Asociación de algunas variables antropométricas y hemodinámicas con la glucemia / Association of Some Anthropometric and Hemodynamic Variables with Glycemia

RESUMEN Fundamentación: diversas fuentes aseveran que existen diferencias en algunas variables antropométricas y hemodinámicas entre individuos con glucemia normal, riesgo y patológica, por lo cual se hace necesario mostrar nuevas evidencias. Objetivo: determinar la relación entre variables antropométricas y hemodinámicas con las cifras de glucemia en individuos del municipio Cienfuegos en el 2010. Métodos: se realizó un estudio descriptivo transversal correlacional. La muestra estuvo conformada por 925 individuos. Las variables analizadas fueron: edad, sexo, color de la piel, cintura abdominal, índice de masa corporal, presión arterial sistólica, diastólica y media, índice de reactividad cardiovascular y glucemia. Se aplicaron pruebas estadísticas no paramétricas para evaluar la correlación entre la glucemia en ayunas y las variables de estudio, con una significación del 99 %. Los resultados se presentan en tablas y gráficos. Resultados: hubo predominio del color de piel blanca y el sexo femenino y los individuos entre 35-44 años representaron el mayor porcentaje de la muestra. Los pacientes con glucemia de riesgo y diabéticos presentaron un incremento de las variables de estudio por encima de lo normal. Conclusiones: existe una correlación positiva entre la concentración de glucosa y las variables de estudio analizadas, lo que explica los desbalances antropométricos y hemodinámicos en pacientes con glicemia riesgo y patológica.

ABSTRACT Foundation: various sources claim that there are differences in some anthropometric and hemodynamic variables between individuals with normal, risk and pathological glycemia, which makes necessary to show new evidence. Objective: to determine the relationship between anthropometric and hemodynamic variables with the glycemia figures in individuals of the Cienfuegos municipality in 2010. Methods: a correlational cross-sectional descriptive study was carried out. The sample consisted of 925 individuals. The variables analyzed were: age, sex, skin color, abdominal waist, body mass index, systolic, diastolic and mean blood pressure, cardiovascular reactivity index and glycemia. Nonparametric statistical tests were applied to evaluate the correlation between fasting blood glucose and the study variables, with a significance of 99 %. The results are presented in tables and graphs. Results: there was a predominance of white skin color and female gender and individuals between 35-44 years represented the highest percentage of the sample. Patients with risk glycemia and diabetics had an increase in the study variables above normal. Conclusions: there is a positive correlation between glucose concentration and the analyzed variables, which explains anthropometric and hemodynamic imbalances in patients with glycemia risk and pathology.

Influencia del estrés psicológico y la actividad física moderada en la reactividad cardiovascular / Influence of Psychological Stress and Moderate Physical Activity in Cardiovascular Reactivity

La reactividad cardiovascular es la respuesta que da el aparato homónimo ante un estímulo externo y se ve modificada por varios parámetros, entre ellos el estrés psicológico, que repercute en la aparición de enfermedades car¬diovasculares. Algunos estudios han demostrado y apoyado los beneficios de la actividad física en el mantenimiento de un estado de salud fisiológica y psicoló¬gicamente óptimos, incluyendo la respuesta cardiovascular al estrés agudo. El presente trabajo tuvo como objetivo describir el impacto que tiene el estrés psi¬cológico y el ejercicio físico aerobio sobre la reactividad cardiovascular. Para ello se consultaron un total de 30 fuentes bibliográficas, entre ellas 2 libros y numerosos artículos de revistas científicas, a los que se tuvo acceso por medio de los principales gestores de la red informática. El estrés psicológico y el ejercicio físico aeróbico actúan de forma antagónica sobre la reactividad cardiovascular.

Reactivity is the response of the homonymous system to an external stimulus and it is modified by various parameters among them the psychological one which influences the appearance of cardiovascular diseases. Some studies have demonstrated and supported the benefits of physical activity in keeping ideal physiological and psychological fitness, including cardiovascular response to acute stress. This work had the objective of describing the influence of psychological stress and aerobic physical activity on cardiovascular reactivity. For that a total of 30 bibliographic sources, among them 2 books and a number of articles from scientific journals, accessed through the main managers the computer network. It was concluded that psychological stress and aerobic physical exercises influence antagonistically on cardiovascular reactivity.

