Descripción del crecimiento del fémur proximal mediante tomografía en pacientes pediátricos sin enfermedad de cadera / Description of proximal femoral growth in pediatric patients without hip disorders using tomography

Objetivo: Describir el crecimiento femoral proximal en una población latinoamericana a través del desplazamiento femoral, el ángulo cervico-diafisario, la longitud del cuello femoral y el diámetro de la cabeza femoral evaluados con tomografía computarizada en pacientes pediátricos sin enfermedad de cadera. Materiales y métodos: Estudio retrospectivo que evaluó imágenes de tomografía computarizada de caderas de pacientes sanos <18 años. Se tomaron las siguientes medidas: desplazamiento femoral, longitud del cuello femoral, diámetro de la cabeza femoral y ángulo cervico-diafisario. Resultados:El desplazamiento femoral aumenta 1,96 mm hasta los 12.5 años, y desde los 12.5 hasta los 16 años, aumenta 1,2 mm. Se constató un aumento lineal del crecimiento de la longitud del cuello femoral. El ángulo cervico-diafisario disminuyó progresivamente hasta los 12 años. A partir de ese momento, la curva se aplanó. Se observó un aumento anual del diámetro de la cabeza femoral de 1,56 mm hasta los 13 años y de 0,62 mm anuales, en adelante. Conclusiones: Las medidas descritas en este estudio son esenciales para el seguimiento, el diagnóstico o el abordaje conductual en múltiples cuadros articulares de cadera durante el crecimiento. Se expone la necesidad de realizar estudios más amplios para establecer rangos de normalidad en la población local con las herramientas tecnológicas disponibles, que fundamenten una referencia para la restauración de la anatomía en la cirugía de preservación.Palabras clave: Cabeza femoral; cuello femoral; desarrollo humano. Nivel de Evidencia :IV

Introduction: This study aims to perform a descriptive analysis of proximal femoral growth in a Latin-American population through femoral offset, neck-shaft angle, femoral neck length, and femoral head diameter evaluated through computed tomography in pediatric patients without hip pathology. Materials and methods: Retrospective study evaluating CT images of the hips of healthy patients under 18 years. The following measurements were taken by a trained orthopedist: femoral offset, femoral neck length, femoral head diameter, and neck-shaft angle. Results:Femoral offset increases by 1.96 mm until age 12.5. From 12.5 to 16 years of age, it increases by 1.2 mm. A constant rise in the growth of the femoral neck length was found. The neck-shaft angle presented a progressive decrease until age 12. After that point, the curve flattened. An increase in femoral head diameter of 1.56 mm per year was observed until age 13 and then 0.62 mm per year. Conclusions: The measurements evaluated in this study are essential for the diagnosis, follow-up, and treatment approach in hip pathologies during growth. More extensive research is needed to define normal ranges that will serve as a baseline for anatomy restoration in hip joint preservation surgery. Level of Evidence: IV

Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia.

INTRODUCTION: Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS: Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS: In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION: Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE: Level III - retrospective cohort study.

FPGA-based real-time simulation of mismatched photovoltaic arrays.

This paper proposes an approach to the real time simulation of photovoltaic (PV) arrays that are subjected to mismatching conditions, e.g. partial shadowing. The method, which has been named Model by Zone (MbZ), adopts the best PV model depending on the operating conditions of the cells in the module: it switches among single-diode model (SDM), linear model and constant voltage model. An optimized digital hardware architecture exploiting parallelism of operations over a FPGA system is exploited to effectively implement the proposed model. It reduces the computation time and the use of hardware resources. The good trade-off between accuracy and computation time of the proposed technique has been demonstrated in two cases of study: by evaluating the long-term PV power production of a PV field subjected to dynamic shadowing conditions and by analyzing the model performance in a maximum power point tracking (MPPT) application. In the former case, the proposed approach improves the computation time by 182.5 % with respect to methods that are available in recent literature, with a Relative Error (RE) at the Global Maximum Power Point (GMPP) lower than 0.39 % . In the MPPT application, the proposed technique allows to achieve a MAPE of 0.0319 % and 0.1892 % in the string voltage and power calculation, respectively.

