Exceso de mortalidad durante la pandemia de COVID-19 en Ecuador. Análisis espacio temporal del exceso de mortalidad durante la pandemia de COVID-19 en Ecuador / Excess Mortality during the COVID- 19 Pandemic in Ecuador. Spatiotemporal Analysis of Excess Mortality During the Covid-19 Pandemic in Ecuador

Introducción: La pandemia de COVID-19 causó una elevada mortalidad en el mundo y en el Ecuador. Esta investigación se propuso analizar el exceso de mortalidad debido a la pandemia de COVID-19 en Ecuador. Método: Estudio observacional, longitudinal, cuantitativo y descriptivo. Clasificado como estudio ecológico en el campo de la epidemiología. Este estudio se centra en la medición del exceso de mortalidad durante los años 2020, 2021 y 2022, tomando como período base el promedio de defunciones ocurridas en el intervalo de 2015 a 2019. Resultados: Ecuador, en el período de enero 2020 a octubre 2022, acumuló un exceso total de muertes de 98.915. En el año 2020, el exceso de mortalidad fue mayor a 46.374, siendo el mes de abril el valor más alto de 15.484. En el año 2021, el exceso de muertes fue de 35.859, siendo abril el mes con mayor exceso de 7.330. Y el año 2022 el exceso de mortalidad fue de 16.682, el mes con mayor exceso fue enero con 4.204. Conclusión: Se evidenció un subregistro de defunciones, así como variaciones temporales y geográficas en el exceso de mortalidad. La provincia con mayor número de fallecidos y exceso de mortalidad fue Guayas seguida de Pichincha. Los resultados proporcionan un análisis del panorama durante la emergencia sanitaria, destacando la importancia de evaluar la capacidad de respuesta de los sistemas de salud en momentos de crisis y la necesidad imperativa de implementar medidas correctivas para el futuro.

Introduction: The COVID-19 pandemic caused a significant mortality in the world and in Ecuador. This research aimed to analyze the excess mortality due to the COVID-19 pandemic in Ecuador. Method: An observational, longitudinal, quantitative and descriptive study, classified as an ecological study in the field of epidemiology. This study focuses on measuring excess mortality during the years 2020, 2021 and 2022, using the average number of deaths that occurred in the period from 2015 to 2019 as the baseline. Results: From January 2020 to October 2022, Ecuador accumulated a total excess of deaths of 98,915. In 2020, the excess mortality was higher at 46,374, with the highest value occurring in April at 15,484. In 2021, the excess deaths amounted to 35,859, with April having the highest excess of 7,330. In 2022, the excess mortality was 16,682, with January recording the highest excess at 4,204. Conclusion: Evidence of underreporting of deaths, as well as temporal and geographi-cal variations in excess mortality, was observed. The province with the highest number of deaths and excess mortality was Guayas, followed by Pichincha. The results provide an analysis of the situation during the health emergency, emphasizing the importance of evaluating the healthcare system's capacity to respond during times of crisis and the imperative need to implement corrective measures for the future.

[Anogenital lesions produced by Human Papillomavirus. Prevalence study in children and adolescent not vaccinated]. / Lesiones anogenitales por Virus Papiloma Humano. Estudio de prevalencia en niños, niñas y adolescentes no vacunados.

In Chilean children and adolescents, human papillomavirus (HPV) infection prevalence is unknown. In 2014, the HPV vaccine was incorporated into the National Immunization Program for girls, and since 2019 for boys. OBJECTIVE: To determine the prevalence, genotypes, and characteristics of HPV infection in children and adolescents with anogenital lesions not vaccinated against HPV. PATIENTS AND METHOD: Children and adolescents with anogenital lesions who consulted at the Luis Calvo Mackenna Children's Hospital between 2013 and 2017 were studied. The reason for consultation, age, sex, family history of HPV lesions, history of sexual abuse, and consensual sexual activity were recorded. HPV was detected by PCR and typification by reverse hybridization of the L1 gene. The samples were analyzed in the Oncogenic Virus Section of the Institute of Public Health. RESULTS: 110 patients were studied; 44.5% were children. HPV was detected in 34 cases (30.9% [CI95% 22.4- 40.4]), 22 (44.9%) were children and 12 (19.7%) adolescents. Eleven (91.7%) adolescents had a history of sexual con tact (p < 0.005); 4 (18.2%) children disclosed sexual abuse. HPV was found in 25% of patients with genital lesions and 50% with perianal lesions (p < 0.015). The most frequent genotypes were 59, 58, 16, 18, 6, and 11. Only low-risk genotypes were detected in children and high-risk genotypes were detected in 11/12 (91.7%) of HPV (+) adolescents. CONCLUSION: The prevalence of HPV infection was 30%. In adolescents, the infection was related to sexual contact and high-risk HPV. In children, it was associated with low-risk genotypes. Perianal lesions are more frequently associated with HPV infec tion than genital lesions in children and adolescents. The visual inspection does not allow to specify the etiology of the genital lesions, so it is necessary to perform a PCR test for HPV.

