Apendicitis aguda en hernia epigástrica: Caso clínico

Objetivo: Reporte de caso clínico de una presentación poco común de apendicitis aguda sin reporte en la literatura actual. Material y Método: revisión de expediente clínico en hospital general regional 196 del instituto mexicano del seguro social. Resultados: Masculino de 47 años con dolor abdominal en epigastrio. Clínicamente se palpa defecto hemiario, encontrando apéndice vermiforme edematosa en saco herniario. Discusión: La presentación de apendicitis aguda en sacos hemiarios epigástricos es extremadamente rara encontrando, solamente, un reporte de caso en la literatura.

Objective: Clinical case report of an uncommon presentation of acute appendicitis with no report in the current literature. Material and Method: review of the clinical record at Hospital General Regional 196 of the Mexican Social Security Institute. Results: 47 year old male with abdominal pain in epigastrium clinically palpated hernial defect, finding edematous vermiform appendix in hernial sac. Discussion: The presentation of acute appendicitis in epigastric hernial sac is extremely rare finding only one case report in the literature.

Experiencia de elastografía strain en 2 casos de lesiones subcutáneas sospechosas de malignidad / Our Experience With Strain Elastography in 2 Cases of Suspected Malignant Subcutaneous Lesions

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Who pays more for health services in middle-income countries: lessons from Mexico.

An evaluative study with a cross-sectional design was carried out on healthcare cost indicators reported by the 2000 National Health Survey in Mexico, to determine which population group had higher health costs/expenditures in relation to family income. The results suggest that in middle-income countries such as Mexico, families with lower incomes tend to pay more for healthcare services.

Barriers to early detection of cervical-uterine cancer in Mexico.

In Mexico, a woman dies of cervical-uterine cancer every 2 hours, indicating a low impact by the national program for early detection of this cancer, principally because of problems related to quality and coverage. Through a qualitative study, we identified the principal barriers to use of the detection program from the point of view of actual and potential program users. Four focus groups were organized in standard conditions in Mexico City (urban, developed) and in the southern state of Oaxaca (rural, economically disadvantaged area). Participants were either women with at least one previous Papanicolaou (Pap) test or women who had never had the test. Barriers to Pap test use included (1) lack of knowledge about cervical-uterine cancer etiology, (2) not knowing that the Pap test exists, (3) the conception that cancer is an inevitably fatal disease, (4) problems in doctor/medical institution-patient relationships, (5) giving priority to unmet needs related to extreme poverty, (6) opposition by the male sexual partner, (7) rejection of the pelvic examination, (8) long waits for sample collection and receiving results, and (9) perceived high costs for care. To increase coverage of the early detection program for cervical-uterine cancer in Mexico, the needs, perceptions, and beliefs of women and their partners must be taken into account when developing policy and planning, given the role these factors play in the decision-making process that leads to their participation or nonparticipation in this program.

[Ambulatory medical care in Mexico: the cost for users]. / Atención médica ambulatoria en México: el costo para los usuarios.

OBJECTIVE: To analyze the results of the National Health Survey (ENSA-II) as to the costs generated by the search and obtainment of ambulatory medical attention in various institutions of the private and public health sector. MATERIAL AND METHODS: Information was raised from the health care cost indicators reported by the study population of the ENSA-II. The dependent variable was the direct expense for the consumer and the independent variables, the condition of being insured and the income. Variation significance levels were identified using the test by Duncan. RESULTS: The costs at national level in US dollar were: transport $2.20, medical visit $7.90, drugs $9.60, diagnostic studies $13.6; average total cost for ambulatory attention was $22.70. Empirical finding suggest a new direct and indirect cost-for-consumer analysis for the health care users. These costs represent an important burden on the family income, which worsens when users are not insured. CONCLUSIONS: Incorporation of the economic perspective to the analysis of public health issues should not be limited to the analysis of the health provider's expenses, particularly if the problems of equity and accessibility must be solved, which are at present characteristic of health care services in Mexico.

[A database for research in public health]. / Base de datos para la investigación en salud pública "BISP".

Epidemiological and health system research projects are often delayed due to the difficulties to build validated data basis in personal computers. This papers presents a new computer interactive program for handling numeric data from a given questionnaire to a structured archive. The questionnaire includes the basic variables of the dwelling and of the members of the household. A list of sociodemographic and health variables are selected, although other variables can be easily added, according to special needs. All the intermediate steps regularly needed to construct a data base are included in the package: capture, verification, validation and record linkage. The package is equipped with the basic procedures needed to produce tabulations and basic statistical analysis.