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The therapy of children with acute lymphoblastic leukemia (ALL) in limited resource geospaces is challenging and must balance safety, efficacy, availability, and affordability. We modified the control arm of the St. Jude Total XI protocol for outpatient delivery including once-weekly daunorubicin and vincristine in initial therapy, postponing intrathecal chemotherapy until day 22, prophylactic oral antibiotics/antimycotics, use of generic drugs, and no central nervous system (CNS) radiation. Data were interrogated from 104 consecutive children ≤12 years (median, 6 years [interquartile range (IQR), 3, 9 years]. All therapies were given in an outpatient setting in 72 children. Median follow-up is 56 months (IQR 20, 126 months). A total of 88 children achieved a hematological complete remission. Median event-free survival (EFS) is 87 months [95% confidence interval (CI), 39, 60], 7.6 years in low-risk children (3.4, 8 years) whereas 2.5 years (1, 10 years) in high-risk children. The 5-year cumulative incidence of relapse (CIR) is 28% (18, 35%), 26% (14, 37%) in low-risk children and 35% (14, 52%) in high-risk children. Median survival for all subjects is not reached but must exceed 5 years. A total of 36 children relapsed at a median of 12 months (5, 23 months). Outcomes were comparable to those reported in the control arm of the Total Therapy XI study, but inferior to current treatment protocols in high-income countries. The average cost of the first 2 years of therapy was $28,500 USD compared with an average cost of approximately $150,000 USD in the US, an 80% saving. In conclusion, using an outpatient-based modification of the St. Jude Total XI protocol, we obtained good results with relatively few hospitalizations or adverse events and at a substantial saving. This model can be applied in other resource-poor geospaces.

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Background: Reliable national estimations for blindness and vision impairment are fundamental to assessing their burden and developing public health policies. However, no comprehensive analysis is available for Mexico. Therefore, in this observational study we describe the national burden of blindness and vision loss by cause and severity during 2019. Methods: Using public data from the Global Burden of Disease (GBD) study 2019, we present national prevalence and years lived with disability (YLDs) counts and crude and age-standardized rates (per 100,000 people) of total, severity- and cause-specific blindness and vision impairment with 95% uncertainty intervals (UIs) by sex and age group. Findings: In Mexico, the burden of blindness and vision impairment was estimated at 11.01 million (95% UI, 9.25-13.11) prevalent cases and 384.96 thousand (259.57-544.24) YLDs during 2019. Uncorrected presbyopia caused the highest burden (6.06 million cases, 4.36-8.08), whereas severe vision loss and blindness affected 619.40 thousand (539.40-717.73) and 513.84 thousand (450.59-570.98) people, respectively. Near vision loss and refraction disorders caused 78.7% of the cases, whereas neonatal disorders and age-related macular degeneration were among the least frequent. Refraction disorders were the main cause of moderate and severe vision loss (61.44 and 35.43%), and cataracts were the second most frequent cause of blindness (26.73%). Females suffered an overall higher burden of blindness and vision impairment (54.99% and 52.85% of the total cases and YLDs), and people >50 years of age suffered the highest burden, with people between 70 and 74 years being the most affected. Interpretation: Vision loss represents a public health problem in Mexico, with women and older people being the most affected. Although the causes of vision loss contribute differentially to the severity of visual impairment, most of the impairment is avoidable. Consequently, a concerted effort at different levels is needed to alleviate this burden. Funding: This study received no funding.

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The global burden of cancer is on the rise, with varying national patterns. To gain a better understanding and control of cancer, it is essential to provide national estimates. Therefore, we present a comparative description of cancer incidence and mortality rates in Mexico from 1990 to 2019, by age and sex for 29 different cancer groups. Based on public data from the Global Burden of Disease Study 2019, we evaluated the national burden of cancer by analyzing counts and crude and age-standardized rates per 100,000 people with 95% uncertainty intervals for 2019 and trends using the annual percentage change from 1990 to 2019. In 2019, cancer resulted in 222,060 incident cases and 105,591 deaths. In 2019, the highest incidence of cancer was observed in non-melanoma skin cancer, prostate cancer, and breast cancer. Additionally, 53% of deaths were attributed to six cancer groups (lung, colorectal, stomach, prostate, breast, and pancreatic). From 1990 to 2019, there was an increasing trend in incidence and mortality rates, which varied by 10-436% among cancer groups. Furthermore, there were cancer-specific sex differences in crude and age-standardized rates. The results show an increase in the national cancer burden with sex-specific patterns of change. These findings can guide national efforts to reduce health loss due to cancer.