Círculos de interés de Estomatología: espacio para la orientación vocacional e información / Vocational training groups: space for vocational guidance and oral hygiene information in schoolchildren

Fundamento: los círculos de interés de Estomatología constituyen espacios que contribuyen a la formación vocacional de los escolares a la vez que promueven su salud bucodental. Objetivo: elaborar un programa educativo para círculo de interés de Estomatología que contribuya a la orientación vocacional y hábitos saludables en escolares. Métodos: se realizó una investigación de desarrollo en la Universidad de Ciencias Médicas de Villa Clara. Se utilizaron métodos teóricos: histórico-lógico, análisis-síntesis e inductivo-deductivo; y empíricos: análisis documental, encuesta en forma de cuestionario a los escolares y la observación. El producto fue valorado por criterios de especialistas. Resultados: la mayoría de los escolares expresó su disposición a participar en el círculo de interés, se detectaron sus carencias acerca de la higiene bucodental y su importancia; y casi todos estaban desinformados sobre temas relacionados con la Estomatología. El programa educativo elaborado ofrecía solución a estas insuficiencias; después de su aplicación se corroboró su efectividad. Conclusiones: fue valorado como pertinente, útil, factible y de adecuado valor metodológico por los especialistas consultados. Con su aplicación, los escolares mejoraron su información e higiene bucodental y se motivaron por los temas relacionados con la Estomatología.

Background: Dentistry vocational training groups are spaces that contribute to the vocational training of school children while promoting their oral health. Objective: to develop an educational program for the Dentistry vocational training groups, that contributes to the vocational guidance and healthy habits in school children Methods: a development research was carried out at Villa Clara University of Medical Sciences. Theoretical methods were used: historical-logical, analysis-synthesis and inductive-deductive; and empirical: documentary analysis, survey in the form of a questionnaire to schoolchildren and observation. The product was evaluated by specialists' criteria. Results: the majority of the students expressed their willingness to participate in the vocational training groups, their shortcomings about oral hygiene and its importance were detected; and almost everyone was uninformed about issues related to Dentistry. The educative program elaborated offered solution to these insufficiencies; after its implementation, its effectiveness was corroborated. Conclusions: it was assessed as pertinent, useful, feasible and of adequate methodological value by the specialists consulted. With its implementation, school children improved their oral hygiene and were motivated by the topics related to Dentistry.

Valor predictivo del cálculo de riesgo cardiovascular global / Predictive Value of Cardiovascular Global Risk Calculation

Las enfermedades cardiovasculares constituyen la principal causa de morbilidad y mortalidad en el mundo. La mejor herramienta para establecer prioridades en la prevención primaria cardiovascular es la estimación precisa del riesgo cardiovascular global. El presente trabajo tuvo como objetivo explicar el valor del cálculo de riesgo cardiovascular como instrumento predictivo para las enfermedades cardiovasculares, para lo cual se realizó una revisión documental de un total de 27 fuentes bibliográficas, entre ellos 26 artículos de revistas científicas de impacto internacional, además de otras fuentes, a las que se accedió por medio de los principales gestores de la información. La predicción del riesgo de morbilidad cardiovascular ha constituido elemento esencial en las guías clínicas de prevención de estas enfermedades y ha devenido una herramienta útil para el médico de familia, para poder establecer prioridades en la atención primaria de salud, lo que posibilitará avanzar hacia el estudio de complejas asociaciones capaces de repercutir en riesgo cardiovascular.

Cardiovascular diseases constitute the main morbidity and mortality cause of death worldwide. The best tool to set priorities in primary cardiovascular prevention is the precise estimation of the global cardiovascular risk. This work was aimed at explaining the predictive value for cardiovascular diseases, for which a documentary review of a total of 27 bibliographic sources was done. Among these 26 international impact articles from journals and a thesis, among other sources were reviewed, to which it was accessed through the main information managers. Risk mobility prediction has been an essential element in preventive clinical guidelines for these diseases and has become a useful tool for the family doctor, to set priorities in primary health care, which will allow making progress in studying complex associations that may impact cardiovascular risk.

