Initial Experience with the Solitaire X 3 mm Stent Retriever for the Treatment of Distal Medium Vessel Occlusions.

Endovascular therapy (EVT) is the standard treatment for ischemic stroke caused by a large vessel occlusion (LVO). The effectiveness of EVT for distal medium vessel occlusions (MDVOs) is still uncertain, but newer, smaller devices show potential for EVT in MDVOs. The new Solitaire X 3 mm device offers a treatment option for MDVOs. Our study encompassed consecutive cases of primary and secondary MDVOs treated with the Solitaire X 3 mm stent-retriever as first-line EVT device between January and December 2022 at 12 European stroke centers. The primary endpoint was a first-pass near-complete or complete reperfusion, defined as a modified treatment in cerebral infarction (mTICI) score of 2c/3. Additionally, we examined reperfusion results, National Institutes of Health Stroke Scale (NIHSS) scores at 24 h and discharge, device malfunctions, complications and procedural technical parameters. Sixty-eight patients (38 women, mean age 72 ± 14 years) were included in our study. Median NIHSS at admission was 11 (IQR 6-16). In 53 (78%) cases, a primary combined approach was used as the frontline technique. Among all enrolled patients, first-pass mTICI 2c/3 was achieved in 22 (32%) and final mTICI 2c/3 in 46 (67.6%) patients after a median of 1.5 (IQR 1-2) passes. Final reperfusion mTICI 2b/3 was observed in 89.7% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR 0-4), and no symptomatic intracranial hemorrhages were reported. Based on our analysis, the utilization of the Solitaire X 3 mm device appears to be both effective and safe for performing EVT in cases of MDVO stroke.

Early exploration of the economic impact of transradial access (TRA) versus transfemoral access (TFA) for neurovascular procedures in Spain.

INTRODUCTION: Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective. METHODS: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed. RESULTS: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results. LIMITATIONS: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured. CONCLUSIONS: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.

Endovascular thrombectomy first-pass reperfusion and ancillary device placement.

BACKGROUND: Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS: Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS: From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS: Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.

Economic impact of the first pass effect in mechanical thrombectomy for acute ischaemic stroke treatment in Spain: a cost-effectiveness analysis from the national health system perspective.

OBJECTIVE: The mechanical thrombectomy (MT) benefit is related to the degree of reperfusion achieved. First pass effect (FPE) is defined as complete/near revascularisation of the large-vessel occlusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after a single device pass. This study assessed the health benefit and economic impact of achieving FPE for acute ischaemic stroke (AIS) patients from the Spanish National Health System (NHS) perspective. DESIGN: A lifetime Markov model was used to estimate incremental costs and health outcomes (measured in quality-adjusted life-years (QALYs)) of patients that achieve FPE. A subanalysis of the Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischaemic Stroke (STRATIS) registry was performed to obtain clinical outcomes. The base case included all patients that achieved at least a final mTICI ≥2 b, while the alternative scenario included all patients regardless of their final mTICI (0-3). Treatment costs were updated to reflect current practice based on expert panel consensus, while other acute and long-term costs were obtained from a previous cost-effectiveness analysis of MT performed in Spain. Sensitivity analyses were performed to assess the model's robustness. SETTING: Spanish healthcare perspective. PARTICIPANTS: AIS patients in Spain. INTERVENTIONS: FPE following MT. OUTCOME MEASURES: The model estimated QALYs, lifetime costs and net monetary benefit for the FPE and non-FPE group, depending on the inclusion of reperfusion groups and formal care costs. RESULTS: STRATIS subanalysis estimated significantly better clinical outcomes at 90 days for the FPE group in all scenarios. In the base case, the model estimated lifetime cost saving per patient of €16 583 and an incremental QALY gain of 1.2 years of perfect health for the FPE group. Cost savings and QALY gains were greater in the alternative scenario (-€44 289; 1.75). In all scenarios, cost savings were driven by the long-term cost reduction. CONCLUSION: Achieving FPE after MT can lead to better health outcomes per AIS patient and important cost savings for the Spanish NHS.

[Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)]. / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Aspectos históricos, clínicos y epidemiológicos de la poliomielitis en México (1946 - 1960) / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

El Dr. Felipe Alfonso Aceves Zubieta, formador de médicos y medios de comunicación / Dr. Felipe Alfonso Aceves Zubieta, trainer of physicians and media

Resumen: Felipe Alfonso Aceves Zubieta (1899-1960) fue un médico mexicano del siglo XX, profesor de varias asignaturas quirúrgicas en la Escuela Nacional de Medicina, y fundador de las Asambleas Nacionales de Cirujanos (1934), de la Revista de Cirugía del Hospital Juárez y de la Academia Mexicana de Cirugía.

