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Resumen: Introducción: La atresia de vías biliares (AVB) es una condición que provoca obstrucción al flujo biliar, y de no corregirse quirúrgicamente, provoca cirrosis y la muerte antes de los 2 años de edad. En México, a partir del año 2013 se incorporó la tarjeta colorimétrica visual (TCV) para la detección oportuna de la AVB a la Cartilla Nacional de Salud (CNS). El objetivo de este estudio fue evaluar el impacto de la TCV para la detección de AVB antes y después de su incorporación a la CNS. Métodos: Estudio ambispectivo, observacional y analítico. Se incluyeron pacientes con AVB atendidos en dos hospitales pediátricos de tercer nivel de atención. Se compararon la edad de referencia, el diagnóstico y la cirugía antes y después de la incorporación de la TCV. Además, se realizó un cuestionario a los padres para conocer su percepción sobre la TCV. Resultados: En 59 niños no hubo diferencias en la edad al diagnóstico (75 vs 70 días) ni en la edad al momento de la cirugía (84 vs 90 días) entre antes y después de la implementación de la TCV. Solo el 30% de los padres recibieron información del uso de la TCV y solo el 38% identificaron las evacuaciones anormales. Conclusiones: Este estudio no mostró cambios en el tiempo para la detección oportuna de AVB mediante el uso de la TCV. Por lo tanto, es necesario reforzar el programa en los tres niveles de atención en nuestro país.

Abstract: Background: Bile duct atresia (BVA) is a condition that causes obstruction to biliary flow, not corrected surgically, causes cirrhosis and death before 2 years of age. In Mexico from 2013 the visual colorimetric card (VVC) was incorporated for the timely detection of BVA to the National Health Card (NHC). The aim of this study was to evaluate the impact of VCT for the detection of BVA before and after the use of NHC incorporation. Methods: Ambispective, analytical observational study. We included patients with AVB treated in two pediatric hospitals of third level care. We compared the age of reference, diagnosis and surgery before and after incorporation of the TCV. In addition, a questionnaire was made to the parents to know their perception about the TCV. Results: In 59 children, there were no differences in age at diagnosis (75 vs 70 days) and age at surgery (84 vs 90 days) between the pre and post-implementation period of the VVC. The questionnaire showed that 10 (30%) of the parents received information about the use of the VVC and 13 (38%) identified the abnormal evacuations. Conclusions: This study did not show changes in time for the timely detection of BVA by using VVC. Therefore, it is necessary to reinforce the program in the three levels of care in our country.

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Background: Bile duct atresia (BVA) is a condition that causes obstruction to biliary flow, not corrected surgically, causes cirrhosis and death before 2 years of age. In Mexico from 2013 the visual colorimetric card (VVC) was incorporated for the timely detection of BVA to the National Health Card (NHC). The aim of this study was to evaluate the impact of VCT for the detection of BVA before and after the use of NHC incorporation. Methods: Ambispective, analytical observational study. We included patients with AVB treated in two pediatric hospitals of third level care. We compared the age of reference, diagnosis and surgery before and after incorporation of the TCV. In addition, a questionnaire was made to the parents to know their perception about the TCV. Results: In 59 children, there were no differences in age at diagnosis (75 vs 70 days) and age at surgery (84 vs 90 days) between the pre and post-implementation period of the VVC. The questionnaire showed that 10 (30%) of the parents received information about the use of the VVC and 13 (38%) identified the abnormal evacuations. Conclusions: This study did not show changes in time for the timely detection of BVA by using VVC. Therefore, it is necessary to reinforce the program in the three levels of care in our country.

