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This research proposes: (i) analyze push and pull motivations in insular marine protected areas, and (ii) determine their effects on tourists' satisfaction, positive recommendations and loyalty in terms of returning. The study was conducted in the Galápagos Islands in Ecuador; a renowned marine protected area with a National Park being a Natural Heritage Site of Humanity by UNESCO. An exploratory (EFA) and confirmatory factor analysis (CFA), followed by a stepwise multiple regression analysis applied on a sample of 407 tourists in the Galápagos Islands showed four push and pull motivational factors in this destination: "passive marine," "active marine," "novelty and escape," and "social relations". "Passive marine" and "social relations" were the most prominent factors influencing tourist satisfaction and return intentions. Moreover, "passive marine" and "novelty and escape " highly influenced visitors' intention to recommend and give positive feedback about this place. These findings constitute action guides for the adequate management of marine protected areas.

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Resumen El síndrome de kwashiorkor se caracteriza por malnutrición proteica y edema generalizado; algunos de los factores de riesgo que se asocian a su aparición son: vivir en pobreza, el destete reciente, las infecciones y las dietas basadas en maíz y arroz. Este síndrome puede generar manifestaciones cutáneas como piel delgada y seca, hiperpigmentación, áreas confluentes de descamación, cabello seco, hipopigmentado y desprendible, así como una dermatitis erosiva con predominio en pliegues cutáneos. El diagnóstico se basa principalmente en una evaluación nutricional integral, exploración física y estudios de laboratorio, y el éxito del tratamiento se basa en la rehabilitación nutricional temprana. Caso clínico: lactante del sexo femenino de 8 meses de edad, que acudió al Instituto Nacional de Pediatría (INP), por presentar una dermatosis generalizada de tipo descamativa de 1 mes de evolución, que fue tratada con ketoconazol tópico. Al interrogatorio la madre refiere alimentación exclusiva con atole de maíz por un diagnóstico de "alergia a la leche" y falta de recursos económicos para comprar la fórmula hidrolizada. La paciente presentaba una dermatosis diseminada que afectaba todos los segmentos corporales, caracterizada por placas hiperpigmentadas, bien definidas, de forma irregular, con descamación en láminas gruesas en región perioral y extremidades, así como áreas erosionadas, pálidas y edema generalizado en extremidades. Se realizaron exámenes de laboratorio que mostraron que la paciente tenía anemia (Hb 11.2 g/dL) e hipoalbuminemia (3.3 g/dL) que, en conjunto con las manifestaciones clínicas, integraron el diagnóstico de síndrome de Kwashiorkor. Se informaron los hallazgos clínicos y de laboratorio al servicio de Gastroenterología y Nutrición, quienes realizaron una valoración nutricional integral y decidieron iniciar tratamiento nutricional; por parte del servicio de Dermatología, se indicó el uso de emolientes y cuidados generales de la piel. Veinte días después la dermatosis y el edema habían remitido.

Abstract Kwashiorkor syndrome is characterized by protein malnutrition and edema, risk factors are recent weaning, infections, and diets based on corn and rice. This malnutrition can lead to skin manifestations such as thin, dry skin, hyperpigmentation, confluent areas of scaling, dry, hypopigmented, and detachable hair, as well as erosive dermatitis, predominantly in skin folds. The diagnosis is based on a nutritional evaluation exam, physical examination and laboratory finding, the treatment is based on early nutritional rehabilitation. Clinical case: 8-month-old female infant who attended the Instituto Nacional de Pediatría, presenting a scaling dermatosis of 1 month's evolution that was treated with topical ketoconazole. The mother reported exclusive feeding with corn gruel due to the diagnosis of "lactose allergy" and commented not enough resources to buy hydrolyzed formula. The patient presented a disseminated dermatosis to all body segments, characterized by well-defined, irregularly shaped, hyperpigmented plaques with scaling in thick sheets in the perioral region and extremities, as well as areas of eroded skin and paleness and edema of extremities. Laboratory tests were taken, where anemia (Hb 11.2 g/dl) and hipoalbuminemia (3.3 g/dl) were documented, the diagnosis of kwashiorkor syndrome was integrated. The clinical and laboratory findings were reported to the Gastroenterology and Nutrition service, who performed a nutritional assessment, and began nutritional treatment, emollients and general skin care were documented; twenty days later, the dermatosis and edema had subsided.