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OBJECTIVE: Determine the proportion of vaccinated patients in a private hematology and internal medicine outpatient clinic and potential factors in adherence in at-risk patients (due to onco-hematological diseases). MATERIALS AND METHODS: This is a cross-sectional study of outpatients from a private clinic. We applied a non-validated instrument to all patients attending the outpatient clinic from May to October 2021. According to the primary diagnosis, we classified patients into onco-hematological and non-onco-hematological patients. Since national authorities exclusively executed and planned the rollout of vaccines, the order and eligibility defined by authorities of vaccination was considered when conducting the analysis and patients were classified according to the their corresponding group. RESULTS: 397 participants were accrued, 269 (68%) had an onco-hematological condition. In the whole group, 73 (18.3%) had a history of infection. Vaccination history was present in 286 persons (72%); 82% had two doses. In the subset of 269 persons with an onco-hematological condition, 191 (71%) were vaccinated, whereas 95 participants with non-hematological conditions (73%) had received the vaccine. Vaccination status was associated with age (OR 1.07, 95%CI: 1.03,1.10, p<0.0001) and body mass index (OR 1.11, 95%CI: 1.04,1.17, p<0.0001). CONCLUSIONS: According to our study, vaccination adherence at our center is significantly different from the nationwide proportion of vaccines.

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The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem to be related with better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude´s TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80 % of patients were able to receive the initial seven-week period of induction / consolidation fully as outpatients and 77 % achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48 %. In adults, the median probability of OS was 24 months, and the 5-year OS was 32 %. Patients with T-cell ALL did significantly worse than those with a B cell phenotype (OS at 5 years 17 versus 40 %, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD. We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC.

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In 2019, the Global Burden of Disease (GBD) estimated that prostate cancer (PC) was the 16th most common cause of death globally in males. In Mexico, PC epidemiology has been studied by a number of metrics and over various periods, although without including the most up-to-date estimates. Herein, we describe and compare the burdens and trends of PC in Mexico and its 32 states from 2000 to 2019. For this study, we extracted online available data from the GBD 2019 to estimate the crude and age-standardized rates (ASR per 100,000 people) of the incidence and mortality of PC. In Mexico, PC caused 27.1 thousand (95% uncertainty intervals, 20.6-36.0 thousand) incident cases and 9.2 thousand (7.7-12.7 thousand) deaths in males of all ages in 2019. Among the states, Sinaloa had the greatest ASR of incidence, and Guerrero had the highest mortality. The burden of PC showed an increasing trend, although the magnitude of change differed between metrics and locations. We found both an increasing national trend and subnational variation in the burden of PC. Our results confirm the need for updated and timely estimates to design effective diagnostic and treatment campaigns in locations where the burden of PC is the highest.

