Characterization of medium and small-scale gold processing operations, wastewaters, and tailings in the Arequipa region of Peru.

Gold cyanidation facilities in the Arequipa Region of Peru are challenged by the availability and quality of water for processing in an arid environment. The facilities reuse decant water which recycles residual cyanide but also undesirable constituents. To understand the impact of intensive water recycling on cyanide and metals concentrations, we collected barren water, decant water, and tailings samples from six gold cyanidation facilities with ore capacities of 10-430 tons per day. Processing facilities in Arequipa recycle all effluents, with decant waters making up 58 ± 11 % of process waters. Decant water contained non-target metals: copper (394 ± 161 mg/L), iron (59 ± 34 mg/L), and zinc (74 ± 42 mg/L). In addition, decant water mean free and complexed cyanide concentrations were 534 ± 129 mg/L and 805 ± 297 mg/L, respectively. Complexed cyanide concentrations remained more constant than free cyanide concentrations with 786 ± 299 mg/L for barren water and 805 ± 297 mg/L for decant water. Cyanide mass balances showed between 21 % and 42 % of unaccounted free cyanide from the start of gold cyanidation and discharge to the tailings storage facility (TSF). Free cyanide estimated losses due to volatilization were 0.8 kg and 2.5 kg of hydrogen cyanide per ton of ore processed at barren water pH of 10.1 and 9.7. Together these results indicate two acute hazards: 1) volatilization of free cyanide during processing and 2) loading and retention of cyanides and metals into TSFs. This study elucidates the extent of uncontrolled vapor phase cyanide release during gold processing operation and contaminant concentrations in the tailings storage facilities. The data highlights the need for improvement oversight, accountability, and regulation of gold processing facilities practicing intensive recycling and zero discharge.

Transitional dynamics from mercury to cyanide-based processing in artisanal and small-scale gold mining: Social, economic, geochemical, and environmental considerations.

Artisanal and small-scale gold mining (ASGM) is the leading global source of anthropogenic mercury (Hg) release to the environment. Top-down mercury reduction efforts have had limited results, but a bottom-up embrace of cyanide (CN) processing could eventually displace mercury amalgamation for gold recovery. However, ASGM transitions to cyanidation nearly always include an overlap phase, with mercury amalgamation then cyanidation being used sequentially. This paper uses a transdisciplinary approach that combines natural and social sciences to develop a holistic picture of why mercury and cyanide converge in gold processing and potential impacts that may be worse than either practice in isolation. We show that socio-economic factors drive the comingling of mercury and cyanide practices in ASGM as much or more so than technical factors. The resultant Hg-CN complexes have been implicated in increasing the mobility of mercury, compared to elemental mercury used in Hg-only processing. To support future inquiry, we identify key knowledge gaps including the role of Hg-CN complexes in mercury oxidation, transport, and fate, and possible links to mercury methylation. The global extent and increase of mercury and cyanide processing in ASGM underscores the importance of further research. The immediacy of the problem also demands interim policy responses while research advances, though ultimately, the well-documented struggles of mercury reduction efforts in ASGM temper optimism about policy responses to the mercury-cyanide transition.

Long-Term Maintenance of Clinical Responses by Individual Patients With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Abatacept.

OBJECTIVE: To investigate the frequency and trajectories of individual patients with polyarticular-course juvenile idiopathic arthritis (JIA) achieving novel composite end points on abatacept. METHODS: Data from a clinical trial of subcutaneous abatacept (NCT01844518) and a post hoc analysis of intravenous abatacept (NCT00095173) in patients with polyarticular-course JIA were included. Three end points were defined and evaluated: combined occurrence of low disease activity (LDA) measured by the Juvenile Arthritis Disease Activity Score; 50% improvement in American College of Rheumatology criteria for JIA (ACR50); and patient-reported outcomes. Patient-reported outcomes included visual analog scale score of minimal pain (pain-min) and Childhood Health Assessment Questionnaire disability index score of 0 (C-HAQ DI0). In this post hoc analysis, maintenance of month 13 and 21 end points (LDA+pain-min, LDA+C-HAQ DI0, and ACR50+pain-min) in those who achieved them at month 4 was determined. RESULTS: Composite end points (LDA+pain-min, LDA+C-HAQ DI0, and ACR50+pain-min) were achieved at month 4 (44.7%, 19.6%, and 58.9% of the 219 patients treated with subcutaneous abatacept, respectively). Of those who achieved LDA+pain-min at month 4, 84.7% (83 of 98) and 65.3% (64 of 98) maintained LDA+pain-min at months 13 and 21, respectively. The proportions of patients meeting LDA+pain-min outcomes increased from 44.7% (98 of 219) at month 4 to 54.8% (120 of 219) at month 21. The frequency of patients who met an LDA+C-HAQ DI score of 0 increased from 19.6% (43 of 219) at month 4 to 28.8% (63 of 219) at month 21. CONCLUSION: Among individual patients with polyarticular-course JIA treated with abatacept who achieved 1 of the combined clinical and patient-reported outcomes composite end points, many maintained them over 21 months of abatacept treatment.