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures.

BACKGROUND: Symptomatic pulmonary cement embolism in patients undergoing thoracic transpedicular fenestrated screw placement is rare. Here, we have added a 64-year-old female undergoing transpedicular screw placement for a T11 fracture who developed a pulmonary cement embolism intraoperatively and add this case to 13 others identified in the literature. CASE DESCRIPTION: A 64-year-old female presented with a type "C", ASIA "E" T11 fracture. The thoracolumbar pedicle screw fixation was supplemented with bone cement due to her underlying severe osteoporosis. During the fluoroscopy-guided supplementation with bone cement, a leak through the paravertebral venous system was noted. Thirty minutes later, the patient acutely developed extreme respiratory failure and required mechanical ventilation for the next 2 days. The diagnosis of pulmonary embolism due to bone cement was confirmed on a contrast computed tomography study of the chest. CONCLUSION: Symptomatic pulmonary cement embolization supplementing transpedicular screws placement for osteoporotic bone is rare. Here, we present a 64-year-old female who during transpedicular fixation of a T11 fracture developed an acute pulmonary embolism from the bone cement resulting in the need for 2 days of postoperative artificial ventilation.

Optimisation of the ultrasound-assisted extraction of betalains and polyphenols from Amaranthus hypochondriacus var. Nutrisol.

The present study optimised the ultrasound-assisted extraction (UAE) of bioactive compounds from Amaranthus hypochondriacus var. Nutrisol. Influence of temperature (25.86-54.14 °C) and ultrasonic power densities (UPD) (76.01-273.99 mW/mL) on total betalains (BT), betacyanins (BC), betaxanthins (BX), total polyphenols (TP), antioxidant activity (AA), colour parameters (L*, a*, and b*), amaranthine (A), and isoamaranthine (IA) were evaluated using response surface methodology. Moreover, betalain extraction kinetics and mass transfer coefficients (KLa) were determined for each experimental condition. BT, BC, BX, TP, AA, b*, KLa, and A were significantly affected (p < 0.05) by temperature extraction and UPD, whereas L*, a*, and IA were only affected (p < 0.05) by temperature. All response models were significantly validated with regression coefficients (R2) ranging from 87.46 to 99.29%. BT, A, IA, and KLa in UAE were 1.38, 1.65, 1.50, and 29.93 times higher than determined using conventional extraction, respectively. Optimal UAE conditions were obtained at 41.80 °C and 188.84 mW/mL using the desired function methodology. Under these conditions, the experimental values for BC, BX, BT, TP, AA, L*, a*, b*, KLa, A, and IA were closely related to the predicted values, indicating the suitability of the developed quadratic models. This study proposes a simple and efficient UAE method to obtain betalains and polyphenols with high antioxidant activity, which can be used in several applications within the food industry.

Effect of Encapsulated Beet Extracts (Beta vulgaris) Added to Yogurt on the Physicochemical Characteristics and Antioxidant Activity.

Beet has been used as an ingredient for functional foods due to its high antioxidant activity, thanks to the betalains it contains. The effects of the addition of beet extract (liquid and lyophilized) on the physicochemical characteristics, color, antioxidant activity (AA), total betalains (TB), total polyphenols (TP), and total protein concentration (TPC) were evaluated on stirred yogurt. The treatments (T1-yogurt natural, T2-yogurt added with beet juice, T3-added extract of beet encapsulated with maltodextrin, and T4-yogurt added with extract of beet encapsulated with inulin) exhibited results with significant differences (p < 0.05). The highest TB content was observed in T2 (209.49 ± 14.91), followed by T3 (18.65 ± 1.01) and later T4 (12.96 ± 0.55). The highest AA was observed on T2 after 14 days (ABTS˙ 0.819 mM TE/100 g and DPPH˙ 0.343 mM TE/100 g), and the lowest was found on T1 at day 14 (ABTS˙ 0.526 mM TE/100 g and DPPH˙ 0.094 mM TE/100 g). A high content of TP was observed (7.13 to 9.79 mg GAE/g). The TPC varied between 11.38 to 12.56 µg/mL. The addition of beet extract significantly increased AA in yogurt, betalains being the main compounds responsible for that bioactivity.

Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL-1 for mepolizumab and above 400 cells·µL-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL-1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

Characterization of Beet Root Extract (Beta vulgaris) Encapsulated with Maltodextrin and Inulin.

Betalains are powerful antioxidants contained in beets. These are divided into betacyanins (red-violet) and betaxanthins (yellow-orange), and they can be used as natural colorants in the food industry. The effects of freeze-drying pure beet juice (B) and the encapsulation of beet juice with a dextrose equivalent (DE) 10 maltodextrin (M) and agave inulin (I) as carrier agents were evaluated. The powders showed significant differences (p < 0.05) in all the variables analyzed: water absorption index (WAI), water solubility index (WSI), glass transition temperature (Tg), total betalains (TB), betacyanins (BC), betaxanthins (BX), total polyphenols (TP), antioxidant activity (AA, via 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid)) (ABTS), and 2,2-diphenyl-1-picrylhydrazyl (DPPH)) and total protein concentration (TPC). The highest values of antioxidant activity were found in the non-encapsulated beet powder, followed by the powder encapsulated with maltodextrin and, to a lesser extent, the powder encapsulated with inulin. The glass transition temperature was 61.63 °C for M and 27.59 °C for I. However, for B it was less than 18.34 °C, which makes handling difficult. Encapsulation of beet extract with maltodextrin and inulin by lyophilization turned out to be an efficient method to increase solubility and diminish hygroscopicity.

A new method for the inoculation of Phytophthora palmivora (Butler) into cacao seedlings under greenhouse conditions.

BACKGROUND: The black pod disease affects cacao plantations worldwide; it is caused by the oomycete species of the genus Phytophthora. The resistance of cacao plants to the black pod is commonly evaluated by artificial inoculation of the pathogen and the monitoring of the disease symptoms. However, it is difficult to identify resistant plants because the commonly used methods for the inoculation of the pathogens produce inconsistent results. Therefore, this study aimed to develop an efficient and reliable method to evaluate the resistance of Theobroma cacao seedlings to the infection by Phytophthora palmivora. RESULTS: Seedlings of different cacao genotypes were inoculated with P. palmivora under greenhouse conditions using the previously reported inoculation methods and a newly proposed method, the agar-water solution method. While none of the previously reported methods was effective, the agar-water solution method ensured a 100% seedling infection under greenhouse conditions. The proposed agar-water methodology is fast, simple and reproducible. Furthermore, the evaluation of this method in susceptible (CCN-51) and tolerant (SCA-6) T. cacao genotypes produced the expected contrasting results. CONCLUSIONS: The agar-water solution method presented in this study is an efficient alternative inoculation protocol for the identification of cacao genotypes that are resistant to black pod under greenhouse conditions.

El desarrollo de la instrumentación quirúrgica en Colombia / Surgical technician career development in Colombia

El desarrollo de la profesión de la instrumentación quirúrgica en el país ha estado vinculado con la organización de la prestación de servicios de salud y en particular con la práctica médica quirúrgica. Así mismo, se ha sincronizado con los avances en protección específica, nuevas vacunas, y con las innovaciones en bioseguridad y vigilancia epidemiológica en el entorno hospitalario. Estas nuevas realidades plantean diversas exigencias para la formación del Instrumentador Quirúrgico.

