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OBJECTIVE: To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis. METHOD: Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student's t: mean difference and χ2. Logistic studies to estimate the probability between variables. RESULTS: 27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion. CONCLUSIONS: There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

OBJETIVO: Evaluar las características tomográficas preoperatorias de la nariz y los senos paranasales de niños con dacriocistitis crónica. MÉTODO: Estudio prospectivo, observacional, transversal y descriptivo. Se evaluaron tomografías de senos paranasales de pacientes candidatos a dacriocistorrinostomía endoscópica, durante 2 años. Se identificaron características demográficas, hallazgos radiológicos, procesos inflamatorios y variantes anatómicas, utilizando la clasificación Lund-Mackay. Análisis estadístico con Stata 10.0, análisis descriptivo con t de Student: diferencia medias y χ2. Estudios logísticos para estimar la probabilidad entre variables. RESULTADOS: Se incluyeron 27 hombres y 11 mujeres (n = 38). De ellos, 22 tenían afección del conducto nasolagrimal unilateral y 16 bilateral. Rango de puntuación de Lund-Mackay: 2-20. Once pacientes tuvieron patología asociada. Seno etmoidal anterior y maxilar más afectados (69%), complejo osteomeatal (68%), etmoidal posterior (51%). La probabilidad de que los pacientes con rinosinusitis grave puedan presentar dacriocistitis es 12 veces mayor que en los pacientes con < 12 puntos. Los hombres presentaron mayor gravedad, afectación y repercusión clínica. CONCLUSIONES: Existe afección rinosinusal radiológica en la dacriocistitis, que debe ser evaluada y tratada en el preoperatorio para evitar complicaciones o reinfecciones posquirúrgicas.

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Abstract Objective: To explore the relation between ABO blood group system and in-hospital mortality in Mexican patients admitted with COVID-19. Materials and methods: We performed a retrospective study with 2,369 hospitalized patients with confirmed SARS-CoV-2 infection in a tertiary referral hospital, admitted between March 27 and December 10, 2020. Data were obtained from electronic health records. Adjusted and unadjusted Cox Proportional-Hazard models were performed to test the association of ABO blood groups with mortality of COVID-19 patients. The variables considered for adjustment of the models were age, sex, and main comorbidities. Results: Out of all studied patients, group O was the most frequent blood type with 1999 patients (84.3%), followed by group A (11.3%), B (3.5%) and AB (0.72%). Blood group A was associated with a lower hazard of death among COVID-19 patients compared with group O (adjusted HR = 0.72, 95% IC 0.55-0.95, P = 0.02. Groups B, AB and Positive Rh were not significantly associated with the outcome. Conclusions: We found evidence of a statistically significant association between ABO blood type and COVID-19 in-hospital death. Patients with blood group A may be less likely to die during hospitalization compared with group O.

Resumen Objetivo: Explorar la relación entre los grupos sanguíneos del sistema ABO y la mortalidad hospitalaria en pacientes mexicanos ingresados por COVID-19. Materiales y métodos: Se realizó un estudio retrospectivo con 2,369 pacientes hospitalizados con infección confirmada por SARS-CoV-2 en un hospital de tercer nivel, ingresados del 27 de marzo al 10 de diciembre del 2020, los datos fueron obtenidos del expediente clínico digital del hospital. Se realizaron modelos de Riesgos-Proporcionales de Cox ajustados y no ajustados para evaluar la asociación de los grupos sanguíneos ABO con la mortalidad hospitalaria de los pacientes COVID-19. Las variables consideradas en el modelo ajustado fueron edad, sexo y principales comorbilidades. Resultados: De todos los pacientes estudiados, el grupo O fue el más frecuente con 1999 pacientes (84.3%), seguido por el grupo A (11.3%), B (3.5%) y AB (0.72%). El grupo sanguíneo A se asoció a menor riesgo de muerte entre pacientes con COVID-19 comparado con el grupo O (HR ajustado = 0.72, IC 95% 0.55-0.95, valor de P = 0.02). Los grupos B, AB y Rh positivo no se asociaron significativamente con el desenlace. Conclusiones: Encontramos evidencia de una asociación estadísticamente significativa entre los grupos sanguíneos ABO y la muerte por COVID-19 en pacientes hospitalizados. El grupo A podría ser menos susceptible a morir durante la hospitalización respecto al grupo O.