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BACKGROUND: Emotional competencies are skills necessary to adequately understand, express, and regulate emotional phenomena. Among the emotional competencies is emotion regulation. Not having adequate development of this emotional competence is related to psychological problems such as depression. One of the characteristics of individuals with developmental disabilities is the presence of difficulties with emotion regulation. These difficulties can affect an individual's autonomy, social competence, and the development of independent life. AIMS: This paper presents a scoping review to identify the technology designed and developed to support the emotion regulation of individuals with developmental disabilities. METHODS AND PROCEDURES: We combined the guidelines for a systematic literature review in computer science and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The process resulted in twelve stages through which we conducted this scoping review. First, a search query was defined and executed in computer science's five most representative search engines. We used different inclusion, exclusion, and quality criteria for selecting the works included in this review. OUTCOMES AND RESULTS: Thirty-nine papers aimed at supporting the emotional competencies of individuals with developmental disabilities were included, of which nine support emotion regulation. As a result, different areas of opportunity in developing technology to support the emotion regulation of individuals with developmental disabilities are discussed. CONCLUSIONS AND IMPLICATIONS: Technology supporting emotion regulation in individuals with developmental disabilities is a growing but little-explored field. For the literature supporting emotion regulation, we detected opportunities for study. Some of them aimed at investigating whether we could use technologies developed for other emotional competencies to support emotion regulation and how the characteristics of this technology can support individuals with developmental disabilities.

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OBJECTIVE: To present a novel case of perinatal bilateral exophthalmos and corneal ulcers in a neonate Antillean manatee and describe the medical treatment that led to the resolution of the observed clinical signs and vision restoration. ANIMAL STUDIED: A manatee stranded alone in Puerto Rico on July 5, 2020. RESULTS: The manatee was found in critical condition with pronounced exophthalmos, lagophthalmos, and corneal opacification of both eyes (OU). Vision impairment was evident due to the lack of ocular menace reflex and bumping into the tank's walls. Biomicroscopy revealed conjunctival hyperemia and chemosis, limited third eyelid movement, but had viscous tears present OU. Dense, full-thickness, white to cream-colored cellular infiltrates affected 70% of the cornea with peripheral active vascularization OU. Rubeosis iridis was also present OU. Treatment consisted of supportive medical management, including nutritional support and topical treatment for ulcerative keratitis. Resolution of the corneal ulcers and functional vision were achieved after 6 weeks of therapy. Currently, bilateral, mild, intermittent exophthalmos is observed with no adverse clinical signs, and the calf is in good health. CONCLUSIONS: The extent of bilateral corneal disease on a neonatal calf may be a result of an intrauterine infection or possible trauma at or right after birth. While the latter may have led to exophthalmia and consequent corneal disease, the exact cause could not be determined. Supportive therapy and medical management of infectious keratitis were successful and led to vision recovery. This is the first report of ocular pathology in a neonatal manatee.

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Socially responsible consumption benefits the environment, the consumer, and the producer. In Mexico, smallholder farmers are vulnerable, and the consumption of organic food products is low. Analysing the purchase intention of organic food products contributes towards generating the most appropriate marketing strategies. Previous models provide evidence that the attitude of the consumer is the biggest predictor of purchase intention. However, little is known about the results of the mediating effect of desire on said relationship. The objective of the study is to analyse the mediating effect of desire on the relationship between attitude and purchase intention. 204 consumers of organic food products were surveyed using a structured, self-administrated questionnaire or through face-to-face interviews, in established retail stores, alternative street markets, and via the web. It was found that when the benefits of organic food products to the consumer, environment, and smallholder farmers are evaluated favourably, then consumer desire is higher, and thus also purchase intention. Consumers have the highest purchase intention for organic food products when their desire to buy them to achieve a goal related with social, personal, and environmental benefits intervenes.