Composición química y aplicaciones clínicas del aceite de oliva extra virgen

La composición química del aceite de oliva extra virgen (AOEV) se compone principalmente de triglicéridos, ácidos grasos insaturados como ácido oleico, ácido linoleico y el α-linolénico. También se destacan compuestos fenólicos de tres clases químicas: simples, secoiridoides y lignanos. En la presente revisión se analizó el consumo del AOEV en enfermedades crónicas, ciertos tipos de cáncer y en enfermedades neurodegenerativas. La evidencia muestra que el consumo de entre 8 y 40 g de AOEV diario tiene efectos protectores en enfermedades cardiovasculares, puede evitar la aparición de diabetes tipo 2 y aumentar los niveles de colesterol HDL. Respecto al cáncer, entre los efectos evaluados se destacan los encontrados a partir de los compuestos fenólicos hidroxitirosol (HT) y oleocantal, los que han demostrado un efecto protector en algunos tipos de cáncer como cáncer de piel y de mama. En las enfermedades neurodegenerativas, se observó que el consumo diario de 50 g de AOEV, tiene un efecto inhibidor en la degeneración neuronal atribuido a sus compuestos fenólicos como oleuropeina e HT. Investigaciones a futuro debieran enfocarse en determinar los efectos a largo plazo del consumo de AOEV en las diferentes enfermedades analizadas, para así poder ir estableciendo la "dosis" de AOEV que permita obtener resultados protectores sobre la salud. Además de explorar los efectos de las diferentes variedades de aceitunas (con sus componentes bioactivos particulares) con el fin de establecer los efectos en la salud y enfermedad asociados a variedades específicas.

The chemical composition of extra virgin olive oil (EVOO) is mainly composed of triglycerides, unsaturated fatty acids such as oleic acid, linoleic acid, and α-linolenic acid. Phenolic compounds of three chemical classes are also relevant, such as simple, secoiridoids, and lignans. Here, we review the association between EVOO consumption and chronic diseases, certain types of cancer, and neurodegenerative diseases. Evidence shows that consuming between 8 and 40 g of EVOO / day has protective effects on cardiovascular diseases, can prevent the onset of type 2 diabetes, and increases HDL cholesterol levels. Regarding cancer, phenolic compounds hydroxytyrosol (HT) and oleocanthal have protective effects on some types of cancer, such as skin and breast cancer. Regarding neurodegenerative diseases, daily consumption of phenolic compounds such as oleuperin and hydroxytyrosol and 50 g of EVOO has an inhibitory effect on neuronal degeneration and a protective effect on neuroprotective capacity. Future research should focus on determining the long-term impact of EVOO consumption on different diseases to establish the "dose" of EVOO that will allow health-protective results. It is also necessary to establish the effects of the specific olives (with their particular bioactive components) to establish the different impacts on health and disease associated with olives varieties.

Doble recubrimiento con membrana amniótica en estrabismo restrictivo / Double covering with amniotic membrane in restrictive strabismus

El manejo del estrabismo restrictivo sigue siendo un problema no resuelto hoy en día.Se presenta un caso de estrabismo restrictivo posquirúrgico severo tras una cirugía de exotropía consecutiva. Describimos a continuación el manejo exitoso mediante una técnica que consiste en envolver el músculo afectado con membrana amniótica o «wrap» en la que añadimos un segundo injerto de membrana amniótica en la reconstrucción de la superficie ocular. (AU)

The management of restrictive strabismus remains an unresolved problem today.A case of severe restrictive strabismus after a consecutive exotropia surgery is presented. We describe the exitosus managment through a technique consist of wrapping with amniotic membrane the affected muscle where we add a second amniotic membraneA graft in the reconstruction of the ocular surface. (AU)

Double covering with amniotic membrane in restrictive strabismus.