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Una adecuada radiopacidad de los materiales para restauraciones provisorias permite su evaluación en el examen radiográfico. Sin embargo, existe gran desconocimiento sobre el cumplimiento de los requerimientos establecidos por la norma ISO 4049. El objetivo del siguiente estudio fue determinar la radiopacidad de los materiales para provisionalización presentes en el mercado nacional y corroborar si estos cumplen con el valor mínimo requerido por la normativa. Se realizó un estudio experimental in vitro, en el cual se prepararon muestras en forma de discos de 10 mm de diámetro y 1 mm de espesor de resinas acrílicas: Acrílico Autocurable (Marché®), Duralay (Reliance), Caulkâ (Dentsply), ALIKE™ (GC) y resinas bisacrílicas: Protemp™4 (3M, 2008), LuxatempStar (DMG), Luxacrown (DMG), Structur Premium (VOCO), ExperTemp™ (Ultradent) y Acrytemp (Zhermack). Las muestras fueron radiografiadas junto a una cuña de aluminio escalonada. Las imágenes fueron analizadas para determinar el valor en escala de grises y su respectivo valor en mm de aluminio. Los datos fueron analizados para verificar si cumplen con la normativa ISO. Se encontraron diferencias estadísticamente significativas. La radiopacidad equivalente de las resinas acrílicas en mm de Al en orden descendente fue de 0,85 ± 0,08 para ALIKE™, 0,72 ± 0,32 para acrílico Marché®, 0,65 ± 0,25 para Caulkâ y 0,56 ± 0,05 para Duralay, siendo todos menores a lo requerido por la norma. La radiopacidad equivalente de las resinas bisacrílicas fue de 1,75 ± 0,2 para Acrytemp, 1,51± 0,27 para Luxacrown, 1,47 ± 0,14 para Structur Premium, 1,43 ± 0,23 para LuxatempStar, 1,02 ± 0,28 para Protemp™4 y 1± 0,1 para ExperTemp™, los cuales son mayores a lo exigido por la norma. En conclusión, las resinas bisacrílicasevaluadas en este estudio cumplen con el requisito de radiopacidad exigido, a diferencia de las acrílicas que no lo cumplen.

An adequate radiopacity of materials for provisionalization allows its proper evaluation on the radiographicexam. However, there is a lack of knowledge about compliance with the requirements established by the ISO 4049 norm. The aim of this study was to determine the radiopacity of provisionalization materials available in the national market and verify if they comply with the minimum requirements of ISO regulations. An in vitro experimental study was carried out, samples of 10 mm in diameter and 1 mm thickness of acrylic resins: Self-Cure Acrylic (Marché®), Duralay (Reliance), Caulkâ (Dentsply), Alike™ (GC) and by sacrilic resins: Protemp™4 (3M), Luxatemp Star (DMG), Luxacrown (DMG), Structur Premium (VOCO), ExperTemp™ (Ultradent), Acrytemp (Zhermack) were prepared. The samples were x-rayed together with a stepped aluminum wedge. The images were analyzed to determine the gray scale value and its equivalent value in mm of Aluminum. The data was analyzed to verify compliance with the ISO standard. Statistically significant differences were found. The equivalent radiopacity of acrylicresins in mm of Al in descending order was 0.85± 0.08 for ALIKE™, 0.72 ± 0.32 for acrylic Marché®, 0.65 ± 0.25 forCaulkâ and 0.56 ± 0.05 forDuralay, all being less than the required by norm. The equivalent radiopacity of by sacrilic resins was 1.75 ± 0.2 for Acrytemp, 1.51± 0.27 for Luxacrown, 1.47 ± 0.14 for Structur Premium, 1.43 ± 0.23 for LuxatempStar, 1.02 ± 0.28 forProtemp™4 and 1± 0.1 forExperTemp™,which are greater than the requirements. In conclusion, the bisacrylic resins evaluated in this study comply with the radiopacity standard, however the acrylic resins evaluated do not comply.