"Comunicación médico -enfermera" basado en el modelo de atención centrado en el paciente: análisis de concepto  / "Doctor-nurse communication" based on the patient-centered care model: concept analysis

El término centrado en el paciente se encontró por primera vez en la literatura en 1969, aplicado en la Medicina denominada "Medicina Centrada en el Paciente", donde el profesional comprendía al usuario como un ser único y ente principal de la calidad (1). Este modelo, se enfoca en satisfacer las necesidades del usuario, siendo un ser activo que participa en la toma de decisiones sobre su enfermedad, tratamiento y rehabilitación. La comunicación Medico- Enfermera, es definido por diferentes autores dentro del sistema tradicional, como un proceso dinámico, bidireccional, de interacción e intercambio de las diferentes percepciones de los profesionales, que permite establecer los objetivos para el cuidado del paciente, lo que se constituye como una herramienta efectiva en los resultados en la atención, en la calidad y en la organización. Se realizó una revisión de la literatura que incluyó la valoración del concepto en diccionarios de la Academia de Lengua Española, de filosofía de Ferrater J y Frolov I. y en 22 artículos científicos obtenidos en las bases de datos de Pubmed, Journal Ovid, Science Direct y Proquest, Se aplicó la metodología Análisis de Concepto propuesto por Walker y Avant (2), lo que permitió conceptualizar la comunicación Medico-Enfermera según el Modelo de Atención centrado en el paciente y dar respuesta a los objetivos de esta investigación.

The term patient-centered was found for the first time in the literature in 1969, with an approach applied in Medicine called "Patient-Centered Medicine", where the professional understood the user as a unique being and as a principal entity of quality (1). The Patient Centered Care Model focuses on satisfying the needs of the user, being an active being that participates in making decisions about his illness, treatment and rehabilitation. The communication Doctor-Nurse, is defined by different authors within the traditional system, as a dynamic, bidirectional process of interaction and exchange of different perceptions of professionals, which allows to establish the objectives for patient care, which is constituted as an effective tool in the results of care, quality and organization. A literature review was carried out that included the evaluation of the concept in dictionaries of the Spanish Language Academy, philosophy of Ferrater J and Frolov I. and in 22 scientific articles obtained in Pubmed databases, Ovid Journal, Science Direct and Proquest, The Concept Analysis methodology proposed by Walker and Avant (2) was applied, which allowed to conceptualize the Doctor-Nurse communication according to the Patient-Centered Care Model and to respond to the objectives of this research.

Suicide in University students in Bogotá, Colombia, 2004-2014. / Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004­2014.

We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 - 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 - 27 years, with 62% of the cases in the 19 - 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004-2014 / Suicide in University students in Bogotá, Colombia, 2004-2014

Resumen Estudio cualitativo, exploratorio, descriptivo y retrospectivo en cinco universidades de Bogotá, Colombia, para conocer la magnitud, las principales características y significados y el impacto del suicidio de estudiantes universitarios. Se realizaron 66 entrevistas semiestructuradas a personal institucional. Se identificaron 45 casos de suicidio consumado en el período 2004 - 2014. El 69% de los casos fueron hombres y el 31% mujeres. El rango de edad estuvo entre 17 y 27 años; 62% entre 19 y 22 años. Las formas más frecuentes de cometer el suicidio fueron el ahorcamiento y el envenenamiento, seguidos del lanzamiento al vacío, el uso de armas de fuego y el consumo de sustancias psicoactivas. El 52% de los casos eligió el lugar de residencia para cometer el hecho; el 16% eligió el campus universitario. Áreas de conocimiento: el 44% pertenecía a ciencias sociales y humanas y el 22% a ingenierías. Motivos y procesos desencadenantes del suicidio identificados, el principal grupo se relaciona con lo familiar, en especial desintegración familiar, ruptura de relaciones de pareja e intolerancia a opciones sexuales diferentes. Los entrevistados expresaron diversos significados del suicidio, tanto positivos: acto de valor y ejercicio de la autonomía, como negativos: impotencia, desadaptación y derrota.