Introducción: La atresia de vías biliares (AVB) es una condición que provoca obstrucción al flujo biliar, y de no corregirse quirúrgicamente, provoca cirrosis y la muerte antes de los 2 años de edad. En México, a partir del año 2013 se incorporó la tarjeta colorimétrica visual (TCV) para la detección oportuna de la AVB a la Cartilla Nacional de Salud (CNS). El objetivo de este estudio fue evaluar el impacto de la TCV para la detección de AVB antes y después de su incorporación a la CNS. Métodos: Estudio ambispectivo, observacional y analítico. Se incluyeron pacientes con AVB atendidos en dos hospitales pediátricos de tercer nivel de atención. Se compararon la edad de referencia, el diagnóstico y la cirugía antes y después de la incorporación de la TCV. Además, se realizó un cuestionario a los padres para conocer su percepción sobre la TCV. Resultados: En 59 niños no hubo diferencias en la edad al diagnóstico (75 vs 70 días) ni en la edad al momento de la cirugía (84 vs 90 días) entre antes y después de la implementación de la TCV. Solo el 30% de los padres recibieron información del uso de la TCV y solo el 38% identificaron las evacuaciones anormales. Conclusiones: Este estudio no mostró cambios en el tiempo para la detección oportuna de AVB mediante el uso de la TCV. Por lo tanto, es necesario reforzar el programa en los tres niveles de atención en nuestro país.

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BACKGROUND: Although pulmonary involvement is common in patients with cancer, its frequency and nature is seldom reported in the medical literature. OBJECTIVE: To determine the frequency and type of lung pathological conditions revealed by autopsy in children with cancer. METHODS: All reports from autopsies performed in children with cancer from 1989 to 2012 in a pediatric hospital were reviewed. RESULTS: In the analyzed period, 118 autopsies (10.2% of all autopsies) corresponded to children who died with cancer; 76 had complete information and were included in the analysis. Children were seen in the Hematology (41 cases) or the Oncology (35 cases) services. Their median age at decease was 7 years (range, 15 days to 16.1 years) and 46.1% were females. Main diagnoses were acute lymphoblastic (31 patients) or myeloblastic (10 patients) leukemias and tumors of the central nervous system (12 patients). A pathological respiratory condition was diagnosed antemortem in 31 (40.8%) patients, and at autopsy in 62 (81.6%) cases. Omitted diagnoses occurred in 58 (76.3%) children, being pneumonia (24 cases) and pulmonary hemorrhage (23 cases) the most frequent omissions. Nine patients had clinically unsuspected tumor infiltration or metastases. CONCLUSIONS: In these children with cancer, more than 80% of autopsies revealed some lung pathology, mainly of infectious or hemorrhagic nature. Thus, pulmonary involvement should be investigated in all children with cancer in a timely and intentional manner.

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UV spectrophotometric measurement is a widely accepted and standardized routine analysis for quantitation of highly purified proteins; however, the reliability of the results strictly depends on the accuracy of the employed extinction coefficients. In this work, an experimental estimation of the differential refractive index (dn/dc), based on dry weight measurements, was performed in order to determine accurate extinction coefficients for four biotherapeutic proteins and one synthetic copolymer after separation in a size-exclusion ultra-performance liquid chromatograph coupled to an ultraviolet, multiangle light scattering and refractive index (SE-UPLC-UV-MALS-RI) multidetection system. The results showed small deviations with respect to theoretical values, calculated from the specific amino acid sequences, for all the studied immunoglobulins. Nevertheless, for proteins like etanercept and glatiramer acetate, several considerations, such as glycan content, partial specific volume, polarizability, and higher order structure, should be considered to properly calculate theoretical extinction coefficient values. Herein, these values were assessed with simple approximations. The precision of the experimentally obtained extinction coefficients, and its convergence towards the theoretical values, makes them useful for characterization and comparability exercises. Also, these values provide insight into the absorbance and scattering properties of the evaluated proteins. Overall, this methodology is capable of providing accurate extinction coefficients useful for development studies.

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OBJECTIVE: To compare the satisfaction level in the academic working environments (AWE) between the residents of two training primary care units. METHODS: Observational, transversal and comparative study. A previously constructed and validated instrument was applied, it included 30 items that evaluated the AWE with the following indicators: support, satisfaction, participation and respect; the reliability index's instrument was high (Cronbach's alpha is 0.88). The statistical analysis was made with the Mann-Whitney U test, and χ2 test for proportions. RESULTS: Regarding the AWE, 4.28% of the residents obtained a really inappropriate environment; 8.57% very appropriate and 14% inappropriate environment. However the 72% was between intermediate environments. No statistical significant difference was found between the three measurements. CONCLUSIONS: Our results are consistent with other national studies results where the "respect" indicator was the one with higher rank. The environment along with "participation," and "support," creates a favorable relationship among residents, teachers and the staff. However, the "imposition" and "rigidity" produces a decrease in the collective participation.