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BACKGROUND: Because of its high prevalence in the female population and its high incidence in reproductive age, Systemic Lupus Erythematosus can complicate pregnancy causing miscarriage, fetal death, preeclampsia, fetal growth restriction (up to 25%) and preterm birth. Doppler ultrasonography measures the flow in the uterine arteries, which is reduced in patients with preeclampsia and FGR, and thus is an ideal method for identifying pregnant women with a high risk of developing an adverse perinatal outcome. OBJECTIVE: Identify if Doppler ultrasound predicts FGR in patients with systemic lupus erythematosus. PATIENTS AND METHOD: In this observational, transversal, prospective study carried out from June 1st, 2010 to November 30th, 2010, in patients who had already been diagnosed with SLE, a complete clinical history was registered, blood samples taken and Doppler of uterine arteries between 18 and 23 gestation weeks taken (measuring the pulsatility index) RESULTS: Of the 17 women in the study, 6 patients had a PI equal or greater than 1.45 (35.29%), of whom in 5 cases (29.41%), the product had FGR. Therefore the sensitivity of this test is 100%, with a specificity of 91%, a predictive positive value of 83% and a predictive negative value of 100%. With a p of 0.0010, which is considered extremely significant, and a confidence interval of 95%. CONCLUSIONS: There exists a high association between an abnormal PI and the development of FGR. Abnormal Doppler ultrasound of uterine arteries is useful for predicting FGR in pregnant women with SLE.

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UNLABELLED: BACGROUND: preterm birth is a major obstetric problem that contributes to 70% of perinatal mortality. OBJECTIVE: to determine the sensitivity, specificity and predictive values of fetal fibronectin and cervical length as predictors of preterm birth in the HGR No. 36, Puebla. MATERIAL AND METHODS: observational, prospective. comparative study. Pregnant women were included between 24 and 33 weeks amenorrhea and diagnosis of preterm labor. Quik Chek Kit was used to detect fibronectin using qualitative methods, and then subjected to measurement of cervical length with endovaginal ultrasound. Patients with a positive result or both proceeded to start treatment. To calculate sensitivity, specificity and predictive values were used odds ratios and Fisher exact test for statistical analysis. RESULTS: of 66 patients 34% reported positive fibronectin with a sensitivity and PPV of 92% and 77% compared with the assessment of 27% of patients with short cervical length at 55% and 88% respectively. 28% had two positive marker (fibronectin/cervical length), the sensitivity, specificity and positive and negative predictive values increased significantly (86%, 100%, 93%, 100%). The average time between birth positive test was observed at 21 days. Risk factors for preterm delivery were found: patients under 25 years (P:0.0009), primigravida (P:0.0057), genitourinary infection (P:0.0001). CONCLUSION: the double marker fibronectin / cervical length is useful for determining patients at risk of preterm delivery because of its high specificity and NPV, ideal for easy handling and low cost.

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BACKGROUND: Premature rupture of membranes is a normal occurrence of labor and can occur before or after the onset of contractions. The clinical factors associated with premature rupture of membranes include: low socioeconomic status, low body mass index, prior preterm pregnancies, smoking, sexually transmitted infections and urinary tract, conization, cervical cerclage and amniocentesis. OBJECTIVE: To evaluate whether prolonged release of the vaginal insert of PGE2 is superior to dinoprostone gel to achieve cervical ripening in patients with term pregnancy that occur with premature rupture of membranes. MATERIAL AND METHOD: Randomized clinical trial in the surgical unit of play in a period of 6 months, with an estimated sample of 50 patients was randomized by block table. After assessment confirming rupture of membranes, Bishop Score and meeting inclusion criteria, group A was applied PGE2 intracervical gel 0.5 mg with a maximum of 3 doses, every 6 hours. Group B was administered at vaginal insert of PGE2 single dose for 24 hours, the patient was left to sleep 30 minutes cardio toco-monitoring chart for at least 2 hours after application. RESULTS: The average time to maturity was 310.59 minutes with a standard deviation of 198.7 and concluded that there was no significant difference between the onset of uterine activity and the onset of labor among the prolonged release dinoprostone and alternatives such as the gel cervical for cervical ripening. CONCLUSIONS: Either this is a good choice to ripen the cervix in patients with term pregnancy and premature rupture of membranes.