Abstract We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 – 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 – 27 years, with 62% of the cases in the 19 – 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

Effect of extrusion cooking on bioactive compounds in encapsulated red cactus pear powder.

Red cactus pear has significant antioxidant activity and potential as a colorant in food, due to the presence of betalains. However, the betalains are highly thermolabile, and their application in thermal process, as extrusion cooking, should be evaluated. The aim of this study was to evaluate the effect of extrusion conditions on the chemical components of red cactus pear encapsulated powder. Cornstarch and encapsulated powder (2.5% w/w) were mixed and processed by extrusion at different barrel temperatures (80, 100, 120, 140 °C) and screw speeds (225, 275, 325 rpm) using a twin-screw extruder. Mean residence time (trm), color (L*, a*, b*), antioxidant activity, total polyphenol, betacyanin, and betaxanthin contents were determined on extrudates, and pigment degradation reaction rate constants (k) and activation energies (Ea) were calculated. Increases in barrel temperature and screw speed decreased the trm, and this was associated with better retentions of antioxidant activity, total polyphenol, betalain contents. The betacyanins k values ranged the -0.0188 to -0.0206/s and for betaxanthins ranged of -0.0122 to -0.0167/s, while Ea values were 1.5888 to 6.1815 kJ/mol, respectively. The bioactive compounds retention suggests that encapsulated powder can be used as pigments and to provide antioxidant properties to extruded products.

Farmacovigilancia en el recién nacido crítico en el estado de Jalisco: Obligación olvidada / Pharmacovigilance in the critical newborn in the state of Jalisco: Forgotten obligation

En los neonatos en estado crítico es necesario establecer un sistema de farmacovigilancia con el cual se les proteja de posibles reacciones adversas a los medicamentos; estas reacciones pueden ser por el efecto farmacológico, la interacción con otros medicamentos, errores de dosificación y la idiosincrasia del paciente, de acuerdo con la Norma Oficial Mexicana 220. Objetivo: Conocer el estado actual de la farmacovigilancia en unidades de cuidado intensivo neonatal del estado de Jalisco. Material y métodos: Mediante un cuestionario estructurado de 12 preguntas, se practicó una encuesta de opinión en referencia a los programas de farmacovigilancia en los recién nacidos en estado crítico en instituciones del área metropolitana de Guadalajara y el interior del estado de Jalisco. Se aplicó en ocho centros hospitalarios que cuentan con terapia intensiva neonatal y en un congreso estatal de pediatría en el año 2011. A todos los participantes se les pidió que de manera voluntaria, llenaran una documento ad hoc; los resultados se procesaron en el programa Epi info 2010. Discusión y conclusiones: Los resultados demuestran que no se está cumpliendo la NOM 220. Existe un gran déficit de unidades con programas implementados de farmacovigilancia y proceso de notificación de reacciones adversas a medicamentos; la cobertura es menor al 50%. Al parecer, el problema es aún mayor en instituciones particulares. Es necesario cumplir con la NOM 220 para asegurar la calidad de atención en los recién nacidos críticos en el estado de Jalisco.

There is a need to establish medication surveillance/monitoring systemsfor newborn patients in critical condition in order to protect these patients from possible adverse reactions to prescribed drugs. In accordance with Mexican official standard NOM 220, these reactions may result from pharmacological effects, interaction with other drugs, dosage errors, and the patient's nature/idiosyncrasy. Objective: Our goal was to gain knowledge on the current situation regarding medication surveillance in neonatal intensive care units within the state of Jalisco. Material and methods: By means of a structured questionnaire involving 12 questions, an opinion poll was carried out with reference to medication surveillance programs for newborn patients in critical condition at institutions within Guadalajara's metropolitan area and the State of Jalisco. The survey was conducted in 8 hospital centers that provide neonatal intensive care and at a state congress on pediatrics that took place in 2011. All of the respondents were asked to voluntarily fill out a questionnaire Ad-hoc, and the results were processed using the Epi Info 2010 program. Discussion and conclusions: The results show that there is widespread noncompliance of NOM 220. There is a considerable deficit with respect to units implementing medication surveillance systems and methods to notify adverse reactions to medication, with implementation rates lower than 50%. It appears that the problem is even greater in private institutions. Compliance with NOM 220 is essential in order to guarantee the quality of the care provided to newborn patients in critical condition within the state of Jalisco.