A case of severe restrictive strabismus after a consecutive exotropia surgery is presented. We describe the exitous managment through a technique consist of wrapping with amniotic membrane (AM) the affected muscle where we add a second AM graft in the reconstruction of the ocular Surface.

Enfermedades minoritarias: síndrome de Birt- Hogg- Dubé / Minority diseases: Birt-Hogg-Dubé syndrome

Presentamos el caso de una mujer de 57 años sin hábitos tóxicos y antecedentes de tres neumotórax derechos espontáneos. Antecedentes familiares de primer grado de neumotórax bilaterales de repetición, poliquistosis renal y tumor digestivo. Derivada a consulta para asesoramiento genético ante la sospecha de síndrome de Birt- Hogg-Dubé (SBHD) por diagnóstico genético confirmado en familiar de segundo grado. En la exploración se evidenciaron lesiones cutáneas compatibles con fibrofoliculomas. En la tomografía computarizada (TC) presencia de quistes pulmonares simples. El cribado genético reveló la presencia de una variante patogénica en el gen de la foliculina. El síndrome de Birt- Hogg- Dubé es una rara genodermatosis de herencia autosómica dominante caracterizada por la presencia de fibrofoliculomas y/o tricodiscomas cutáneos, quistes pulmonares, neumotórax espontáneos y tumores renales. El pronóstico depende de la gravedad de las afectaciones viscerales y del tipo de tumor renal implicado. (AU)

We present the case of a 57-year-old woman with no toxic habits and a history of three spontaneous right pneumothoraces. First-degree family history of recurrent bilateral pneumothoraces, polycystic kidney disease, and digestive tumor. Referred to consultation for genetic counseling on suspicion of Birt-Hogg-Dubé syndrome (SBHD) due to a confirmed genetic diagnosis in a seconddegree relative. The examination revealed skin lesions compatible with fibrofolliculomas. In the computed tomography (CT) presence of simple pulmonary cysts. Genetic screening revealed the presence of a pathogenic variant in the folliculin gene. Birt-Hogg-Dubé syndrome is a rare autosomal dominantly inherited genodermatosis characterized by the presence of cutaneous fibrofolliculomas and/or trichodiscomas, pulmonary cysts, spontaneous pneumothoraces, and renal tumors. The prognosis depends on the severity of the visceral involvement and the type of renal tumor involved. (AU)

Prevalencia de dolor y patología osteomuscular en la población adulta de músicos del Área de Gestión Sanitaria de Osuna / Prevalence of pain and musculoskeletal diseases in adult population in Osuna Health Management Area

Objetivo El objetivo principal de este estudio es determinar la prevalencia de patología osteomuscular relacionada con la práctica musical (playing-related musculoskeletal disorders [PRMD]) existente en la población adulta expuesta ocupacionalmente del Área de Gestión Sanitaria de Osuna. Diseño Se trata de un estudio observacional transversal de prevalencia. Lugar: se ha realizado una incursión comunitaria al medio del músico (escuelas de música, conservatorios y bandas de música municipales del Área de Gestión Sanitaria de Osuna). Participantes: han participado un total de 264 músicos mayores de 18 años. Intervención: se han realizado entrevistas semiestructuradas. Variables: las principales variables contempladas han sido la existencia de dolor o molestias relacionadas con la práctica musical alguna vez, variables que definen sociodemográficamente la muestra (edad, sexo, profesión), variables que perfilan la trayectoria musical (instrumento, años tocándolo, horas de práctica a la semana), así como percepción del dolor, zona de dolor e interferencia con el ánimo, entre otras. Resultados Entre los resultados destaca que el 76% de los músicos han referido PRMD en alguna ocasión, siendo más frecuentes en las mujeres (p=0,009; IC 95%), en los músicos de la familia de cuerda (p= 0,041; IC 95%) y en aquellos que realizan menos deporte. (p = 0,000006; IC 95%). Conclusiones Estudiar la prevalencia en nuestro medio del dolor asociado a la práctica musical nos resulta de gran interés por las potenciales opciones de intervención desde el ámbito de Atención Primaria y Comunitaria (AU)