Patient-Reported Outcomes Among Patients Ages Two to Seventeen Years With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Subcutaneous Abatacept: Two-Year Results From an International Phase III Study.

OBJECTIVE: To describe longitudinal changes in patient-reported outcomes (PROs) in children with polyarticular-course juvenile idiopathic arthritis (pJIA) treated with subcutaneous abatacept. METHODS: Secondary analysis of a single-arm, open-label 24-month study of patients ages 6-17 years and 2-5 years. PROs included Childhood Health Assessment Questionnaire-Disability Index (CHAQ-DI), parent global assessment of child well-being (PaGA), pain assessment, and Activity Limitation Questionnaire (ALQ). Clinical outcomes included 50% or greater improvement in JIA American College of Rheumatology (ACR) criteria, clinically inactive disease, and Juvenile Arthritis Disease Activity Score. RESULTS: For the 6- to 17-year-old (n = 173) and 2- to 5-year-old (n = 46) cohorts, respectively, median (Q1, Q3) changes from baseline in CHAQ-DI at months 4 and 24 were -0.3 (-0.8, 0.0) and -0.5 (-1.0, -0.1), and -0.4 (-0.8, 0.0) and -0.5 (-1.0--0.1). Median pain scores were below cutoff threshold for clinically relevant pain (<35 mm) by month 1 (6 to 17 years, 32.3 mm; 2 to 5 years, 25.7 mm), reaching a nadir at month 24 (6 to 17 years, 6.0 mm; 2 to 5 years, 2.0 mm). For the 6- to 17-year-old and 2- to 5-year-old cohorts, respectively, median PaGA scores were 47.8 (n = 172) and 42.1 (n = 46) at baseline and 6.3 (n = 107) and 2.0 (n = 37) at month 24. In both cohorts, ALQ components improved from baseline to month 4 and were largely maintained to month 24. Clinical outcomes improved through to month 24. CONCLUSION: Early and sustained PRO improvements were reported in this phase III, open-label trial of subcutaneous abatacept in patients with pJIA.

Development of Novel Antibody-Camptothecin Conjugates.

We have developed a highly active and well-tolerated camptothecin (CPT) drug-linker designed for antibody-mediated drug delivery in which the lead molecule consists of a 7-aminomethyl-10,11-methylenedioxy CPT (CPT1) derivative payload attached to a novel hydrophilic protease-cleavable valine-lysine-glycine tripeptide linker. A defined polyethylene glycol stretcher was included to improve the properties of the drug-linker, facilitating high antibody-drug conjugate (ADC) drug loading, while reducing the propensity for aggregation. A CPT1 ADC with 8 drug-linkers/mAb displayed a pharmacokinetic profile coincident with parental unconjugated antibody and had high serum stability. The ADCs were broadly active against cancer cells in vitro and in mouse xenograft models, giving tumor regressions and complete responses at low (≤3 mg/kg, single administration) doses. Pronounced activities were obtained in both solid and hematologic tumor models and in models of bystander killing activity and multidrug resistance. Payload release studies demonstrated that two CPTs, CPT1 and the corresponding glycine analog (CPT2), were released from a cAC10 ADC by tumor cells. An ADC containing this drug-linker was well tolerated in rats at 60 mg/kg, given weekly four times. Thus, ADCs comprised of this valine-lysine-glycine linker with CPT drug payloads have promise in targeted drug delivery.

Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna / Postoperative infectious complications after open prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia

RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.

SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.

Subcutaneous Abatacept in Patients With Polyarticular-Course Juvenile Idiopathic Arthritis: Results From a Phase III Open-Label Study.

OBJECTIVE: To investigate the pharmacokinetics, effectiveness, and safety of subcutaneous (SC) abatacept treatment over 24 months in patients with polyarticular-course juvenile idiopathic arthritis (JIA). METHODS: In this phase III, open-label, international, multicenter, single-arm study, patients with polyarticular JIA (cohort 1, ages 6-17 years and cohort 2, ages 2-5 years) in whom treatment with ≥1 disease-modifying antirheumatic drug was unsuccessful received weight-tiered SC abatacept weekly: 10 to <25 kg (50 mg), 25 to <50 kg (87.5 mg), ≥50 kg (125 mg). Patients who had met the JIA-American College of Rheumatology 30% improvement criteria (achieved a JIA-ACR 30 response) at month 4 were given the option to continue SC abatacept to month 24. The primary end point was the abatacept steady-state serum trough concentration (Cminss ) in cohort 1 at month 4. Other outcome measures included JIA-ACR 30, 50, 70, 90, 100, and inactive disease status, the median Juvenile Arthritis Disease Activity Score in 71 joints using the C-reactive protein level (JADAS-71-CRP) over time, safety, and immunogenicity. RESULTS: The median abatacept Cminss at month 4 (primary end point) and at month 24 was above the target therapeutic exposure (10 µg/ml) in both cohorts. The percentage of patients who had achieved JIA-ACR 30, 50, 70, 90, or 100 responses or had inactive disease responses at month 4 (intent-to-treat population) was 83.2%, 72.8%, 52.6%, 28.3%, 14.5%, and 30.1%, respectively, in cohort 1 (n = 173) and 89.1%, 84.8%, 73.9%, 58.7%, 41.3%, and 50.0%, respectively, in cohort 2 (n = 46); the responses were maintained to month 24. The median (interquartile range) JADAS-71-CRP improved from baseline to month 4: cohort 1, from 21.0 (13.5, 30.3) to 4.6 (2.1, 9.4); cohort 2, from 18.1 (14.0, 23.1) to 2.1 (0.3, 4.4). Improvements were sustained to month 24, at which time 27 of 173 patients (cohort 1) and 11 of 22 patients (cohort 2) had achieved JADAS-71-CRP remission. No unexpected adverse events were reported; 4 of 172 patients (2.3%) in cohort 1 and 4 of 46 (8.7%) in cohort 2 developed anti-abatacept antibodies, with no clinical effects. CONCLUSION: Weight-stratified SC abatacept yielded target therapeutic exposures across age and weight groups, was well tolerated, and improved polyarticular JIA symptoms over 24 months.

Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis.

BACKGROUND: Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who previously had an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (DMARDs). METHODS: In this 12-month, double-blind, active-controlled and placebo-controlled, phase 3 trial, we randomly assigned patients in a 2:2:2:1:1 ratio to receive one of the following regimens: tofacitinib at a 5-mg dose taken orally twice daily (107 patients), tofacitinib at a 10-mg dose taken orally twice daily (104), adalimumab at a 40-mg dose administered subcutaneously once every 2 weeks (106), placebo with a blinded switch to the 5-mg tofacitinib dose at 3 months (52), or placebo with a blinded switch to the 10-mg tofacitinib dose at 3 months (53). Placebo groups were pooled for analyses up to month 3. Primary end points were the proportion of patients who had an American College of Rheumatology 20 (ACR20) response (≥20% improvement from baseline in the number of tender and swollen joints and at least three of five other important domains) at month 3 and the change from baseline in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score (scores range from 0 to 3, with higher scores indicating greater disability) at month 3. RESULTS: ACR20 response rates at month 3 were 50% in the 5-mg tofacitinib group and 61% in the 10-mg tofacitinib group, as compared with 33% in the placebo group (P=0.01 for the comparison of the 5-mg dose with placebo; P<0.001 for the comparison of the 10-mg dose with placebo); the rate was 52% in the adalimumab group. The mean change in the HAQ-DI score was -0.35 in the 5-mg tofacitinib group and -0.40 in the 10-mg tofacitinib group, as compared with -0.18 in the placebo group (P=0.006 for the comparison of the 5-mg dose with placebo; P<0.001 for the comparison of the 10-mg dose with placebo); the score change was -0.38 in the adalimumab group. The rate of adverse events through month 12 was 66% in the 5-mg tofacitinib group, 71% in the 10-mg tofacitinib group, 72% in the adalimumab group, 69% in the placebo group that switched to the 5-mg tofacitinib dose, and 64% in the placebo group that switched to the 10-mg tofacitinib dose. There were four cases of cancer, three serious infections, and four cases of herpes zoster in patients who received tofacitinib during the trial. CONCLUSIONS: The efficacy of tofacitinib was superior to that of placebo at month 3 in patients with psoriatic arthritis who had previously had an inadequate response to conventional synthetic DMARDs. Adverse events were more frequent with tofacitinib than with placebo. (Funded by Pfizer; OPAL Broaden ClinicalTrials.gov number, NCT01877668 .).

