Vulnerability assessment of debris flow in the central Peruvian rainforest - An intercultural approach.

For several decades, calamitous debris flows have inflicted profound negative impact on Peruvian rainforest society, encompassing both economic losses and human casualties. To address this concern, this study proposes a methodological tool to assess vulnerability while focusing on intercultural nuances. The contextual analysis of the incident reports identifies La Merced (Junín, Perú) as a severely affected locality, thereby justifying its selection for a detailed case study on the Pampa del Carmen sector. The study conducted a thorough systematic review of parameters such as diglossia, poverty, and origin that are crucial for vulnerability assessment. Moreover, these parameters aided in developing a structured digital survey. The integration of survey data into the analytic hierarchy process revealed high levels of vulnerability in the sector, emphasizing the imminent need for targeted interventions. The intercultural approach is significant as it facilitates future risk mitigation strategies based on effective integration and genuine acknowledgment of social dynamics and individual freedoms within the region for devising impactful risk management policies and plans.

Health-care policies during the COVID-19 pandemic in Mexico: A continuous case of heterogeneous, reactive, and unequal response.

Background: The pandemic in Mexico underlined pre-existing health-care system inequalities. Within the first six months of the COVID-19 pandemic, 154 health policies across health institutions were found to be uncoordinated and heterogeneous, leading to health inequalities in access and potential health outcomes. Data & methods: Using a rapid qualitative research methodology, data was collected using purposive sampling of institutional policies published for public access on the official websites of the four public health institutions in Mexico from June 16th, 2020 to October 30th, 2021. This policy review used archival analysis to understand the differences in health-care policies during the COVID-19 pandemic in Mexico. These policies were classified under the RREAL framework and as a continuation of our first publication. Results: During this study, categories of public health response and vaccination dominated the policies enacted. The SSA was the main author of publications. There seems to be a more unified policy response. However, health inequalities persist. Conclusions: The Mexican government continued to be reactive to the increase in cases or the arrival of new variants, rather than preventative. Research and development of policies need to work together in soaring cases like COVID-19 to work more effectively against the economic and epidemiological burden of a pandemic. It is suggested that this "vaccination" should be included in the RREAL classification. Other sectors (i.e. the ministry of foreign affairs) should be considered relevant players in the future management of a pandemic.

Development of a Hip Joint Socket by Finite-Element-Based Analysis for Mechanical Assessment.

This article evaluates a hip joint socket design by finite element method (FEM). The study was based on the needs and characteristics of a patient with an oncological amputation; however, the solution and the presented method may be generalized for patients with similar conditions. The research aimed to solve a generalized problem, taking a typical case from the study area as a reference. Data were collected on the use of the current improving prosthesis-specifically in interaction with its socket-to obtain information on the new approach design: this step constituted the work's starting point, where the problems to be solved in conventional designs were revealed. Currently, the development of this type of support does not consider the functionality and comfort of the patient. Research has reported that 58% of patients with sockets have rejected their use, because they do not fit comfortably and functionally; therefore, patients' low acceptance or rejection of the use of the prosthesis socket has been documented. In this study, different designs were evaluated, based on the FEM as scientific support for the results obtained, for the development of a new ergonomic fit with a 60% increase in patient compliance, that had correct gait performance when correcting postures, improved fit-user interaction, and that presented an esthetic fit that met the usability factor. The validation of the results was carried out through the physical construction of the prototype. The research showed how the finite element method improved the design, analyzing the structural behavioral, and that it could reduce cost and time instead of generating several prototypes.

Ethic Policy Forum: Inclusión de minorías étnicas latinoamericanas en los ensayos clínicos

Objetivo: Analizar los aspectos normativos y éticos relacionados a la inclusión de las minorías étnicas en los ensayos clínicos en Latinoamérica y el Caribe. Material y Métodos : Se presentan resultados del análisis ético y normativo realizado por el grupo de investigadores en bioética, del Ethic Policy Forum; foro de análisis, discusión y formulación de propuestas en políticas y normativas relacionadas con aspectos de ética en investigación en los países de Latinoamérica y el Caribe, constituido por el Instituto de Evaluación de Tecnologías en Salud e Investigación del Seguro Social de Salud del Perú, la Universidad Católica Santa María de Arequipa, Perú y la Red Internacional de Salud Colectiva y salud Intercultural de la Universidad Autónoma del Estado de México. Resultados: Se evidencia que las minorías étnicas no están adecuadamente representadas en los ensayos clínicos en Latinoamérica y el Caribe y la normativa al respecto no está estandarizada, o no existe en todos los países de la Región. Los ensayos con minorías étnicas, pueden tener beneficios, pero también potenciales riesgos y conflictos éticos, que requieren una adecuada evaluación de las vulnerabilidades, acompañamiento efectivo en el consentimiento informado y proceso de investigación, por Comités de ética de investigación capacitados salud intercultural y en ética de la investigación con pueblos indígenas y afrodescendientes. Conclusión : Los ensayos clínicos deben incluir a minorías étnicas, con potencial beneficio de los productos de investigación. La investigación debe desarrollarse bajo principios éticos y normativas que protejan a estas minorías.