Hábitos alimentarios asociados a sintomatología digestiva alta en estudiantes sin patología del tracto digestivo superior / Eating Habits of Students Associated with Digestive Complications not Diagnosed as an Upper Gastrointestinal Pathology / Hábitos alimentares associados a sintomatologia digestiva alta em estudantes sem patologia do trato digestivo superior

[{"text": "Objetivo: determinar la relación entre hábitos alimentarios y la presencia de síntomas digestivos altos en estudiantes de la Universidad Nacional de San Luis. Metodología: estudio transversal descriptivo, en el cual participaron 150 sujetos (mujeres = 86, hombres = 64), estudiantes de 20 a 30 años de edad, de la Universidad Nacional de San Luis, sede San Luis; se utilizó una encuesta validada del Ministerio de Desarrollo Social de Argentina, adaptada a los fines de la presente investigación. Resultados: la mayoría de los estudiantes consume casi siempre las cuatro comidas principales; las formas de cocción predominantes fueron: horno, plancha y hervido. Se observó escasa y poco variada selección de frutas y verduras, un consumo ocasional de bebidas alcohólicas y de productos ricos en grasas, sal y azúcares. La elección de dulces y azúcares, mate cebado, té y café fue elevada. Los síntomas más recurrentes fueron: distensión abdominal, hambre dolorosa, regurgitación, náuseas y pirosis; los que menos aparecieron fueron vómito y anorexia. Los estudiantes asociaron la recurrencia de los síntomas al consumo de comidas con salsa, comidas picantes, mate cebado, té y café. En el sexo masculino, las bebidas alcohólicas también se asociaron a la sintomatología digestiva. Conclusiones: se pudo observar la presencia de más de un síntoma digestivo alto simultáneo en cada estudiante, unido a la presencia de hábitos alimentarios perjudiciales. Por ello, es indispensable impartir educación alimentaria nutricional.", "_i": "es"}, {"text": "Objective: To determine the relationship between the eating habits and the presence of upper digestive problems of 150 university students. Methodology: This is a descriptive cross-sectional study in which 150 individuals participated (86 females, 64 males). The students ranged from 20 to 30 years of age and were from the Universidad Nacional de San Luis. The study used a survey validated by the Ministry of Social Development of Argentina, which was adapted to the purposes of the present investigation. Results: The majority of the students almost always consumed four main meals, the main methods of cooking were: to bake, to grill and to boil. It was observed that there was hardly any variety in the selection of fruits and vegetables, in the occasional consumption of alcoholic drinks or in food products rich in fat, salt and sugar. The choice of sweets and sugars, mate "cebado" tea and coffee was high. The most recurring symptoms were: stomach distension, painful hunger, regurgitation, nausea, and heartburn. Those symptoms that occurred less were vomiting and anorexia. The students associated the recurrences of symptoms with the consumption of these fares: foods with sauce, spicy meals, mate "cebado", tea and coffee. In males, alcoholic beverages were also associated with digestive problems. Conclusions: It was possible simultaneously to observe the presence of more than one upper digestive problem in each of the students in correlation to harmful eating habits. For this reason, it is essential to provide education in nutritional eating.", "_i": "en"}, {"text": "Objetivo: determinar a relação entre hábitos alimentares dos alunos da Universidade Nacional de San Luis e a presença de sintomas digestivos superiores. Metodologia: estudo descritivo, transversal, em que participaram 150 estudantes (femininos = 86, masculinos = 64) de 20 a 30 anos de idade, da Universidade Nacional de San Luis, sede San Luis, usando um inquérito validado pelo Ministério do Desenvolvimento Social da Argentina, adaptado aos fins da presente investigação. Resultados: a maioria dos estudantes realiza quase sempre as quatro principais refeições, as formas de cocção predominantes foram: forno, na chapa e fervido. Observou-se escasso e pouco variado consumo de frutas e vegetais, um consumo ocasional de bebidas alcoólicas e produtos ricos em gorduras, sal e açúcares. O consumo de doces e açúcares, chimarrão, chá e café foram elevados. Os sintomas mais frequentes foram: distensão abdominal, fome dolorosa, regurgitação, náuseas e pirose, e os que menos apareceram foram: vômito e anorexia. Os estudantes associaram a recorrência dos sintomas ao consumo de: comidas com molho, comidas picantes, chimarrão, chá e café. No sexo masculino, as bebidas alcoólicas foram também associadas à sintomatologia digestiva. Conclusões: observou-se a presença de mais de um sintoma simultaneamente em cada estudante e, por sua vez, a prática de comportamentos alimentares prejudiciais para eles mesmos. Portanto, é essencial a realização de educação alimentar nutricional.", "_i": "pt"}]

