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Los accidentes ofídicos en Colombia y Latinoamérica, soneventos endémicos de conocimiento necesario para todo personal desalud dada su relevancia en salud pública e impacto en la economíalocal. La frecuencia de envenenamiento por el género Bothrops superacon creces las de otras, y, sin desvirtuar las demás, es la que másfrecuentemente se va enfrentar el médico de atención primaria. Siendola lesión renal aguda una de las complicaciones más serias delenvenenamiento por este género, es necesario conocer la patogénesis yel mecanismo de nefrotoxicidad, así como predictores de requerimientode TRR (terapia de reemplazo renal). En este reporte de caso sedescribe un paciente con accidente bothropico grave con compromisorenal y con necesidad de soporte renal definitivo, siendo unacomplicación que debe reconocerse en este tipo de eventos. El pacienterequirió manejo con suero antiveneno al igual que se inicióhemodiálisis para manejo de la injuria renal aguda presentada (AU)

Ophidic accidents in Colombia and Latin America are endemic eventsof necessary knowledge for all health personnel given their relevancein public health and impact on the local economy. The frequency ofpoisoning by the Bothrops genus far exceeds that of others, and,without distorting the others, it is the one that the primary carephysician will most frequently face. Being acute kidney injury is oneof the most serious complications of poisoning by this genus, it isnecessary to know the pathogenesis and the mechanism ofnephrotoxicity, as well as predictors of RRT (renal replacementtherapy) requirement. This case report describes a patient with severebothropic accident with renal compromise and in need of definitiverenal support, being a complication that must be recognized in this typeof event. The patient required management with antivenom serum aswell as hemodialysis to manage the acute kidney injury presented.Keywords: snake bites; bothrops; acute kidney injury; coagulopathy (AU)

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Milk is a liquid food that possesses an important quantity of highly bioavailable macronutrients. In addition, it is readily accessible, as well as relatively inexpensive. Given that the knowledge of physicians about nutrition and food composition is deficient, in general, many of the dietary interventions recommended in diverse clinical settings lack a scientific basis. The aim of the present review was to produce a technical opinion that serves as a frame of reference to best sustain recommendations for consuming milk and dairy products as daily nutrition in the adult and older adult. The effects of milk and dairy products during the pediatric stage are not addressed in the present work. The Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría jointly discussed and analyzed topics dealing with the legal designation of milk, the classification and nutritional profile of cow's milk, its nutritional characteristics, its consumption in the adult, intolerance to cow's milk, and associations of milk consumption with digestive tract alterations and other conditions. Finally, certain aspects of milk consumption in the older adult and its relation to overall health are briefly discussed.

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Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the "Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico" and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients.

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OBJECTIVE: The goal of this study was to inform public health policy which can reduce Colombia's estimated infant mortality rate (IMR), 17.78 deaths for 1000 live births (2011), by lowering preventable first day mortality (PFDM). STUDY DESIGN: This study combined a time series analysis, using a linear regression method, for the period 2001-2012 with a cross-sectional analysis, using odds ratios and bi-variate methods, for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socio-economic, and medical correlates. METHODS: The study examined the trends for 2001-2012 in Colombia's infant mortality rate per 1000, and in the relative significance of PFDM by cause. It established the relative odds of PFDM for 2012 by major risk categories, defined by birthweight and gestational age, and within those by biological, sociodemographic risk factors or groups and by potential access to and use of care. Then, the study established the major causes of PFDM within major risk categories and groups. RESULTS: Between 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%), and handling causes associated with late diagnosis and treatment (55.80%). PFDM is primarily a socio-economic phenomenon, even among normal weight and gestational age newborns, who account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and among members of the inferior subsidised social insurance regime. CONCLUSION: From efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birthweight, and then to babies with very low gestation age and birthweight. At the same time, more prenatal visits could lead to fewer very high-risk situations at the outset. In view of the Colombian regulation to the contrary, the use of foetal monitoring and echography methods by all general practitioners should be considered. They should be trained accordingly. Policies should focus on members of the underprovided subsidised health insurance regime, rural areas, young, low-educated and single mothers during pregnancy, mainly delivery.