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OBJECTIVES: To determine the clinical features, as well as to present an analysis of the cases of maternal death during a period of ten years. PATIENTS AND METHODS: A descriptive, transverse, retrospective and cases series research was carried out. There was a revision of the expedients of maternal death occurred at the Regional General Hospital number 36 in Puebla, from January 1st, 1996 to December 31st, 2005. They were selected the patients who passed away because of obstetric death. The data collection included the following variables: age, body mass index, education, number of gestations, type of labour, prenatal control, basic cause of dead, and the month and the year in which it occurred. The descriptive statistics was used with central tendency and dispersion measurements. RESULTS: 75 maternal deaths were registered; one of them was excluded because it was not an obstetric cause. The maternal death rate was 63.46 per 100,000 born alive. The 17.5% corresponded to indirect obstetric causes and 82.5% to direct obstetric causes; the 73% were preventable, 27% were no preventable. Forty-eight cases corresponded to ages between 21 and 34 years. Forty-six cases corresponded to mothers with 2 to 4 pregnancies. In 43 cases they had a level of education which ranks between elementary and junior high school. In 31 cases they had a body mass index of 21 to 26. The eclampsia was the cause of maternal death in 20 cases and the obstetric haemorrhage in 16 cases. There were appropriate prenatal controls in 38 cases. CONCLUSIONS: The maternal death cases corresponded to an average age women, multigravidas, no obese, and apparently appropriate prenatal control. During this period there was a tendency to the decrease of obstetric haemorrhage and an increase of the preeclampsia-eclampsia as causes of maternal death.

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La estimación de la presion arterial pulmonar (PAP) mediante ecocardiografia Doppler ha demostrado en numerosos estudios unabuena correlación con valores obtenidos mediante os de Cateterismo Cardiaco. Evaluaciones previas han mostrado una leve elevación de la Presion arterial Pulmonar en niños nativos de la altura, algunos de estos niños presentan Hipertensión Arterial Pulmonar Severa sintomática El objetivo del presente estudio es determinar el valor de la presion arterial pulmonar en niños normales nativos de altura (La Paz 3700 m.) utilizando el método no invasivo de Ecocardiografia Doppler.El grupo de estudio consistió en 54 niños nativos y residente de La Paz(3700m.) cuya edad oscilo entre 3 días a 5 años, se incluyo solamente niños cuyo examen clínico por un cardiólogo fue considerado normal y el Ecocardiograma Doppler descarto cardiopatía organica. Se establecieron cuatro grupos de acuerdo a la edad , Grupo I ( 3 díasa1 año) n=13, Grupo II, (1a 2 años) n =7, Grupo III( 2 a 3 años ) n=11,Grupo IV (3 a 5 años ) n=23En todos los casos se midieron las dimensiones de cavidades cardiacas mediante ecocardiografia modo M.La estimación de la Presion Arterial Pulmonar se efectuó utilizando la velocidad de flujo máximo del jet de Insuficiencia Tricuspídea mediante doppler continuo, la ecuación simplifi cada de Bernoulli, para determinar la presion sistólica de ventrículo derecho a la que se adiciono el valor estimado de la presion de aurícula derecha considerado 10 mmHg. para niños normales. Resultados : Las dimensiones de ventrículo derecho fueron signifi cativamente mayores en los niños nativos de altura en todos los grupos etáreos estudiados. La presion arterial pulmonar sistólica promedio en el grupo I fue de 44mmHg, grupo II: 52 mmHg. Grupo III : 35 mmHg., Grupo IV:42 mmHg. La presion arterial pulmonar sistólica promedio de todo el grupo de niños nativos de altura (3 días a 5 años) fue de 43 mmHg.(+ - 7,1 ) ( rango35-52 mmHg. )...