Diagnóstico de neurodiscapacidad en el periodo neonatal en México, resultados de una encuesta realizada al personal de salud / Neurodisability diagnosis in the neonatal period in Mexico, results of a survey of health personnel

Introducción: En México existe incertidumbre acerca de los recursos humanos y tecnológicos disponibles para el diagnóstico de la neurodiscapacidad, es por eso que el objetivo de este estudio fue conocer la disponibilidad de dichos recursos, así como identificar la existencia de programas para establecer el diagnóstico en el periodo neonatal, en los diferentes centros de trabajo del país. Material y métodos: Durante el XVI Congreso Nacional de Neonatología que celebró la Federación Nacional de Neonatología de México, en febrero de 2011 en Cancún, México, se realizó una encuesta entre los pediatras, neonatólogos, enfermeras y personal de salud del país. Resultados: El 65% respondió que en su lugar de trabajo cuentan con programas de tamizaje para retinopatía del prematuro, sordera, parálisis cerebral, epilepsia y retraso mental; también los encuestados mencionaron tener los siguientes especialistas en sus instituciones: neurólogos, oftalmólogos y personal para la detección de problemas de sordera. Conclusiones: El panorama es sombrío, ya que en todas las áreas de cobertura se reporta menos del 70% de estos recursos. Se hace notar que para la detección de la ceguera y la sordera se cuenta con más recursos disponibles. El resto de los problemas investigados presenta graves indicadores negativos, por lo tanto, es urgente legislar en el campo de acción de la neonatología, cuestionando la eficacia y seguridad de algunos de los tratamientos y su contribución al daño neurológico.

Introduction: In Mexico there is uncertainty about the human and technological resources available for the diagnosis of neurodisability, so the objective of the present study was: to determine the availability of those resources and to identify the existence of programs to establish the diagnosis in the neonatal period, in different workplaces in the country. Material and methods: During the Sixteenth National Congress of Neonatology, held by the National Federation of Neonatology of Mexico, in February 2011 in Cancún, Mexico. It was conducted a survey among pediatricians, neonatologists, nurses, and health personnel working in the country. Results: 65% answered that in their workplace have screening programs for: retinopathy of prematurity, deafness, cerebral palsy, mental retardation epilepsy, also the respondents mentioned that count with the following specialists at their institutions: neurologists, ophthalmologist and personal for the detection of deafness. Conclusions: The picture is bleak; in all areas reported coverage less than 70%. It is noted that for detection of blindness and deafness there are more resources available. The rest of the problems investigated have severe negative indicators. So it is urgent to legislate currently in the field of neonatology, questioning the efficacy and safety of some treatments and their contribution to neurological damage.

Síndrome de ovario poliquístico. Fisiopatología en mujeres obesas y no obesas / Polycystic ovary syndrome.Pathophysiology obese vs nonobese women