[Normal values of gases in the vein of the umbilical cord during the postpartum period and postcesarea immediately in normal fetuses to term]. / Valores normales de gases en la vena del cordón umbilical durante el postparto y postcesárea inmediato en fetos de término normales.

BACKGROUND: To be able to diagnose and catalogue a patient with imbalance of the acid basic condition a gasometría must be realized. The pH and the gasometría of the blood of umbilical cord are useful tools to study the immediate situation of the newborn child. The values gasométricos in the vein and the artery of the umbilical cord change according to the geographical altitude. OBJECTIVE: To identify the normal values of the venous gases of the umbilical cord in the postpartum immediate one of normal fetuses to term, born by obstetric resolution, without hurt, in the Spanish Hospital of the Mexico City and to identify the difference with the considered normal values for other institutions of different conditions of the Mexican Republic located to different altitudes. MATERIAL AND METHOD: Transversal, prospective, descriptive and observacional study effected in the service of Obstetrics of the Hospital Español of Mexico (Maternidad Mundet). All the patients were included pregnant woman of term, with pregnancy of normal evolution, with an obstetric resolution without evidence of foetal hurt that they deposited with labor or for elective Caesarean. RESULTS: The average of the curves of normal distribution of the pH, of the PCO2, of the HCO3, of the PO2, of the base excess and of the foetal hemoglobin they were: 7.34, 39.3081, 20.66, 29.3529,-4.09 and 15.18, respectively.The distribution curves of the analyzed values were normal, in no.case there was asymmetry, with a not significant Kolmogorov. CONCLUSIONS: The gasometric of the cord is a simple, practical method and, especially I target to value the foetal condition intraparto. The values found in our analysis do not demonstrate statistically significant differences with the values of other studies effected to minor altitudes that that of the Mexico City. The analysis that here one presents is a partial check of the final sample that will belong 300 individuals.

[Relapsing risk and obstetric-neonatal outcome in pregnancy and systemic lupus erythematosus]. / Reactivación y pronóstico obstétrico-neonatal en lupus y embarazo.

OBJECTIVE: to assess the effect of pregnancy on systemic lupus erythematosus (SLE) activity, and the obstetric/neonatal outcome. METHODS: historic cohort including 24 female SLE patients who became pregnant. For every pregnant/puerperal period, the presence of lupus relapse, mean relapse, Mex-SLEDAI score and prednisone dose were compared. RESULTS: higher relapse risk (RR = 11.8), more relapse episodes (1.0 ± 1.3 vs. 0.02 ± 0.17), higher Mex-SLEDAI scores (2.0 ± 2.5 vs. 01 ± 0.7) and higher prednisone requirements (13.5 ± 12.6 vs. 7.2 ± 7.5 mg/day), were observed in pregnancy puerperal periods. The abortion incidence: 10.8 %, fetal death: 5.4 %, preeclampsia: 18.8 %, preterm deliveries: 18.9 %, neonatal mortality rate: 6.0 %, perinatal mortality rate: 10.5 %, LES activity associated to obstetric morbidity (83.3 % vs. 38.8 %, p = 0.005), preterm deliveries (43.6 % vs. 11.1 %), neonatal morbidity (46.7 % vs. 11.1 %, and low birth weight (25 % vs. 0). CONCLUSIONS: lupus pregnancy resulted in higher relapse risk, and more severe LES activity. Lupus activity also worsens obstetric and neonatal outcome.