Objective The main aim of this study is to determine the prevalence of PRMD (playing-related musculoskeletal disorders) in adults exposed to it due to their profession, in the area of Osuna. Design It is a cross-sectional study. Site: the study is based on data collected in the local community of musicians (music schools, conservatories and music bands from the region). Participants: 264 individuals older than 18 years old have participated. Interventions: semi-structured interviews were conducted. Main measurements: the main variables considered were: presence of pain or discomfort related to musical practice, socio-demographic variables defining the sample (age, gender, profession), variables characterizing the musical trajectory of the participant (instrument, number of years playing, number of hours of practice per week), perception of pain, area of pain, interference with their mood, among others. Results 76% of the musicians had experienced PRMD in some occasion, being more frequent among women (p = 0,009; IC 95%), string musicians (p= 0,041; IC 95%) and among those doing less physical activity (p = 0,000006; IC 95%). Conclusions Studying the prevalence of playing-related pain was of great interest, given the potential interventions that could be applied in Primary and Community medical care (AU)

[Prevalence of pain and musculoskeletal diseases in adult population in Osuna Health Management Area]. / Prevalencia de dolor y patología osteomuscular en la población adulta de músicos del Área de Gestión Sanitaria de Osuna.

OBJECTIVE: The main aim of this study is to determine the prevalence of PRMD (playing-related musculoskeletal disorders) in adults exposed to it due to their profession, in the area of Osuna. DESIGN: It is a cross-sectional study. Site: the study is based on data collected in the local community of musicians (music schools, conservatories and music bands from the region). PARTICIPANTS: 264 individuals older than 18 years old have participated. INTERVENTIONS: semi-structured interviews were conducted. MAIN MEASUREMENTS: the main variables considered were: presence of pain or discomfort related to musical practice, socio-demographic variables defining the sample (age, gender, profession), variables characterizing the musical trajectory of the participant (instrument, number of years playing, number of hours of practice per week), perception of pain, area of pain, interference with their mood, among others. RESULTS: 76% of the musicians had experienced PRMD in some occasion, being more frequent among women (p = 0,009; IC 95%), string musicians (p= 0,041; IC 95%) and among those doing less physical activity (p = 0,000006; IC 95%). CONCLUSIONS: Studying the prevalence of playing-related pain was of great interest, given the potential interventions that could be applied in Primary and Community medical care.

Diagnóstico de un caso de ceguera nocturna estacionaria congénita tipo 2 ligada al cromosoma X mediante electrorretinografía y secuenciación del gen CACNA1F / Diagnosis of an X-linked type 2 congenital stationary night blindness using electroretinography and CACNA1F sequencing

Un varón de 4 años, sin antecedentes relevantes, consulta por disminución de agudeza visual bilateral, más acusada en condiciones escotópicas, que no mejora con corrección óptica. No se aprecian alteraciones fundoscópicas significativas, por lo que se sospecha una distrofia retiniana. La secuenciación del gen CACNA1F detecta la mutación c.3081C > A (p.Tyr1027Ter), que se ha producido de novo en la madre del paciente. Esta mutación, en el contexto clínico referido y con un patrón electronegativo compatible, establece el diagnóstico de ceguera nocturna estacionaria congénita tipo 2 ligada al cromosoma X. La electrofisiología y el estudio genético deben formar parte del protocolo diagnóstico de cualquier pérdida de visión inexplicada en niños. La descripción, la nomenclatura y la clasificación de las distrofias retinianas hereditarias con base en sus características genotípicas y electrorretinográficas evita los errores diagnósticos derivados de su habitual superposición clínica y fenotípica

A 4-year-old boy, with no history of relevance, presented with bilateral visual impairment, more so in scotopic conditions, and did not improve with optical correction. No significant funduscopic abnormalities were seen, leading to a suspicion of retinal dystrophy. Sequencing of the CACNA1F gene detected the c.3081C > A (p.Tyr1027Ter) mutation, which had occurred de novo in the patient's mother. This mutation, in the aforementioned clinical context, and with a compatible electronegative pattern, establishes the diagnosis of X-linked type 2 congenital stationary night blindness. Electrophysiology and genetic testing should be part of the diagnostic protocol for any unexplained loss of vision in children. The description, nomenclature and classification of hereditary retinal dystrophies based on their genotypic and electroretinograpic characteristics, avoids diagnostic errors due to their usual clinical and phenotypic overlap

Diagnosis of an X-linked type 2 congenital stationary night blindness using electroretinography and CACNA1F sequencing. / Diagnóstico de un caso de ceguera nocturna estacionaria congénita tipo 2 ligada al cromosoma X mediante electrorretinografía y secuenciación del gen CACNA1F.