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OBJECTIVE: To evaluate the competence of the primary care physicians for the evaluation of rheumatic disorders. PARTICIPANTS AND METHODS: In a cross-sectional survey we included primary care physicians working at the official Mexican Social Security Institute that provides nation-wide health-care for salaried workers. Four hospitals from 23 potentially eligible primary-care hospitals in Guadalajara, Jalisco, Mexico, were randomly selected. From these hospitals the physicians who agree to participate were asked to answer a questionnaire for clinical competence. Using a Delphi modified approach; this questionnaire was elaborated by a group of rheumatologists and researchers working in continuous medical education. A Kuder-Richardson reliability index was computed in 0.94. The diseases included in the questionnaire were: (1) rheumatoid arthritis, (2) Sjogren syndrome, 3) gout, 4) osteoarthritis and 5) systemic lupus erythematosus and questions regarding to these were made using the technique of "representative patients". Domains included in the questionnaire were: assessment of risk factors, strategies for diagnosis, and treatment. According to the scores obtained in the questionnaire the ranges for clinical competence were: very high level 93-110 points, high level 75-92, moderate 57-74, low 39-56, very low 21-38 and <20 points was considered obtained by chance. RESULTS: One-hundred and four primary care physicians were interviewed. From the total, 60 (58%) physicians had the speciality of family physician. Only 11% (95% CI 5-17) of the interviewed had a high level of competence according to the instrument. Moderate competence was achieved by 20% (95% CI 13-27), whereas suboptimal levels had 51%: being low 31% (95% CI 22-40), very low 20% (95% CI 13-27). An additional 18% had scores obtained by chance (95% CI 11-25). There was no statistical difference in the scores between physicians with or without the specialty in family medicine. CONCLUSIONS: These results pointed-out a sub-optimal competence in a significant proportion of the primary care-physicians attending rheumatic disorders. Higher efforts need to be made to increase the levels of competence and improve the effectiveness of continuous medical education for these physicians.

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BACKGROUND: From a participative educational position view, enhancement of the teaching is subjected to the fact that mentors had though about conditions and circumstances that determine their performance and to get a solid position that guides them into overcoming their day-to-day trouble burden. Our objective was to measure effects of a participative educational strategy that motivates critical evaluation in the development of a position on education; seven groups of teachers were compared. METHODS: Through a longitudinal comparative intervention design, 71 students (mentors) coming from seven educational interventions, were studied, during a period from 2002 to 2005. RESULTS: Differences between previous and posterior to educational process measuring were statistically significant in favor of the development of a position in all the groups (Wilcoxon p < 0.01); 68 out of 71 mentors developed a position on education. CONCLUSIONS: A participative educational strategy consolidated a personal position, resulting from the reflexive activity of the mentor.

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OBJECTIVE: To evaluate the scope of an educational strategy for developing an aptitude for critical reading of educational research information (CRERI) and for clinical research information (CRCRI). METHODS: A longitudinal, intervening, comparative study was performed on seven groups with educational interventions that promote development skills rather than learning contents. This was evaluated through two instruments that measure skills for critical reading information from educational and clinical investigation reports. RESULTS: Significant differences were encountered favorable to CRCRI, among the initial and final evaluation of students in a whole manner (p < 0.001). Group analysis showed differences until the end of educational interventions in three of them (p < 0.01). CONCLUSIONS: The educational strategy had two favorable effects on the CRCRI; nevertheless the educational interventions were solely aimed at promoting CRERI. The extension from one to another aptitude was shown to be independent of contents. This strategy can be an alternative for encouraging students to self-learning, which leads to a better usage of available information sources.

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INTRODUCTION: In research activities, critical thinking about mechanisms that control the selection of certain knowledge forms and correlative practices are unusual. OBJECTIVE: To compare the levels of epistemological meditation in professional groups with different grades of expertise in research field. METHODS: Prolective, comparative, cross-sectional study by means of validated questionnaire that measure posture (consistence in points of view about diverse scientific conceptions and activities), main indicator of epistemological meditation level. Three groups were included: 25 professional biomedical researchers (group "A"), 22 postgraduate professors of health sciences (group "B") and 16 postgraduate students of social sciences (group "C"). RESULTS: Most participants showed low scores in posture with not significant differences between groups (p > 0.05). However, group "B" after an educational intervention, showed significant increase in consistence points of view (p < 0.01). DISCUSSION: Epistemological meditation about scientific work is not a feature of research activities in studied groups. The grades of expertise in research field do not have influence in posture development.