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INTRODUCTION: High-dose melphalan (HD-Mel) has been successfully employed in autografting patients with multiple myeloma. An advantage of this regimen is that the total dose of Mel can be delivered in a single day, being particularly useful when non-frozen hematopoietic stem cells are employed in the autograft. MATERIAL AND METHODS: All consecutive patients with R/R lymphomas, both HL and NHL studied and treated at two different centers were prospectively included in a study of ASCT employing a single dose of HD-Mel (200 mg/m2). A group of R/R HL or NHL autografted employing BEAM-like preparative regimens was constructed matched by diagnosis and age. The primary endpoint of the study was overall survival (OS), the secondary endpoint was event-free survival (EFS). RESULTS: Twenty-five R/R HL/NHL patients were prospectively accrued in the study. There were 8 (32%) females, 13 (52%) patients had at least 1 adverse effect: 7 (28%) developed mucositis, 5 (20%) neutropenic fever, and 6 (24%) grade IV nausea. In the HD-Mel group, median overall survival (OS) was not achieved and OS at 36 months was 71%, the transplant-related mortality being 0%. In the control group, median OS was not achieved and the 36-month OS was 76%, results not statistically significant (p 0.5). The EFS was also similar in both groups (p 0.5). CONCLUSION: HD-Mel alone is non-inferior to a BEAM-like regimen as a preparative regimen for autografting patients with R/R HL and NHL. The regimen is adequate to graft persons with non-frozen stem cells.

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The pharmacokinetics, PK/PD ratios, and Monte Carlo modeling of enrofloxacin HCl-2H2 O (Enro-C) and its reference preparation (Enro-R) were determined in cows. Fifty-four Jersey cows were randomly assigned to six groups receiving a single IM dose of 10, 15, or 20 mg/kg of Enro-C (Enro-C10 , Enro-C15 , Enro-C20 ) or Enro-R. Serial serum samples were collected and enrofloxacin concentrations quantified. A composite set of minimum inhibitory concentrations (MIC) of Leptospira spp. was utilized to calculate PK/PD ratios: maximum serum concentration/MIC (Cmax /MIC90 ) and area under the serum vs. time concentration of enrofloxacin/MIC (AUC0-24 /MIC90 ). Monte Carlo simulations targeted Cmax /MIC = 10 and AUC0-24 /MIC = 125. Mean Cmax obtained were 6.17 and 2.46 µg/ml; 8.75 and 3.54 µg/ml; and 13.89 and 4.25 µg/ml, respectively for Enro-C and Enro-R. Cmax /MIC90 ratios were 6.17 and 2.46, 8.75 and 3.54, and 13.89 and 4.25 for Enro-C and Enro-R, respectively. Monte Carlo simulations based on Cmax /MIC90  = 10 indicate that only Enro-C15 and Enro-C20 may be useful to treat leptospirosis in cows, predicting a success rate ≥95% when MIC50  = 0.5 µg/ml, and ≥80% when MIC90  = 1.0 µg/ml. Although Enro-C15 and Enro-C20 may be useful to treat leptospirosis in cattle, clinical trials are necessary to confirm this proposal.

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EL síndrome metabólico es un conjunto de factores de riesgo de origen metabólico que pueden aparecer de manera simultánea o secuencial en un mismo individuo, el SM es causado por la combinación de factores genéticos y factores asociados al estilo de vida, especialmente la sobrealimentación y la ausencia de actividad física, que promueven a su vez el desarrollo de enfermedades cardiovasculares (ECV) y otras patologías como la diabetes, enfermedad coronaria y cerebro vascular.. Entre los factores indirectos del síndrome metabólico, se ha establecido recientemente los niveles bajos de te stosterona como factor desencadenante en hombres. De allí que se desarrolló la presente investigación con el objeto de relacionar los niveles séricos de testosterona total y libre con el síndrome metabólico y sus criterios, en la población masculina. Para ello se determinaron los parámetros clínicos (presión arterial, circunferencia abdominal) y bioquímicos (glucemia basal, HDL-Colesterol, Triglicéridos ) que evalúan el síndrome metabólico asi como los niveles de Testosterona Total y Ligada . Resultados: los niveles de testosterona total y libre, son inferiores en el grupo de pacientes con síndrome metabólico, sin embargo al determinar la significancia estadística mediante la t de Student, no se aprecia diferencia en los valores promedio de testosterona total (sig 0,08) más si en los valores promedio de testosterona libre (sig 0,000). Ambas (testosterona total y libre) se correlacionan significativamente de manera inversa con la obesidad abdominal. Los niveles de testosterona libre se relacionan inversa y significativamente con la edad.