Doppler echocardiography estimation of Systolic Pulmonary Pressurehas a good correlation with simultaneous invasive mesurements.Previous studies have demonstrated that pulmonary artery pressure iselevated in children at high altitude, some of this children develop hyperreactivepulmonary hypertension.The objetive of this study was to determine the normal data of SystolicPulmonary Pressure, measured with Doppler Echocardiography, inchildren at high altitude.The study group included 54 children natives and residents of highaltitude (La Paz Bolivia 3600-4000 m.) Children from ages of 3 days to 5years were enrolled, if the clinical examination was considered normalby a staff cardiologist and Doppler echocardiography examinations ruledout associated organic heart disease.Four groups were defi ned according to age: group I (N=13) from 3 daysto 1 year, group II (N=7) from 1 to 2 year, group III (N=11) from 2 to 3years, group IV (N=23) from 3 to 5 years.The M mode mean standard dimensions were obtained for all the patients.Values for the systolic pulmonary artery pressure were obtained withcontinuous doppler using the peak velocity of tricuspid regurgitation, andthe simplifi ed Bernoulli equation, to obtain the right ventricular pressure,an estimated 10 mmHg right atrial pressure was added .RESULTSRight ventricular dimension was signifi cantly larger in children at highaltitude in all the groups. Average systolic pulmonary artery pressurewas: group I: 44mmHg, group II: 52mmHg, group III: 35mmHg, groupIV: 42mmHg. Average systolic pulmonary artery pressure was 43mmHgDE+-7,1(range 35-52).Conclusion: Systolic pulmonary artery pressure was signifi catively higher( Mild Degree) in children up to 5 years old, at high altitude ( La Paz,Bolivia 3600-4000 m.) as compared with sea level.A signifi cant range of Pulmonary artery pressures were observed in thisgroup of high altitude children. Therefore as suggested by other studies...

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OBJECTIVE: To examine the efficacy and safety of oxitocin administered through umbilical vein after delivery to diminish the incidence of retained placenta, blood loss and third stage of labour. METHODOLOGY: A double blind, clinical trial was performed in which 64 women in labour, any age, with normal pregnancies, with gestational time between 37 to 42 weeks, were randomized to one of two groups. Group 1 received 10 UI of oxitocin (2 mL) diluted in 18 mL of saline solution through umbilical vein, immediately after delivery. Group 2 received only 20 mL of saline solution. Blood loss, time of third stage of labour, retained placenta, nausea, vomit and arterial hypotension were measured. RESULTS: Blood loss was 263.7 +/- 220.9 mL in group 1 (n=32) and 286.7 + 230.4 in group 2 (n=32) (p=0.68, Student T test). Time of third stage of labour was 265.3 +/- 383.9 seconds in group 1 and 197.1 +/- 314.3 in group 2 (p=0.44, Student T test). There was one retained placenta in group 1 and two in group 2 (RR 0.5 IC 0.04 a 5.24). There were not side effects in any group. CONCLUSIONS: Oxitocin trough umbilical vein immediately after delivery was not useful to diminish blood loss, retained placenta or time of third stage of labour.

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OBJECTIVE: We examined the relation of maternal sociodemographic, medical, and behavioral characteristics with risk of abruptio placentae in Peruvian women. STUDY DESIGN: This case-control study included 255 abruptio placentae cases and 258 pregnant controls. Multivariable logistic regression models were fit to calculate odds ratios (OR) and 95% CIs adjusted for putative abruptio placentae risk factors. RESULTS: History of delivering a stillborn infant (OR 10.0; 95%CI 4.0-25.2), pregnancy complicated by preeclampsia/eclampsia (OR 3.7; 95%CI 2.2-6.3); and a low rate of pregnancy weight gain (<0.15 kg/wk) (OR 2.5; 95%CI 1.3-4.7), were associated with significantly increased risk of abruptio placentae. Advanced maternal age, low educational attainment, male infant gender, cigarette smoking, and grand multiparty were not risk factors of abruptio placentae in this population. CONCLUSION: At present, the constellation of abruptio placentae risk factors do not provide clinically meaningful opportunities for identifying high-risk patients.

