Determination of Micromovements in Removable Prosthesis during Mastication: A Pilot Study with 3D Electromagnetic Articulography.

Edentulism can generate negative impacts on self-esteem, interpersonal relationships, and oral functions. Removable prostheses are commonly used for tooth replacement, but they may cause discomfort due to micromovements during mastication. Objective and quantifiable methods are needed to evaluate these micromovements. A pilot study was conducted to determine the micromovements in removable prostheses during mastication using a 3D electromagnetic articulography (EMA-3D) system. One elderly participant wearing lower removable prostheses and an upper total well-fitting removable prosthesis was studied. The EMA-3D system was used to record movements in three spatial planes. Peanuts were given as test food, and the participant was instructed to chew normally while recordings were carried out until feeling the need to swallow. Analyses of the upper total prosthesis show micromovements ranging from 0.63 ± 0.11 to 1.02 ± 0.13 mm. During simultaneous analyses of the upper prosthesis and lower partial prosthesis, interference was not observed. This pilot study demonstrated the feasibility of using the EMA-3D system to evaluate micromovements in removable prostheses during mastication. Further research is needed to evaluate a larger sample and assess the clinical implications of these micromovements.

Source apportionment of lead in the blood of women of reproductive age living near tailings in Taxco, Guerrero, Mexico: An isotopic study.

The concentration and isotopic composition of lead in the blood of forty seven women of reproductive age (15-45y) exposed to multiple sources in two rural communities of the mining region of Taxco, Guerrero in southern Mexico were determined in order to identify specific contributing sources and their apportionment and to trace probable ingestion pathways. Our data indicate that >36% of the studied women have blood lead concentrations above 10µgdL-1 and up to 87% above 5µgdL-1. Tailings contain between 2128 and 5988mgkg-1 of lead and represent the most conspicuous source in the area. Lead contents in indoor dust are largely variable (21.7-987mgkg-1) but only 15% of samples are above the Mexican Regulatory Guideline for urban soils (400mgkg-1). By contrast, 85% of glazed containers (range: 0.026-68.6mgkg-1) used for cooking and food storage are above the maximum 2mgL-1 of soluble lead established in the Mexican Guideline. The isotopic composition indicates that lead in the blood of 95% of the studied women can be modeled in terms of a mixing system between local ores (and derivatives), glazed pottery and Morelos bedrock, end-members, with the two former being largely the most important contributors. Only one sample shows influence of indoor paints. Indoor dust is dominated by ores and derivatives but some samples show evidence of contribution from a less radiogenic source very likely represented by interior paints. This study supports the application of lead isotopic ratios to identify potential sources and their apportionment in humans exposed to multiple sources of lead from both, natural and anthropogenic origin.

Effects of a Humor Therapy Program on Stress Levels in Pediatric Inpatients.

OBJECTIVE: Disease and hospitalization generate stress, which can affect the response to treatment. Humor has been used in many hospitals to decrease stress. The aim of this study was to evaluate the impact of a humor therapy program on stress levels in pediatric inpatients. METHODS: In the first phase, an intervention and a control group were studied over 2 consecutive 3-month periods; the interventions were performed by a team of artists trained in humor therapy. Salivary cortisol levels were measured by enzyme-linked immunosorbent assay, and the Weisz test, a pictorial chart that determines subjective stress perception, and the Parker test, which assesses objective stress, were applied. In the second phase, salivary cortisol levels were measured and the Weisz test was administered before and after the interventions. RESULTS: A total of 306 patients were recruited into this study: 198 in the first phase (94 in the intervention group and 104 in the nonintervention group) and 108 in the second phase. There were no differences between groups regarding age, sex, or medical diagnosis. The children in the intervention group presented lower cortisol levels, lower scores on the Parker test, and higher scores on the Weisz test than children in the nonintervention group. In the second phase, the children showed lower salivary cortisol levels and higher scores on the Weisz test after the intervention. CONCLUSIONS: Humor therapy has beneficial effects on stress and cortisol levels in pediatric inpatients. This supports the implementation and reinforcement of these therapies in pediatric hospitals.

[Prevalence of purchase of antibiotics without prescription and antibiotic recommendation practices for children under five years of age in private pharmacies in peri-urban areas of Lima, Peru]. / Prevalencia de compra sin receta y recomendación de antibióticos para niños menores de 5 años en farmacias privadas de zonas periurbanas en Lima, Perú.

