[The evaluation of science]. / La evaluación de la ciencia.

The evaluation and quantification of scientific activity is an extremely complex task. Evaluation of research results is often difficult, and different indicators for the quantification and evaluation of scientific publications have been identified, as well as the development and success of the training programs of researchers.

La evaluación y la cuantificación de la actividad científica es una tarea sumamente compleja. La evaluación de los resultados de la investigación suele ser difícil, por lo que se han identificado diferentes indicadores para la cuantificación y valoración de las publicaciones científicas, así como el desarrollo y éxito de los programas de formación de los investigadores.

[The ENARM and the schools and faculties of medicine. An analysis that nobody will like]. / El ENARM y las escuelas y facultades de medicina. Un análisis que no le va a gustar a nadie.

In Mexico, the career of Doctor of Medicine has been considered as a prerequisite stage to access the specialization. Of course the majority of medical graduates aspire to undertake postgraduate courses in the different institutions that have a university program. The Examen Nacional de Aspirantes a Residencias Médicas (ENARM) (National Evaluation for Medical Residency Applicants) has become for the supporters a gap between the possibility of practicing the profession in a decent way and with a regular remuneration or exercising it in very limited conditions and with low economic income or even without exercising it. For educational institutions, the ENARM and the percentages of selection of their graduates are indicators of efficiency and a source of prestige and even of propaganda among the aspirants to study medicine. In this study, we carried out an analysis of the results of the ENARM in the last 15 years. For this we refer to the reports of the Postgraduate and Continuing Education Committee of the CIFRHS of the Directorate of Health Education of the General Directorate of Quality and Health Education Of the Undersecretariat of Innovation and Quality of the Ministry of Health, from the examination carried out in 2001 to the one carried out in 2016.

En México, la carrera de médico cirujano se ha considerado como una fase propedéutica para acceder a la especialización. Desde luego, la mayoría de los egresados de la carrera de medicina aspiran a realizar cursos de posgrado en las diferentes instituciones que tienen un programa universitario. El Examen Nacional de Aspirantes a Residencias Médicas (ENARM) se ha convertido para los sustentantes en un parteaguas entre la posibilidad de ejercer la profesión de una manera digna y con una retribución en promedio buena o ejercerla en condiciones muy limitadas y con ingresos económicos bajos o incluso no ejercerla. Para las instituciones educativas el ENARM y los porcentajes de selección de sus egresados son indicadores de eficiencia y motivo de prestigio e incluso de propaganda entre los aspirantes a estudiar medicina. En el presente estudio, realizamos un análisis de los resultados del ENARM en los últimos 15 años. Para ello consultamos los informes del Comité de Posgrado y Educación Continua de la Comisión Interinstitucional para la Formación de Recursos Humanos para la Salud (CIFRHS) de la Dirección de Educación en Salud de la Dirección General de Calidad y Educación en Salud de la Subsecretaría de Innovación y Calidad de la Secretaría de Salud, a partir del examen realizado en el año 2001 al realizado en 2016.

[Why a degree of speciality instead of a Master's?] / ¿Por qué especialidad y no maestría?

It was at the beginning of the last century, in the hospitals where most of the attention was given, when it was established the habit of admitting apprentices as members of the medical team. However, it was not clearly established how aspirants were admitted, how their learning was to be developed, or what their functions were.

Fue a principios del siglo pasado, en los hospitales donde se brindaba la mayor parte de la atención, cuando se fue estableciendo la costumbre de admitir aprendices como miembros del equipo médico. Sin embargo, no estaba claramente establecido cómo se admitía a los aspirantes, de qué manera se iba a desarrollar su aprendizaje, o en qué consistían sus funciones.

[The Journals role in continuing medical education]. / El papel de las publicaciones periódicas en la educación continua.

In the 19th century, the first journals in medicine appeared in order to disseminate knowledge among creators and discoverers, but especially among users of knowledge, some of these journals continue to be published nowadays. Subsequently, an organization that initially aspired to collect, sort, archive and distribute the publications: the Index Medicus. Over time, it was imperative to create indexes that measure the performance of journals and with that of researchers.

En el siglo XIX surgen las primeras publicaciones periódicas en medicina con la finalidad de difundir el conocimiento entre los creadores y descubridores del mismo pero, sobre todo, entre los usuarios del conocimiento; con el tiempo fue imperiosa la necesidad de crear índices que midieran el desempeño de las revistas y con él, el de los investigadores.

Dicyano and pyridine derivatives of ß-carotene: synthesis and vibronic, electronic, and photophysical properties.

Density functional theory and time-dependent density functional theory calculations provide pictures of the molecular orbitals involved in the ground and excited states of two cyano derivatives of 8'-apo-ß-caroten-8'-al synthesized via an acid-base-catalyzed Knoevenagel condensation reaction. Population analysis shows that the symmetry-allowed transition, S(0) ((1)A(g)) → S(2) ((1)B(u)) based on the C(2h) symmetry is a HOMO (highest occupied molecular orbital) to LUMO (lowest unoccupied molecular orbital) π → π* transition with electron densities located mostly on the polyene chain. Calculated and actual steady-state absorption spectra show similar features with low-energy peak maxima between 550 and 600 nm.