Objetive: To analyze the normative and ethical aspects related to the inclusion of ethnic minorities in clinical trials in Latin America and the Caribbean. Material and Methods : The results of the ethical and normative analysis carried out by the group of researchers in bioethics of the Ethic Policy Forum are presented; forum for analysis, discussion and formulation of proposals in policies and regulations related to aspects of ethics in research in the countries of Latin America and the Caribbean, constituted by the "Instituto de Evaluación de Tecnologías en Salud e Investigación" from Peru, the Universidad Católica Santa María de Arequipa, Peru and the International Network of Collective Health and Intercultural Health of the "Universidad Autónoma del Estado de México". Results : It is evident that ethnic minorities are not adequately represented in clinical trials in Latin America and the Caribbean and the regulations in this regard are not standardized, or do not exist in all the countries of the Region. Trials with ethnic minorities can have benefits but also potential risks and ethical conflicts, which require an adequate assessment of vulnerabilities, effective support in informed consent and the research process, by Research Ethics Committees trained in intercultural health and ethics of research with indigenous peoples and Afro-descendants. Conclusion : Clinical trials should include ethnic minorities, with potential benefit from research products. Research must be developed under ethical and regulatory principles that protect these minorities.

Alteración del perfil materno de adipocinas circulantes en preeclampsia / Altered maternal adipokine profile in preeclampsia

Resumen OBJETIVOS: Evaluar las concentraciones séricas maternas de las adipocinas: adiponectina, adipsina, leptina, lipocalina-2, proteína quimioatrayente de monocitos-1, factor de crecimiento nervioso, resistina y factor de necrosis tumoral alfa y su relación con el índice de masa corporal previo al embarazo y la ganancia de peso gestacional en mujeres con preeclampsia comparadas con mujeres sanas, y hacer un análisis de la clasificación de preeclampsia en temprana y tardía. MATERIALES Y MÉTODOS: Estudio transversal, comparativo, retrolectivo, con muestreo no probabilístico por conveniencia efectuado en pacientes atendidas en el Hospital de Gineco-Obstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS). En el preoperatorio se tomó una muestra de sangre para determinar las concentraciones séricas de las adipocinas mediante ensayos multianalito. RESULTADOS: Se estudió una muestra de 75 mujeres con embarazo sano y 44 con preeclampsia (temprana n = 20, tardía n = 24). Solo las concentraciones de adipsina, leptina y factor de necrosis tumoral alfa fueron mayores en preeclampsia que en el embarazo sano [mediana (rango intercuartílico): 3.9 µg/mL (2.9-5.4) vs 2.5 µg/mL (1.9-3.1), 10.6 ng/mL (6.0-19.1) en comparación con 7.1 ng/mL (3.8-12.4), 3.6 pg/mL (2.7-5.8) vs 2.9 (2.3-3.5), respectivamente]. Las concentraciones de las adipocinas no se correlacionaron con el índice de masa corporal previo al embarazo ni con la ganancia de peso gestacional. No hubo diferencias significativas en las concentraciones entre los subtipos de preeclampsia. CONCLUSIÓN: En el tercer trimestre del embarazo la preeclampsia se asocia con un perfil sérico de adipocinas alterado, caracterizado por concentraciones elevadas de adipsina, leptina y factor de necrosis tumoral alfa, que no se relaciona con el índice de masa corporal previo al embarazo, la ganancia de peso gestacional y el subtipo de preeclampsia.