A 4-year-old boy, with no history of relevance, presented with bilateral visual impairment, more so in scotopic conditions, and did not improve with optical correction. No significant funduscopic abnormalities were seen, leading to a suspicion of retinal dystrophy. Sequencing of the CACNA1F gene detected the c.3081C>A (p.Tyr1027Ter) mutation, which had occurred de novo in the patient's mother. This mutation, in the aforementioned clinical context, and with a compatible electronegative pattern, establishes the diagnosis of X-linked type 2 congenital stationary night blindness. Electrophysiology and genetic testing should be part of the diagnostic protocol for any unexplained loss of vision in children. The description, nomenclature and classification of hereditary retinal dystrophies based on their genotypic and electroretinograpic characteristics, avoids diagnostic errors due to their usual clinical and phenotypic overlap.

Novedades en las guías sobre el tratamiento del asma grave / The latest developments in the guidelines on severe asthma treatment

Las guías de práctica clínica (GPC) aparecieron con el fin de homogenizar el diagnóstico y tratamiento del asma; inicialmente como un consenso de expertos, y posteriormente incluyendo para sus afirmaciones y recomendaciones técnicas de medicina basada en la evidencia, e incorporar en sus actualizaciones frecuentes, los cambios en el conocimiento fisiopatológico y en el manejo de la enfermedad. En el 2019 se han realizado actualizaciones de las tres principales GPC incluyendo el tratamiento del paciente con asma grave no controlada, el uso de fármacos biológicos y otros procedimientos

The clinical practice guidelines (CPG) appeared with the intention to homogenize the asthma diagnosis and treatment, initially as an expert consensus, and afterwards including evidence based medicine data for its affirmations and technical recommendations incorporating advances in knowledge and management of the disease in their frequent updates. In 2019 the 3 principal CPG, have updates including the management of non-controlled severe asthma patients, biological treatments use and other procedures

Tuberculosis miliar y tuberculoma coroideo en una niña de 3 meses: diagnóstico y seguimiento de un caso / Miliary tuberculosis and choroidal tuberculoma in a three-month old baby girl: Diagnosis and follow-up of a case

Se presenta a una niña de 3 meses de edad con un cuadro febril sin foco y con empeoramiento. La exploración fundoscópica mostró una lesión coroidea en el ojo izquierdo junto con lesiones en otros órganos sugestivas de tuberculosis diseminada. La evolución fue favorable tras tratamiento con cuádruple terapia antibiótica asociada a corticoterapia. La tuberculosis diseminada debe tenerse en cuenta ante un cuadro febril de tórpida evolución. La exploración oftalmológica de estos pacientes es fundamental, ya que, aunque es poco frecuente, los signos característicos de las uveítis posteriores nos orientarán hacia el diagnóstico y tratamiento precoz de esta enfermedad

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases

Miliary tuberculosis and choroidal tuberculoma in a three-month old baby girl: Diagnosis and follow-up of a case. / Tuberculosis miliar y tuberculoma coroideo en una niña de 3 meses: diagnóstico y seguimiento de un caso.

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases.

Gene expression changes by high-polyphenols cocoa powder intake: a randomized crossover clinical study.

PURPOSE: To assess the effect of the intake of a single dose of high-polyphenols cocoa on gene expression in peripheral mononuclear cells (PBMCs), and analyze conjugated (-)-epicatechin metabolites in plasma, which may be related with an antioxidant response in healthy human. METHODS: A randomized, controlled, double-blind, cross-over, clinical trial in healthy young adults who consumed a single dose of high-polyphenols cocoa powder and maltodextrins as control, with a one-week washout period. Analysis of circulating metabolites, plasma antioxidant capacity and gene expression changes in PBMCs were performed under fasting conditions and 2-h after treatment using microarray in a subsample. Pathway analysis was conducted using Ingenuity Pathway Analysis (IPA). RESULTS: Twenty healthy participants (9 F) were included in the study. A significant increase in circulating (-)-epicatechin metabolites was found after cocoa intake in all participants without related changes in antioxidant capacity of plasma. The metabolites profile slightly varied across subjects. Treatments triggered different transcriptional changes in PBMC. A group of 98 genes showed changes in expression after cocoa treatment, while only 18 were modified by control. Differentially expressed genes included inflammatory cytokines and other molecules involved in redox balance. Gene and network analysis after cocoa intake converged in functions annotated as decreased production of reactive oxygen species (p = 9.58E-04), decreased leukocyte activation (p = 4E-03) and calcium mobilization (p = 2.51E-05). CONCLUSIONS: No association was found between conjugated metabolites in plasma and antioxidant capacity. Changes in PBMCs gene expression suggest anti-inflammatory effects.

