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Resumen OBJETIVO: Evaluar las diferencias en los desenlaces de los ejercicios del módulo de habilidades motoras básicas del simulador Simbionix LAP Mentor entre un grupo de residentes de Ginecología y otro de especialistas en cirugía laparoscópica. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, longitudinal y comparativo efectuado de diciembre de 2019 a enero de 2020 en el Hospital Español de México. Se seleccionaron médicos residentes de Ginecología y especialistas en la misma rama con experiencia diversa en cirugía laparoscópica. Se evaluaron, con un programa de adiestramiento mediante simulación de alta fidelidad, los ejercicios del módulo de habilidades motoras básicas de un sistema de realidad virtual. Para las variables con distribución normal se aplicó la prueba de t de Student y la de U de Mann-Whitney para las variables que no cumplieron el criterio de normalidad. RESULTADOS: Se incluyeron 31 participantes: el grupo de especialistas (n = 19) y el de residentes (n = 12). Se encontraron diferencias significativas entre residentes y especialistas en el ejercicio 3-coordinación ojo-mano (4.45 seg, IC95%: 0.167-8.73; p < 0.05) y en el ejercicio 5-tracción y engrapado de mangueras con fugas (29.58 seg, IC95%: -42.99 -14.00; p < 0.001), a favor del grupo de especialistas. En los ejercicios 7-corte y ejercicio 8-fulguración no hubo diferencias significativas entre uno y otro grupo. CONCLUSIONES: El simulador de realidad virtual Simbionix LAP Mentor detecta diferencias entre grupos de ginecoobstetras con diferente experiencia en cirugía ginecológica de mínima invasión y residentes de la especialidad.

Abstract OBJECTIVE: To evaluate the differences in the outcomes of the exercises of the basic motor skills module of the Simbionix LAP Mentor simulator between a group of gynecology residents and another group of already graduated specialists. MATERIALS AND METHODS: Observational, prospective, longitudinal and comparative study carried out from December 2019 to January 2020 at the Hospital Español de México. Gynecology residents and specialists in the same branch with diverse experience in laparoscopic surgery were selected. The exercises of the basic motor skills module of a virtual reality system were evaluated with a high-fidelity simulation training program. The Student's t test was applied for variables with normal distribution and the Mann-Whitney U test for variables that did not meet the normality criterion. RESULTS: Thirty-one participants were included: the specialist group (n = 19) and the resident group (n = 12). Significant differences between residents and specialists were found in exercise 3-eye-hand coordination (4.45 sec, 95%CI: 0.167-8.73; p < 0.05) and in exercise 5-pulling and stapling of leaking hoses (29.58 sec, 95%CI: -42.99 -14.00; p < 0.001), in favor of the specialist group. In exercise 7-cutting and exercise 8-fulguration there were no significant differences between one group and the other. CONCLUSIONS: The Simbionix LAP Mentor virtual reality simulator detects differences between groups of obstetrician-gynecologists with different experience in minimally invasive gynecologic surgery and residents of the specialty.

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El virus Zika, es un arbovirus del género flavivirus (familia Flaviviridae), muy cercano filogenéticamente al del dengue, fiebre amarilla, la encefalitis japonesa, o el virus del Nilo Occidental. El presente estudio exploratorio busca identificar los casos confirmados y sugestivos de infección por virus Zika en mujeres embarazadas en la Unidad de Medicina Familiar N° 60 del IMSS de Coatzacoalcos, Veracruz. México como primera aproximación epidemiológica en esta región.

The Zika virus is an arbovirus of the genus flavivirus (family Flaviviridae), very closely phylogenetically a virus such as dengue fever, yellow fever, Japanese encephalitis, or West Nile virus. According to the Epidemiological Surveillance System for Zíka Virus Disease, until November 4th, 2016, in Mexico there were 6,094 confirmed cases of infection and 3,167 suspected cases of Zika virus infection in pregnant women in 24 states of the Mexican Republic, with a higher prevalence in Veracruz, Chiapas, Colima, Campeche, Yucatan and Quintana Roo. This is an original study that focuses on identifying the confirmed and suggestive cases of Zika virus infection in pregnant women in the Family Medicine Unit No. 60 of the IMSS in Coatzacoalcos, Veracruz. Mexico; It is an exploratory study in the registry of cases of pregnant women with Zika virus infection in the Family Medicine Unit No. 60 of Coatzacoalcos, Veracruz, Mexico as epidemiological basis