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Se comunica un caso de síndrome de Dandy-Walker evaluado por control sonográfico prenatal y luego postparto. Un quiste en fosa posterior comunicado con el cuarto ventrículo y ausencia de vernis cerebeloso se halló en la necropsia, además de polihidramnios moderado y anomalías faciales, como micrognatia, rudimentos de pabellones auriculares y flexus adductus bilateral en manos. Otros defectos congénitos asociados contribuyeron al 90 por ciento de muertes posnatales. El síndrome Dandy-Walker puede ser diagnosticado intraútero por la demostración sonográfica de cambios morfológicos característicos en la fosa posterior del encéfalo. El examen prenatal, incluye una evaluación de defectos supratentoriales y otros defectos extracraniales. Coexisten anomalías estructurales faciales y anomalías cromosómicas que frecuentemente marcan un mal pronóstico de supervivencia.

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Realizando un análisis situacional de los anteriormente mencionado existen una serie de problemas en el curriculum de la asignatura que enumero a continuación:. Aucencia de objetivos, . Métodos de enseñanza tradicionales centrada en los profesores y no en los estudiantes, . Formas de ensenaza no estructurados adecuadamente, . Contenidos no armónicos con los problemas dominantes de salud de la población, . Desarmonia entre la transmisión de conocimientos teóricos con la práctica hospitalaria, . Falta de coordinación y uniformidad en la enseñanza práctica, . Realización de las clases prácticas solo en medio hospitalario, . No se toma en cuenta la tabla de especificaciones para la evaluación al estudiante, . Falta de evaluación del proceso docente-educativo donde no funciona el sistema de retroinformación del sistema para el desarrollo curricular...

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El departamento de Medicina dos corresponde al ciclo clínico y está conformada por las siguientes asignaturas, Neumología reumatología infectología, inmunología, dermatología y cardiología, se imparte en el cuarto año de la carrera de medicina. En la asignatura de cardiología actualmente se trabaja con los sistemas tradicionales de enseñanza, donde el profesor es el centro que imparte conocimientos y el alumno es el receptor del mismo, con aprendizaje memorístico, con poco razonamiento y desarrollo de habilidades, jugando el alumno un rol pasivo dentro del sistema enseñanza - aprendizaje. De igual manera se evidencia la ausencia de objetivos generales, objetivos de tema y de clase, cada profesor imparte enseñanza de acuerdo a su criterio y posibilidades, no existe un plan temático, con referencia a los contenidos debo manifestar que en ella están consignados muchos temas considerados problemas dominantes de salud, mientras que otros se encontrarían en exceso como la endocarditis, pericarditis y la electrocardiografía esta ultima por que prácticamente todos los centros de atención de primer y segundo nivel no cuentan con este equipo...

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Se presenta la experiencia de 122 pacientes caracterizados en el Instituto Nacional del Torax de la Paz Bolivia, con los diagnósticos de cardiopatia congenita acianógena ( desde 1980 hasta 1991). Las cardiopatías más frecuentesmente cateterizadas fueron PCA 43,4 porciento, CIA 22 porciento, CIV 20,5 porciento, HAP 5 porciento, EAo 3.3 porciento y CoAo 2,5 porciento. Los pacientes procedieron de 8 departamentos de Bolivia, de La Paz 54 porciento, Oruro 28,7 porciento, Potosi, 7.4 porciento, Sucre 4.1 porciento, Cochabamba 1.6 porciento, Santa Cruz 1.6 porciento, Tarija 1.6 porciento, beni 0.8 porciento.

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La información recopilada sobre las adicciones en México permite determinar: que el consumo de drogas tiene una tendencia creciente; que los jóvenes son el grupo más afectado; que cada vez más aumenta el riesgo hacia la adicción en grupos de edad infantil; que el problema de la adicción es más complejo, agudo y preocupante. En virtud de esta situación, es apremiante llevar a cabo estudios o investigaciones con el objeto de justipreciar los diversos factores causales de la farmacodependencia, así como los elementos asociados con ésta, para establecer acciones tendientes a prevenirla y combatirla. En congruencia con lo anterior, se propone: 1. evaluación del consumo de drogas por región; 2.- evaluar los factores que inciden en el problema de la farmacodependencia; 3.- determinar los factores susceptibles de modificación; y 4.- establecer programas contra la farmacodependencia

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