Mortality from Congenital Heart Disease in Mexico: A Problem on the Rise.

BACKGROUND AND OBJECTIVES: Temporal trends in mortality from congenital heart disease (CHD) vary among regions. It is therefore necessary to study this problem in each country. In Mexico, congenital anomalies were responsible for 24% of infant mortality in 2013 and CHD represented 55% of total deaths from congenital anomalies among children under 1 year of age. The objectives of this study were to analyze the trends in infant mortality from CHD in Mexico (1998 to 2013), its specific causes, age at death and associated socio-demographic factors. METHODS: Population-based study which calculated the compounded annual growth rate of death rom CHD between 1998 and 2013. Specific causes, age at which death from CHD occurred and risk factors associated with mortality were analyzed for the year 2013. RESULTS: Infant mortality from CHD increased 24.8% from 1998 to 2013 (114.4 to 146.4/ 100,000 live births). A total of 3,593 CHD deaths occurred in 2013; the main causes were CHD with left-to-right shunt (n = 487; 19.8/100,000 live births) and cyanotic heart disease (n = 410; 16.7/100,000). A total of 1,049 (29.2%) deaths from CHD occurred during the first week of life. Risk factors associated with mortality from CHD were, in order of magnitude: non-institutional birth, rural area, birth in a public hospital and male sex. CONCLUSIONS: Mortality from CHD has increased in Mexico. The main causes were CHD with left-to-right shunt, which are not necessarily fatal if treated promptly. Populations vulnerable to death from CHD were identified. Approximately one-third of the CHD occurred during the first week of life. It is important to promote early diagnosis, especially for non-institutional births.

[Sperm capacitation with double ejaculate of short interval. A choice in assisted reproduction]. / Capacitación espermática con doble eyaculado de corto intervalo. Una alternativa en reproducción asistida.

In the techniques of assisted reproduction a minimum number of spermatozoa are required, but some patients cannot provide them with one capacitated seminal sample. In this study we investigated if in vitro sperm capacitation of two ejaculates obtained one hour apart from patients with reduced sperm amounts provides an adequate number of spermatozoa. Samples of 75 patients with a low seminal account were processed. They provided one second seminal sample after 60 minutes from the first one. The parameters of the capacitated sample of the first ejaculate (PE) were compared with the parameters of the capacitated sample joining the first and the second ejaculates (PSE). A paired t-test was applied considering a significant value of p < 0.05. Concentration, mobility, total of mobile cells (TCM) and total of mobile cells with normal morphology (ICR) were 31.28 +/-17.65 million/mililiter, 50.45 +/-26.3%, 9.06 +/-7.85 million and 0.64 +/- 0.62 million, respectively in first ejaculate. The respective values in first and second ejaculates were 54.45 +/- 35.06 million/mililiter, 59.39 +/- 25.41%, 17.94 +/- 12.18 million and 1.32 +/- 1.11 million, which represents a significant increase (p<0.05) of 74%, 17%, 98% and 106% respectively. Neither the volume (0.49 +/- 0.037 mililiter versus 0.49 +/- 0.019 mililiter, increase 0%) nor morphology (5.66 +/- 2.76% versus 6.11 +/- 4.88%, increase 7.9%) had a significant change. Sperm capacitation with double ejaculate of short interval must be considered for patients with decreased sperm amounts when deciding the reproductive technique.

Ignaz Semmelweis y la investigación de la etiología en la fiebre puerperal / Ignaz Semmelweis and the research on the etiology of childbeb fever

Se conoce en la historia de la ciencia y el desarrollo del conocimiento muchos casos de mujeres y hombres cuyos descubrimientos y aportaciones fueron rechazados inicialmente y reconocidos hasta después de su muerte. Ignaz Phillip Semmelweis es uno de estos casos en la medicina. Su aportación, no obstante, tuvo un impacto trascendental en la práctia de la obstetricia y en el control de las infecciones hospitalarias. A poco más de 150 años de la investigación realizada por Semmelweis sobre la "etiología y profilaxis de la fiebre puerperal", es pertinente hacer una relfexión sobre aquellos aspectos que aún hoy en día mantienen su vigencia en la búsqueda de explicaciones a los retos de la práctica médica y la investigación en salud. La época en que vivió Semmelweis estuvo marcada por una gran convulsión social en toda Europa y en el terreno de las ideas y la ciencia se experimentaron cambios que marcan aún hoy nuestro pensamiento