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Angiotensin-(1-7) is an endogenous peptide known for its vasoprotective, antioxidant, and anti-inflammatory effects, making it a promising therapeutic candidate for various clinical conditions. However, the peptide exhibits pH-dependent physical instability in aqueous solutions, and a comprehensive atomistic study elucidating this behavior and its implications is currently lacking. Therefore, we performed all-atom molecular dynamics simulations to investigate the early formation of angiotensin-(1-7) oligomeric aggregates under different conditions: acidic and neutral pH-like conditions, physiological and high ionic strength, and high and low peptide concentrations. Our results are as follows: (1) under acidic pH-like conditions, angiotensin-(1-7) showed minimal clustering, (2) under neutral pH-like conditions, the peptides aggregated into a single cluster, consistent with the reported physical instability, and (3) increasing salt concentration under acidic pH-like conditions resulted in aggregation similar to that observed under neutral pH-like conditions. These results suggest that a combination of salt concentration and pH conditions can modulate angiotensin-(1-7) aggregation. Our protocol (molecular dynamics + cluster analysis + amino acid interaction map analysis) is general and could be applied to other peptides to study interpeptide interaction mechanisms.

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Introducción: La sociedad contemporánea reclama la presencia de personas competentes, con la recursividad necesaria para acometer de manera innovadora las funciones y tareas para las que han sido preparadas desde el punto de vista teórico. Solo que esta preparación, como eslabón aislado, no garantiza la generación de sujetos competentes. La calidad de los servicios de salud se mide por el nivel de competencia de sus trabajadores. Dentro de los aspectos generales del sistema de educación superior, se mantiene que estos estarán en continuo perfeccionamiento. Es necesario diseñar estrategias didácticas en la asignatura Obstetricia y Ginecología para la formación basada en competencias para el desempeño. Objetivo: Diseñar los procesos didácticos para la formación de competencias en Obstetricia y Ginecología. Posicionamiento del autor: Se necesita diseñar estrategias didácticas en la asignatura de Obstetricia y Ginecología para la formación basada en competencias para el desempeño, para lo cual se realizó un análisis documental, histórico-lógico, de los programas de estudios de la asignatura de Obstetricia y Ginecología, previo a 2010, para proponer las transformaciones pertinentes en los procesos didácticos de la asignatura. Conclusiones: Los resultados mostraron las transformaciones realizadas al programa de la asignatura desde 2010 hasta 2020. El diseño estuvo basado en el modelo por competencias para el desempeño, por la necesidad de incrementar la calidad de los servicios de salud, a partir de los principios de la educación médica cubana como parte del sistema nacional de salud(AU)

Introduction: The contemporary society demands the presence of competent people, with the necessary resources to undertake, in an innovative way, the functions and tasks for which they have been trained from the theoretical point of view. However, this preparation, as an isolated link, does not guarantee the generation of competent individuals. The quality of health services is measured by the level of competence of workers. The general aspects of the higher education system maintain that workers will continuously improve professionally. It is necessary to design didactic strategies for the Obstetrics and Gynecology subject aimed at training based on performance competencies. Objective: To design the didactic processes for the formation of competencies in Obstetrics and Gynecology. Author's stand: It is necessary to design didactic strategies for the Obstetrics and Gynecology subject in view of training based on performance competencies, for which a documentary and historical-logical analysis of its syllabus was carried, prior to 2010, in order to propose the relevant transformations in the didactic processes of the subject. Conclusions: The results showed the transformations made to the syllabus of the subject from 2010 to 2020. The design was based on the performance competency model, due to the need to increase the quality of health services, based on the principles of Cuban medical education as part of the national health system(AU)

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Nile tilapia is the most commercially important fish in Chiapas as well as in other parts of the world. An understanding of parasite infection dynamics in tilapia may assist in applying proper prophylactic measures for reducing the loss of fish caused by parasitic diseases. Different environments and culture systems may imply different infection dynamics; therefore, the present study identified and compared the infection parameters (prevalence, mean abundance, and intensity) of parasites of Oreochromis niloticus cultured in floating cages and ponds. A total of 18 metazoan parasite taxa were recovered from gills, skin, fins and intestines of 310 specimens from floating cages and ponds. Fourteen species of parasites were found in floating cages: 8 monogenean species, 1 nematode, 1 digenea, 1 crustacea, 3 protozoans. In ponds, 16 parasite taxa were reported: 11 were monogeneans species, 4 protozoans and 1 crustacean. In both systems, monogeneans (Cichlidogyrus sclerosus, C. tilapiae, Gyrodactylus cichlidarum) and protozoans (Trichodina compacta) were most prevalent. Tilapia in ponds sustained higher parasitic infections than those in floating cages (p < 0.05). The Canonical Correspondence Analysis showed two groups: the first grouped the ponds, associated with high values of nitrite, nitrate, ammonia, conductivity, temperature, and the abundance of the ectoparasites C. halli, C. dossoui, Scutogyrus longicornis, C. sclerosus and T. compacta. The second group grouped the cages, associated with Clinostomum marginatum, Apiosoma piscicola, Lernea sp., and Contracaecum sp. and a high dissolved oxygen concentration. Our findings suggest that monitoring programs are required to improve the sanitary conditions of tilapia cultures in Chiapas.