Dicyano and pyridine derivatives of retinal: synthesis and vibronic, electronic, and photophysical properties.

Two new derivatives of all-trans retinal, one containing a pyridine and a cyanide substituent, all-trans-15-cyano-15'-pyridylretinal (2), and the other containing two cyanide substituents, all-trans-15,15'-dicyanoretinal (3), have been synthesized from all-trans-retinal (1) by the Knoevenagel reaction. Compound 2 crystallizes in the space group P1; compound 3 crystallizes in the space group P2(1)/n. The polyene chains are bowed. The compounds exhibit C[triple bond]N vibrations in the infrared and Raman regions and undergo irreversible oxidations. Compounds 2 and 3 display electronic absorptions with maxima located at 442 and 487 nm and emission peaks located at 583 and 500 nm, respectively. Density Functional Theory and Time Dependent Density Functional Theory calculations reveal that the electronic transition from the HOMO to the LUMO can be associated with the A(g) --> B(u) electronic transition and a peak corresponding to the HOMO --> LUMO+1 transition can be associated with the "cis-peak".

Does bariatric surgery improve the patient's quality of life?

OBJECTIVE: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS) on the quality of life (QoL), applying the Nottingham Health Profile (NHP) and the bariatric analysis and reporting outcome system (BAROS). DESIGN: A prospective cohort study was performed in 100 adult patients (> 18 years) undergoing bariatric surgery by malabsorptive technique for one year. RESEARCH METHODS AND PROCEDURES: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI) was 50.7 kg/m². RESULTS: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001) with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered "very good". CONCLUSION: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

[Nutritional management of intestinal failure and potential stimulation mechanisms]. / Tratamiento nutricional del fallo intestinal y potenciales mecanismos de estimulación.

Severe forms of intestinal failure represent one of the most complex pathologies to manage, in both children and adults. In adults, the most common causes are chronic intestinal pseudo-obstruction and severe short bowel syndrome following large intestinal resections, particularly due to massive mesenteric ischemic, within the context of cardiopathies occurring with atrial fibrillation. The essential management after stabilizing the patient consists in nutritional support, either by parenteral or enteral routes, with tolerance to oral diet being the final goal of intestinal adaptation in these pathologies. Surgery may be indicated in some cases to increase the absorptive surface area. Parenteral nutrition is an essential support measure that sometimes has to be maintained for long time, even forever, except for technique-related complications or unfavorable clinical course that would lead to extreme surgical alternatives such as intestinal transplantation. Hormonal therapy with trophism-stimulating factors opens new alternatives that are already being tried in humans.

Successful laparoscopic management of unilateral chyluria in a 5 year old.

Chyluria is defined as abnormal passage of chyle in the urine. It is usually seen in adults and is bilateral. The commonest cause is infestation with Wuchereria bancrofti. Other causes include trauma, tumours, tuberculosis and congenital malformations. This report describes the successful management of a 5-year-old child with long-standing, resistant and symptomatic unilateral chyluria. Failure of conservative treatment led to use of laparoscopic techniques to perform a lymphorenal disconnection with excellent outcome. Relevant literature is reviewed.

Perspectives in the design and development of new products for enteral nutrition.

Enteral nutrition is a technique that even though it was used in times immemorial, in the last 25 years has suffered a considerable development, from being considered a secondary therapeutic weapon destined only to feed the patient, to occupying an important status that goes beyond the single act of nourishing. The quantitative composition but overall the qualitative one, is object of an interesting argument in which a profile allowing the modulation of certain aspects of the organism response through the supplementation with different nutrients is searched. That includes from the keeping of the intestinal trophism and of the anti-bacteria intestinal barrier, so important to avoid the frightening multiple organ dysfunction, up to the lessening of the Systemic Response Inflammatory Syndrome (SRIS), going through the immuno-modulative feeding concepts, specific-feeding, pharmaco-nutrient or eco-nutrition. In this new dynamic not only certain nutrients such as glutamine, arginine, nucleotides, omega-3 fatty acids and many antioxidants have acquired importance, but also the manipulation of other molecules of a non- nutritional nature, such as hormones, cytokines and blockers. These aspects that imply passionate ways of investigation for the future are born from the better knowledge that is being acquired from such a severe pathophysiology processes such as sepsis and the organism response before fast and severe aggression; therefore, the modulation of that response through changes in the quantitative and qualitative formulas composition is being attempted.

Vascular effects of 7-epiclusianone, a prenylated benzophenone from Rheedia gardneriana, on the rat aorta.