OBJECTIVES: To determine the prevalence of purchase of antibiotics without prescription and antibiotic recommendation for its use in children <5 years of age in private pharmacies in peri-urban areas of Lima. MATERIALS AND METHODS: An anonymous population survey was conducted among adults who bought an antibiotic for a child <5 years of age from a private pharmacy. Fictitious cases were applied in a subgroup of pharmacies to evaluate antibiotic recommendation practices. RESULTS: The prevalence of purchase of antibiotics without a prescription was 13%, including 1.7% that were chosen by consumers and 11.3% that were recommended by pharmacists. A total of 66.7% of the medications purchased to treat colds were antibiotics, 56.9% of which were prescribed. 64.4% of medications purchased to treat bronchospasm, 96.4% of the medications to treat watery diarrhea and 90.9% of the medications to treat pharyngitis were antibiotics. Amoxicillin (51.5%) and trimethoprim-sulfamethoxazole (20.6%) were the most commonly purchased antibiotics. A pharmacist suggested an antibiotic in 60% of the fictitious common cold cases, 76% of the bronchospasm cases, 44% of the watery diarrhea cases, and 76% of the dysentery cases. CONCLUSIONS: The purchase of antibiotics for children <5 years of age in private pharmacies primarily occurs with a medical prescription. The pharmacist commonly recommended an antibiotic in cases lacking a prescription. Measures are needed to reduce the inappropriate use of antibiotics at medical facilities and in pharmacies.

Prevalencia de compra sin receta y recomendación de antibióticos para niños menores de 5 años en farmacias privadas de zonas periurbanas en Lima, Perú / Prevalence of purchase of antibiotics without prescription and antibiotic recommendation practices for children under five years of age in private pharmacies in peri-urban areas of Lima, Peru

RESUMEN Objetivos . Determinar la prevalencia de compra sin receta médica y recomendación de antibióticos para su uso en niños menores de 5 años en farmacias privadas de zonas periurbanas de Lima. Materiales y métodos. Se aplicó una encuesta anónima poblacional en adultos que compraron un antibiótico para un niño menor de cinco años en una farmacia privada. En un subgrupo de farmacias se aplicaron casos ficticios para evaluar prácticas de recomendación de antibióticos. Resultados. La prevalencia de compra sin receta fue de 13%; 1,7% por automedicación y 11,3% por indicación del farmacéutico. El 66,7% de los medicamentos para tratar resfrío fueron antibióticos de los cuales 56,9% tenían receta. El 64,4% de los medicamentos comprados para tratar broncoespasmo fueron antibióticos; el 96,4% de los medicamentos para tratar diarreas acuosas y el 90,9% de los medicamentos para tratar faringitis. Amoxicilina (51,5%) y trimetoprim-sulfametoxazol (20,6%) fueron los más comprados. En el 60% de los casos ficticios de resfrío común, en el 76% de los de broncoespasmo, en el 44% de los de diarrea acuosa y en el 76% de los casos de disentería, el farmacéutico indicó un antibiótico. Conclusiones . La compra de antibióticos para niños menores de cinco años en farmacias privadas es principalmente con receta médica. La recomendación de antibióticos por parte de la farmacia es alta cuando no hay receta médica. Urgen medidas para disminuir el uso inadecuado de antibióticos tanto a nivel médico como en las farmacias.

ABSTRACT Objectives. To determine the prevalence of purchase of antibiotics without prescription and antibiotic recommendation for its use in children <5 years of age in private pharmacies in peri-urban areas of Lima. Materials and methods. An anonymous population survey was conducted among adults who bought an antibiotic for a child <5 years of age from a private pharmacy. Fictitious cases were applied in a subgroup of pharmacies to evaluate antibiotic recommendation practices. Results. The prevalence of purchase of antibiotics without a prescription was 13%, including 1.7% that were chosen by consumers and 11.3% that were recommended by pharmacists. A total of 66.7% of the medications purchased to treat colds were antibiotics, 56.9% of which were prescribed. 64.4% of medications purchased to treat bronchospasm, 96.4% of the medications to treat watery diarrhea and 90.9% of the medications to treat pharyngitis were antibiotics. Amoxicillin (51.5%) and trimethoprim-sulfamethoxazole (20.6%) were the most commonly purchased antibiotics. A pharmacist suggested an antibiotic in 60% of the fictitious common cold cases, 76% of the bronchospasm cases, 44% of the watery diarrhea cases, and 76% of the dysentery cases. Conclusions. The purchase of antibiotics for children <5 years of age in private pharmacies primarily occurs with a medical prescription. The pharmacist commonly recommended an antibiotic in cases lacking a prescription. Measures are needed to reduce the inappropriate use of antibiotics at medical facilities and in pharmacies.