Abstract: Felipe Alfonso Aceves-Zubieta (1899-1960), was a Mexican physician, who teached several surgical subjects at National School of Medicine, in Mexico City, and was the founder of Asambleas Nacionales de Cirujanos (1934), Revista de Cirugía del Hospital Juárez and Academia Mexicana de Cirugía.

On the first occupational medicine initiatives in Mexico: The Real del Monte miners' hospital. / De las primeras iniciativas de medicina laboral en México: el hospital de mineros de Real del Monte.

Despite the legislation of Otto von Bismarck (1815-1898) on social security rights formulated in 1883 in Germany where it is stated that it is the duty of the State to promote the welfare of all members of society, particularly the weakest and most needy, using the means available to them, and the proposals of laws against accidents issued on April 30, 1904 in the State of Mexico in 1904, in the Mexico of the Porfirio Díaz era, providing workers with formal medical care was not contemplated, except in the case of some railway companies, hospitals for the care of patients with occupational diseases were not built. One of these exceptions was the Hospital del Mineral del Real del Monte de Pachuca, founded in the late nineteenth century and after the mining company passed to the Americans in 1906, it was agreed that the company acquired the hospital and equated it with the medical and surgical advances of the time for immediate care of injuries, especially of the orthopedic type, which enabled not only the healing of wounds, but also rehabilitation. This hospital is one of the oldest in Mexico with regard to three disciplines: orthopedics, occupational medicine and rehabilitation. It ceased to operate in 1982, and currently it is a museum with a rich collection of documents and instruments related to the aforementioned disciplines.

A pesar de la legislación de Otto von Bismarck (1815-1898) sobre derechos de seguridad social formulada en 1883 en Alemania donde se señala que es deber del Estado promover el bienestar de todos los miembros de la sociedad, particularmente de los más débiles y necesitados utilizando los medios con los que dispone, y las propuestas de leyes contra accidentes expedidas el 30 de abril de 1904 en el Estado de México, en el México del porfiriato no se consideró brindar atención médica formal a los trabajadores, salvo algunas empresas ferrocarrileras, no se construyeron hospitales para atender a pacientes con enfermedades laborales. Una de estas excepciones fue el Hospital del Mineral de Real del Monte de Pachuca, fundado a finales del siglo XIX y después de que la Compañía minera pasó a los norteamericanos en 1906, se acordó que la empresa adquiriera el hospital y lo equipara con los adelantos médicos y quirúrgicos de la época para la inmediata atención de lesiones, en especial de tipo ortopédico, lo que permitió curar heridas y la rehabilitación. Este nosocomio constituye uno de los antecedentes más antiguos en México en las tres disciplinas: ortopedia, medicina del trabajo y rehabilitación. Dejó de funcionar en 1982 y actualmente es un museo con un rico acervo documental y de instrumental de las disciplinas mencionadas.

[Surgical experience and statistics at a rural hospital in San Luis Potosí, Mexico]. / Experiencia y estadística quirúrgica en un hospital rural de San Luis Potosí

BACKGROUND: Worldwide, rural hospitals are a second level of health care for populations with <50,000 persons. On average, they perform 1000 surgical procedures with a mortality rate of 2%, assist in the transfer of patients (30-50%) and treat a wide variety of illnesses amenable to surgical treatment, depending on the prevalence of the disease in each community. Our objective was to describe the analysis of the performed surgical procedures in a rural hospital in San Luis Potosi, México. METHODS: This was a retrospective, observational, descriptive and transversal study. We collected data from the clinical files of all surgical patients of the General Surgery, Obstetrics/Gynecology and Orthopedics Departments from January 1 to December 31, 2007, analyzing mean age, number of surgeries, types of illness, morbidity and mortality. RESULTS: Of the 5544 discharges, there were 1508 surgical patients (27.2%) with an 80% female predominance and obstetric patients (57%). Mean age of the patients was 44.8 years. There were 86 different procedures performed. The most frequent procedures were total bilateral oophorectomy (36%), cesarean section (17%), inguinal hernia repair (6%), and cholecystectomy (4%), among others. From all the procedures, 51% were ambulatory, 11% trauma and 6% pediatrics. Morbidity was 0.76%, mortality 1.1% and the transferred patients represented 8.9%. CONCLUSIONS: Outcomes of the rural hospital exceed the expectations of a second-level of health care and include participation of the trauma and pediatric surgery departments, with 86 different surgical treatments performed.