Introducción: el síndrome de ovario poliquístico es un trastorno endocrino metabólico de etiología incierta, que afecta a mujeres en edad reproductiva con una prevalencia del 5-10 %, y se caracteriza por oligo o anovulación, oligomenorrea e hiperandrogenismo clínico o bioquímico. Su presentación clínica está sujeta a la presencia de una predisposición genética, sometida a diferentes influencias externas tales como la obesidad, entre otras.Objetivo: revisar la literatura disponible acerca de las diferencias fisiopatológicas entre pacientes obesas y no obesas con el síndrome. Metodología: se realizó una búsqueda de los artículos disponibles en Ovid, Pubmed y Medline usando las palabras clave: polycystic ovary syndrome, obese and nonobese.Resultados: aunque la resistencia la insulina no es un hallazgo universal en mujeres con el síndrome, su papel en los cambios metabólicos de estas pacientes es evidente. Hay gran variabilidad en cuanto a la sensibilidad a la insulina en cada paciente, con una respuesta ovárica androgénica variable. Se observa un aumento de los andrógenos, inhibición de la acción de la insulina y disminución de la captación de glucosa por parte del órgano blanco. También hay alteración de las lipoproteínas y del metabolismo lipídico. En las pacientes no obesas predomina una alteración del eje hipotálamo - hipófisis- ovario; mientras que en las obesas, predomina una alteración en la sensibilidad a la insulina.

Objetive: To review the literature available about the difference between obese and non obese women with polycystic ovary syndrome (POS) Background: POS is characterized by endocrine and metabolic abnormalities. The etiology of POS remains uncertain and its prevalence is 5-10 % in reproductive-age women. POS is diagnosed by the presence of oligovulation or anovulation, oligomenorrhea and hyperandrogenemia or hyperandrogenism. Clinical presentation depends on a genetic predisposition (associated with metabolic abnormalities) influenced by external factors such as obesity. Methods: Pubmed, Ovid and Medline databases were searched up using polycystic ovary syndrome, obese, nonobese as key words. Results: Insulin resistance is not a universal finding in women with POS (it is onlypresent in 60 % of them), its role in metabolic changes is evident. There is a great variability in insulin resistance levels in each patient with variable response to androgens production from ovaries. There is an increase in androgens, inhibition of insulin action and decrease in glucose uptake in the target organ. It is associated with lipid and lipoprotein abnormalities. In nonobese women with POS predominates an alteration in the hypothalamo-pituitary-adrenal axis while in obese women with POS there is more marked dysregulationin insulin sensitivity. In the obese women with POS plasmatic levels of sex hormone–binding globulin (SHBG) are significantly low.

Transporte neonatal seguro en la población abierta del estado de Jalisco: impacto del programa S.T.A.B.L.E. en la morbilidad y mortalidad / Safe neonatal transport in Jalisco state: impact of S.T.A.B.L.E. program on morbidity and mortality