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La comprensión del proceso de la coagulación ha progresado durante la última década, evolucionando a partir del concepto según el cual la producción del coágulo se iniciaba por acción de las plaquetas y la activación de uno de los dos sistemas separados, la vía extrínseca y la vía intrínseca, al concepto actual que hace énfasis sobre la vía común y un sistema proteolítico que da lugar a la degradación de los coágulos formados y a la prevención de la formación indeseada de coágulos. La alteración de este equilibrio cobra especial importancia en los pacientes con trauma craneoencefálico, en quienes -a la luz de los conocimientos actuales- se pueden presentar trastornos de la coagulación que van desde lesiones procoagulantes, en un extremo, hasta lesiones anticoagulantes, en el otro extremo. La meta de los autores es brindar a los clínicos de una guía de evaluación inicial, de seguimiento y, de las posibilidades terapéuticas disponibles en el momento.

The understanding of the coagulation process has progressed during last decade evolving from the concept according to which the production of the clot begins by means of the action of platelets and the activation of one of two separated systems, the extrinsic route and the intrinsic route, to the present concept that makes emphasis on the common route and a proteolytic system that give rise to the degradation of formed clots and to the undesired prevention of the formation of the clot. The alteration of this balance receives special importance in the patients with brain trauma in those who to the light of the present knowledge may present upheavals of the coagulation which can go from procoagulating injuries in one end to anticoagulating injuries in the other. The goal of the authors is to provide a clinical guide with initial evaluation, pursuit and therapeutic possibiliti.es available at the moment.

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The economic contribution of draught animals to smallholder Mazahua campesino systems in two mountain villages of San Felipe del Progreso, in the central highlands of Mexico, was assessed. Campesinos rely on draught animals for cultivation tasks, as pack animals, and as transport for agricultural and domestic activities. The villages were San Pablo Tlalchichilpa (SPT) and La Concepción Mayorazgo (LCM). Twelve households that possessed draught animals were monitored from July 1999 to June 2000, nine in SPT and three in LCM, in terms of animal inventories and income from their draught animals, in cash and opportunity values. Equines in SPT have substituted bulls, and are recognized for their multipurpose contribution, while in LCM bulls are still used for ploughing the land. Overall total mean gross income was US dollar 490.78 per farm per year, plus US dollar 56 as opportunity value of the fertilizer value of manure for both villages. Deducting estimated costs, owning draught animals leaves a mean net margin of US dollar 412.50/year in SPT and of US dollar 285.64/year in LCM. There is a significant correlation (p < 0.05) between ownership of draught animals and incomes, with a regression coefficient of US dollar 279.16 per year per draught animal. Besides positive economic returns, having work animals alleviates drudgery for the campesino families.

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BACKGROUND: Prognosis in neuroblastoma is based upon several clinical factors such as age, tumoral staging and other genetic factors like N-myc oncogene amplification or deletion of the short arm of chromosome 1 (del 1p). Recent reports indicate that bcl-2 protein expression is associated with a poor outcome in patients with neuroblastoma. MATERIALS AND METHODS: We present a study of 80 cases from the files of the Spanish neuroblastoma study group (N-II-92) analysing bcl-2 protein expression by means of immunohistochemical methods and its relation with other parameters such as histopathology, PCNA expression, N-myc amplification and DNA study of apoptosis. RESULTS: We found a statistical correlation between bcl-2 protein expression and unfavourable histopathology, N-myc amplification and PCNA nuclear staining. An inverse relation between bcl-2 staining and apoptosis was detected. CONCLUSIONS: Based on present findings it can be concluded that the determination of bcl-2 protein provides prognostic information when associated with other biological factors involved in neuroblastomas.

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Además de presentar ciertos aspectos de la selección de audifonos el principal objetivo de este articulo consiste en proporcionar información sobre algunos criterios aplicables a la salud institucional, a fin de que los mismos recursos, con optima calidad, sean asequibles a una mayor población

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The gene encoding toxin gamma from the scorpion, Tityus serrulatus, was amplified by PCR from genomic DNA employing synthetic oligonucleotides designed from the reported cDNA sequence. The nucleotide sequence of this gene reveals the presence of an intron of 475 base pairs (bp) which interrupts the region that encodes the signal peptide of the precursor toxin. A comparison of the intron boundary sequences of the gamma toxin gene with ones from other arachnid genes is also presented.

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El estudio de las otoemisiones acusticas, por su rapidez, objetividad, simplicidad e inocuidad presenta una nueva alternativa en la evaluación precoz de la audición en lactantes, complementaria a las técnicas electrofisiológicas. Su indicación en la valoración de la audición en adultos y diagnóstico de diferentes tipos de hipoacusia, esta aun restringido y discutido. Otro gran atractivo de este novedoso examen es de caracter investigativo en el estudio de la fisiologia y patologia del oído interno

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