Abstract OBJECTIVES: To evaluate maternal serum concentrations of adipokines: adiponectin, adipsin, leptin, lipocalin-2, monocyte chemoattractant protein-1, nerve growth factor, resistin and tumor necrosis factor-alpha and their relationship with pre-pregnancy body mass index and gestational weight gain in women with preeclampsia compared with healthy women, and to perform an analysis classifying preeclampsia as early and late. MATERIALS AND METHODS: Cross-sectional, comparative, retrolective, non-probabilistic convenience sampling study carried out in patients attended at the Hospital de Gineco-Obstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS). Preoperatively, a blood sample was taken to determine serum adipokine concentrations by multianalyte assays. RESULTS: A sample of 75 women with healthy pregnancy and 44 with preeclampsia (early n = 20, late n = 24) was studied. Only adipsin, leptin, and tumor necrosis factor-alpha concentrations were higher in preeclampsia than in healthy pregnancy [median (interquartile range): 3. 9 µg/mL (2.9-5.4) vs. 2.5 µg/mL (1.9-3.1), 10.6 ng/mL (6.0-19.1) compared to 7.1 ng/mL (3.8-12.4), 3.6 pg/mL (2.7-5.8) vs. 2.9 (2.3-3.5), respectively]. Adipokine concentrations did not correlate with pre-pregnancy body mass index and gestational weight gain. There were no significant differences in concentrations between preeclampsia subtypes. CONCLUSION: In the third trimester of pregnancy, preeclampsia is associated with an altered serum adipokine profile, characterized by elevated concentrations of adipsin, leptin, and tumor necrosis factor-alpha, which is not related to prepregnancy body mass index, gestational weight gain, and preeclampsia subtype.

Recién nacido con pénfigo sifilítico en tiempos de pandemia / Newborn with syphilitic pemphigus in pandemic's time

Resumen La sífilis congénita es la infección del recién nacido (RN) por Treponema palllidum transmitida durante el embarazo desde la madre al feto. Actualmente, sigue siendo una causa importante de morbi-mortalidad fetal prevenible en todo el mundo, pese a que con un tratamiento adecuado y oportuno en la madre, se logra revertir en forma efectiva los resultados adversos en el feto y RN. Lo anterior destaca la importancia del control del embarazo, y la pesquisa precoz de la infección materna. Si bien, Chile ha experimentado un aumento de la incidencia de sífilis en la población general, se ha mantenido una tasa estable de sífilis congénita de 0,1 por 1.000 RN vivos. Presentamos el caso clínico de un RN, hijo de una madre sin control del embarazo, que presentó lesiones compatibles con un pénfigo sifilítico.

Abstract Congenital syphilis is the infection by Treponema pallidum of the newborn, due to mother-to-child transmission of spirochaetes during pregnancy. It remains as a major cause of preventable fetal and neonatal morbidity and mortality if the mother is not opportunely treated. This highlights the importance of an adequate prenatal control, early screening for maternal infection and timely treatment. Although Chile has experienced an increase in the incidence of syphilis in the general population, a stable rate of congenital syphilis in 0.1/1.000 live births has been maintained. In this case report, we present a newborn whose mother did not have antenatal control and showed dermatological lesions compatible with syphilitic pemphigus.

Epigenetic Alterations Related to Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is the most common metabolic complication in pregnancy, which affects the future health of both the mother and the newborn. Its pathophysiology involves nutritional, hormonal, immunological, genetic and epigenetic factors. Among the latter, it has been observed that alterations in DNA (deoxyribonucleic acid) methylation patterns and in the levels of certain micro RNAs, whether in placenta or adipose tissue, are related to well-known characteristics of the disease, such as hyperglycemia, insulin resistance, inflammation and excessive placental growth. Furthermore, epigenetic alterations of gestational diabetes mellitus are observable in maternal blood, although their pathophysiological roles are completely unknown. Despite this, it has not been possible to determine the causes of the epigenetic characteristics of GDM, highlighting the need for integral and longitudinal studies. Based on this, this article summarizes the most relevant and recent studies on epigenetic alterations in placenta, adipose tissue and maternal blood associated with GDM in order to provide the reader with a general overview of the subject and indicate future research topics.

[Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America]. / Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada.

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada / Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

[Newborn with syphilitic pemphigus in pandemic's time]. / Recién nacido con pénfigo sifilítico en tiempos de pandemia.

Congenital syphilis is the infection by Treponema pallidum of the newborn, due to mother-to-child transmission of spirochaetes during pregnancy. It remains as a major cause of preventable fetal and neonatal morbidity and mortality if the mother is not opportunely treated. This highlights the importance of an adequate prenatal control, early screening for maternal infection and timely treatment. Although Chile has experienced an increase in the incidence of syphilis in the general population, a stable rate of congenital syphilis in 0.1/1.000 live births has been maintained. In this case report, we present a newborn whose mother did not have antenatal control and showed dermatological lesions compatible with syphilitic pemphigus.