Gender differences in clinical outcome after coronary stenting

OBJECTIVE: The purpose of this study was to determine the effect of gender differences in the clinical outcome of women and men submitted to coronary stenting at our institution. BACKGROUND: Studies regarding gender differences in outcome after invasive coronary interventions have revealed conflicting data regarding risk for complications. Some studies have pointed to female gender as a predictor of mortality and complications after those procedures. To our knowledge no such evaluation has been performed in our country. METHODS: We reviewed the medical records, cardiac catheterization and procedural data of 205 men and 122 women referred to our section that underwent coronary stenting at the Cardiovascular Center of Puerto Rico and the Caribbean from July 1, 1998 to March 30, 1999. The clinical and procedural characteristics and the immediate procedure-related complications were analyzed. Clinical events during the six-month period after the procedure were evaluated in patients that returned for follow-up to the section. Student's t-test or Mann-Whitney-Wilcoxon, when appropriate, was used to compare continuous data. The chi-square test or Fisher's exact test, was employed to compare categorical data. RESULTS: The initial procedural success and the frequency of early complications were comparable to those informed in the medical literature and not statistically significant between genders. The only statistically significant gender differences in outcome occurred in men who had higher re-hospitalization and re-intervention rates in the six-month period after the procedure. A lower mean ejection fraction and higher previous history of myocardial infarction and cigarette smoking in this group could have been related to the higher complication rate. CONCLUSION: Although the sample examined is small, its findings point to the need of a larger prospective study to further explore the possibility that the previously reported differences in outcome in men and women submitted to interventional procedures would have a stronger relation to clinical factors than to the direct effect of gender.

Surgical versus interventional procedures in patients with multivessel coronary artery disease

OBJECTIVE: This study examined the clinical characteristics, risk factors, indications and post-intervention complications of patients with multivessel coronary artery disease (CAD) submitted to either percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement versus isolated coronary artery bypass grafting (CABG). BACKGROUND: Several studies have examined the relative safety and outcome of patients submitted to those interventional procedures compared to CABG. Limited information is available regarding that subject in Puerto Rico. METHODS: We performed a retrospective analysis of the clinical, angiographic, operative, interventional, post-operative and post-interventional data of patients submitted to those procedures in our institution from January 1998 to August 1998. There were 53 patients in the interventional group and 206 patients in the CAGB group. Comparison of quantitative variables by procedure was based on Student t test or Mann-Whitney-Wilcoxon test; categorical variables were compared using Pearson's chi-square or Fisher's exact test. RESULTS: There were no significant differences in age, body surface area, or cardiac risk factors. The most common pre-existing cardiovascular diagnosis was unstable angina. Three-vessel disease was the most common angiographic finding among CABG patients (61.7 percent). Two-vessel disease without left anterior descending coronary artery obstruction was significantly more common in the PTCA/Stent patients (58.5 percent). The vast majority (97.6 percent) of patients in the PTCA/Stent group and 52.4 percent of the CABG group had two-vessel intervention. A significantly higher frequency of complications occurred in the CABG group. However, the incidence of major complications, in both groups was not statistically different. Atrial arrhythmias were significantly more frequent in the CABG group. CONCLUSION: A larger prospective study should be conducted in order to corroborate these preliminary findings and seek effective solution to any identifiable problem.

Perioperative outcomes in octogenarians undergoing cardiac surgery in Puerto Rico

With the advances in surgical techniques and the advent of an aging population, the application of cardiac surgeries has broadened to include those patients over the age of 80. In order to characterize the in-hospital morbidity and mortality of elderly patients undergoing cardiac surgery at our cardiovascular center, a retrospective review of all medical records of consecutive octogenarian patients was made. Between January 1998 and April 1999, 76 patients (mean age (SD), 82.5 (2.6)) underwent cardiac surgery, of which, 61.8 percent were males. Surgical procedures consisted of isolated coronary artery bypass grafting (CABG)in 64 patients, isolated aortic valve replacement (AVR) in 4 patients, combined CABG and left carotid endarterectomy in 4 patients, combined CABG and AVR in 2 patients, combined CABG and aortic aneurysm repair in 1 patient and combined AVR and aortic dissection repair in 1 patient. Surgery was elective in 51.3 percent of patients and seventy-one percent (54) experienced at least one postoperative complication. The most common complication was atrial arrhythmia (28) followed by low cardiac output (23) and pneumonia (16). Hospital mortality occurred in 11 (14.7 percent) patients, an estimate in agreement with previous published studies on octogenarians. Since the number of patients studied was small, these results require confirmation by other cardiovascular centers in the island. Further research to determine independent predictors of postoperative morbidity and mortality, to assess survival and quality of life after cardiac surgery and to evaluate cost-effectiveness considering new trends in managed health care is warranted.