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INTRODUCTION AND OBJECTIVES: Self-expanding metallic stents (SEMS) are the ideal treatment for malignant gastric outlet obstruction (MGOO) in patients with a short life expectancy, but stent dysfunction is frequent. The primary aim of our study was to identify the predictive factors of SEMS dysfunction in MGOO and the secondary aim was to determine the technical success, clinical success, and nutritional impact after SEMS placement. MATERIAL AND METHODS: A retrospective, longitudinal study was conducted at the gastrointestinal endoscopy department of the Instituto Nacional de Cancerología in Mexico City. Patients diagnosed with MGOO that underwent SEMS placement within the time frame of January 2015 to May 2018 were included. We utilized the gastric outlet obstruction scoring system (GOOSS) to determine clinical success and SEMS dysfunction. RESULTS: The study included 43 patients, technical success was 97.7% (n=42), and clinical success was 88.3% (n=38). SEMS dysfunction presented in 30.2% (n=13) of the patients, occurring in<6 months after placement in 53.8% (n=7) of them. In the univariate analysis, the histologic subtype, diffuse gastric adenocarcinoma (p=0.02) and the use of uncovered SEMS (p=0.02) were the variables associated with dysfunction. Albumin levels and body mass index did not increase after SEMS placement. Medical follow-up was a mean 5.8 months (1-24 months). CONCLUSIONS: SEMS demonstrated adequate technical and clinical efficacy in the treatment of MGOO. SEMS dysfunction was frequent and diffuse type gastric cancer and uncovered SEMS appeared to be dysfunction predictors.

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INTRODUCTION AND AIM: Intragastric balloon therapy is a temporary, minimally invasive method for inducing weight loss. Any balloon with a volume of 400mL induces satiety and delayed gastric emptying. The aim of the present study was to demonstrate its safety and efficacy. MATERIALS AND METHODS: We analyzed the safety and effectiveness of balloon placement in relation to weight loss in 128patients. Subgroups were compared through the Student's t test, ANOVA test, and the chi-square test, depending on the type of variable and the number of groups evaluated. Statistical significance was set at a P≤.05 to evaluate weight loss. RESULTS: Mean weight loss after balloon therapy was 10.7kg, with only 2 cases of complications due to oral feeding intolerance. Mean length of time with the balloon was 8months. There were no complications after 6months, but no further weight loss either (P=.540). Final weight loss versus initial weight loss was significant (P=.000). There was greater weight loss in the group that attended the bimonthly control appointments than in the group that did not: 12.7kg vs. 7.26kg (P=.000). CONCLUSIONS: The rates of the adverse events of intolerance and complications were very low in our study, compared with results in the literature: 1.6% vs. 4.7% and 0% vs. 3%, respectively. Intragastric balloon placement had better results when the patients attended the control appointments. Intragastric balloon therapy is a safe and efficacious method for reducing weight in patients with overweight and obesity.

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Resumen El cáncer de ovario se ha caracterizado por ser la neoplasia ginecológica de peor pronóstico. Lo anterior es consecuencia del curso silente de la enfermedad que ocasiona que la mayoría de las veces el diagnóstico se realice en etapas avanzadas. La información recolectada señala que los avances terapéuticos no han demostrado ser efectivos en mejorar la sobrevida de las pacientes con cáncer de ovario, lo cual orienta a la búsqueda constante de un método (o conjunto de éstos), que permita llevar a cabo el tamizaje y la detección temprana de dicha patología. Sin embargo, debido a que actualmente no se ha logrado identificar un método que sea costo-efectivo para el tamizaje, el mismo no se aplica a la población general y se reserva para casos específicos, como mujeres con antecedentes familiares de la enfermedad o que presentan síndromes hereditarios. Esta revisión incluye además información sobre las diferentes técnicas de imagen utilizadas tanto para el estudio y caracterización de masas anexiales, como para el estadiaje y pronóstico del cáncer de ovario. De las técnicas estudiadas, el ultrasonido (US) demostró ser la mejor opción para el abordaje inicial de masas anexiales; sin embargo, a la hora de realizar el estadiaje resultó ser inferior a la tomografía computarizada (TC) y la resonancia magnética (RM).

Abstract Ovarian cancer is the gynecological malignancy with the worst prognosis. Due to the silent course of the disease the diagnosis is made mainly in advanced stages. The literature reviewed showed that the therapeutic advances have not shown any major improvement in patient´s survival with ovarian cancer, therefore there is a constant research for a technique (or a set of them) that allows a proper screening and early detection of the disease. However, a cost effective method has not been found for screening, therefore it is not recommended for general population and it is reserved for specific cases, such as women with family history of ovarian cancer and with hereditary syndromes. This review also includes information about the different imaging techniques available not only for the study and characterization of neoplasms, but also for staging and prognosis of ovarian cancer. The ultrasound proved to be the best option for the initial approach of adnexal masses, however it has shown to be inferior for staging than CT-Scan and MRI.