The Metabolic syndrome is a cluster of risk factors of metabolic origin that may occur simultaneously or sequentially in the same individual, the SM is caused by a combination of genetic factors and factors related to lifestyle, especially overeating and lack physical activity, which in turn promote the development of cardiovascular disease (CVD) and other diseases such as diabetes, heart disease and cerebrovascular .. Indirect factors of metabolic syndrome, was recently established low levels of testosterone as a factor trigger in men. Hence, this research was conducted in order to relate the serum total and free testosterone with metabolic syndrome and its criteria in the male population. For this clinical parameters (blood pressure, abdominal circumference) and biochemical (fasting glucose, HDL-cholesterol, triglycerides) evaluating the metabolic syndrome as well as Total Testosterone levels were determined and Bound. Results: The levels of total and free testosterone are lower in the group of patients with metabolic syndrome, however to determine statistical significance using Student's t, no difference was seen in the average values of total testosterone (sig 0.08 ) more if in the mean values of free testosterone (sig 0.000). Both (total and free testosterone) was significantly inversely correlated with abdominal obesity. Free testosterone levels are associated inversely and significantly with age.

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Objetivo: se realizó un estudio descriptivo y retrospectivo sobre el impacto socio-económico y extensionista del ingreso domiciliario en la Atención Primaria de Salud. Método: el universo estuvo constituido por todos los ingresos domiciliarios de los grupos básicos 1 y 2 del Policlínico Universitario "Hermanos Cruz" de Pinar de Río, durante el año 2008. Se determinaron las principales enfermedades que causaron ingreso domiciliario y se aplicó una encuesta para recoger los datos individuales y generales de los pacientes a quienes se les brindó este servicio. Se realizó la revisión de las historias clínicas individuales en los Consultorios Médicos de pertenencia, que los que reportaron como ingresos en este período. Se exploró sobre el papel y conocimiento de los estudiantes sobre el ingreso en el hogar y su labor extensionista a través de la promoción de salud y las actividades asistenciales. Se aplicaron los métodos de la estadística descriptiva. Resultados: las principales causas fueron: las afecciones del embarazo, la existencia de mayor satisfacción para la familia y el paciente con esta modalidad de atención, así como la labor extensionista de los estudiantes de medicina que rotaban por esos consultorios. Se demostró el costo-beneficio de 27 780,00 pesos diarios y 194 460,00 pesos semanales en relación al ingreso hospitalario además, existencia de una buena satisfacción en la comunidad por esta oferta de servicios médicos en la atención primaria de salud, que trae consigo la elevación de la resolutividad local y una mejor competencia y desempeño del Médico y Enfermera de la familia. Conclusión: sobre la viabilidad del sistema y la aceptación y beneficios económicos para la familia y el estado.

A retrospective and descriptive study was conducted at "Hermanos Cruz" Outpatient Clinic, Pinar del Rio during January 2008-2009 aimed at determining the socio-economic and extensional impact of domiciliary admissions. The target group was comprised of the total of this kind of admissions for number 1 and 2 basic working groups. The 10 main pathologies causing domiciliary admissions were determined, and a survey was applied to collect individual and general data of the patients under this medical care service. Individual Clinical Histories in the Doctor's Offices having domiciliary admissions during the period under study were revised. The role of medical students was explored, as well as their level of knowledge regarding domiciliary admissions, extensional doings through health promotion and medical care activities. One of the main causes was pregnancy-associated illnesses; verifying a greater familial and patient agreement with this type of admission. Extensional activities of medical students during the training period at the doctor's offices were considered satisfactory. The cost-benefit reached a figure of 27780.00 Cuban pesos daily and 194460.00 Cuban pesos weekly compared with hospital admissions; as well as the level of satisfaction in the community regarding this modality of medical services in Primary Health Care. Higher local solutions to health problems are achieved, together with better competence and performance of the Family Doctors and Nurses.

