RESUMO
With the limitations of surgical reconstructive procedures, the growing number of gunshot wounds, burns, and work accidents in Mexico that result in complex facial deformities leaves only 1 option-face transplantation. The National Institute of Medical Sciences and Nutrition "Salvador Zubiran" (INCMNSZ) has performed transplants since 1971. We at INCMNSZ undertook the 1st bilateral upper-limb transplantation in Latin America in 2012. We are willing to continue in this manner toward conducting face transplantation at our institute. To this end, we identified and solved various challenges. The 1st challenge was acceptance and inclusion of vascularized composite allotransplantation (VCA) within general Mexican health law and approval of the face transplantation procedure. Subsequently, the health ministry provided a license to INCMNSZ to perform the procedure. The 2nd challenge concerned who would pay for the procedure. The costs will be paid by the patient (1st-party payer), social security institutions (2nd-party payers), and the health ministry (3rd-party payer). The 3rd challenge was to maintain ongoing surgical training of the team using cadavers. The fourth challenge was to locate donors; toward this end, we developed a campaign for promoting face donation in social media, making a comic book, and training organ and tissue coordinators to further VCA. Thus, INCMNSZ has the legal, administrative, medical, and surgical wherewithal to accomplish face transplantation.
Assuntos
Face/cirurgia , Traumatismos Faciais/cirurgia , Transplante de Face/métodos , Doadores de Tecidos , Cadáver , Traumatismos Faciais/epidemiologia , Humanos , Incidência , México/epidemiologia , Alotransplante de Tecidos Compostos Vascularizados/métodosRESUMO
UNLABELLED: The slipped capital femoral epiphysis (SCFE) is a fracture that occurs through the growth cartilage and causes slippage inside and under the proximal femoral epiphysis. The objective of this study was to determine whether the variables obesity, trauma and intense physical activity are associated with SCFE. A 32-item questionnaire was designed, in which weight, size and body mass index (BMI) were also reported. MATERIALS AND METHODS: Case and control study conducted from November 2009 to November 2010 at IMSS Trauma and Orthopedics Hospital #21. Inclusion criteria for cases were as follows: patients ages 9-16 years, with a diagnosis of SCFE made with anteroposterior (AP) and lateral hip X-rays, who answered a questionnaire and with weight and size measurements. Inclusion criteria for controls were as follows: students ages 10-16 years who answered the same questionnaire and had measurement of the same parameters. RESULTS: Mean age, weight, and BMI in cases were 11.9 years, 69.16 and 27.5 kg, respectively, and 12.74 years, 55.53 and 21.49 kg in controls. A BMI above percentile 95 was a risk factor for SCFE, with an odds ratio of 17.8 and a confidence interval (CI) of 1.69 to 3.97. The same was observed for trauma as a risk factor for SCFE, with an odds ratio of 5.2 and a CI of 1.36-2.74. Male gender was another risk factor. A significant chi square was found in cases with a p = 0.05. Intense physical activity was not a risk factor for SCFE, with a 0.58 odds ratio. The difference in mean weight between cases and controls was significant in the t test with p = 0.05. CONCLUSION: Obesity and trauma were associated with SCFE; physical activity was not. Given the increasing incidence of obesity, the orthopedic surgeon should be familiar with and have available percentile tables for early detection of obesity, and should educate the patients in whom this condition is detected to prevent SCFE and its complications.
Assuntos
Epifise Deslocada/epidemiologia , Cabeça do Fêmur , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To update information on drug interactions in patients with HIV/AIDS. METHOD: PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant. RESULTS: 52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. CONCLUSIONS: There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process.
Assuntos
Fármacos Anti-HIV/farmacocinética , Interações Medicamentosas , Infecções por HIV/metabolismo , Biotransformação , Citocromo P-450 CYP3A/metabolismo , Infecções por HIV/tratamento farmacológico , Humanos , Absorção IntestinalRESUMO
PIP: In 1900, 78% of Mexican women over age 10 were illiterate, and only 713,000 persons attended school. The population over age 15 averaged less than 1 year of school attendance. The illiteracy rate according to the 1990 census was 11%, and 23.6 million persons over age 5 attended some educational institution. The average school attendance for those over 15 was 6.5 years. Despite the great achievements of the past 9 decades, the 1990 census indicates that serious challenges remain. The proportion of illiterates in the population over age 15 declined from 44.1% in 1950 to 25.8% in 1970 and 12.4% in 1990, but the absolute numbers remained almost constant between 7 and 8 million for many years, and only recently declined to 6.2 million. 37.4% of persons 65 and over but only 3.9% of those 15-19 are illiterate. Of the 6.2 million illiterates, 2.3 million are male and 3.9 million female, for rates of 9.7% and 15% respectively. 21% of illiterates are 15-29 years old, and half reside in just 6 Mexican states. 90.0% of Mexican children 6-11 years old attend school, as do 75% of those 12-14 and nearly half of those 15-19. If school attendance at both primary and secondary levels had been obligatory in 1990, some 2.5 million more children would have been enrolled, the majority in dispersed rural localities and marginal urban zones.^ieng
Assuntos
Escolaridade , Estudantes , América , Países em Desenvolvimento , Economia , América Latina , México , América do Norte , Classe Social , Fatores SocioeconômicosRESUMO
The usefulness of ultrasonography in IUD insertion and control, was evaluated. A follow up of IUD localization, placed at the end of puerperium and in non puerperal patients, was done. The copper T IUD 200 was used, and was placed in 50 patients. Ultrasonographic study was done right after IUD placement, at one month and at three months; uterine longitudinal sections, as well as transversal ones, for adequate localization of IUD; data were taken for control and followup. There were no IUD expulsion, pregnancy, or uterine perforation. Conclusions were: 1. Ultrasonography is useful for IUD control. 2. IUD placement at the hospital is adequate. 3. There were no complications. 4. Alterations produced by IUD insertion are more frequent during the first month, and very scarce at third month. 5. Dysmenorrhea was most frequent after IUD insertion. 6. Echosonographic control of IUD is the most accurate method in order to know its localization within the uterine cavity.