. @*Results@#A total of 21 patients underwent ETPGBD with dual stenting (57.14% male, mean age: 62.14±17.21 years). The median interval between the placement of the first and the second stents was 37 days (range: 0–226 days). Technical and clinical success rates were 100%, with a recurrence rate of 4.76% (n=1) and adverse event rate of 9.52% (n=2) during a mean follow-up period of 471.74±345.64 days (median: 341 days, range: 55–1084 days). @*Conclusions@#ETPGBD with dual gallbladder stenting is a safe and effective technique for long-term gallbladder drainage in non-surgical candidates. Larger controlled studies are needed to validate our findings for the widespread implementation of this technique.

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aims@#Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic. @*Methods@#A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. @*Results@#Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I2=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I2=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I2=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I2=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events. @*Conclusions@#EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Percepción de actores involucrados acerca del parto humanizado y la violencia obstétrica en Chile: una revisión panorámica / Stakeholders' perceptions of humanized birth practices and obstetric violence in Chile: a scoping review

INTRODUCCIÓN: Chile tiene una política incipiente en relación con prácticas de parto humanizado y la violencia obstétrica es una materia de creciente discusión pública levantada por las mujeres. A pesar de este avance, no se han observado iniciativas para superar el conflicto. Surge la pregunta acerca de los diferentes puntos de vista de los principales actores involucrados, con el fin de identificar estrategias que contribuyan al desarrollo de políticas públicas de salud que consideren a los actores influyentes. OBJETIVO: Identificar la percepción de actores acerca del parto humanizado y la violencia obstétrica. MÉTODO: Se condujo una revisión panorámica (scoping review) que incluyó la descripción y el análisis de artículos y textos de análisis que reflejaran la visión de la comunidad científica y declaraciones de actores del sector gubernamental, social, profesional y político expresados en sitios web institucionales. Se desarrolló un análisis de contenido temático cualitativo, de naturaleza inductiva. RESULTADOS: Se incluyeron setenta documentos. La comunidad científica se visualiza alineada con las recomendaciones ministeriales de parto personalizado. Varios investigadores analizan las dificultades de implementación debido a la construcción histórica, sociocultural y económica del modelo biomédico de atención del parto predominante. Se observa convergencia entre la comunidad científica y otros actores en torno al reconocimiento de los beneficios del parto humanizado, así como acerca de la necesidad de superar obstáculos institucionales del sector de salud. No obstante, el proceso de cambio propuesto es lento y se observan resistencias entre profesionales de la salud para abordar las quejas de las mujeres frente a la violencia obstétrica y su demanda de atención de calidad. Esta situación se refleja a nivel parlamentario. CONCLUSIONES: El análisis de actores identifica áreas de conflicto y de consenso, así como diversas dimensiones interactuantes que obstaculizan el avance hacia la humanización de la atención del parto. Esta estrategia amplia de análisis contribuye a la identificación de aspectos críticos a ser abordados para un desarrollo de políticas sanitarias integrales y efectivas.

INTRODUCTION: Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. OBJECTIVES: To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. METHODS: We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. RESULTS: We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. CONCLUSIONS: The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.

Manifestaciones pulmonares y radiológicas del Sars-Cov2 en pediatría / Pulmonary manifestations and radiological findings of SarsCov2 in children

Las infecciones respiratorias agudas son causa de alta morbi-mortalidad a nivel mundial. El Coronavirus descubierto en Wuhan, China en el 2019 es de interés mundial por las diferentes manifestaciones clínicas que pueden aparecer en niños. Nuestro objetivo principal es revisar las manifestaciones del COVID-19 en el aparato respiratorio y los hallazgos a nivel radiológicos en pediatría. Se estiman que solo el 5,7% de los niños han sido hospitalizados, siendo los niños con comorbilidades y menores de 1 año los que suponen un riesgo mayor para enfermedad grave. A nivel global la mediana de edad de presentación de los casos es alrededor de 7 años, detectándose más casos a mayor edad, pero siendo la gravedad inversamente proporcional a la edad. La forma asintomática o leve son las presentaciones más comunes reportadas en niños, siendo de hasta en el 90% de los niños infectados. Los estudios de laboratorio pueden ser normales o presentar leucocitos alterados en un 69,2% y a nivel radiológico se ha observado en niños que en un 69% presentan opacidades bilaterales en vidrio despulido. En este momento, cualquier infección respiratoria aguda hay que descartar COVID-19, para poder evitar complicaciones en el paciente...(AU)

Human pilot study of bare-metal stent: INC-01

ABSTRACT Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.