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INTRODUCTION: COVID-19 sequelae, or the short-, medium-, and long-term manifestations of the disease are under continuous study. There are currently few reports on the evolution of hematological variables following a demonstrated absence of SARS-CoV-2 after infection. OBJECTIVE: Identify hematological alterations in Cuban adults recovered from SARS-CoV-2 infection, and their relation with disease severity. METHODS: We selected 348 persons recovered from COVID-19 residing in Havana, Cuba with an RT-PCR study negative for SARS-CoV-2 performed two weeks after hospital discharge; a structured survey was administered to obtain clinical-epidemiological data. Three groups were established according to COVID-19 clinical criteria: asymptomatic, mild/moderately symptomatic, and severely symptomatic, which, in turn, were divided according to hospital discharge date and blood sample collection date. We performed hemograms with differential leukocyte counts and compared results among groups. We then measured the associations between hematological variables, personal medical history, and relevant lifestyle habits (smoking). RESULTS: All hematological variables were within normal reference limits, although men from the group of severely ill patients had increased total leukocytes, neutrophils and lymphocytes, and decreased hemoglobin and eosinophils, which was also evident in those with a recovery time of 31-90 days. CONCLUSIONS: The relation between hematological variables and degree of clinical severity offers evidence as to persistence of systemic alterations (possibly inflammatory) associated with viral infection. Their identification and characterization can facilitate personalized patient followup and rehabilitation.

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RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

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Internal carotid dissection is the most common cause of stroke in the young population. Stroke, the presence of a pseudoaneurysm, and decreased artery lumen with cerebral flow impairment are indications for treatment. Medical therapy with antithrombotic drugs and endovascular therapy with stenting are the main available options. The C-Guard stent is an open cell mesh-covered dual layer stent that has been mainly used in cases of internal carotid artery stenosis with a post-operative reduction in stroke incidence. Thus, we present two cases of internal carotid artery dissections of the cervical segment treated with the open cell dual-layer C-Guard stent without complications.

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Retinoblastoma is the most frequent ocular malignancy in the pediatric population and intra-arterial chemotherapy has emerged as the first-line treatment of this entity with cure rates ranging from 33-100%, depending on the severity of the disease. We present the case of an advanced retinoblastoma in a pediatric patient who underwent intra-arterial chemotherapy through a contralateral route due to unsuccessful catheterization of the ophthalmic artery. The patient was diagnosed with a class D retinoblastoma which underwent the catheterization of the ophthalmic artery through the contralateral internal carotid and through the anterior communicating artery. In this case, intra-arterial chemotherapy administration was successfully delivered without complications. Contralateral routes for intra-arterial chemotherapy are safe and allow adequate penetration of the chemotherapeutic drugs in cases where a well-developed anterior communicating artery is present.

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BACKGROUND: In the French West-Indies, few studies have been performed on fertility and sexual problems in cancer survivors, which are frequent and recurring issues reported by surveys on unmet needs. Additionally, mutualizing human and material resources and promoting cooperation through a collaborative platform are the most appropriate response to complex health pathways in the Caribbean territories. Implementation of such a collaborative platform will help to launch a strategic Caribbean partnership to transfer theoretical and technical skills and care standards in oncofertility and oncosexuality. METHODS: We propose to set up a collaborative digital platform to strengthen, from the French expertise, Cuban health professionals' knowledge, know-how, and skills in oncofertility and oncosexuality. The project will be coordinated by a coordinating, scientific, and supervisory committee, and the main activities will include: 1. Theoretical training in e-learning adapted to low-speed Internet. 2. Practical training in fertility preservation and sexual rehabilitation. 3. Digital multidisciplinary consultation meetings for medical decisions to be taken for complex clinical cases. The platform will benefit from a recurrent evaluation, by the two cancer registries of Martinique and Cuba, with the following performance indicators: number of Cuban professionals trained, number of professionals sensitized, hourly volumes (or number of training courses provided), satisfaction of trained professionals, number of e-RCPs carried out online and number of missionaries supported. These indicators will be set up and analyzed by the registers. This project meets the Cuban and French health policies (cancer plans and national sexual health strategies) and will be implemented in liaison with the Health Agencies of both countries and the Embassy of France in Cuba. DISCUSSION: This project aims to provide support through bilateral exchanges to improve reproductive and sexual health in Cuba's cancer patients. This collaboration will be based on a long-lasting French expertise and a solid Cuban health system. Consequently, this collaborative digital platform will contribute to data collection for cancer surveillance, and the two participating countries will ultimately be identified in the Caribbean as having centers of competence and excellence in oncofertility and oncosexuality with care standards.