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La Extensión Universitaria se enmarca en una perspectiva estratégica en su correspondiente expresión dentro de la planeación, tanto a nivel del sistema de la Educación Médica Superior como en el de las propias instituciones y sus estructuras. La Universalización de la Educación Médica Superior en Cuba es una realidad, se impone la necesidad de una estrategia que fortalezca desde la Atención Primaria a través de la promoción de salud, la labor extensionista de la universidad médica con la comunidad y para la comunidad. Mediante el método de revisión bibliográfica, el método comparativo e histórico lógico, así como la aplicación de encuestas, se presentan preceptos teóricos que tributan a la concepción de la estrategia antes mencionada. La promoción de salud es el eje central de la labor extensionista en la Universidad Médica Cubana, coadyuvando a elevar el nivel de conciencia y la capacidad de acción, tanto individual como colectiva a través de sus proyectos en vertientes fundamentales como la comunidad universitaria y extrauniversitaria, con la identificación de las principales necesidades de salud.

University extension must be in the line of the strategic perspective and its respective expression within the strategic planning toward Higher Medical Education, institutions and their structures. Currently, the Universalization of Higher Medical Education is a reality in Cuba, and the need of a strategy to strengthen primary health care by means of health promotion is imperative; as well as the university extension within the community and to the community. Methods such as: Literature reviews, comparative and historical-logical, surveys together with theoretical precepts which respond to the conception of the mentioned strategy were used. Health promotion is the Axis of the university extension in Cuban Medical Universities, contributing to the development of individual and collective awareness with the capacity of action simultaneously, and through projects into the main aspects: university and extra-university activities to identify the most important health needs in the community.

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RESUMEN La Extensión Universitaria dada su importancia y complejidad debe enmarcarse en una perspectiva estratégica y en su correspondiente expresión dentro de la planeación, tanto a nivel del sistema de la Educación Médica Superior, como al de las propias instituciones y sus estructuras. En el momento actual donde la Universalización de la Educación Médica Superior en Cuba es una realidad, se impone la necesidad de una estrategia que fortalezca desde la atención primaria a través de la promoción de salud la labor extensionista de la universidad médica con la comunidad y para la comunidad. Sin embargo, aún la materialización práctica del concepto amplio sobre dicho trabajo muestra algunas barreras. El trabajo promocional y sociocultural universitario denota una marcada relación dialéctica entre sus dos dimensiones: la administrativa y la tecnológica, las que desde su comprensión e implementación posibilitan perfeccionar la labor extensionista de la Universidad. El nuevo paradigma descansa sobre un concepto amplio de la Extensión Universitaria, diversificado con su consecuente aplicación en la práctica, asumiéndolo como un proceso formativo, dinámico e integrador, multifacético respaldado por un sistema de formación y capacitación, estimulación, comunicación y aseguramiento que hagan más efectiva dicha labor. La promoción de salud es el eje central de la labor extensionista en la Universidad Médica Cubana, coadyuvando a elevar el nivel de conciencia y la capacidad de acción, tanto individual como colectiva a través de sus proyectos en vertientes fundamentales como la comunidad universitaria y extrauniversitaria, con la identificación de las principales necesidades de salud (ASS).

ABSTRACT The university extension, due to its importance and complexity, must be in line with a strategic perspective and with its corresponding expression within the planning of Higher Medical Education and at the level of the institutions and their structures at the same time. Currently, the universalization of Higher Medical Education in Cuba is a reality, that is why it is necessary to create a strategy which reinforces primary health care by means of health promotion, the features of the medical university extension for and with the community. However; in practice such concept shows some barriers to bring it to fruition. Promotional and university sociocultural works indicate a marked dialectic relationship between the two dimensions: administrative and technological, which from the point of view of its comprehension and implementation make possible to perfect the university extension. The new paradigm is supported by an all-embracing concept of University Extension, that is consistently diversified into its application in practice and undertake as a formative, dynamic, comprehensive and multi-faceted process, which at the same time is endorsed by a system of formation, training, encouragement, communication and assurance to make this work more effective. Health promotion is the core of the university extension in Cuban Medical University, it contributes to increase the level of awareness and the capacity of action from the individual and collective point of view by means of its projects; having basic aspects such as: the university and the extra-university community, where the main health needs are identified.