Functional Connectivity Changes in Behavioral, Semantic, and Nonfluent Variants of Frontotemporal Dementia.

Frontotemporal dementia (FTD) affects behavior, language, and personality. This study aims to explore functional connectivity changes in three FTD variants: behavioral (bvFTD), semantic (svPPA), and nonfluent variant (nfvPPA). Seventy-six patients diagnosed with FTD by international criteria and thirty-two controls were investigated. Functional connectivity from resting functional magnetic resonance imaging (fMRI) was estimated for the whole brain. Two types of analysis were done: network basic statistic and topological measures by graph theory. Several hubs in the limbic system and basal ganglia were compromised in the behavioral variant apart from frontal networks. Nonfluent variants showed a major disconnection with respect to the behavioral variant in operculum and parietal inferior. The global efficiency had lower coefficients in nonfluent variants than behavioral variants and controls. Our results support an extensive disconnection among frontal, limbic, basal ganglia, and parietal hubs.

Supraspinal modulation of neuronal synchronization by nociceptive stimulation induces an enduring reorganization of dorsal horn neuronal connectivity.

KEY POINTS: The state of central sensitization induced by the intradermic injection of capsaicin leads to structured (non-random) changes in functional connectivity between dorsal horn neuronal populations distributed along the spinal lumbar segments in anaesthetized cats. The capsaicin-induced changes in neuronal connectivity and the concurrent increase in secondary hyperalgesia are transiently reversed by the systemic administration of small doses of lidocaine, a clinically effective procedure to treat neuropathic pain. The effects of both capsaicin and lidocaine are greatly attenuated in spinalized preparations, showing that supraspinal influences play a significant role in the shaping of nociceptive-induced changes in dorsal horn functional neuronal connectivity. We conclude that changes in functional connectivity between segmental populations of dorsal horn neurones induced by capsaicin and lidocaine result from a cooperative adaptive interaction between supraspinal and spinal neuronal networks, a process that may have a relevant role in the pathogenesis of chronic pain and analgesia. ABSTRACT: Despite a profusion of information on the molecular and cellular mechanisms involved in the central sensitization produced by intense nociceptive stimulation, the changes in the patterns of functional connectivity between spinal neurones associated with the development of secondary hyperalgesia and allodynia remain largely unknown. Here we show that the state of central sensitization produced by the intradermal injection of capsaicin is associated with structured transformations in neuronal synchronization that lead to an enduring reorganization of the functional connectivity within a segmentally distributed ensemble of dorsal horn neurones. These changes are transiently reversed by the systemic administration of small doses of lidocaine, a clinically effective procedure to treat neuropathic pain. Lidocaine also reduces the capsaicin-induced facilitation of the spinal responses evoked by weak mechanical stimulation of the skin in the region of secondary but not primary hyperalgesia. The effects of both intradermic capsaicin and systemic lidocaine on the segmental correlation and coherence between ongoing cord dorsum potentials and on the responses evoked by tactile stimulation in the region of secondary hyperalgesia are greatly attenuated in spinalized preparations, showing that supraspinal influences are involved in the reorganization of the nociceptive-induced structured patterns of dorsal horn neuronal connectivity. We conclude that the structured reorganization of the functional connectivity between the dorsal horn neurones induced by capsaicin nociceptive stimulation results from cooperative interactions between supraspinal and spinal networks, a process that may have a relevant role in the shaping of the spinal state in the pathogenesis of chronic pain and analgesia.