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Anti-fungi activity of organic extracts from the tree Fagara monophylla (Rutaceae) in Venezuela. The tree Fagara monophylla ranges throughout Tropical America. The genus Fagara has a diversity of alkaloid compounds with antibiotic properties; nevertheless, there are few reports antifungal activity of its organic compounds. Organic extracts from Venezuelan F. monophylla were tested for antimicrobial activity against Aspergillus terreus, A. flavus, Penicillium digitatum, P. funiculosum, P. citrinum, Paecilomyces and Candida albicans. Minimal Inhibitory Concentration (MIC) was determined. The susceptibility trials of organic fractions (Hex., CH2Cl2 and MeOH) showed that the highest inhibition was presented by MeOH against A. flavus (55 mm), P. digitatum (60 mm), P. funiculosum (56 mm) and C. albicans (26 mm). The activities of MeOH/EtOAc fractions 1 and 2 suggest a combined effect against A. flavus, P. digitatum and P. funiculosum. The MIC of 1 MeOH/ EtOAc subfraction activity was lower against C. albicans (32 µg/ml) and moderate (128 µg/ml) against P. digitatum. This organic extract has a great antifungal potential. The phytochemical proves and TLC testing on the organic extract, and the MeOH/EtOAc subfraction, respectively, indicated the presence of alkaloid compounds. Rev. Biol. Trop. 55 (3-4): 767-775. Epub 2007 December, 28.

Fagara monophylla está distribuida en América Tropical. El género Fagara tiene diversidad de compuestos alcaloides con propiedades antibacterianas; sin embargo existe escasa información acerca de su actividad antifúngica. Evaluamos extractos de F. monophylla in vitro con los hongos Aspergillus terreus, A. flavus, Penicillium digitatum, P. citrinum, P. funiculosum, Paecilomyces y Candida albicans determinando la Concentración Mínima Inhibitoria (CMI). Hicimos pruebas de susceptibilidad con las fracciones Hex., CH2Cl2 y la MeOH. La mayor inhibición la presentó la fracción MeOH frente a A. flavus (55 mm), P. digitatum (60 mm), P. funiculosum (56 mm) y C. albicans (26 mm). Las actividades mostradas por las fracciones 1 y 2 de MeOH/EtOAc sugieren la acción de un efecto combinado frente a A flavus, P, digitatum y P. funiculosum. La CMI de la subfracción 1 MeOH/EtOAc frente a Candida albicans fue baja (32 µg/ml), y para P. digitatum la CMI fue moderada (128 µg/ml). Este extracto orgánico posee gran potencial de actividad antifúngica. Las pruebas fitoquímicas y los ensayos realizados por TLC al extracto orgánico y a la subfracción 1 MeOH/EtOAc, respectivamente, mostraron la presencia de alcaloides.

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The tree Fagara monophylla ranges throughout Tropical America. The genus Fagara has a diversity of alkaloid compounds with antibiotic properties; nevertheless, there are few reports antifungal activity of its organic compounds. Organic extracts from Venezuelan F. monophylla were tested for antimicrobial activity against Aspergillus terreus, A. flavus, Penicillium digitatum, P. funiculosum, P. citrinum, Paecilomyces and Candida albicans. Minimal Inhibitory Concentration (MIC) was determined. The susceptibility trials of organic fractions (Hex., CH2Cl2 and MeOH) showed that the highest inhibition was presented by MeOH against A. flavus (55 mm), P. digitatum (60 mm), P. funiculosum (56 mm) and C. albicans (26 mm). The activities of MeOH/EtOAc fractions 1 and 2 suggest a combined effect against A. flavus, P. digitatum and P. funiculosum. The MIC of 1 MeOH/ EtOAc subfraction activity was lower against C. albicans (32 microg/ml) and moderate (128 microg/ml) against P. digitatum. This organic extract has a great antifungal potential. The phytochemical proves and TLC testing on the organic extract, and the MeOH/EtOAc subfraction, respectively, indicated the presence of alkaloid compounds.