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La úlcera varicosa es una complicación frecuente en la insuficiencia venosa de los miembros inferiores que condiciona múltiples trastornos locales y sistémicos, con una mala calidad de vida del paciente. El objetivo del presente trabajo fue evaluar el efecto cicatrizante del oleozón en ulceras varicosas de los miembros inferiores en la atención primaria. Se tomó una muestra de 60 pacientes con úlceras varicosas en miembros inferiores que fueron divididos en dos grupos: A) 30 tratados con oleozón®, B) 30 tratados convencionalmente, de forma ambulatoria desde enero de 2007 hasta mayo de 2008. Se consideró como buen resultado cuando a los 45 días de tratamiento o antes, el paciente presentó una remisión parcial o total y se consideró fracasado cuando no hubo remisión. Se utilizó la prueba de comparación de frecuencias de X² al 95 % de confianza y obtuvo un incremento significativo del doble de casos con remisión total bajo tratamiento con oleozón®, de manera que la eficacia quedó comprobada para el tratamiento ambulatorio en la Atención Primaria de Salud, de las úlceras varicosas de miembros inferiores, rebeldes a tratamiento convencional.

Varicous ulcers are frequent complications of the venous insufficiency of the lower limbs, leading to multiple local and systemic impairments, producing patients having bad quality of life. The aim of the present paper was to evaluate the scarring effect of oleozón®, on various ulcers of the lower limbs at the Primary Health Care level. A sample of60 patients were divided into two groups: A) 30 patients, receiving ozonized oil (oleozón®), B) 30 patients conventionally treated, in ambulatory way since January 2007 to May 2008. A good result was considered when after 45 days of treatment or before that time a partial or total remission was obtained, and failure when no remission was observed. X2 test was used to compare frequencies at 95 % of certainty. There was two fold number of cases under on remission in group A, showing the efficacy of the treatment, otherwise rebels to the conventional treatment.

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Entre 2001 y 2005, se revisaron 52 pacientes con patología compleja de la cadera (luxación congénita e inveterada de cadera, revisión de reducción abierta de luxación congénita de cadera y enfermedad de Legg-Calve-Perthes), con un promedio de edad de 9,5 años. En todos estos pacientes se usaron aloinjertos óseos estructurales (tira de cresta ilíaca bicortical o tricortical), los cuales se tallaban para hacer la acetabuloplastia de aumentación y se ubicaban tangenciales a la cabeza femoral sobre la cápsula articular fijándolos al ilíaco a través de un tornillo cortical de 3,5 mm. Se observó una mejoría de los parámetros radiológicos como ángulo centro-borde de Wiberg, índice acetabular de Tõnnis y porcentaje de cubrimiento acetabular. En el 100% de los casos el aloinjerto se incorporó al ilíaco original con un bajo índice de complicaciones. Con la actual disponibilidad de un Banco de Huesos, es plausible realizar reconstrucciones acetabulares en casos complejos de la población pediátrica, disminuyendo la morbilidad del procedimiento mediante aloinjertos masivos. Éste se convierte en un procedimiento de salvamento que mejora la cobertura ósea de la cabeza femoral, disminuyendo las cargas por Unidad de área y, por ende, retrasando la aparición de fenómenos degenerativos.

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El páncreas bífido es una anormalidad congénita poco común. Se han publicado dos casos de esta variante anatómica. El objetivo es presentar uno nuevo con esta anormalidad en el conducto pancreático. La historia clínica corresponde a una mujer de 54 años de edad, con carcinoma del recto e ictericia obstructiva por metástasis a hilio hepático. La colangiopacreatografía endoscópica, confirmó obstrucción biliar sin posibilidades de manejo endoscópico. El conducto pancreático mostró ser de tipo bífido. Se ilustran las características radiológicas de páncreas bífido