Xantogranuloma juvenil del adulto con presentación única en el conducto auditivo externo, una entidad poco común y una localización infrecuente: reporte de caso / Juvenile xanthogranuloma in an adult with a single manifestation in the external auditory canal, an uncommon entity and unusual localization: Case report

La xantogranulomatosis juvenil es una patología infrecuente que se presenta predominantemente en la primera infancia, ya que los adultos pueden verse afectados con poca frecuencia. La manifestación cutánea se da en la mayoría de los casos como un nódulo rojo-amarillo indurado y solitario, que con frecuencia se presenta a nivel de cabeza y cuello, seguido del tronco, extremidades inferiores y superiores. Aunque infrecuentes, las manifestaciones extracutáneas pueden presentarse con principal compromiso oftalmológico (1). En el artículo se presenta el caso de un hombre de 42 años que consultó por la aparición de una lesión en el conducto auditivo externo derecho, con un aumento progresivo del tamaño asociado con otorrea serohemática intermitente e hipoacusia. El diagnóstico se realizó por medio de hallazgos clínicos, histopatológicos e inmunohistoquímicos. Se realizó escisión total de la lesión; posteriormente, el paciente presentó una evolución adecuada y mejoría de la sintomatología. Se presenta este caso por lo infrecuente de la entidad y por lo inusual de su localización.

Juvenile xanthogranulomatosis, an unusual pathology that occurs predominantly in early childhood, adults can be affected infrequently, the skin manifestation occurs in most cases, as a solitary, indurated red-yellow papule or nodule, with a highest frequency occurs at head and neck level, followed by the trunk and the lower and upper extremities. Extracutaneous manifestations are uncommon, however they can be present with principal ocular level involvement (1). We present the case of a 42-year-old man who consulted due to an appearance of a lesion in the right external auditory canal with a progressive increase in size associated with intermittent otorrhea and hearing loss. The diagnosis was made by clinical, histopathological and immunohistochemical findings. Excision of the entire lesion was performed, after which the patient presented adequate evolution and improvement of symptoms. This case is presented due to the infrequency of the entity and the unusual localization

Manejo del tinnitus con estimulador de sonido con especificidad frecuencial / Treatment of tinnitus with sound stimulator with frequency specificity

Introducción: el tinnitus tiene efectos deletéreos sobre la calidad de vida de un paciente. Cuando la lesión está a nivel coclear, se puede usar acondicionamiento acústico para su tratamiento. Objetivo: determinar el cambio en la percepción del tinnitus antes y después de la intervención terapéutica. Metodología: se planteó un estudio de serie de casos. Pacientes con tinnitus no pulsátil de moderado a catastrófico tratados con estimulador REVE 134™. Se incluyeron pacientes que no mejoraron luego de 3 meses con tratamiento médico. Se les practicó microaudiometría (67 frecuencias) para definir la región coclear afectada. Se excluyeron pacientes con umbrales audiométricos > 60 dB, aquellos con lesiones retrococleares y quienes no desearon participar. Las variables de desenlace fueron Tinnitus Handicap Inventory (THI), escala visual análoga (EVA) y Tinnitus Reaction Questionnaire (TQR), que se midieron pretratamiento y a los 3 y 6 meses postratamiento. Resultados: se incluyeron 11 pacientes (hombres = 5, mujeres = 6). En 5 casos el tinnitus fue bilateral y en 6, unilateral. Los valores pretratamiento fueron THI = 61,4 ± 27,4, EVA = 6,9 ± 2,7 y TQR = 43,2 ± 31,9 (Kolmogorov-Smirnov, p > 0,05). Hubo mejoría estadísticamente significativa con el tratamiento, THI (3 meses = 30,6 ± 21,1; 6 meses = 19 ± 19,2), EVA (3 meses = 5,6 ± 2,3; 6 meses = 3,5 ± 2,0), TQR (3 meses = 25,6 ± 20,0; 6 meses = 14,3 ± 19,9); ANOVA de medidas repetidas (p = 0,007, p = 0,027, p = 0,037; respectivamente). Conclusión: el tratamiento con REVE 134™ fue efectivo en pacientes con tinnitus no pulsátil de moderado a catastrófico.