[Synchronous double primary ovarian tumor in situ]. / Tumor doble primario sincrónico de ovario in situ.

BACKGROUND: Afinding of primary malignancies of different histological nature in each ovary is a particularly interesting condition since the information available about it is scarce and because there is hardly any consensus about its definition, classification and proper diagnostic-therapeutic approach. CLINICAL CASE: A case of a 49-year-old female patient presenting an abdominal mass with irregular 10 x 10 cm edges that comprises the area between the left illiac fossa and the umbilical scar. An exploratory laparatomy revealed two masses; a 15 cm cystic one in the left ovary, and an 8 cm one in the right ovary. The following histopathological analysis revealed a bilateral papillary carcinoma. A full oncogy-necological surgical protocol for ovarian carcinoma was applied. The last histopathological analysis revealed a clear cell carcinoma in the left ovary, and a moderately differentiated endometrioid carcinoma in the right one. CONCLUSIONS: A rare case of a synchronous double primary ovarian tumor is reported. Its clinical presentation, diagnosis, treatment and follow-up pose a particular classification issue.

Consumo de alcohol y factores de riesgo en estudiantes de dos universidades colombianas / Alcohol consumption and risk factors in students of two colombian universities

El objetivo fue identificar factores de riesgo del consumo de alcohol en estudiantes universitarios colombianos. Participaron 397 mujeres y 312 hombres, estudiantes de dos universidades privadas y católicas de la ciudad de Medellín (Colombia). Los resultados identificaron como factores de riesgo las dificultades para decir “no” a la gente (p=0.012) y el consumo de sustancias psicoactivas por miembros de la familia (p=0.022).

The objective of the current research was to identify the risk factors associated to alcohol consumption of Colombian University students. 397 women and 312 men, students from two private and Catholic universities in the city of Medellín (Colombia) took part in it. The results identified as risk factors the difficulties to say 'no' to the people (p=0.012) and the consumption of psychoactive substances by members of the family (p=0.022).

[Pregnancy outcomes before and after the onset of rheumatoid arthritis]. / Desenlace obstétrico antes y después del inicio de la artritis reumatoide.

OBJECTIVE: to compare the obstetric prognosis before and after the onset of rheumatoid arthritis (RA). METHODS: a survey in RA women patients who become sexually active before disease onset, and who tried or got pregnant after diagnosis was performed. Obstetrical features such as: number of pregnancies, threat of abortion, abortion, early natal death, congenital abnormalities and preeclampsia-eclampsia syndrome, before and after RA onset were compared. RESULTS: only 47 women were eligible (age: 40.5 ± 11.0 years; time of evolution: 15.9 ± 11.5 years; positive rheumatoid factor: 93.6 %) from 700 screened. After RA onset there were 63 gestations in 36 patients who got pregnant (secondary infertility rate: 21.3 %). A significant increase in frequency and number of cesarean deliveries, besides a higher number of pregnancies with preeclampsia, were found after RA onset. Additionally, four newborns with congenital anomalies were reported after the disease onset compared to none before RA onset. CONCLUSIONS: compared to pre-RA obstetric events, a higher frequency and number of adverse outcomes was found in pregnancies that occurred after RA onset.

[Antiphospholipid syndrome and human reproduction]. / Síndrome antifosfolipídico y reproducción humana.

Recurrent pregnancy loss is secondary to multiple illnesses. An important cause sometimes undiagnosed is the antiphospholipid syndrome, an autoimmune disease with various clinical alterations (miscarriage, hypertensive disorders, preterm delivery, vascular thrombosis, intrauterine retard growth, death intrauterine, abruption placentae). There are major and minor clinical criteria and precise indications that guide the physician to its recognition. Antibodies related with the syndrome are anticardiolipin and lupic anticoagulant, but other phospholipids seems to be implicated on this pathology and its participation on trombotic events is even unknown. Opportune diagnosis is of vital importance for fetomaternal morbidity and mortality. The repercussions are important during gestational stage, but effects c an persist o r even appear during the puerperium, predisposing t o trombotic events. The antiphospholipid s yndrome th at accompanies gestation, requires of efficient valuation and a special treatment, with a narrow prenatal surveillance. The best therapy for reproductive future which has less undesirable effects, is with heparin and acetylsalicylic acid administration; prednisone (steroids) is used in cases of active illness. The current knowledge about this disease makes possible that a pregnancy at term can be achieved with the least as possible number of complications.