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Antecedentes. Existe mucha controversia en el uso de la esfinterotomía endoscópica de precorte condicionado a lo conflictivo de los resultados en la literatura. A pesar de ello, múltiples centros hospitalarios han reportado éxito en el uso de esta técnica para incrementar la tasa de canulación de la vía biliar y poder realizar maniobras terapéuticas. Objetivo. Determinar la seguridad y eficacia en la práctica de esfinterotomía endoscópica de precorte así como la incidencia de complicaciones. Material-métodos y resultados. Realizamos esfinterotomía endoscópica de precorte en 120 pacientes en quienes no fue posible la canulación selectiva de la vía biliar ni la práctica de esfinterotomía convencional o guiada. El diámetro del conducto colédoco fue correlacionada con la tasa de complicaciones. La canulación de la vía biliar y la práctica de esfinterotomía convencional o guiada. El diámetro del conducto colédoco fue correlacionado con la tasa de complicaciones. La canulación de la vía biliar y la práctica de esfinterotomía de precorte en 103 pacientes (86 por ciento ) y en 12 de los 17 pacientes en quienes se repitió el procedimiento, para una tasa total de canulación del 96 por ciento. Ocho pacientes (6.9 por ciento) presentaron complicaciones, seis con hemorragia y dos con perforación retroduodenal que fueron manejadas en forma conservadora sin mortalidad relacionada al procedimiento. Un paciente con hemorragia digestiva fue intervenido quirúrgicamente. El diámetro normal de las vías biliares se consideró factor de riesgo para conplicaciones. Conclusiones. La esfinterotomía de precorte es segura y eficaz, debe evitarse en pacientes con vías biliares no dilatadas y realizarse por un endoscopista con habilidad y experiencia

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En Cuba se han realizado dos encuestas antropométricas de niños y adolescentes basadas en muestras nacionales y un tercer estudio en la provincia de Ciudad de La Habana que han permitido conocer las características físicas de esa población y evaluar periódicamente su situación nutricional. En este trabajo se presentan los resultados obtenidos al comparar los pesos y las tallas de los niños de 0 a 5 años residentes en dicha provincia, que integraron las muestras analizadas en los referidos estudios, con los valores internacionales de referencia propuestos por la OMS. Estos resultados indican que, a pesar de las dificultades económicas que enfrenta el país, la prevalencia de desnutrición en estos niños es muy baja. En 1993, la prevalencia de talla baja para la edad fue 3,1%, la de peso bajo para la talla, 0,4%, y la de peso bajo para la edad, 1,5%. El sobrepeso fue la forma de malnutrición más frecuente y su prevalencia ascendió a 5,2%. Entre 1972 y 1993 la prevalencia de desnutrición crónica se redujo 32,6%, la de desnutrición aguda, 69,2%, la de desnutrición global, 44,4%, y la de sobrepeso, 48,5%.

Two anthropometric surveys of children and adolescents have been carried out in Cuba with national samples. A third study done in the province of Ciudad de la Habana provided information on the physical characteristics of the population in that area and a baseline for the periodic evaluation of its nutritional status. This article compares the weight and height results obtained in these surveys for children 0 to 5 years old who lived in this province with the international reference standards proposed by WHO. The results show that, despite the economic difficulties the country has faced, the prevalence of malnutrition is low. In 1993, the prevalence of low heightfor-age was 3.1%; that of low weight-for-height, 0.4%; and that of low weight-for-age, 1.5%. Overweight was the most common type of malnutrition, with a prevalence of 5.2%. Between 1972 and 1993, the prevalence of chronic malnutrition fell 32.6%, acute malnutrition was reduced by 69.2%; malnutrition of all types decreased by 44.4%; and overweight fell 48.5%.

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Se presentan los valores de circunferencia cefálica, obtenidos del estudio de una muestra representativa de la población del país entre 0,1 y 19,9 años de edad, integrada por 29 759 individuos de uno y otro sexos. Se dan a conocer las correcciones de los valores de circunferencia cefálica del estudio nacional de 1972 y se comparan los resultados con los de 1982

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