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The traditional classification of avian Haemosporida is based mainly on morphology and life history traits. Recently, molecular hypotheses have challenged the traditional classification, leading to contradictory opinions on whether morphology is phylogenetically informative. However, the morphology has never been used to reconstruct the relationships within the group. We inferred the phylogeny of avian Haemosporida from 133 morphological characters present in blood stages. We included all species with at least one mitochondrial gene characterized (n = 93). The morphological hypothesis was compared with the one retrieved from mitochondrial DNA (mtDNA) nucleotide sequences and a hypothesis that used a combination of morphological and molecular data (i.e., total evidence). In order to recover the evolutionary history and identify phylogenetically and taxonomically informative characters, they were mapped on the total evidence phylogeny. The morphological hypothesis presented more polytomies than the other two, especially within Haemoproteus. In the molecular hypothesis, the two Haemoproteus subgenera are paraphyletic, and some relationships within Parahaemoproteus were resolved. By combining the morphological and molecular data, we were able to resolve the majority of polytomies and posterior probabilities increased. We identified a unique combination of morphological traits, clearly differentiating avian Haemosporida genera, sub-genera of Leucocytozoon and Haemoproteus, and some Plasmodium sub-genera. Plasmodium had the highest number of synapomorphies. Furthermore, 86% of the species presented a unique combination of taxonomically informative characters. A limiting factor was the mismatch of traits characterized in species descriptions, leading to a morphological matrix with a considerable amount of missing data, particularly for the stages of early young and young gametocytes (67% of all missing data). Characters lacking information for the majority of species included the colour of pigment granules, the cytoplasm appearance, and the presence and dimensions of vacuoles. According to our results, the combination of morphology and mtDNA proved to be a robust alternative to reconstruct the relationships among avian Haemosporida, obtaining a resolution and support similar to that obtained using full mitochondrial genome sequences for over 100 lineages.

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La galactosialidosis (OMIM #256540) es una enfermedad metabólica lisosomal causada por mutaciones en el gen CTSA, que codifica la proteína protectora catepsina A. La pérdida de función de dicha proteína causa, secundariamente, un déficit combinado de dos enzimas, beta-galactosidasa y neuraminidasa. Se expone el caso de un paciente que presentó manifestaciones clínicas compatibles con el subtipo infantil tardío de galactosialidosis. El análisis bioquímico mostró déficits de las dos enzimas implicadas, mientras que el estudio molecular reveló dos mutaciones: una nueva mutación nunca antes descrita, p.His475Pro (c.1424 A>C), y una mutación previamente reportada, p.Arg441Cys (c.1321C>T), localizadas en los exones 15 y 14, respectivamente.

Galactosialidosis (OMIM #256540) is an autosomal recessive lysosomal storage disorder caused by mutations in the CTSAgene, which encodes the protective protein cathepsin A. The loss of function of this protein causes a secondarily deficiency of beta-galactosidase and N-acetyl-α-neuraminidase enzymes activities. We describe the clinical, biochemical and molecular analysis of a case report with a phenotype compatible with the late infantile form. The biochemical analysis reveled deficiencies of beta-galactosidase and neuraminidase activities in dried blood spot and fibroblasts and the molecular study showed two missense mutations in the CTSA gene: a previously reported mutation, p.Arg441Cys (c.1321C>T), and a novel mutation, p.His475Pro (c.1424 A>C), located in exons 14 and 15, respectively.

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Galactosialidosis (OMIM #256540) is an autosomal recessive lysosomal storage disorder caused by mutations in the CTSA gene, which encodes the protective protein cathepsin A. The loss of function of this protein causes a secondarily deficiency of beta-galactosidase and N-acetyl-a-neuraminidase enzymes activities. We describe the clinical, biochemical and molecular analysis of a case report with a phenotype compatible with the late infantile form. The biochemical analysis reveled deficiencies of beta-galactosidase and neuraminidase activities in dried blood spot and fibroblasts and the molecular study showed two missense mutations in the CTSA gene: a previously reported mutation, p.Arg441Cys (c.1321C>T), and a novel mutation, p.His475Pro (c.1424 A>C), located in exons 14 and 15, respectively.