Loss of endogenous androgen receptor protein accelerates motor neuron degeneration and accentuates androgen insensitivity in a mouse model of X-linked spinal and bulbar muscular atrophy.

X-linked spinal and bulbar muscular atrophy (SBMA; Kennedy's disease) is a polyglutamine (polyQ) disease in which the affected males suffer progressive motor neuron degeneration accompanied by signs of androgen insensitivity, such as gynecomastia and reduced fertility. SBMA is caused by CAG repeat expansions in the androgen receptor (AR) gene resulting in the production of AR protein with an extended glutamine tract. SBMA is one of nine polyQ diseases in which polyQ expansion is believed to impart a toxic gain-of-function effect upon the mutant protein, and initiate a cascade of events that culminate in neurodegeneration. However, whether loss of a disease protein's normal function concomitantly contributes to the neurodegeneration remains unanswered. To address this, we examined the role of normal AR function in SBMA by crossing a highly representative AR YAC transgenic mouse model with 100 glutamines (AR100) and a corresponding control (AR20) onto an AR null (testicular feminization; Tfm) background. Absence of endogenous AR protein in AR100Tfm mice had profound effects upon neuromuscular and endocrine-reproductive features of this SBMA mouse model, as AR100Tfm mice displayed accelerated neurodegeneration and severe androgen insensitivity in comparison to AR100 littermates. Reduction in size and number of androgen-sensitive motor neurons in the spinal cord of AR100Tfm mice underscored the importance of AR action for neuronal health and survival. Promoter-reporter assays confirmed that AR transactivation competence diminishes in a polyQ length-dependent fashion. Our studies indicate that SBMA disease pathogenesis, both in the nervous system and the periphery, involves two simultaneous pathways: gain-of-function misfolded protein toxicity and loss of normal protein function.

Ruido laboral y su impacto en salud / Occupational noise and its impact on health

Se denomina traumatismo acústico al deterioro de la audición producido por la exposición a ruido. Este traumatismo se presenta como enfermedad profesional en individuos que ejercen ocupaciones en un medio en el que se mantiene de forma prolongada un ruido superior a 80 dB, conocido como Traumatismo Acústico Crónico. El Traumatismo Acústico Agudo ocurre en determinadas actividades que generan un gran impacto sonoro y en situaciones accidentales. En la Asociación Chilena de Seguridad la hipoacusia causada por la exposición a ruido representa el 80 poe ciento de las incapacidades permanentes por enfermedades profesionales. La hipoacusia sensorioneural producida por ruido no tiene tratamiento alguno, es decir, una vez instalada no hay posibilidad de remisión. El esfuerzo debe dirigirse a la prevención, mediante la aplicación de medidas adecuadas. La profilaxis se basa en control audiométrico periódico junto con medidas de protección individuales y colectivas.

Apendicitis aguda y embarazo; experiencia en el Hospital Español de México / Acute appendicitis and pregnancy experience at Hospital Español de Mexico

La pendicitis es la complicación quirúrgica más frecuente durante el embarazo. Plantea dificultades para el diagnóstico, y requiere de un tratamiento quirúrgico de urgencia. El objetivo de este estadio fue determinar el perfil clínco de esta asociación para establecer bases para el diagnóstico de apendicitis en el embarazo. Se revisaron los casos con diagnóstico preoperatorio de apendicitis y embarazo entre enero de 1990 a diciembre de 1996 en el Hospital Español de México. Se encontraron 17. La edad promedio fue de 28.6 años. De los 17 casos, 12 (70.50 por ciento) fueron verdaderamente apendicitis, y el tiempo transcurrido entre la aparición de síntomas y la realización de la laparotomía fue de 43.35 horas. La historia natural de la apendicitis no se modifica por la presencia del embarazo. El dolor abdominal periste como síntoma clave y se presentó en 100 por ciento de los casos. La laparotomía temprana permite una disminución en la morbilidad y mortalidad materno fetal