The vascular effects of 7-epiclusianone on the rat aorta were investigated. In the rat aortic rings with functional endothelia, 7-epiclusianone up to 10microM induced a concentration-dependent vasodilatation of the sustained contractions induced by phenylephrine (0.3microM). At concentrations higher than 10microM, 7-epiclusianone induced a concentration-dependent contraction in the aortic rings. The vasodilator effect of 7-epiclusianone was drastically decreased with L-NAME (100microM) as well as in endothelium-denuded aortic rings. Moreover, indomethacin (10microM) induced a significant shift to the left in the vasodilator but did not modify the vasoconstrictor effect of 7-epiclusianone. In arteries without pre-contraction, 7-epiclusianone (3-100microM) induced concentration-dependent contraction only in endothelium-intact and in the presence of L-NAME (100microM). This effect was inhibited by indomethacin (10microM) and ZM230487 (1microM), selective inhibitors of cyclooxygenase and of 5-lipoxygenase, respectively. We can conclude that at low concentrations 7-epiclusianone induces an endothelium-dependent vasodilator effect in rat aortic rings. At higher concentrations and in conditions where NO synthase was inhibited, 7-epiclusianone induces a vasocontractile effect. Nitric oxide seems to participate in the vasodilatation, while endothelial cyclooxygenase- and 5-lipoxygenase-derived products play a role in the vasoconstrictor effect.

[Malnutrition prevalence in patients admitted to a rehabilitation and orthopedic surgery hospital]. / Prevalencia de desnutrición en pacientes ingresados en un hospital de rehabilitación y traumatología.

OBJECTIVE: Different studies show the scarce attention granted to the nutritional state in historical and clinical practice, what determines the ignorance of the patient's nutritional status to their entrance in the hospital and, therefore, the impossibility to prevent the hospital malnutrition. The objective of our study has been to determine the prevalence of patients' malnutrition entered in a Hospital of Orthopedic surgery and Rehabilitation. METHODS: Observational and analytical study in 250 randomized patients (60% men and 40% women), who were nutritionally evaluated when entering, the hospital, by means of anthropometry (Weigh, height, BMI, skin-fold, corporal circumferences) and biochemical tests (Albumin, Prealbumin and Transferrin). RESULTS: According to the BMI the prevalence of malnutrition was of 8%, the average of caloric malnutrition was of 2.8% (according to anthropometry) and the prevalence of many-sided malnutrition rises to 54.8% (according to biochemical markers). CONCLUSIONS: The high prevalence of fundamental malnutrition (54.8%) demonstrated in this study, it shows the importance of determining the nutritional status when entering the hospital, particularly surgical type' patiens as is the case of most of those who enter the Orthopedic surgery hospitals.

Pediatric tracheostomy: a 13-year experience.

Pediatric tracheostomy has been reported to be a surgical procedure with significant morbidity and mortality. The use of tracheostomy in airway management has changed over time as regards indication and outcome. A review of the last 13 years' experience in our institution was carried out to focus on this group of patients and the recent trends in airway management. A retrospective analysis of hospital records was done and information collected with respect to age, gender, indication for tracheostomy, duration, complications, and follow-up. Thirty-nine tracheotomies were done in 36 patients, of whom males outnumbered females 2:1. The mean patient age was 41.6 months while nearly a third were newborns. The indications were congenital and acquired obstructive lesions. Apart from nine cases, all have been treated and decannulated. Follow-up ranged from 1 month to 8 years, and decannulation time from 48 h to 45 months. Home tracheostomy care was very well managed by the parents. One tracheostomy-related death was encountered. Complications were minor and transient and occurred post-decannulation in our series, in contrast to the major complications, both acute and chronic, reported in the literature. More neonates and infants are undergoing tracheostomy and surviving. Pediatric tracheostomy is a safe procedure with home care by parents feasible.

Aspiration of a tracheostomy tube flange.

Foreign body aspiration is a common pediatric emergency. Aspiration of a metallic tracheostomy tube flange into the left main bronchus and the resultant subacute respiratory distress is presented. Being the only case of its kind in reported pediatric literature, a review of the etiology, clinical presentation and prevention of this accident is appended.

Bloody diarrhea caused by a needle in the pancreatic head.

Bloody diarrhea in adolescents is not uncommon polyposis, inflammatory bowel disease, and infections are the usual causes. A 13-year-old boy with a metallic foreign body in the head of the pancreas presented with bloody diarrhea. The clinical problems and surgical approach are discussed.

Extranasal glial heterotopia: case report.

Glial heterotopia or the occurrence of isolated non-teratomatous extracranial glial tissue is rare. We report a neonate with extensive extranasal glial heterotopia involving the left buccopharyngeal region, palate and base of the skull and presenting with respiratory distress and a bleeding oral mass. A staged operative approach was adopted to excise the lesion. The literature on the subject is briefly reviewed.

Periscapular bronchogenic cyst.

Periscapular location of bronchogenic cysts is extremely rare with four cases reported in literature. We report a relatively late presentation in a ten-year-old boy that was clinically mistaken for a typical sebaceous cyst. The definitive treatment is total excision after preoperative imaging to detect the occasional intrathoracic extension. Histologically they are lined by pseudostratified ciliated columnar epithelium, which can rarely undergo malignant transformation.