La galactosialidosis (OMIM #256540) es una enfermedad metabólica lisosomal causada por mutaciones en el gen CTSA, que codifica la proteina protectora catepsina A. La pérdida de función de dicha proteína causa, secundariamente, un déficit combinado de dos enzimas, beta-galactosidasa y neuraminidasa. Se expone el caso de un paciente que presentó manifestaciones clínicas compatibles con el subtipo infantil tardío de galactosialidosis. El análisis bioquímico mostró déficits de las dos enzimas implicadas, mientras que el estudio molecular reveló dos mutaciones: una nueva mutación nunca antes descrita, p.His475Pro (c.1424 A>C), y una mutación previamente reportada, p.Arg441Cys (c.1321C>T), localizadas en los exones 15 y 14, respectivamente.

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BACKGROUND: Infection is the most common complication related to permanent pacemaker implantation. The objetive of this study is to establish the prevalence and determine the frequency of risk factors associated with exteriorization of cardiac pacemakers at the Department of Cardiac Electrophysiology at the UMAE Hospital de Especialidades "Dr. Antonio Fraga Mouret" Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social. METHODS: A descriptive cross-sectional study from September 2005 to September 2010, where, for the analysis of the risk factors we selected cases and controls by age, sex and the diagnosis of Diabetes, or not. Was calculated measures of central tendency (mean, median and mode) and chi-squared, Fisher exact test and exact odds ratio. RESULTS: 3192 cardiac pacemakers were implanted, identifying 83 exteriorization cases, where 46 of them were selected for cases and controls, and the mean age was 71 years. CONCLUSIONS: Our prevalence of exteriorization of cardiac pacemakers is 2.6 %, these results are similar to previously published studies. None of the risk factors described are present as a cause in our population. The surgical technique used may be an important risk factor, so further studies analysing all techniques are needed.

Introducción: el objetivo de este estudio es establecer la prevalencia y determinar la frecuencia de factores de riesgo de exteriorización de marcapasos definitivos (MPD), en el departamento de Electrofisiología Cardiaca de la UMAE Hospital de Especialidades "Dr. Antonio Fraga Mouret" del Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social.Métodos: se llevó a cabo un estudio transversal, descriptivo del periodo: septiembre del 2005 a septiembre del 2010, para el análisis de los factores se manejó como casos y controles; se eligieron emparejándose por edad, sexo y presencia, o no, de factores de riesgo. Se realizó el cálculo de medidas de tendencia central (media, mediana y moda), así como pruebas de chi cuadrada, test de Fisher y razón de momios.Resultados: se implantaron 3192 MPD, identificando 83 casos de exteriorizaciones, seleccionando 43 casos para casos y controles, la edad promedio fue de 71 años. Ninguno de los factores de riesgo ni el tipo de técnica quirúrgica presentó significancia estadística.Conclusiones: nuestra prevalencia de exteriorizaciones es del 2.6 %, valores muy similares a los reportes publicados. Ninguno de los factores de riesgo descritos se encuentra presente como causa de exteriorización en nuestra población. El análisis de la técnica quirúrgica utilizada puede ser un factor importante, por lo que se necesitan estudios posteriores.

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The aim of this report was to present a case of granulomatous lesion on the ventral surface of the tongue in a 9-month-old, healthy, infant girl, caused by the habit of scraping the tongue on mandibular central incisors. Clinical treatment consisted of manual smoothing of the sharp edges of both incisors and excision of the 2-cm pediculate ulcerative granulomatous mass localized on the ventral surface of the tongue. After 3 weeks, the child could be properly fed and a complete healing of the lesion was observed.

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La literatura señala al segundo molar deciduo como el diente más afectado por caries. Objetivo: verificar la presencia y el área de retención alimenticia de la superficie oclusal de los segundos molares deciduos en niños de 36 a 48 meses. Material y métodos: Se examinaron 54 niños en dos tiempos (to: 0 y t1: 30 minutos), después de ingerir una galleta de chocolate. Se tomaron fotografías digitales para registrar la presencia y realizar el cálculo del área a través del programa Image Tool 3.0. Resultados: A pesar de que los dientes inferiores presentaron mayor presencia de retención en el tiempo final (90.74 por ciento) comparados a los superiores (85.18 por ciento) la diferencia no fue estadísticamente significativa (c2, p = 0.220). Mediante el examen de Mann-Whitney, fue observada una mayor área de retención en los dientes inferiores comparado a los superiores tanto en el tiempo inicial (Inferiores: 0.42 ± 0.02 y superiores: 0.27 ± 0.02) como en el tiempo final (Inferiores: 0.11 ±0.01 y superiores: 0.06 ± 0.01). Conclusiones: Los datos obtenidos están de acuerdo con las observaciones clínicas de ser los segundos molares deciduos inferiores, los molares de mayor complejidad oclusal y retención de alimentos, por tanto los más susceptibles.