Bordetella pertussis diagnosis in children under five years of age in the Regional Hospital of Cajamarca, Northern Peru.

INTRODUCTION: Bordetella pertussis is an important human pathogen that causes whooping cough (pertussis), an endemic illness responsible of significant morbidity and mortality, especially in infants and children. Worldwide, there are an estimated of 16 million cases of pertussis, resulting in about 195,000 child deaths per year. In Peru, pertussis is a major health problem that has been on the increase despite immunization efforts. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age suspected to have whopping cough in Cajamarca, Peru. METHODOLOGY: Children diagnosed with whooping cough admitted to the Hospital Regional de Cajamarca from August 2010 to July 2013 were included. Nasopharyngeal samples were obtained for B. pertussis culture and polymerase chain reaction (PCR) detection. RESULTS: In 133 children, the pertussis toxin and IS481 gene were detected in 38.35% (51/133) of the cases by PCR, while only 9.02% (12/133) of the Bordetella cultures were positive. The most frequent symptoms in patients with positive B. pertussis were paroxysm of coughing 68.63% (35/51), cyanosis 56.86% (29/51), respiratory distress 43.14% (22/51), and fever 39.22% (20/51). Pneumonia and acute bronchial obstructive syndrome were present in 17.65% (9/51) and 13.72% (7/51) of the cases, respectively. CONCLUSIONS: B. pertussis is responsible for an important proportion of whooping cough in hospitalized children in Cajamarca. Epidemiologic surveillance programs for B. pertussis are essential in Peru, especially in children who could most benefit from the vaccine.

Zinc Absorption from Fortified Milk Powder in Adolescent Girls.

Zinc (Zn) is essential for development, growth, and reproduction. The Mexican government subsidizes micronutrient-fortified milk for risk groups, with positive effect on the targeted groups' plasma Zn level, inferring a good absorption is achieved although it has not being measured. The aim of this study was to determine the impact of micronutrient-fortified milk intake during 27 days on Zn absorption in adolescent girls from northwest Mexico. Therefore, Zn absorption was evaluated in 14 healthy adolescent girls (14.1 years old) with adequate plasma Zn levels, before and after 27 days of fortified Zn milk intake. Fractional Zn absorption (FZA) was calculated from urinary ratios of stable isotopic Zn tracers administered orally and intravenously on days 0 and 27, and total absorbed Zn (TZA) was calculated. At the beginning, Zn intake was 6.8 ± 0.85 mg/d (mean ± SE), and 50 % of the adolescent girls did not achieve their requirement (7.3 mg/d). Additionally, FZA was negatively correlated with Zn intake (r =-0.61, p = 0.02), while TZA (1.06 mg/d) was insufficient to cover the physiologic requirements of adolescent girls (3.02 mg/d). At the end of the intervention, all the girls reached the Zn intake recommendation and TZA, 3.09 mg/d, which was enough to meet the physiological requirement for 57 % of the adolescent girls. Therefore, the low Zn intake and the Zn status of adolescent girls were positively impacted by Zn-fortified milk intake and its good absorption rate.

Prescribing patterns and economic costs of proton pump inhibitors in Colombia / Patrones de prescripción y costos económicos de inhibidores de bomba de protones en Colombia

Objective:To determine the prescribing patterns for protonpump inhibitors and to estimate the economic cost of their usein a group of patients affiliated with the Colombian Health Sys-tem.Methods:This is a descriptive observational study. Data foranalysis consisted of prescriptions dispensed between October1st, 2010 and October 31st, 2010 and were collected from a sys-tematic database of 4.2 million members. Socio-demographicvariables were considered along with the defined daily dose,comedication, convenience of the indication for proton pumpinhibitor use and costs.Results:In this study, 113,560 prescriptions were dispensed in89 cities, mostly to women (57.6 percent) with a mean age of 54.4 ±18.7 years; the drugs were omeprazole (n=111,294; 97.81 percent),esomeprazole (n=1,378; 1.2 percent), lansoprazole (n=524; 0.4 percent),pantoprazole and rabeprazole. The indication for 87,349 of theformulas (76.9 percent) was justified and statistically associated withthe use of NSAIDs, antithrombotics, corticosteroids, anti-ul-cer, antibiotics and prokinetics. No justification was found for26,211 (23.1 percent) of the prescriptions, which were associated withantidiabetics, antihypertensives,hypolipidemics andothers(p <0.001). The annual justified cost was estimated to beUS$ 1,654,701 and the unjustified cost was estimated tobe U.S. $ 2,202,590, as calculated using the minimum re-ference prices.