Introduction: tinnitus can affect the quality of life of a patient. Acoustic stimulation can be used as treatment when the cause of tinnitus is located in the cochlea. Objective: To determine changes in tinnitus perception before and after therapeutic intervention. Methodology: We performed a case series study. Patients with nonpulsatile tinnitus, with no improvement with medical therapy, and moderate to catastrophic grade were treated with the REVE 134™ system. A microaudiometry (67 frequencies) was performed to determine the cochlear regions affected. Patients with auditory thresholds >60 dB, retrocochlear pathologies and who did not want to participate in the study were excluded. The variables studied were Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) and Tinnitus Reaction Questionnaire (TQR), that were measured before, three and six months after treatment. Results: 11 patients (male: 5, women: 6) were included. In 5 of them, tinnitus was bilateral and in 6, unilateral. Pretreatment values were: THI = 61.4 ± 27.4, VAS = 6.9 ± 2.7 and TQR = 43.2 ± 31.9 (Kolmogorov-Smirnov, p > 0.05). We found improvement in tinnitus perception with the therapy, and this values had statistical significance (THI: 3rd month = 30.6 ± 21.1; 6th month = 19 ± 19.2), VAS (3rd month = 5.6 ± 2.3; 6th month = 3.5 ± 2.0), TQR (3rd month = 25.6 ± 20.0; 6th month =14.3 ± 19.9); repetitive measures of ANOVA (p = 0.007, p = 0.027, p = 0.037; respectively). Conclusion: Treatment with REVE 134™ was effective in patients with moderate to catastrophic tinnitus.

Immune tolerance at the maternal-placental interface in healthy pregnancy and pre-eclampsia.

AIM: The objective of this review is to describe the immunological mechanisms which facilitate maternal tolerance at the maternal-placental interface, and to discuss how these mechanisms are disrupted in pre-eclampsia. METHODS: A literature review was performed based on the analysis of papers available on PubMed. The most important and relevant studies regarding the immunological mechanisms which facilitate maternal tolerance in healthy pregnancy and pre-eclampsia are presented in this article. RESULTS: The maternal-placental interface is the site where the immune tolerance begins and develops. Within the innate immunity, natural killer cells, macrophages and dendritic cells play a pivotal role in tolerance through regulation of inflammation. On the other hand, within the adaptive immunity, the correct increase of regulatory T cells is crucial for ensuring immune tolerance toward placental cells. Disturbances in maternal tolerance can lead to the appearance of pregnancy complications such as pre-eclampsia, which has a considerable impact on perinatal morbidity and mortality. CONCLUSION: Our partial knowledge of immunological mechanisms involved in tolerance at the maternal-placental interface indicates that pre-eclampsia is characterized by alterations of this maternal immune tolerance, which could represent the origin of the disease.

Pediatric Kidney Transplantation in Perú: A Single-Center Initial Experience.

BACKGROUND: Pediatric kidney transplantation (PKTx) is the preferred therapy for children with end-stage renal disease (ESRD) worldwide. Regrettably, in Perú, access to PKTx is extremely difficult due to recipient/donor socio-economic status, health care structure and especially, scarcity of organs. Our center (the only pediatric institute in the country) has recently started a PKTx program with good midterm results. The aim of this study was to present our outcomes. METHODS: Retrospective analysis of prospectively collected data between December 2017 and August 2019. Fourteen PKTx (< 18 years old) were achieved. As per our protocol: pre-implantation/protocol biopsies, antibody assessment (T/B cell flow cytometric plus HLA testing applying polymerase chain reaction-based technology), triple immunosuppression (tacrolimus, mycophenolate mofetil, steroids) and induction therapy was performed in every case. RESULTS: The recipient's mean age at the time of PKTx was 14.14 ± 2.62, 8/14 (57.14%) were male, 50% developed ESRD due to undetermined etiology, 11/14 (78.57%) received a deceased donor allograft, and 9/14 (64.28%) required induction with thymoglobulin. Postoperative complications included: delayed graft function (1/14, 7.14%), 1 (7.14%) developed gross hematuria associated with allograft disfunction post-protocol allograft biopsy that was managed conservatively and 1 recipient (7.14%) developed grade II oligoastrocytoma, at 10 months post PKTx. CONCLUSIONS: PKTx is the best therapeutic option for children with ESRD. Our group demonstrated that even in countries with limited resources like Perú, good midterm results can be achieved. Emphasis should be given to improve access to transplantation especially in the setting of pediatric recipients.