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ANTECEDENTES: La encefalopatía posterior reversible se relaciona con enfermedades hipertensivas del embarazo, con clínica inespecífica. El diagnóstico se realiza mediante resonancia magnética y electroencefalograma, y el tratamiento oportuno evita complicaciones. CASO CLÍNICO: Primigesta de 15 años con embarazo pretérmino, hipertensión arterial y convulsiones tónico-clónicas, que desarrolló encefalopatía posterior atípica con múltiples lesiones cerebrales. Se administraron antihipertensivos, sin mejoría de los síntomas neurológicos. El manejo de esta patología depende de la situación desencadenante, no existe evidencia suficiente del soporte con medidas antiedema preventivas en pacientes con factores de riesgo. El retraso en el tratamiento oportuno y la presentación atípica favorecen la progresión de las secuelas neurológicas. BACKGROUND: Reversible posterior encephalopathy is related to hypertensive diseases of pregnancy, with a nonspecific clinic. The diagnosis is made by magnetic resonance and electroencephalogram, appropriate treatment prevents complications. ­­. CASE REPORT: 15-year-old primigesta with preterm pregnancy, arterial hypertension and tonic-clonic seizures, presents atypical posterior encephalopathy with multiple brain lesions, antihypertensives were administered without improvement of neurological symptoms. The management of this pathology depends on the triggering situation, there is insufficient evidence to support preventive anti-edema measures in patients with risk factors. The delay in timely treatment and atypical presentation favors the progression of neurological sequelae.

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El virus Zika, es un arbovirus del género flavivirus (familia Flaviviridae), muy cercano filogenéticamente a virus como el dengue, fiebre amarilla, la encefalitis japonesa, o el virus del Nilo Occidental. El presente estudio es de tipo exploratorio con base en el registro de casos de recién nacidos y lactantes hijos de mujeres embarazadas con infección de virus Zika en la Unidad de Medicina Familiar Nº 60 de Coatzacoalcos, Veracruz, dentro del período de diciembre del 2016 a julio del 2017. Se realizó un estudio polietápico que constó de revisión de casos por medio de uso de expediente clínico en la Consulta Externa en la Unidad Médico Familiar Nº 60 del IMSS de Coatzacoalcos, Veracruz. como primera aproximación epidemiológica en esta región en recién nacidos y lactantes hijos de madres con infección por virus Zika, que posteriormente fueron sometidos a estudios de valoración oftalmológica, neurológica y somatométrica; con ayuda del servicio de Salud Pública de dicha unidad (AU)

Zika virus is an arbovirus of the genusflavivirus (family Flaviviridae), very close phylogenetically to viruses such as denque, yellow fever, japanese encephalitis, or West Nile virus. The present study is exploratory based on the registry of cases of newborns and infants born to pregnant women with zika virus infection in the Family Medicine Unit Nº 60 of Coatzacalcos, Veracruz, within the period of December 2016 to July 2017. A multistage study was carried out that consisted of the review of cases through the use of a clinical file in the Outpatient Consultation in the Family Medical Unit Nº 60 of the IMSS. of Coatzacoalcos, Veracruz. As a first epidemiological approach in this region in newborns and infants born to mothers with Zika virus infection, who were subsequently subjected to ophtalmological, neurological and somatometric assessment studies; with the help of the Public Health service of said unit (AU)

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BACKGROUND: Matricaria Chamomilla L. (Mch), popularly known as chamomile, has been used for centuries as an herbolary remedy due to its broad clinical spectrum. The aim of this study was to evaluate the effect of Mch associated to a vehicle with emollient function in induced atopic dermatitis (AD)-like lesions in a murine model. METHODS: AD was induced with dinitrochlorobenzene on 12 male seven-week old BALB/c mice. Animals were divided in three groups (control, GC; control negative, GCN; and experimental, GE). Liquid petrolatum was applied to the GCN and liquid petrolatum with aqueous extract of Mch at 7% to the GE. Induction and evolution of the lesions were verified by biopsy at 2nd and 6th week. Evaluation of peripheral blood cells to correlate inflammatory cells was made as well at the same weeks. Lesions were clinically evaluated at 2nd, 4th and 6th week. Scratching was monitored according to the observation methodology of Kobayashi et al. RESULTS: Mch aqueous extract associated to a vehicle with emollient function improves atopic dermatitis-like lesions after two weeks.

INTRODUCCIÓN: Matricaria chamomilla L. (Mch), conocida popularmente como manzanilla, ha sido utilizada por cientos de años como remedio herbolario debido a su amplio espectro en cuanto a sus usos clínicos. El objetivo de este trabajo fue evaluar el efecto de Mch asociada a un vehículo con función emoliente como tratamiento de lesiones tipo-dermatitis atópica (DA) en un modelo murino. MÉTODOS: se indujo DA con dinitroclorobenceno a 12 ratones BALB/c macho de siete semanas de edad, divididos en tres grupos (control, GC; control negativo, GCN y; experimental, GE). Se aplicó petrolato líquido al GCN y petrolato líquido con extracto acuoso de Mch al 7% al GE durante cuatro semanas. La inducción y evolución de las lesiones se corroboraron por biopsia a las dos y seis semanas, analizando sangre periférica en búsqueda de células inflamatorias en los mismos tiempos. Las lesiones fueron evaluadas clínicamente a las dos, cuatro y seis semanas. El rascado se evaluó de acuerdo a la metodología de observación de Kobayashi et al. RESULTADOS: el extracto acuoso liofilizado de Mch asociado a un vehículo con función emoliente demostró mejoría del aspecto de las lesiones tipo DA después de dos semanas.