Prescribing patterns and economic costs of proton pump inhibitors in Colombia.

OBJECTIVE: To determine the prescribing patterns for proton pump inhibitors and to estimate the economic cost of their use in a group of patients affiliated with the Colombian Health System. METHODS: This is a descriptive observational study. Data for analysis consisted of prescriptions dispensed between October 1st, 2010 and October 31st, 2010 and were collected from a systematic database of 4.2 million members. Socio-demographic variables were considered along with the defined daily dose,comedication, convenience of the indication for proton pump inhibitor use and costs. RESULTS: In this study, 113,560 prescriptions were dispensed in 89 cities, mostly to women (57.6%) with a mean age of 54.4 ± 18.7 years; the drugs were omeprazole (n= 111.294; 97.81%),esomeprazole (n= 1.378; 1.2%), lansoprazole (n= 524; 0.4%), pantoprazole and rabeprazole. The indication for 87.349 of the formulas (76.9%) was justified and statistically associated with the use of NSAIDs, antithrombotics, corticosteroids, anti-ulcer, antibiotics and prokinetics. No justification was found for 26.211 (23.1%) of the prescriptions, which were associated with antidiabetics, antihypertensives, hypolipidemics and others (p <0.001).The annual justified cost was estimated to be US$ 1,654,701 and the unjustified cost was estimated to be U.S. $2,202,590, as calculated using the minimum reference prices. DISCUSSION: Each month, the Colombian health system is overloaded by unjustified costs that include payments for non-approved indications of proton pump inhibitors and for drugs outside the list of essential medications. This issue is contributing to rising costs of healthcare in Colombia.

OBJETIVOS: Determinar los patrones de prescripción de inhibidores de la bomba de protones y estimar el costo económico que genera su utilización en pacientes afiliados al Sistema General de Seguridad Social en Salud de Colombia. METODOLOGÍA: Estudio descriptivo observacional. Se analizarondatos de formulas dispensadas entre 1 y 31 de octubre de 2010 de una base de datos sistematizada de 4.2 millones de afiliados.Se consideraron variables socio-demograficas, dosis diaria definida,comedicación recibida, conveniencia o no del tipo de indicación de IBP y costos. RESULTADOS: Se dispensaron 113 560 formulas en 89 municipios,principalmente a mujeres (57.6%); promedio de edad 54.4±18.7 años; los medicamentos fueron omeprazol (n= 111294, 97.8%),esomeprazol (n= 1378, 1.2%), lanzoprazol (n= 524, 0.4%), pantoprazol y rabeprazol a dosis diarias definidas adecuadas. Se halló justificación en la indicación de 87349 fórmulas (76.9%) asociadas estadísticamente con uso de AINEs, antitrombóticos, corticoides, antiulcerosos, antibióticos, procinéticos, y sin justificación 26211 (23.1%) asociadas a antidiabéticos, antihipertensivos e hipolipemiantes y otros (p <0.001). El costo anual justificado fue de US$1.654.701 y no justificado de U.S.$2,202,590 empleando mínimos precios de referencia. DISCUSIÓN: Mensualmente se está cargando al sistema de salud colombiano con costos no justificados del uso de inhibidores de bomba de protones en indicaciones no aprobadas y con medicamentos por fuera del listado de esenciales que contribuyen a encarecer la atención sanitaria.

[Exactitude of self-reported weight and height in 15 to 19 year old female adolescents of the State of Mexico]. / Exactitud del autorreporte de peso y talla en mujeres de 15 a 19 años del Estado de México.

OBJECTIVE: To know the accuracy of weight and height in 15 to 19 years old women in relation to age, marginalization and migratory intensity level of localities and father's academic level. MATERIALS AND METHODS: The study was carried out with a probabilistic sample of public high school students at the State of Mexico (N=2 357), to whom self-reported weight and height were asked and were directly measured afterwards. Data were collected from January to April 2007. RESULTS: The results obtained showed that these adolescents overestimate their height not significantly, and significantly underestimate their weight, with similar trends analyzing age, marginalization levels, migratory intensity and father's education status. CONCLUSIONS: Results show the validity of self-reported height but not of self-reported weight among this sample.