Efecto en el control glucémico y modificación del tratamiento en pacientes sometidos a cirugía bariátrica / Effect on glycemic control and modification of treatment in patients submitted to bariatric surgery

Resumen: La obesidad es el factor de riesgo ambiental más importante de diabetes mellitus tipo 2 y puede encontrarse hasta en 90% de los pacientes. La cirugía bariátrica, también conocida como cirugía metabólica, es cada vez más reconocida como una de las intervenciones más eficaces contra la obesidad y comorbilidades, ayudando a los pacientes a lograr la pérdida de peso sostenible y a mejorar su salud en general. Este artículo revisa los diferentes tipos de cirugía bariátrica, así como su efecto en el control glucémico y en la remisión de la diabetes mellitus 2.

Abstract: Obesity is the most important environmental risk factor of diabetes mellitus type 2 and may be found in 90% of patients. Bariatric surgery, also known as metabolic surgery, is each more recognized as one of the most efficient interventions against obesity and comorbidities, helping patients to reach the sustainable weight loss and to improve their general health. This article reviews the different types of bariatric surgery, as well as its impact on glycemic control and on the remission of diabetes mellitus type 2.

Choque séptico. Lo que sabíamos y lo que debemos saber.. / Septic shock. What we knew and what we should know..

Resumen En el mundo, la prevalência de sepsis es de más de 19 millones de casos por año, con mortalidad estimada de 30%. Los factores de riesgo identificados más frecuentemente son las enfermedades crónicas (VIH-SIDA, EPOC y neoplasias), así como la administración de agentes inmunosupresores. La población más susceptible de padecer estas complicaciones es la que se encuentra en los extremos de la vida. De los múltiples agentes patógenos, las bacterias son los microorganismos principalmente implicados en la aparición de la sepsis grave. Entre los focos infecciosos, en primer lugar está la neumonía, seguida de infecciones intraabdominales, de las vías urinarias e infecciones primarias del torrente sanguíneo. Se ha demostrado que el tratamiento temprano aumenta la supervivencia de manera significativa. Las intervenciones que deben realizarse incluyen: tratamiento antimicrobiano, resucitación hídrica, apoyo ventilatorio y tratamiento de soporte (profilaxis antitrombótica, control de la glucemia y profilaxis para evitar úlceras gástricas por estrés y nutrición, entre otras medidas).

Abstract Globally, the prevalence of sepsis is more than 19 million cases per year with an estimated mortality of 30%. The most frequently identified risk factors are chronic diseases (HIV-AIDS, COPD and neoplasms) and the use of immunosuppressive agents. The most susceptible popula tion to develop these complications are the ones in babyhood or the elderly. Among the multiple pathogens, bacteria are considered the microorganisms primarily involved in the development of severe sepsis. Within the foci of infection, pneumonia is considered to be the most common, followed by intra-abdominal infections, urinary tract and primary bloodstream infections. It has been demonstrated that early treatment significantly improves survival. Interventions to be performed include antimicrobial therapy, fluid resuscitation, ventilatory support and supportive measures (antithrombotic prophylaxis, glycemic control and prophylaxis to prevent stress gastric ulcers and nutrition).

Less invasive beractant administration in preterm infants: a pilot study

OBJECTIVES: The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure. METHOD: This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO2. Clinicaltrials.gov: NCT02611284. RESULTS: In the group with less invasive surfactant administration, beractant was successfully administered in all patients. Thirteen patients (43.3%) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes. CONCLUSION: The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.

Effect of Combined Aerobic and Anaerobic Training on Hemodynamic Response, Serum Oxidative Stress Markers and Platelet ATP Synthase Activities in Patients with Coronary Heart Disease: A Pilot Study.

Background: The overall aim of this work was to study the impact of combined aerobic and anaerobic training in relation to hemodynamic response (heart rate, systolic blood pressure, and double product), serum oxidative stress markers (lipoperoxides, nitrites-nitrates) and platelet ATP synthase activities in patients with coronary heart disease. Materials and Methods: Ten subjects, 9 male and 1 female, (mean age 57.7±7.2 years) with coronary heart disease participated in this study. Patients performed combined aerobic and anaerobic exercise for 24 sessions (three times a week). Results: The results suggest myocardium adaptations, manifested in the reduction of heart rate with increased workloads and increased double product [(heart rate) x (systolic blood pressure)] according to the intensity, frequency and duration of training. The ATP synthesis rate was significantly increased at session 3 (post-exercise) compared to session 1 (pre exercise). Furthermore, rate of ATP hydrolysis was significantly decreased at session 24 (post-exercise 3) compared to session 1 (post-exercise 1). Serum lipid peroxidation products and nitric oxide catabolites were significantly diminished at session 24 (pre-exercise). Conclusion: In some patients hemodynamic responses showed improvements in response to exercise. The exercise sessions induced lower levels of lipid peroxidation products, nitric oxide catabolites and ATPase activity. Conversely, ATP synthase activity showed higher values at the end of the experiment. These results confirm the beneficial effect of combined aerobic and anaerobic exercise.

