[Maternal mortality: relation between directive management and opportune clinical care]. / Mortalidad materna: enlace entre gestión directiva y atención clínica oportuna.

The authorities of the High Medical Specialized Units (HMSUs) Obstetric/Gynecology Service (OB/GYN) and Intensive Care Unit (ICU) elaborated a strategy, which included the organization and interrelation of both hospital services and the implementation of an Epidemiologic Monitoring Program for all critical complicated pregnancies. This plan consisted in an assignment of personnel for special care, immediate communication with heads of services to coordinate the attention and to facilitate the resources for medical attention in these patients, as well as daily follow up by the authorities until complete resolution. Through epidemiological monitoring, 274 cases of pregnant women with high risk of mortality were identified during 2005, and 437 during 2006 (increased 59 %). The admittance to ICU for this reason in 2003 was 17; in 2005 was 24 and in 2006 was 42 (147 % from 2003 to 2006). Maternal deaths diminished from: 3/17 (17.6 %) to 1/24 (4.1 %) to 2/42 (4.7 %) during the same years, respectively. The maternal death rate from 2004 to 2006 was: 33.2, 17.4, and 22 per 100,000 newborns, respectively, below the national and institutional average. The coordination between the Headquarters and the HMSUs that take care of obstetrical patients helped diminution maternal death over this period.

[Holt-Oram syndrome and portal extrahepatic hypertension. A case report]. / Síndrome de Holt-Oram asociado con hipertensión portal.

BACKGROUND: The Holt-Oram syndrome (HOS) is characterized by skeletal abnormalities, frequently accompanied by congenital cardiac defects. It was first described by Holt and Oram in 1960. It has a prevalence of 0.95/10,000 live newborns. The syndrome shows a dominant autosomic heritance with high penetrance. A mutation in the transcription gene factor TBX5 has been identified. This factor has been shown to be important in the heart and upper extremities development. CLINICAL CASE: A 17 year-old boy with muscle-skeletal abnormalities in forearms and hands, with implantation defects of thumbs and narrow shoulders as well as wide atrial septal defect type osteum secundum. He also showed portal cavernomatosus degeneration which conditioned portal extrahepatic hypertension and esophageal varicose veins. The diagnosis was established by clinical, radiological and auxiliary studies. His parents were also studied, and they did not show abnormalities. CONCLUSIONS: Two previous cases have been reported in the Mexican medical literature, both due to de novo genetic mutation. However, none has been associated with portal cavernomatosus degeneration and portal hypertension.

[Rehabilitation service in a primary care unit]. / Impacto del servicio de rehabilitación en el primer nivel de artención.

OBJECTIVE: to evaluate the impact of rehabilitation service in two primary care units (PCU). METHODS: a comparative cross-sectional study was performed in two PCU (No. 53 and No. 51). The former has a rehabilitation service and the second one refers to a rehabilitation consultant at a specialized hospital. The variables evaluated were: amount of cases, days of disability, average days/cases, and average cost/case according to specific disease considering the five main medical disease required disability for general or risk work disease. We used descriptive statistics for results and Student's t test to evaluate significance. RESULTS: back pain was the first cause of disablement; the average in opportunity care was seven days. The average number of days disability benefit for hand trauma, ankle sprain, and for back pain was lower in PCU No. 53, as well as for cervical sprain, but slightly higher for knee sprain. Evaluating the global incapacity days average and cost for each case, we found a significant difference to PCU No. 53. CONCLUSIONS: recovery time to return work was faster and lower the average cost in patients from to the PCU No. 53 which has its own rehabilitation service.

Sarampión y enfisema subcutáneo: presentación de tres casos / Measles and subcutaneous emphysema: a three case study

Se presentaron tres casos de sarampión complicados con bronconeumonía y enfisema subcutáneo, en niños de una familia campesina, no vacunados contra el sarampión. En seis meses se trataron 183 casos, de los cuales sólo tres presentaron enfisema subcutáneo, haciendo una incidencia de 1.6%; además se fundamentó en ellos la presencia de bronconeumonía, siendo relevantes los accesos de tos, lo cual sugiere que la fisiopatología de esta complicación se explica por la teoría del gradiente de presión propuesta por Bloch en 1968. Los factores encontrados en estos pacientes demuestran un sarampión más agresivo y con mayor probabilidad de presentar complicaciones; sin embargo, el valor pronóstico de la severidad del cuadro sarampionoso ante la presencia del enfisema subcutáneo es limitado y el manejo debe encaminarse más que nada a tratar el proceso bronconeumónico agregado