Exactitud del autorreporte de peso y talla en mujeres de 15 a 19 años del Estado de México / Exactitude of self-reported weight and height in 15 to 19 year old female adolescents of the State of Mexico

OBJETIVO:Conocer la exactitud del autorreporte del peso y la talla en mujeres adolescentes de 15 a 19 años en función de la edad, el nivel de marginación, la intensidad de migración de las localidades y la escolaridad del padre. MATERIAL Y MÉTODOS:Se obtuvo una muestra representativa de mujeres estudiantes en escuelas públicas de nivel medio superior en el Estado de México (N=2 357) a quienes se les solicitó el dato por autorreporte del peso y la estatura y luego se las midió y pesó. Los datos se recopilaron durante los meses de enero a abril de 2007. RESULTADOS:Las adolescentes sobrestimaron su estatura de manera no significativa y subestimaron en grado significativo su peso, con tendencias similares al analizar por edad, nivel de marginación, intensidad de migración y escolaridad del padre. CONCLUSIONES:Los resultados muestran la validez del autorreporte de la estatura, mas no del peso corporal en esta muestra.

OBJECTIVE:To know the accuracy of weight and height in 15 to 19 years old women in relation to age, marginalization and migratory intensity level of localities and father's academic level. MATERIALS AND METHODS: The study was carried out with a probabilistic sample of public high school students at the State of Mexico (N=2 357), to whom self-reported weight and height were asked and were directly measured afterwards. Data were collected from January to April 2007. RESULTS:The results obtained showed that these adolescents overestimate their height not significantly, and significantly underestimate their weight, with similar trends analyzing age, marginalization levels, migratory intensity and father's education status. CONCLUSIONS:Results show the validity of self-reported height but not of self-reported weight among this sample.

Utilidad del Sistema API 20NE para identificar especies del género Acinetobacter y otros bacilos gramnegativos no fermentadores / Use of the API 20NE System to identify species of the Acinetobacter genus and other non fermenting gram-negative bacilli

Se utilizaron 62 cepas identificadas inicialmente como bacilos gramnegativos no fermentadores (BGNNF), aisladas de pacientes con diagnóstico de infección nosocomial, con el objeto de determinar su género y especie. Cuarenta y cinco cepas fueron identificadas como Acinetobacter baumannii, 10 como Pseudomonas aeruginosa, 3 como Stenotrophomonas maltophilia, 3 como Comamonas acidovorans y 1 como Achromobacter xylosoxidans subsp. xylosoxidans, mediante el API 20NE. Con respecto a las cepas de Acinetobacter, el ARDRA permitió identificar 20 cepas como A. baumannii y 23 como Acinetobacter genoespecie 13TU, pero 2 cepas no fueron identificadas por este método. La secuencia de la subunidad 16S del ADNr de todas las cepas incluidas en este estudio permitió identificar 20 cepas como A. baumannii, 23 cepas como Acinetobacter RUH1139, 10 como P. aeruginosa, 4 como A. xylosoxidans subsp. xylosoxidans (2 de estas cuatro cepas habían sido identificadas como A. baumannii mediante API20NE), 3 como S. maltophilia, 1 como C. acidovorans y 1 como β-Proteubacterium. Las discrepancias entre la identificación bioquímica por API 20NE y por ARDRA, para diferenciar las genoespecies de Acinetobacter, fue resuelta por la secuenciación de la subunidad 16S del ADNr, indicando que la identificación de los aislados de Acinetobacter, entre otros BGNNF, mediante API 20NE, debe ser confirmada por técnicas genéticas.