Spinal Muscular Atrophy: Review of a Child Onset Disease.

Spinal Muscular Atrophy (SMA) is a group of inherited disorders that involve mainly bulbar and spinal motor neurons; causing muscle weakness and atrophy of proximal and symmetrical predominantly in lower extremities, without affecting the facial muscles and the intellectual ability. It is also unclear if SMA is a developmental or a neurodegenerative disease and occurs predominantly in childhood. The continuous clinical spectrum of SMA has been divided into 3 types based on the age at onset and highest motor milestones achieved. SMA type I was described by Hoffman in 1894 and in 1900 was reported as a disease characterized by hypotonia during the first 3 months of life, as well, is considered as the leading cause of death in children under two years of age among genetic diseases worldwide. SMA type II patients can achieve sitting but not walking. While SMA type III patients achieve full milestones with a progressive loss of walking ability. Deterioration in muscle strength and motor function eventually occurs in SMA type II and III. SMA occurs due to depletion of SMN, a ubiquitously expressed protein, which in all cells regulates RNA biogenesis and splicing through its role in the assembly of small nuclear ribonucleoprotein (snRNP) complexes.

Initial respiratory management in preterm infants and bronchopulmonary dysplasia

BACKGROUND: Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes. OBJECTIVE: To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks. DESIGN/METHODS: A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours). RESULTS: Of the 329 eligible patients, a total of 49 percent did not need intubation, and 68.4 percent did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group. CONCLUSIONS: In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity =89.5 percent and specificity = 67 percent). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients.

Tratamiento de la infección de la artroplastia total de cadera / Treatment applied in total hip arthroplasty infection / Traitement des arthroplasties totales de hanche infestées

Se realizó un estudio descriptivo, prospectivo, longitudinal, en el Complejo Científico Internacional "Frank País" en el período del 1ro, de octubre de 2003 al 31 de septiembre de 2005, con una muestra de 34 pacientes adultos con artroplastia total de cadera infectada tratadas por el Servicio de Séptico. El 44,2 por ciento perteneció al sexo femenino y el 55,8 por ciento al masculino. En el sexo masculino, el grupo de edad de 60 a 69 años, fue el de mayor número de casos con un 23,52 por ciento del total de pacientes. En el estadio II de Fitzgerald se incluyó el mayor número de pacientes (14 pacientes para un 41,16 por ciento). El agente bacteriano que con mayor frecuencia se aisló en el primer cultivo fue el Staphylococcus epidermidis en 11 pacientes. En ningún paciente se utilizó como método de tratamiento la administración exclusiva de antibióticos sin cirugía. La artroplastia de recambio (en dos tiempos) fue el método de tratamiento más utilizado y se aplicó a 14 pacientes (41,17 por ciento). A los seis meses de realizado el tratamiento combinado de desbridamiento amplio, administración de antibióticos por vía parenteral, uso de artroclisis y retención protésica, se observó buena evolución en 8 de los 13 pacientes y en 11 de los 14 tratados con artroplastia de recambio en dos tiempos, La complicación más frecuente fue el dolor residual, el que se presentó en 14 pacientes.

We made a longitudinal, prospective and descriptive study in "Frank País" International Scientific Center during October 1, 2003 to September 31, 2005 with a cohort of 34 adult patients presenting total arthroplasty of infected hip treated in Septic Service. The 44.2 percent was of female sex and the 55.8 percent of male one. In this latter, age group was of 60 to 69 years and was the greatest case figure with a 23.52 percent of patient total. In Fitzgerald II stage was included the greatest figure of patients (14 patients for a 41.16 percent). The more frequent bacterial agent was Staphylococcus epidermidis in 11 patients. In no patient we used the exclusive administration of antibiotics with surgery as treatment method. The turnover arthroplasty (in two steps) was the more used treatment method and we applied it in 14 patients (41.17 percent). At 6 months of combined treatment of wide debridement, the parenteral antibiotic administration, the use of arthrodesis and prosthetic retention, we noted a good course in 8 of the 13 patients treated with two steps-turnover arthroplasty. The more frequent complication was the residual pain, present in 14 patients.