Incidencia de Escherichia coli O157: H7 en heces de rumiantes lactantes con síndrome diarreico / Incidence of Escherichia coli 0157: H7 in feces of lactating ruminants with diarrheal syndrome

RESUMEN Objetivo. Identificar Escherichia coli O157:H7 presente en heces diarreicas de rumiantes lactantes con síndrome diarreico y seguridad de ingesta de calostro. Materiales y métodos. Se realizó un muestreo de 316 rumiantes durante el período de agosto 2015 a marzo 2016 en los municipios de Río Grande, General Enrique Estrada, Morelos y Calera de Víctor Rosales del estado de Zacatecas, 67 de bovinos, 183 de ovinos y 66 de caprinos. Resultados. Se identificaron en medio cromogénico CHROMagarTM: 260 coliformes, 78 Escherichia coli O157:H7, 16 Proteus spp., y 25 colonias de bacterias sin identificar con este medio, encontrándose una incidencia de Escherichia coli O157:H7 de 22.03% en los cuatro municipios. Conclusiones. Escherichia coli O157:H7 es la segunda bacteria encontrada en heces de rumiantes con un 22% de incidencia, la cual es un factor de riesgo de muerte en rumiantes lactantes (menos de 21 días de nacidos) causando pérdidas económicas y riesgo para la salud de la población del estado de Zacatecas.

ABSTRACT Objective. To identify Escherichia coli 0157:H7 present in diarrheal feces of lactating ruminants with diarrheal syndrome and safety of colostrum intake. Materials and methods. A feces sampling of 316 ruminants was carried out during the period of August 2015 to March 2016 in the municipalities of Río Grande, General Enrique Estrada, Morelos and Calera de Victor Rosales of the state of Zacatecas, obtained from 67 cattle, 183 sheep and 66 goats. Results. The following were identified in CHROMagarTM chromogenic medium: 260 coliforms, 78 Escherichia coli 0157:H7, 16 Proteus spp. and 25 colonies of unidentified bacteria, finding an incidence of Escherichia coli 0157:H7 of 22.03% in the four municipalities. Conclusions. Escherichia coli 0157:H7 is the second bacteria found in ruminant feces with an incidence of 22%, which is a mortality risk factor in lactating ruminants (less than 21 days old), causing economic loss and health risk for the population of the state of Zacatecas.

Prevalência de las alteraciones del metabolismo óseo-mineral asociadas a enfermedad renal crónica no en diálisis / Prevalence of bone mineral metabolism alterations associated with chronic kidney disease not on dialysis

Resumen Introducción: la enfermedad renal crónica (ERC) es un problema de salud pública, siendo el trastorno del metabolismo óseo mineral una de sus principales complicaciones y que contribuye directamente a la morbilidad y mortalidad. Varios estudios previos han demostrado un aumento de su prevalencia a medida que disminuye la tasa de filtración glomerular (TFG), sin embargo, no contamos con datos en nuestro país ni en América Latina. Métodos: realizamos un estudio transversal unicéntrico en un servicio de consulta de nefrología, en adultos con ERC G1 a 5 que no estuvieran en terapia de reemplazo renal, evaluados entre enero de 2014 y marzo de 2015. La recolección de datos se realizó con un instrumento predefinido que incluía datos demográficos, alteraciones de los parámetros del metabolismo mineral y óseo, y su manejo. Resultados: se incluyeron 2026 pacientes, de los cuales 1756 tenían medición de hormona paratiroidea, la edad promedio fue 74 años, el 62 % eran mujeres. La distribución por grados de ERC fue: G1:4,9 %, G2:22,8 %, G3: 57,4 %, G4: 12,5 % y G5:2,4 %. Las principales causas fueron la nefropatía hipertensiva y diabética. Encontramos deficiencia de vitamina D en el 78,16 %, hiperparatiroidismo secundario en el 63,67 % e hiperfosfatemia en el 12,38 %, con aumento de la prevalencia a medida que la TFG empeoraba. Conclusiones: encontramos que las alteraciones del metabolismo mineral y óseo son frecuentes en los pacientes con enfermedad renal crónica e inician desde estadios tempranos, como se ha demostrado en otros estudios. Consideramos que estos resultados llevarán a nuevas investigaciones de manejo en pacientes con ERC.