Experiencia y estadística quirúrgica en un hospital rural de San Luis Potosí / Surgical experience and statistics at a rural hospital in San Luis Potosí, Mexico

Introducción: Los hospitales rurales representan un medio de cobertura de atención de segundo nivel en poblaciones con menos de 50 000 habitantes, con un promedio de 1000 procedimientos quirúrgicos, mortalidad de 2 %, traslados de 30 a 50 % y una variedad de padecimientos susceptibles de ser operados que varía en cada país o comunidad. El objetivo de este estudio es describir el análisis de las intervenciones quirúrgicas realizadas en un hospital rural de San Luis Potosí, México. Material y métodos: Estudio retrospectivo observacional, descriptivo, transversal, en el que se recabaron los datos de los expedientes de los pacientes operados entre el 1 de enero y 31 de diciembre de 2007 en los servicios de Cirugía General, Ginecoobstetricia y Ortopedia, para determinar el número de cirugías, edad de los pacientes, tipo de padecimientos, y porcentajes de mortalidad y complicaciones. Resultados: De 5544 pacientes egresados, 1508 fueron operados (27.2 %); predominó el sexo femenino (80 %), edad media de 44.8 años y las pacientes obstétricas (57 %). Con base en 86 procedimientos distintos, los más efectuados fueron oclusión tubaria bilateral (36 %), cesárea (17 %), inguinoplastia (6 %) y colecistectomía (4 %). De los procedimientos, 51 % fue ambulatorio, 11 % de manejo en trauma y 6 % en población pediátrica. La morbilidad fue de 0.76 %, mortalidad de 1.1 % y el índice de traslados de 8.9 %. Conclusiones: La utilidad de los hospitales rurales sobrepasa la mera cobertura de atención de segundo nivel, pues cooperan en la atención de trauma y cirugía pediátrica; los hospitales rurales brindan alternativas de solución quirúrgica con una variedad de 86 diferentes procedimientos.

BACKGROUND: Worldwide, rural hospitals are a second level of health care for populations with <50,000 persons. On average, they perform 1000 surgical procedures with a mortality rate of 2%, assist in the transfer of patients (30-50%) and treat a wide variety of illnesses amenable to surgical treatment, depending on the prevalence of the disease in each community. Our objective was to describe the analysis of the performed surgical procedures in a rural hospital in San Luis Potosi, México. METHODS: This was a retrospective, observational, descriptive and transversal study. We collected data from the clinical files of all surgical patients of the General Surgery, Obstetrics/Gynecology and Orthopedics Departments from January 1 to December 31, 2007, analyzing mean age, number of surgeries, types of illness, morbidity and mortality. RESULTS: Of the 5544 discharges, there were 1508 surgical patients (27.2%) with an 80% female predominance and obstetric patients (57%). Mean age of the patients was 44.8 years. There were 86 different procedures performed. The most frequent procedures were total bilateral oophorectomy (36%), cesarean section (17%), inguinal hernia repair (6%), and cholecystectomy (4%), among others. From all the procedures, 51% were ambulatory, 11% trauma and 6% pediatrics. Morbidity was 0.76%, mortality 1.1% and the transferred patients represented 8.9%. CONCLUSIONS: Outcomes of the rural hospital exceed the expectations of a second-level of health care and include participation of the trauma and pediatric surgery departments, with 86 different surgical treatments performed.

[The beginnings of trauma management in Mexico City. 1847-1914]. / El inicio del manejo del traumatismo en la Ciudad de México (1847-1914).

We describe how surgical trauma was managed in Mexico City from 1847 to 1912. Management included minimal interventions, generally ending with the patient's death. Other more radical procedures such as abdomen trauma proposed in 1874 anld performed in 1898 are also described. A variety of techniques employed and type of trauma cases registered that yielded more radical attitudes that brought about the creation of public emergency rooms (the Cruz Verde) and military surgical rooms in railroad cars that oversaw the care of soldiers during the revalutionary period are discussed.