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Objetivo: Analizar los pasos necesarios para conseguir una donación efectiva de órganos, describir nuestra experiencia y desarrollar una serie de propuestas para mejorar las tasas de donación. Método. Estudio de serie de casos, de forma retrospectiva fueron recogidas un grupo de variables demográficas y las características que permitían definir a los pacientes en: posibles donantes, donantes potenciales, donantes reales y donantes efectivos. También fueron recogidas las causas de ME y de pérdidas de donantes. Resultados. Durante los años 1998 al 2004 fueron evaluados 248 pacientes con una edad media de 40.9±13.5 años, siendoel 70.2 por ciento hombres (174), a 86 de estos pacientes se les diagnóstico ME (34.7 por ciento) llegando a ser donantes reales 29 (33.7 por ciento) y de estos donantes efectivos 20 (68.9 por ciento), en los donantes sólo fueron extraídos los riñones. La tasa de donantes de órganos por millón de población en los primeros cinco años fue muy irregular, estabilizándose en los años 2003 y 2004 muy cercana a la obtenida por el país. La causa de ME predominante fue la enfermedad cerebrovascular hemorrágica. Las causas de pérdidas de donantes de órganos más frecuentes fueron el fallo del mantenimiento y la negativafamiliar. Tanto por falla del mantenimiento como por las negativas familiares se observó una disminución progresiva con el transcurso de los años. Conclusión. El estudio de siete años de trabajo en la donación de órganos permitió conocer las áreas de mejora quedando resumidas en: incremento de la detección de posiblesdonantes, mejorar el acercamiento familiar y el mantenimiento del donante, lograr donaciones multiorgánicas e iniciar la obtención de tejidos(AU)

Objective. To analyze the necessary steps to get an effective organdonation, to describe our experience, and to develop a series of proposal to improve the donations rate. Method. It is a study of series of cases. In a retrospective way, some demographic variables were analyzed, as well as the characteristics that allowed us to define the patients into: possible donners, potential donners, real donners and effective donners. The causes of brain death (neurological death) and the loss of donners were also analyzed. Results. From 1998 to 2004, 248 patients were evaluated with an average age of 40.9±13.5. Out this total 70.2 percent were males (174 patients). From this group of male patients, 86 were diagnosed with brain death (34.7 percent) only 29 of them (33.7 percent) were real donner. From this real donners, 20 patients (68.9 percent) were effective donners. In all these donners, the kidneys were the only one organs used. The organ donners rate per million inhabitants in the first 5 years was very irregular, audit was steady in the years 2003 and 2004 which was very closed to the one obtained in the country. The most predominant cause of brain death was the hemorrhagic cerebrovascular disease. The most frequent causes of organ donners loss were the damage in the human body and the family refusal. These two elements have diminished progressively within the pass of the time. Conclusion. A seven year study of the organs donation allowed us to know the areas of improvement which are summarized in aspects such as: an increment in the better conditions of the donner; and also to achieve multi-organic donation and to start with the attainment of tissue(AU)

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En la relación del presente estudio se incluyeron a 98 pacientes que cumplan con los criterios de inclusión, de cuyos resultados se pude inferir que: en relación a la edad gestacional el 63.3 porciento de las pacientes cursaban tercer trimestre de embarazo, seguido de 17.3 porciento que cursaba su segundo trimestre y solamente 16.6 porciento se encontraba en la etapa inicial de su gestación. Respecto a las alteraciones del examen de orina se observó que 80.7 porciento presento bacteriuría y solamente 12.2 porciento se evidencio la presencia de leucocitos y en 7.1 porciento de nitritos. Correlacionando examen general de orina y urocultivo se encontró que de las 98 pacientes en las que se encontró alteración del EGO 37 tuvieron cultivo negativo lo que representa 37.8 porciento y un 62.2 porciento correspondiente a 61 pacientes se evidencio la presencia de germen patógeno. De las 61 pacientes con crecimiento en el urocultivo se encontró la presencia de E coli en 29 pacientes para 47.5 porciento, seguido de enterobacter con 19.9 porciento en 12 pacientes y el tercer lugar correspondio a Klesiella con 16.3 porciento en 10 pacientes. Respecto a la sensibilidad bacteriana para E coli el germen más frecuente fue de 89.6 porciento para Nitrofurantoina en comparación con 82.7 porciento para amoxicilina, no siendo a´si con enterobacter cuya sensibilidad para amoxicilina fue de 100 porciento en contra de 75 porciento para Nitrofurantoina, en relación a Klebsiella predomino su sensibilidad a Nitrofurantoina con 80 porciento. En relación a la eficacia de ambos fármacos estudiados se encontró que de las 34 pacientes que recibieron esquema de Nitrofuranotina 30 presentaron curación para 88.2 porciento y solamente en 4 pacientes persistió el germen para 11.8 porciento. Las que recibieron esquema 2 con amoxicilina fueron 27 pacientes se observó su curación en 16 pacientes para 59.2 porciento y fracaso en 11 con 40.8 porciento...