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Objetivo: conocer algunas características hospitalarias e identificar su asociación con las defunciones calificadas como inesperadas. Material y métodos: se trata a un estudio transversal en el que fueron evaluados los expedientes de las defunciones ocurridas entre 1994 y 1995 en un hospital pediátrico de tercer nivel, sin distinción del sexo, edad o enfermedad del paciente. Una vez valoradas, las defunciones fueron calificadas como esperadas, inesperadas o súbitas por el Subcomité de Mortalidad del hospital. El análisis se realizó con medidas de frecuencia y estimación de pruebas de hipótesis para muestras independientes con intervalo de confianza de 95 por ciento (IC 95 por ciento). Resultados: se estudiaron 411 defunciones evaluadas por el Subcomité de Mortalidad, que representaron 79.5 por ciento del total. De acuerdo con la evolución del padecimiento, 67.6 por ciento fue calificado como defunción esperada a corto plazo, 11.9 por ciento como esperada a largo plazo, 15.6 por ciento inesperada y 4.9 por ciento súbita. Los pacientes evaluados como estables al ingreso tuvieron mayor frecuencia de defunciones inesperadas que los muy graves (OR = 8.4, IC 95 por ciento = 3.9-18). La identificación de problemas en el diagnóstico (OR = 2.3, IC 95 por ciento 1.3-3.8) y en el tratamiento (OR = 3.8, IC 95 por ciento = 2.3-6.2) fueron variables que presentaron diferencias significativas. Conclusiones: la evaluación de las condiciones en que se presentaron las defunciones respecto a la atención hospitalaria permite tomar medidas que pueden prevenir problemas en la atención médica futura

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Debido al riesgo que para la salud significa por sus efectos tóxicos, cancerígenos y mutágenos entre otros, la presencia de aflatoxinas en los alimentos y sobre todo en aquellos de mayor consumo por nuestra población, como son el arroz y el trigo, se investigó la posible presencia de aflatosina B en estos cereales, tanto de importación como de producción nacional, durante 1981. Para lograr esto, se seleccionaron aleatoriamente 156 muestras, de las cuales 76 correspondían a arroz y 80 a trigo y algunos derivados de éste, como son la harina de trigo, el gofio y la harina lacteada. Las determinaciones analíticas se realizaron por el método de multidetección de Stoloff (1971), modificado por Szigeti y Rodríguez en 1979 y las muestras que resultaron sospechosas de contaminación con aflatoxina B, se sometieron al análisis específico descrito por Jones, 1972. Como resultado se detectó sólo una muestra positiva de arroz. Por lo que se concluye que el arroz y el trigo analizado no son fuente significativa de contaminación con aflatoxina B, para la población consumidora, no obstante se recomienda la aplicación de prácticas agrícolas y de almacenaje correctas para evitar posible contaminación de estos cereales (AU)

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Debido al riesgo que para la salud significa por sus efectos tóxicos, cancerígenos y mutágenos entre otros, la presencia de aflatoxinas en los alimentos y sobre todo en aquellos de mayor consumo por nuestra población, como son el arroz y el trigo, se investigó la posible presencia de aflatosina B en estos cereales, tanto de importación como de producción nacional, durante 1981. Para lograr esto, se seleccionaron aleatoriamente 156 muestras, de las cuales 76 correspondían a arroz y 80 a trigo y algunos derivados de éste, como son la harina de trigo, el gofio y la harina lacteada. Las determinaciones analíticas se realizaron por el método de multidetección de Stoloff (1971), modificado por Szigeti y Rodríguez en 1979 y las muestras que resultaron sospechosas de contaminación con aflatoxina B, se sometieron al análisis específico descrito por Jones, 1972. Como resultado se detectó sólo una muestra positiva de arroz. Por lo que se concluye que el arroz y el trigo analizado no son fuente significativa de contaminación con aflatoxina B, para la población consumidora, no obstante se recomienda la aplicación de prácticas agrícolas y de almacenaje correctas para evitar posible contaminación de estos cereales

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