Abstract Background: chronic kidney disease (CKD) is a public health problem, and bone mineral metabolism disorder is one of its main complications that directly contributes to morbidity and mortality. Several previous studies have shown an increase in its prevalence as the glomerular filtration rate (GFR) decreases, however, we do not have data from our country or Latin America. Methods: We conducted a unicentric cross-sectional study in a nephrology consultation service in adults with CKD G1 to 5 who were not in renal replacement therapy, evaluated between January 2014 and March 2015. Data collection was performed with an instrument predefined that included demographic data, alterations of the mineral and bone metabolism parameters, and their management. Results: 2026 patients were included, of whom 1756 had parathyroid hormone measurement, the average age was 74 years, 62% were women. The distribution by degrees of CKD was: G1: 4.9%, G2: 22.8%, G3: 57.4%, G4: 12.5% and G5: 2.4%. The main causes were hypertensive and diabetic nephropathy. We found vitamin D deficiency in 78.16%, secondary hyperparathyroidism in 63.67% and hyperphosphatemia in 12.38%, with an increase in prevalence as GFR worsened. Conclusions: We found that mineral and bone metabolism alterations are frequent in patients with chronic kidney disease and start from early stages, as has been demonstrated in other studies. We believe that these results will lead to new management investigations in patients with CKD.

Rinomodelación con hilo - Fundamento anatómico / Nasal modelling with thread - Anatomical basis

Este trabajo está enfocado en pacientes que presentan una rinodeformidad mínima, en quienes creo, como cirujanos plásticos, que podemos realizar una intervención quirúrgica mínimamente invasiva mediante una rinomodelación simple con hilo (vicril - mononylon). Para casos de mayor rinodeformidad (giba ósea y cartilaginosa de cualquier tipo) podemos realizar una rinomodelación combinada (resección de giba) con hilo. Existen varias técnicas descriptas de rinomodelación. Esta técnica se basa en la esqueletización de los cartílagos alares con transección lateral, disección limitada del dorso, miotomía del musculo depresor, preservando el ligamento suspensor de la punta a través de incisiones mínimas colocando un hilo, que actúa como tutor y no tensor, desde la columela al rádix nasal, por lo que se obtiene un refi namiento de la punta nasal proyectando la misma y acortando la longitud nasal. También indicada en casos de resección de giba ósea y cartilaginosa realizando una rinomodelación combinada.

Estandarización y evaluación de un modelo de entrenamiento quirúrgico de cirugía endoscópica nasosinusal en cabezas de cordero desarrollado en el Hospital Militar Central / Standardization and evaluation of a surgical training model of functional endoscopic sinus surgery in lamb heads developed in the Central Military Hospital

Objetivo: Estandarización y evaluación del modelo de entrenamiento quirúrgico en cirugía endoscópica rinosinusal en residentes de otorrinolaringología del Hospital Militar Central. Diseño: Estudio experimental no aleatorio (antesdespués) Metodología: Se evaluó a los sujetos en estudio con la escala validada para habilidades quirúrgicas "GOALS" antes y después de realizar nuestro modelo de entrenamiento quirúrgico propuesto en cabezas de cordero, se midió el cambio en las habilidades quirúrgicas de los sujetos en estudio y se realizó el análisis estadístico con pruebas no paramétricas para muestras relacionadas (prueba de wilcoxon) en el programa SPSS(v.15) Resultados: Se reclutaron 12 residentes de Otorrinolaringología, se realizó una medición de las competencias quirúrgicas previa y posterior al entrenamiento comparando el desempeño quirúrgico antes y después evidenciando una mejoría en la percepción de profundidad y destreza bimanual estadísticamente significativa (p<0,05Wilcoxon), sin embargo, posterior al entrenamiento completo no encontramos una mejoría estadísticamente significativa en habilidades como manipulación de los tejidos y autonomía (p>0,05 Wilcoxon). Conclusiones: El modelo de entrenamiento quirúrgico propuesto mejora el desempeño de habilidades mínimas necesarias para una cirugía endoscópica nasal adecuada y segura, sin embargo, la simulación presenta limitaciones con respecto al desarrollo de habilidades como el manejo de los tejidos, sangrado y autonomía del procedimiento.