Prevalencia de desesperanza y factores sociodemográficos de migrantes mexicanos repatriados / Prevalence of despair and social-demographic factors related of repatriated mexican migrants / Prevalência de desesperança e fatores sociodemográficos de migrantes mexicanos repatriados

Objetivo: Describir las características sociodemográficas generales, así como algunas vinculadas con el proceso de migración y evaluar el nivel de desesperanza de los mexicanos que son deportados de los Estados Unidos de América (EE.UU) al Aeropuerto Internacional de la Ciudad de México (AICM), a través del Programa de Repatriación al Interior de México (PRIM). Métodos: Estudio descriptivo de tipo transversal en el periodo de julio a diciembre de 2015. Se aplicó en forma aleatoria, confidencial y previo consentimiento un cuestionario estructurado a migrantes mexicanos deportados a su arribo a México y provenientes de los EE.UU, se incluyó una sección de datos sociodemográficos generales; de aspectos relacionados con la migración y, se evaluó el nivel de desesperanza por medio de la Escala de Desesperanza de Beck. Resultados: Se encuestó a 367 migrantes mexicanos deportados, sólo siete fueron mujeres, la mayoría en un rango de edad de 18 a 35 años, el 23% reporta enfermedades pre-existentes, sólo el 45% tuvo un buen acceso a servicios de salud en EE.UU, el 56% ya había sido repatriado en dos o más ocasiones, el 75% había vivido más de cinco años en ese país, sólo el 13% utilizó una Ventanilla de Salud de algún consulado mexicano durante su estancia. La prevalencia de desesperanza fue del 6% en esta población. Conclusiones: El abordaje de la salud mental en poblaciones de migrantes mexicanos carece de políticas públicas. La caracterización de la población migrante repatriada debe ser el punto de partida para incidir en políticas públicas que mejoren la calidad de vida de los migrantes de retorno.

Objective: To describe some general social-demographic characteristics associated with the phenomenon of migration and assess the level of despair among Mexicans who are deported from USA to the City of Mexico International Airport through the Program of Repatriation. Methods: This is a descriptive and transversal study carried out from July to December 2015. A confidential questionnaire was randomly given, provided the previous informed consent, to Mexican migrants who had been deported from USA. Data sections on general social-demographic characteristics and migration-related issues were included. The level of despair was estimated using Beck's Despair Scale. Results: 367 deported Mexican migrants were studied. Only 7 were women. The majority were in the range of 18 to 35 years old. 23% reported having had preexisting illnesses and only 45% had access to health services in USA. 56% had previously been deported in two or more occasions. 75% had been living in USA for more than 5 years. Only 13% used the Health Window at any Mexican Consulate during their stay. The prevalence of despair was 6%. Conclusions: Addressing the condition of mental health among these populations requires further public policies and the precise identification of their characteristics should be the starting point to improve their quality of life upon return.

Objetivo: Descrever as características sociodemográficas gerais, assim como algumas associadas ao processo de migração e avaliar o nível de desesperança dos mexicanos que são deportados dos Estados Unidos da América (EE.UU) ao Aeroporto Internacional da Cidade do México (AICM), através do Programa de Repatriação ao Interior do México (PRIM). Métodos: Estudo descritivo de tipo transversal no período de julho a dezembro de 2015. Aplicou-se em forma aleatória, confidencial e com consentimento prévio, um questionário estruturado a migrantes mexicanos deportados a seu arribo ao México e provindos dos EE.UU. Incluiu-se uma secção de dados sociodemográficos gerais; de aspectos relacionados com a migração e, avaliou-se o nível de desesperança por médio da Escala de Desesperança de Beck. Resultados: Foram questionados 367 migrantes mexicanos deportados, só sete foram mulheres, a maioria em uma faixa etária de 18 a 35 anos, o 23% informa doenças pré-existentes, só o 45% teve um bom acesso a serviços de saúde nos EE.UU, o 56% já tinha sido repatriado em dois ou mais ocasiões, o 75% tinha vivido mais de cinco anos nesse país, só o 13% utilizou um guiché de Saúde de algum consulado mexicano durante sua permanência. A prevalência de desesperança foi do 6% nesta população. Conclusões: A abordagem da saúde mental em populações de migrantes mexicanos carece de políticas públicas. A caracterização da população migrante repatriada deve ser o ponto de partida para promover políticas públicas que melhorem a qualidade de vida dos migrantes de retorno.

Angiografía mediante tomografía de coherencia óptica en patología macular vascular / Optical coherence tomography angiography in macular vascular pathology

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