Introducción. El transporte neonatal desde las unidades médicas hasta las unidades de tercer nivel en muchos casos es desorganizado y arriesgado, situación que compromete aún más el estado de salud del neonato enfermo. El objetivo del estudio fue analizar el impacto del programa S.T.A.B.L.E. (de las siglas en inglés: Sugar and Safe care, Temperature, Airway, Blood, Lab work, Emotional support) en la morbimortalidad de los neonatos trasladados del interior del estado de Jalisco y de la zona metropolitana de Guadalajara, a la Unidad de Cuidados Intensivos Neonatales Externos (UCIN-EX) del Hospital Civil de Guadalajara. Métodos. Se diseñó un estudio prospectivo de 2005 a 2009. El proceso de intervención se basó en la aplicación del programa S.T.A.B.L.E. a todo neonato que requirió ser trasladado. Esto se logró con la intervención de los médicos reguladores del Sistema de Atención Médica de Urgencias (SAMU) del estado de Jalisco. Se implementó un curso de capacitación para el personal médico y paramédico de los centros de atención que refieren pacientes a nuestra unidad, con el fin darles a conocer el programa S.T.A.B.L.E. y su forma de aplicación. Resultados. Un total de 3,277 neonatos fueron incluidos en el estudio, 384 antes de implementar el programa y 2,893 con la aplicación del programa S.T.A.B.L.E. En el grupo con intervención se observó una frecuencia mayor de pacientes con temperatura corporal normal a su ingreso a la unidad receptora [516 (87%) vs. 227 (59%) p < 0.01 ], así como cifras de glicemia en rangos normales [690 (93%) vs. 173 (45%) p < 0.001]. La mortalidad durante el periodo de hospitalización en la unidad receptora fue menor en el grupo con intervención [405 (14%) vs. 84 (22%) p < 0.05]. Después del proceso de intervención, más pacientes fueron trasladados en incubadora [2,806 (97%) vs. 200 (52%) p < 0.001]; de igual forma, en más pacientes se aplicaron métodos de monitoreo de oximetría de pulso [2,575 (89%) vs. 235 (61 %) p < 0.01 ]. En cuanto al número de transportes neonatales regulados y autorizados por el sistema SAMU, se observó un incremento a favor del grupo con intervención [2,806 (97%) vs. 234(61%) p < 0.001]. La frecuencia de defunciones durante el transporte neonatal no presentó diferencias [30 (1 %) vs. 10 (2.6%) p = NS]. Conclusiones. El traslado de neonatos enfermos al tercer nivel de atención médica en el estado de Jalisco se realizó de forma segura, con una mejoría importante en la morbilidad. El programa S.T.A.B.L.E. fue altamente eficiente y de fácil aplicación. La disminución de la mortalidad de los pacientes con intervención del programa durante el periodo de hospitalización requiere estudios especialmente diseñados para establecer posibles asociaciones.

Background. Transporting newborn infants to third-level units is often disorganized, thus entailing several risks that may further compromise the health of newborn patients. Methods. A prospective study was designed in orderto assess the impact ofthe S.T.A.B.L.E. program (Sugarand Safe Care, Temperature, Airway, Blood, Lab work, Emotional support) from 2005 to 2009 in regard to morbidity and mortality rates of newborn patients who had to be transferred from other regions within Jalisco state or within Guadalajara's metropolitan area to the Neonatal Intensive Care Unit ofthe Civil Hospital in Guadalajara. The intervention process was based on applying the S.T.A.B.L.E. program to all newborns who needed to be transferred and was achieved with the intervention ofthe physicians regulating the Emergency Medical Assistance System (SAMU) of the state of Jalisco. A training course, as well as an educational brochure, was given to medical and paramedical staff from the medical assistance centers referring patients to our unit in orderto provide them with information on the S.T.A.B.L.E. program and its implementation. Results. A total of 3,277 newborn infants were included in the study, 384 before the intervention program and 2,893 once the S.T.A.B.L.E. program was implemented. Within the group transferred after the program's implementation, we observed a greater incidence of patients with normal body temperature upon admission to the receiving unit [516 (87%) vs. 227 (59%); p < 0.01 ] as well as with blood glucose figures within the normal range [690 (93%) vs. 173 (45%); p < 0.001]. Mortality during the hospitalization period in the receiving unit was lower in the group treated after the program's implementation [405 (14%) vs. 84 (22%); p < 0.05]. After the intervention process, more patients were transported in incubators [2,806 (97%) vs. 200 (52%); p < 0.001] and equally, pulse oximetry monitoring methods were applied in a greater number of patients [2,575 (89%) vs. 235 (61 %); p < 0.01 ]. With regard to the number of transfers of newborns that were regulated and authorized by the SAMU system, we also observed an increase in such numbers for the group treated after the intervention program [2,806 (97%) vs. 234 (61 %); p < 0.001]. There was no difference in the incidence of death during the newborns' transport [30 (1%) vs. 10 (2.6%); p = NS]. Conclusions. Transfer of ill newborns to third-level medical care units in the state of Jalisco was safely undertaken with a significant improvement in morbidity rates. The S.T.A.B.L.E. program was highly effective and easy to implement. The decrease in mortality during the hospitalization period of patients treated after the intervention program merits further studies especially designed to establish possible associations.