We used 62 strains initially identified as non fermenting gram-negative bacilli (NFGNB) isolated from patients with a nosocomial infection diagnosis with the purpose of identifying their genus and species. Forty five strains were identified as Acinetobacter baumannii, 10 as Pseudomonas aeruginosa, 3 as Stenotrophomonas maltophilia, 3 as Comamonas acidovorans and 1 as Achromobacter xylosoxidans subspecies xylosoxidans through the API 20NE. Regarding the Acinetobacter strains, the ARDRA allowed to identify 20 strains as A. baumannii and 23 as Acinetobacter genospecies 13TU, but 2 strains were not identified with this method. The ADNr 16S sequence of all the strains included in this study allowed to identify 20 strains as A. baumannii, 23 strains as Acinetobacter RUH1139, 10 as P. aeruginosa, 4 as A. xylosoxidans subsp. xylosoxidans (2 of these four strains strains had been identified as A. baumannii through API20NE), 3 as S. maltophilia, and 1 as C. acidovorans and 1 as β-Proteubacterium. The discrepancies between the biochemical identification by API 20NE and by ARDRA to differentiate the Acinetobacter genospecies was resolved by the ADNr16S sequencing, indicating that the identification of the Acinetobacter isolates, among other NFGNB, through API 20NE, should be confirmed through genetic techniques.

[Early onset depression: prevalence, course, and treatment seeking delay]. / La depresión con inicio temprano: prevalencia, curso natural y latencia para buscar tratamiento.

OBJECTIVE: To estimate the prevalence of early onset depression in the Mexican population and compare its natural history, comorbidity and treatment latency between early onset and adult onset depression. MATERIAL AND METHODS: The National Survey of Psychiatric Epidemiology (ENEP) is representative of the Mexican urban population aged 18 to 65. The diagnostic instrument is the Composite International Diagnostic Interview (CIDI). Statistical analysis was performed with descriptive and logistic regression analyses, considering the multistage, stratified and weighted sample design of the survey. RESULTS: Two percent of the Mexican population has suffered from depression as children or adolescents, with an average 7 episodes during their lifetime (compared with 3 episodes for adult onset); the first episode lasted a mean of 31 months (compared with 16 for adult onset) and generally did not receive any treatment. CONCLUSIONS: The longer duration of the first episode and the greater number of lifetime episodes for subjects with early onset is attributed to the lack of early detection and of timely treatment of depression in Mexican youth. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

La depresión con inicio temprano: prevalencia, curso natural y latencia para buscar tratamiento / Early onset depression: prevalence, course, and treatment latency

OBJETIVO: Conocer, en la población mexicana, la prevalencia de la depresión con inicio temprano, y comparar el curso natural, la comorbilidad y la latencia para buscar tratamiento entre los deprimidos con inicio temprano y aquellos con inicio en la edad adulta. MATERIAL Y MÉTODOS: La Encuesta Nacional de Epidemiología Psiquiátrica es representativa de la población nacional urbana, de entre 18 a 65 años de edad. Se realizó en México, entre 2001 y 2002, con el instrumento diagnóstico de la versión computarizada de la Entrevista Internacional Compuesta de Diagnóstico. Los análisis toman en cuenta el diseño complejo de la muestra multietápica, estratificada y ponderada utilizando análisis descriptivo y regresiones logísticas. RESULTADOS: El 2.0 por ciento de la población ha padecido depresión en la infancia o adolescencia con un promedio de siete episodios a lo largo de la vida (comparado con tres para los de inicio en la adultez), el primero persiste por unos 31 meses (comparado con 16 meses), durante los cuales generalmente no reciben tratamiento. CONCLUSIONES: La mayor duración del primer episodio y el mayor número de episodios en la vida de aquellos con depresión de inicio temprano se debe a la falta de detección y tratamiento oportuno en jóvenes.

Reemplazo valvular con prótesis mecánica de bola de fabricación nacional / Valve replacement with cage ball valve manufactured in Mexico

Este informe preliminar documenta la experiencia clínica con el uso de una prótesis mecánica de bola de fabricación nacional mexicana. Entre mayo de 1985 y marzo de 1986, se efectuaron en forma consecutiva 25 reemplazos valvulares en 23 pacientes: 14 en posición aórtica, 9 mitrales y 2 mitro aórtios. La edad promedio fue de 32 años. La etiología fue reumática en el 95% de los casos. La clase funcional pre-operatorio fué: clase II en 6 pacientes, clase III en 15 pacientes y clase IV en 2 casos. La mortalidad operatoria fue de un caso (4.5%). Se efectuó seguimiento en todos los sobrevivientes con promedio de 5 meses. No se han observado muertes tardías ni complicaciones relacionadas con la prótesis, la curva de sobrevida actuarial a 10 meses es de 96.0%. La mayor parte de los pacientes pasaron a clase funcional I (80%) y II (20%). Nuestro estudio sugiere que la prótesis mecánica de bola Biomed tiene buen funcionamiento y que los resultados clínicos justifican hasta ahora continuar con el uso de ella