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Librarian and information services focused on supporting research, teaching, and health care are vital for the generation of new knowledge and its application in health care, both by staff and students, helps to improve the quality of medical care. Therefore, in this article we expose an historical and social tour of 50 years of the Instituto Mexicano del Seguro Social's library services in Puebla. From 1964 to 2014 occurred many events in the development of these services in our area, from the creation of a small space in the basement, to the implementation of spaces created deliberately to provide dignified service to all users, which is why this historical sketch is here as an acknowledgement to the first librarians who contributed to the training of specialists in Mexico.

Los servicios bibliotecarios y de información enfocados a apoyar la investigación, la docencia y la atención médica son de vital importancia para la generación de nuevos conocimientos y su aplicación en la atención médica por el personal del área de la salud, y los alumnos en proceso de formación, contribuye a mejorar la calidad de la atención médica. Por ello, en el presente artículo exponemos un recorrido histórico y social de 50 años de los servicios bibliotecarios del Instituto Mexicano del Seguro Social en Puebla. De 1964 a 2014 ocurrieron muchos sucesos en el desarrollo de estos servicios en nuestro medio, desde la creación de un espacio pequeño ubicado en el sótano, hasta un espacio establecido ex profeso para otorgar servicio digno a todos los usuarios, por lo que se muestra este bosquejo histórico como reconocimiento a aquellos primeros bibliotecarios que contribuyeron a la formación de especialistas en México.

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Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes.

Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.

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BACKGROUND: Quality of life (QOL) is an important consideration in the counseling, implementation, and post-treatment management of arduous treatments for life-threatening conditions such as allogeneic hematopoietic cell transplantation (allo-HCT). OBJECTIVE: To analyze the QOL of leukemia patients allografted with the Mexican reduced-intensity conditioning regimen in two Mexican academic medical centers. MATERIAL AND METHODS: By means of the quality metric short form 36 version 2 to measure generic health concepts, relevant QOL was analyzed in leukemia patients who underwent allo-HCT using reduced-intensity conditioning on an outpatient basis at either the Centro de Hematología y Medicina Interna de Puebla of the Clínica Ruiz or the Hematology Service of the Internal Medicine Department of the Hospital "Dr. José Eleuterio González" of the Universidad Autónoma de Nuevo León, and who had survived more than 12 months after the allograft, who could be approached, who were in a continued complete remission (with or without graft-versus-host disease), and who were willing to respond to the questionnaire. Thirty-five patients fulfilling these requirements were included, and a sex- and age-matched group of 35 reference subjects was also studied. RESULTS: Allografted patients were found to have a slightly better mental component summary than the reference subjects (53.23 vs. 48.66 points; p = 0.01), whereas the physical component summary did not show a difference (54.53 vs. 52.05 points; p = 0.59). Most of the differences between allografted individuals and reference subject controls were not significant. CONCLUSIONS: Despite several sources of bias, these data suggest that allografted individuals employing the Mexican reduced-intensity conditioning regimen enjoy a health-related QOL life similar to that of reference subjects, adding another advantage of this method of conducting stem cell allografts. However, more work needs to be done to elucidate the impact of reduced-intensity conditioning on post allo-HCT QOL.

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INTRODUCTION: Hallux valgus is a frequent cause of pain, mainly in female population, characterized by deformity of the foot and important functional consequences. Open surgical techniques require relatively extensive incisions. Recently we see a tendency to use less invasive techniques with shorter hospitalization periods and better recovery. OBJECTIVE: To evaluate postsurgical clinical results in hallux valgus with minimally invasive surgery techniques according to the AOFAS scale. DESIGN: Longitudinal, prospective, descriptive and homodemic study. LOCATION: Hospital of Orthopedics and Traumatology, UMAE Puebla of the Mexican Institute of Social Security. MATERIAL AND METHODS: Twenty-nine patients with diagnosis of Hallux valgus treated between September 2004 and March 2008 were included. According to the AOFAS scale, we collected data from before the surgery, at one month and at 6 months postoperatively. We used univariate analysis of frequencies, measures of central tendency for demographic variables and the Wilcoxon test to evaluate pre and postoperative results with support from the SPSS version 12 program. RESULTS: The global evaluation of minimally invasive surgical technique according to AOFAS showed an average in the preoperative period of 60.37 (95% CI, between 53.87-66.38), at one month of 89 (95% CI, between 85.18-90.81) and at 6 months of 96.62 (95% CI, between 94.63-98.70). Mean age was 42 years (20-65), 22 women (75.86%) and 7 men (24.13%). We observed differences in the preoperative period, at one month and at 6 months with a p < 0.05 in global evaluation of AOFAS measurement scale for pain and function. DISCUSSION: Our results show that minimally invasive surgical technique is a good option for treatment of this pathology; they reveal the need to continue the study and to compare it with open surgical technique. Minimally invasive surgical technique, if properly done, reports good results and is an adequate therapeutic alternative for treatment of symptomatic hallux valgus.

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