Aim: Standardization and assessment of the surgical training model in functional endoscopic sinus surgery in otolaryngology residents of the Central Military Hospital. Design: Non-randomized experimental study (before-after) Methods: we perform an assesment of the subjects enrolled in our study with the validated scale for surgical skills "GOALS" before and after the training with our proposed surgical training model in lambs heads, the change in the surgical skills of the subjects under study was measured and the statistical analysis was performed with nonparametric tests for related samples (wilcoxon test) in SPSS(v.15) estatistical software. Results: Twelve otorhinolaryngology residents were enrolled in the study, the surgical performance before and after the training model was compared showing an improvement in depth perception and bimanual dexterity, we found statistically significant differences (p<0.05 Wilcoxon). However, after the complete training, we did not find a statistically significant improvement in skills such as tissue manipulation and autonomy (p>0.05 Wilcoxon). Conclusions: Our surgery training model in lamb's head improves the performance of minimum skills necessary for an adequate and safe functional endoscopic sinus surgery , however, the simulation presents limitations regarding the development of some skills such as tissue management, bleeding and autonomy of the procedure.

Absceso retrofaríngeo en lactante menor: reporte de caso y revisión de la literatura / Retropharyngeal abscess in a toddler: case report and literature review

El absceso retrofaríngeo corresponde a una complicación infrecuente de las infecciones de tracto respiratorio superior, asociada a una potencial pero significativa morbimortalidad. Posee mayor incidencia en la edad pediátrica, siendo la media de presentación los 3 años. En la literatura se le atribuyen diferentes factores de riesgo, destacando como factores endógenos enfermedades crónicas como diabetes mellitus y otros estados de inmunodeficiencia, y como factor exógeno las infecciones de vía aérea superior, dentarias y el traumatismo por cuerpo extraño. Si bien es difícil aislar un solo agente etiológico, se describe con mayor frecuencia la participación de Streptococcus pyogenes. El diagnóstico es eminentemente clínico, con confirmación imagenológica con tomografía computarizada como gold standard. El tratamiento es controversial, existiendo defensores de un tratamiento quirúrgico precoz versus un manejo expectante con antibióticos endovenosos. Se presenta a continuación el caso de una lactante menor de 1 año 4 meses hospitalizada en el Servicio de Pediatría en Hospital San Camilo en San Felipe por un cuadro febril agudo, catalogado inicialmente como meningitis, resultando en un absceso retrofaríngeo con extensión hacia mediastino superior, el cual fue resuelto de manera exitosa con tratamiento quirúrgico precoz asociado a antibióticos endovenosos de amplio espectro.

Retropharyngeal abscess corresponds to an uncommon complication of upper respiratory tract infections, associated with a potential but significant morbidity and mortality. It has a greater incidence in the pediatric age, being the average of presentation the 3 years. Different risk factors are attributed to the disease in the literature, standing out endogenous chronic diseases such as diabetes mellitus and other immunodeficiency states, and exogenous factors such as upper airway infections, dental infections and foreign body trauma. Although it is difficult to isolate a single etiologic agent, the involvement of Streptococcus pyogenes is more frequently described. The diagnosis is eminently clinical, with confirmed imaging with Tomography computed as gold standard. Treatment is controversial, with advocates of early surgical treatment versus expectant management with intravenous antibiotics. Is presented below the case of a toddler girl of 1 year and 4 months hospitalized in the Pediatrics service at San Camilo's Hospital in San Felipe by an acute febrile condition, initially classified as meningitis, resulting in a retropharyngeal abscess with extension towards the upper mediastinum, which was successfully solved with early surgical treatment associated with broad-spectrum intravenous antibiotics.

Are cannabinoids effective for treatment of pain in patients with active cancer? / ¿Son efectivos los cannabinoides para el tratamiento del dolor en pacientes con cáncer activo?

Cannabinoids have been proposed for the treatment of patients with cancer pain, especially if standard treatment does not control symptoms. Using Epistemonikos database, which is maintained by searching 30 databases, we identified nine systematic reviews including seven trials that answer the question of interest, of which six are randomized trials. We performed a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded it is unclear whether cannabinoids decrease pain and improve quality of life in patients with refractory cancer pain because the certainty of the evidence is very low, and it probably increases adverse effects substantially.

El uso de cannabinoides ha sido propuesto para el tratamiento de pacientes con dolor oncológico, principalmente para aquellos en quienes el tratamiento habitual no es suficiente. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos nueve revisiones sistemáticas que en conjunto incluyen siete estudios que responden la pregunta de interés, de los cuáles seis corresponden a estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si los cannabinoides producen una disminución del dolor o una mejoría en la calidad de vida en pacientes con dolor oncológico refractario porque la certeza de la evidencia es muy baja, pero probablemente se asocian a efectos adversos importantes.