Une étude descriptive, prospective et longitudinale d'un échantillon de 34 patients adultes atteints d'une infection de leur arthroplastie totale de hanche, et traités chirurgicalement au Service de chirurgie septique du Centre orthopédique international « Frank Pais ¼ a été réalisée entre le 1er octobre 2003 et le 31 septembre 2005. Les cas du sexe féminin et ceux du sexe masculin ont été respectivement 44,2 percent et 55,8 percent, étant la tranche d'âge de 60 à 69 ans la plus souvent touchée dans le sexe masculin (23,52 percent). Le plus grand nombre de patients (14 patients ; 41,16 percent) étaient en stade II de Fitzgerald. Dans les premières cultures, le germe majoritairement rencontré a été le Staphylococcus epidermidis (11 patients). L'antibiothérapie sans chirurgie n'a pas été le seul traitement utilisé. L'arthroplastie de remplacement (en deux temps) a été le traitement le plus souvent utilisé (14 patients ; 41,17 percent). Après six mois de traitement combiné de débridement, antibiothérapie par voie parentale, arthroclyse et prothèse, on a pu constater une bonne récupération chez 8 patients sur 13, et chez 11 patients sur 14 traités par arthroplastie de remplacement en deux temps. La douleur résiduelle a été la complication la plus fréquente (chez 14 patients).

Cultivo de Poecilia reticulata (Pisces: Poecilidae) en cuerpos de agua tropicales, Veracruz, México / Culture of Poecilia reticulata (Pisces: Poecilidae)in tropical water bodies, Veracruz, México

Los peces ornamentales cultivados se han popularizado como mascotas, generando una demanda local que no se ha podido cubrir con la producción de México y por lo tanto deben importarse. Poecilia reticulata "guppy ",es un pez muy popular en el ámbito acuarístico,hoy en día se ha logrado desarrollar una gran cantidad de variedades según su coloración,tipo y forma de cola. Son peces vivíparos que toleran un ámbito extremo de temperatura,siendo la más adecuada entre 25ºC y 28ºC.El tiempo que tardan las hembras en expulsar a las crías una vez que quedan preñadas, oscila entre los 25 y 30 días dependiendo de la temperatura. En esta investigación, el ciclo reproductivo completo se desarrolló en jaulas flotantes, en una laguna tropical situada en la Llanura Costera del Golfo Sur, Veracruz, México. Se diseñó la infraestructura necesaria para producir guppys (P. reticulata) incluyendo el manejo de reproductores,crianza, engorda, alimentación y comercialización,e valuando su factibilidad técnica y financiera. Se realizó un estudio de mercado,a través de una encuesta aplicada a los propietarios de los 22 acuarios existentes en la Ciudad de Veracruz,México. Se analizaron las frecuencias de oferta y demanda de cada especie con respecto a la temporada del año, lugar de origen y resistencia al manejo. Las características hidrobiológicas presentaron valores medios de temperatura (31.4ºC), oxígeno disuelto (4.5 mgl-1) y pH (6.8). Con los datos obtenidos en campo se realizó un modelo para producción de P.reticulata ,obteniendo una relación beneficio/costo=1.16,correspondiente al ingreso mínimo potencial con una ganancia bruta de US$257.67, proporcionando empleo a dos personas El aprovechamiento de cuerpos de agua en regiones tropicales a través de la producción de peces de ornato representa una alternativa para disminuir la presión sobre las poblaciones silvestres y las tierras de cultivo,proporcionar fuentes de empleo e incrementar los ingresos para el...

Poecilia reticulata, also known as guppy, is the most popular fish in the aquarium environment. Guppys are viviparous fish with high tolerance to extreme temperatures.The development of the offspring takes between 25 and 30 days. We developed a technology for raising guppys,which outlines infrastructure and devices for reproduction, nursery, feeding, and commercialization,evaluating the financial and technical feasibility of this technology in a case study. The complete reproductive cycle occured in floating cages with 1 mm mesh and the method was tested in a tropical lagoon in Mexico.Water quality was monitored throughout the study period (temperature, dissolved oxygen and pH levels). A marketing survey was carried out at all existing aquarium shops in Veracruz City. Data collected depict quantities demanded and offered for each species by season,place of origin, and resistance to handling.The hydrobiological characteristics were:average temperature 31.4 ºC, dissolved oxygen 4.5 mgl-1,and pH level 6.8.With these values we built a production function,and used it to evaluate profitability. We estimate a benefit/cost ratio of 1.16,with a net annual income of US$257.67. The system may provide two permanent jobs

El reto actual de la medicina familiar en México / Contemporary challenge of family medicine in Mexico

El presente trabajo es un ensayo sobre la situación actual que vive la medicina familiar en México en marco de la seguridad social, desde el enfoque de la transición económica, epidemiológica, demográfica y cultural, procesos que afectan la práctica médica en general y la medicina familiar en particular. Enfatiza la importancia que la relación médico-paciente-familia tiene en el momento actual para satisfacer las expectativas tanto de los pacientes como de los prestadores de los servicios y para contener los costos de éstos en la atención médica. Así mismo resalta la importancia de la educación para la salud como elemento fundamental para prevenir y resolver los principales problemas de salud y modificar favorablemente los patrones culturales de las poblaciones migrantes y en la adquisición de una cultura de la salud y finalmente como recurso para enfrentar la crisis actual que vive la medicina familiar en México