Métodos alternos de anális estadístico en epidemiología: frequentista, verosimilitud y bayesiano / Alternative methods of statistical analysis in epidemiology: frequency, likelihood, and Bayesian

Una de las críticas a la pruebas de significancia, basadas en los intervalos de confianza y en el valor de p (p-value), es su interpretación utilizando el concepto de repeticiones. Este tipo de interpretación se conoce como la interpretación frecuentista (frequentist interpretation), la cual indica una repetición de las muestras de estudio bajo condiciones similares, condición difícil de aplicar en estudios epidemiológicos observacionales. Por lo tanto, se han desarrollado otras alternativas que puedan contestar esta interrogante. Una de estas alternativas es el cálculo de los intervalos de verosimilitud (likelihood intervals); otra se obtiene mediante el cálculo de intervalos bayesianos (Bayesian intervals). En este documento presentamos una breve descripción de estos métodos y su aplicaciones en estudios epidemiológicos. Se espera que con el desarrollo de nuevos programas de computación, las aplicaciones de estos métodos irán en aumento, por lo que los investigadores de la salud tendrán otras alternativas de análisis y evaluación de datos estadísticos.

Variations in the survival probabilities of the PVC-protected red mangrove propagules: testing the encased replanting technique

The EcoEléctrica Mangrove Planting Project, a five-year voluntary effort, has the purpose of testing a recently developed mangrove planting technique at the EcoEléctrica site in Peñuelas, Puerto Rico. The goal of the project is to provide empirical validation to promote or improve the technique to be used in recovering mangrove ecosystems in Puerto Rico and United States. The research presented herein analyzed the information collected on the first two years of the project. The proportions of remaining casings and seeds per study zone were compared using the chi-square distribution. Zone 1 had the least pipes lost while Zone 4 had the most (p < 0.05). Forty-three percent of the seeds in Zone 1 remained in the casing, while 26 percent remained in Zone 2 (p = 0.03). Median growth rates of seeds per study zone showed that Zone 1 had the highest median growth rates. Survival analysis described the survival experience of the seeds, and differences in survival probabilities were compared with the log-rank test. Zone 1 seeds had a better survival experience compared to Zones 2, 3 and 4 (p < 0.0001). Survival probabilities for being free of spots were over 60 percent during the whole study period. No significant differences were observed in the survival experience with the use-or-no use of casing extensions (p = 0.40), and the use-or-no use of nursed seeds (p = 0.26). Differences in survival probabilities might be attributed to variations in wave energy, depth or substrate conditions. This hypothesis will be evaluated in the second phase of the study.

Aspectos metodológicos de bioestadística y epidemiología en un ensayo clínico / Methodological aspects of biostatistics and epidemiology in a clinical trial

Various methodological issues in biostatistics and epidemiology which are relevant for the development of a clinical trial are discussed. A brief set of definitions regarding clinical trials and methods for the assignment of treatments is presented. In addition, methods to reduce the possibility of bias that may be introduced into a clinical trial are summarized. The different elements that must be included in the informed consent form are defined. General considerations for data analysis and for sample size required to obtain an adequate statistical power are illustrated. Finally, critical questions that can be used for the review of the literature on clinical trials are suggested

Early postoperative complications after coronary artery bypass grafting at the Cardiovascular Center of Puerto Rico and the Caribbean

OBJECTIVES: This study describes the preoperative cardiovascular characteristics, intraoperative data, in-hospital complications and factors associated to procedural-related complications in patients undergoing coronary artery bypass grafting (CABG). BACKGROUND: There is a growing body of evidence of CABG safety and efficacy; however, limited data is available regarding the value of this surgical procedure in the Puerto Rican population. METHODS: We retrospectively reviewed the medical records of 200 consecutive patients submitted to CABG at the Cardiovascular Center of Puerto Rico and the Caribbean over a three-month period in 1997. Bivariate and multivariate analyses were performed to determine factors associated with the occurrence of complications. RESULTS: The most frequent cardiac risk factor was hypertension (77 per cent); stable angina (60.5 per cent) was the predominant cardiac clinical diagnosis. Three vessel disease with proximal left anterior descending coronary artery stenosis (42.1 per cent) was the most common anatomical lesion. The rate of major complications such as death (3 per cent), perioperative myocardial infarction (2 per cent), reoperation to control bleeding (1.5 per cent), pulmonary embolism (1 per cent), and stroke (1 per cent) was low and similar to the rate reported elsewhere. Multivariate analysis showed that non-use of LIMA graft, extended hospital stay, prolonged cardiopulmonary bypass time, and left ventricular dysfunction were significantly associated with the occurrence of complications (p < 0.05); on the other hand, there was a trend for older age to be associated with the occurrence of complications (p = 0.057). CONCLUSIONS: CABG is being performed with an acceptably low complication rate in this institution.