El inicio del manejo del traumatismo en la Ciudad de México (1847-1914) / The beginnings of trauma management in Mexico City. 1847-1914

Describimos el inicio del manejo de las urgencias en la ciudad de México desde las afanadurías de las demarcaciones de policía donde se dejaba morir al paciente bajo un manejo mínimo (por considerársele al paciente objeto del crimen), hasta los procedimientos radicales como el traumatismo de abdomen propuesto desde 1874 y realizado en 1898. También describimos la variedad de técnicas y los principales padecimientos (con estadísticas de la época), de los problemas más relevantes del traumatismo ocurrido en nuestra capital desde 1847 a 1912, que se centraban en las lesiones abdominales, fracturas y heridas por arma cortante, hasta el cambio radical de la patología por las heridas de arma de fuego, y de una actitud más radical que daría surgimiento a los puestos de socorro de la Cruz Verde y a la atención en ferrocarril de los revolucionarios.

We describe how surgical trauma was managed in Mexico City from 1847 to 1912. Management included minimal interventions, generally ending with the patient's death. Other more radical procedures such as abdomen trauma proposed in 1874 and performed in 1898 are also described. A variety of techniques employed and type of trauma cases registered that yielded more radical attitudes that brought about the creation of public emergency rooms (the Cruz Verde) and military surgical rooms in railroad cars that oversaw the care of soldiers during the revolutionary period are discussed.

Evolución de la formación de investigadores en pregrado en la Facultad de Medicina, UNAM / Researcher training among medical students

Presentamos un resumen histórico de las experiencias educativas en la formación e iniciación temprana de estudiantes en la investigación del área de la salud. El trabajo abarca desde 1890, fecha de la primera publicación por un alumno, hasta la época actual en que estos alumnos, bajo la asesoría de un tutor, se adiestran en el rigor del método científico y publican sus experiencias o presentan sus trabajos en congresos y reuniones científicas.

Causas y mortalidad de la obstrucción intestinal en el anciano / Causes and mortality of intestinal obstruction in the elderly patiente

Objetivo: determinar la etiología, sintomatología, y evolución de los pacientes ancianos operados por obstrucción intestinal (OI). Antecedentes: la OI es una de las principales causas de cirugía por urgencia de ancianos, con mortalidad de 20 a 40 por ciento. Se cree que la etiología de estas obstrucciones se debe a defectos de pared, adherencias o problemas oncológicos. Método: se recabaron los datos de sintomatología y hallazgos quirúrgicos en pacientes mayores de 65 años de edad, atendidos por el Servicio de Cirugía General por urgencias, entre diciembre de 1996 a junio de 1998. Resultados: en 104 pacientes ancianos operados por urgencia, 40 fueron por OI, la primera causa fue hernia inguinal y umbilical complicada (35 por ciento). La mortalidad fue de 37 por ciento secundaria a desequilibrio metabólico y neumonías. Conclusiones: las principales causas de OI fueron los defectos de pared abdominal. Recomendamos una inmediata cirugía y corrección preoperatoria de las enfermedades agregadas.

Investigación durante la licenciatura / Medical research by pre-graduate students

Presentamos nuestra experiencias con un grupo de alumnos de pregrado en medicina, participantes en un programa de incorporación temprana a la investigación. Se trató de alumnos sobresalientes que han desarrollado protocolos personales y publicado sus experiencias en revistas médicas indizadas.Desde 1991 a 1998 se han incorporado al programa 321 alumnos con 289 proyectos concluidos, 24 estudiantes publicaron 54 artículos de investigación médica. El incorporar a una edad más temprana a los alumnos sobresalientes, acorta los tiempos de instrucción a los nuevos investigadores, incentiva a las nuevas generaciones para escoger la carrera científica aun antes de concluir su licenciatura.

Dr. Agustín Farfán: cirujano novohispano del siglo XVI / Doctor Agustín Farfán: novohispanic surgeon of XVI century

El siglo XVI fue un periodo en el que la fusión de dos razas produjo la cultura mexicana. Este mestizaje se reflejó en la escuela médica mexicana con exponentes como el Dr. Fr. Agustín Farfán (1532-1604), quien publicó dos de las primeras obras médicas: el Tractado de Anothomia y Chivgia (1579) y el Tracto breve de Medicina (1592, 1604, 1610). Maestro universitario, supo manejar los conceptos medioevales con las tendencias renacentistas y la terapéutica mesoamericana, siendo una de las bases de nuestra cirugía mexicana