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El Síndrome de Disfunción Orgánica Múltiple se define como la disminución potencialmente reversible en la función de uno o más órganos, que son incapaces de mantener la homeostasis sin un sostén terapéutico. El término disfunción implica un proceso continuo y dinámico en la pérdida de la función de un órgano, que va de menos a más, siendo la etapa final en la claudicación de la función de dicho órgano lo que denominamos disfunción. La reversibilidad de este síndrome y la mortalidad que le acompaña hace que se convierta en una entidad prioritaria en las Unidades de Cuidados Intensivos. Este trabajo hace una revisión amplia del Síndrome de Disfunción Orgánica Múltiple, en su primera parte actualiza los conceptos y aborda los factores predisponentes, la etiología, la fisiopatología, la epidemiología y los índices que más frecuentemente evalúan el pronóstico...(AU)

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Se presenta el caso de un paciente de 62 años con historia de hipertensión arterial que ingresa en Unidad de Cuidados Intensivos del Hospital Universitario Dr Gustavo Aldereguía Lima de Cienfuegos por sufrir múltiples traumatismos : cráneo , tórax, abdomen y miembros. Fue necesario realizar pleurotomias, derecha e izquierda por hemoneumotórax bilateral, presentó inestabilidad hemodinámica que necesitó de apoyo vasoactivo y adecuado manejo del aporte de volumen . Predominó en la evolución el dolor rebelde al tratamiento habitual y que amenazaba con empeorar el pronóstico, por lo que se decide emplear la analgesia peridural , se logró estabilidad ventilatoria y clínica, se evitaron así los efectos deletéreos que provoca el dolor, con resultado final favorable y egreso del servicio sin mayores secuelas...(AU)

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Las enfermedades cerebrovasculares constituyen la tercera causa de muerte y primera de discapacidad en el mundo y en Cuba; se encuentran dentro de los programas priorizados por la Organización Mundial de la Salud y por nuestro Ministerio de Salud Pública.Caracterizar las enfermedades cerebrovasculares en los Servicios de Terapia Polivalente en la región central del país. Estudio multicentro, descriptivo, de serie de casos, realizado en los Hospitales Universitarios Clínicos Quirúrgicos Dr Gustavo Aldereguía Lima de Cienfuegos y Arnaldo Milián Castro de Villa Clara, con la revisión de 1218 expedientes clínicos de pacientes a los que se aplicó formulario para obtención de datos, procesados ulteriormente por SPSS. Predominaron: el color de la piel blanca (75,3 porciento), el sexo masculino ( 56,7 porciento), y la hipertensión arterial como marcador de riesgo (71,3 porciento). La enfermedad cerebrovascular isquémica fue la más reportada (86,7 porciento) y el antiagregante plaquetario el medicamento más empleado durante la misma (77,5 porciento).La localización de la lesión en la región parietal se observó en el 51,1 porciento y el diagnóstico predominante fue el infarto aterotrombótico (59,9 por ciento). La complicación más reportada fue el edema cerebral (45,2 porciento).El estado al egreso predominante fue vivo con discapacidad(62,2 porciento). La enfermedad cerebrovascular es un problema de salud en nuestro medio. La hipertensión arterial es el marcador de riesgo más observado. Predominan los ictus isquémicos y una vez establecida la enfermedad evoluciona a la discapacidad o fallecimiento en la mayoría de los casos...(AU)

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