Chronic hepatitis C: treatment comparison between 3 and 5 million units of interferon alpha-2b

Interferon (IFN) is the only drug that has been approved by the FDA for therapy of chronic hepatitis C. However, optimal dose and duration of therapy are still controversial. This study compares the effectiveness of treatment of chronic hepatitis C patients with 3 vs. 5 million units (MU) of recombinant alpha-interferon 2-b three times per week. We also evaluated the relapse rate with a shorter 12 week-course of therapy in those patients who had normalization of aminotransferases by week 12. Seventy-five patients were randomized to receive either 3 vs. 5 MU of IFN; seventy-two completed the study. A complete response was seen in 11/35 (31 per cent) of those treated with 5 MU vs. 13/37 (35 per cent) in the 3 MU dose (p = 0.74). Patients were followed after IFN was withdrawn and only 2 had persistently normal aminotransferases. Analysis of multiple variables was done to predict response to FN and only elevations of GGT, ferritin and alkaline phosphatase were found to be predictors of a poor response. Therefore, we recommend initial therapy with 3 MU of IFN for a longer period than 12 weeks in patients who show a response.

Association between dietary fat and breast cancer in Puerto Rican postmenopausal women attending a breast cancer clinic

OBJECTIVE: A pilot case-control study was conducted to examine the possible association between dietary fat intake and the development of postmenopausal breast cancer. BACKGROUND: Studies regarding the association between dietary fat intake and the development of breast cancer among postmenopausal women are lacking in Puerto Rico. METHODS: Eighteen cases and eighteen controls were interviewed to obtain sociodemographic information, medical history and dietary fat intake. A semiquantitative food frequency questionnaire containing 67 food items was used to collect the dietary information. RESULTS: Unadjusted odds ratios (OR) and their 95 per cent confidence intervals (CI) showed a non-significant positive association for total fat intake and the development of postmenopausal breast cancer (OR = 1.57; 95 per cent CI: 0.42-5.90, p = 0.25). The same non significant positive association was found for saturated fat intake (OR = 1.57; 95 per cent CI: 0.42-5.90, p = 0.25). Polyunsaturated fat (OR = 1.25; 95 per cent CI: 0.34-4.64, p = 0.37) and monounsaturated fat (OR = 1.25; 95 per cent CI: 0.34-4.64, p = 0.37) were also positively associated with postmenopausal breast cancer, although the associations were not statistically significant. CONCLUSIONS: These results are consistent with other case-control studies that have shown non-significant positive associations between total fat and the different components of dietary fat and postmenopausal breast cancer.

Dietary fat and breast cancer: a brief update on current knowledge

Descriptive epidemiologic data suggest a relationship between consumption of high fat diets and breast cancer; although these data can be potentially confounded by other causative exposures. Results of published case-control and cohort studies are inconclusive. Nevertheless, dietary fat significantly affects mammary tumorigenesis in mice and rats in laboratory experiments. We will review current epidemiologic and animal studies, explain the possible mechanisms of how dietary fat may affect breast cancer, and provide preliminary dietary recommendations.

Traumatismo hemifacial por arma de fuego. Caso clínico / Gunshot hemifacial trauma. A clinical case

Caso clínico de traumatismo por arma de fuego de grueso calibre (30-35), que lesiona la hemicara izquierda, con pérdida de sustancia total de cuerpo mandibular izquierdo, multifragmentaria de maxilar superior, piso nasal y tabique, con exposición de piso orbitario, hueso malar y porción anterior de arco cigomático, así como desprendimiento parcial de tejidos blandos de la región nasal, geniana, maxilar, mandíbular y región anterior maseterina, que fue trasladado desde su domicilio (sierra de Juárez) hasta el hospital, en un período de 7 horas