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Nile tilapia (Oreochromis niloticus Linnaeus, 1758) is one of the most important aquaculture species in the world, and, when introduced, the ectoparasites of Nile tilapia have followed. Currently, farmers worldwide consider these ectoparasites harmless, but intensities can reach up to 1000 individuals per fish in tropical regions. In this cross-sectional study, we used the condition factor to estimate the potential effects of low (45 ± 31 ectoparasites per fish) and high (295 ± 191) ectoparasitic burdens across 28 tilapia farms and included the analysis of the effects of 44 management and environmental variable from the farms. A stepwise procedure in a multiple linear regression analysis retained the variables that explained the most variance, which was the ectoparasitic burden (57 %). We found significantly higher values of the condition factor in Nile tilapia with low ectoparasitic burden than in those with high ectoparasitic burden. Additionally, Nile tilapia with a high ectoparasitic burden weighed less than half than those with a low burden (102 ± 105 g versus 230 ± 128 g, respectively). We also found a significant non-linear, negative relationship between the ectoparasitic burden and the relative condition factor values per fish, which was most likely due to an increase in gill mucus caused by the ectoparasitic burden that depleted energy in the Nile tilapia. The economic consequence of the ectoparasitic burden translated roughly into a loss up to 12-15 % in profit margin per ton of fish, based on the price of Nile tilapia in the Mexican market.

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Between August and December 2013, the offshore cages of a commercial marine farm culturing red drum Sciaenops ocellatus in Campeche Bay Mexico were affected by an outbreak of an ulcerative granulomatous disease with up to 70% cumulative mortality. Thirty-one adults displaying open ulcers on the skin were submitted for diagnosis. At necropsy, multiple white-yellowish nodules (0.1-0.5 cm in diameter) were present in all internal organs, where the kidney and the spleen were the most severely affected. Histopathology evinced typical systemic granulomatous formations. Gram and Ziehl-Neelsen stains on tissue imprints, bacterial swabs and tissue sections revealed Gram-positive, acid-fast, branching beaded long rod filamentous bacteria. Tissue samples resulted positive for nocardiosis with a Nocardia genus-specific nested PCR. Definite identification at the species level and taxonomic positioning of the fastidious pathogen were achieved through a specific Nocardia seriolae PCR and by sequencing the gyrB gene of pure isolates. After administration of antibiotics during fry production, a posterior follow-up monitoring (from 2014 to 2017) detected mild but recurrent outbreaks of the bacteria with no seasonality pattern. To the extent of our knowledge, this is the first report of piscine nocardiosis in Mexico and the first time this disease is detected in red drum.

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BACKGROUND: Astyanax mexicanus from the river basins of the Gulf of Mexico slope are small freshwater fish that usually live in large groups in different freshwater environments. The group is considered successful due to its high capacity for dispersal and adaptation to different habitats, and the species present high morphological variability throughout their distribution in Mexico. This has produced the most extreme morphotype of the group; the hypogeous or troglobite, which has no eyes or coloration, and is probably the cause of taxonomic uncertainty in the recognition of species across the entire range. Most studies of A. mexicanus have mainly focused on cave individuals, as well as their adjacent surface locations, providing an incomplete evolutionary history, particularly in terms of factors related to dispersal and the potential corridors used, barriers to gene flow, and distribution of genetic variability. The aim of the present study is to determine the population structure and the degree and direction of genetic flow in this complex taxonomic group, incorporating geographic locations not previously included in analyses using microsatellite loci. Our aim is to contribute to the knowledge of the intricate evolutionary history of A. mexicanus throughout most of its range. METHODS: The present study included a set of several cave and surface locations of A. mexicanus, which have been widely sampled along the Gulf of Mexico slope, in a genetic population analysis using 10 microsatellite loci. RESULTS: Ten genetic populations or lineages were identified. In these populations, gene flow was recorded at two time periods. Historical gene flow, both inter and intra-basin, was observed among surface populations, from surface to cave populations, and among cave populations, whereas recording of contemporary gene flow was limited to intra-basin exchanges and observed among surface populations, surface to cave populations, and cave populations.

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Introducción: Los aneurismas del segmento comunicante posterior representan aproximadamente 25% de todos los aneurismas intracraneales, y el 50% de los aneurismas de la arteria carótida interna. El objetivo fue evaluar la eficacia del tratamiento quirúrgico y endovascular en el manejo de aneurismas de esta localización. Material y Métodos: Estudio comparativo retrospectivo. Se revisó las historias clínicas de pacientes con aneurisma del segmento comunicante posterior que ingresaron al departamento de Neurocirugía del Hospital Nacional Guillermo Almenara durante el periodo 2010-2017. Se comparó estancia hospitalaria, complicaciones, mortalidad y estado funcional a los 12 meses, en relación al tratamiento recibido, microquirúrgico o endovascular. Resultados: Se evaluaron 256 pacientes, 111 (43,36%) recibieron tratamiento quirúrgico, y 145 (56,64%) endovascular. En el caso de aneurismas rotos, el estado de independencia funcional fue alcanzado por 68 (66,7%) y 69 (70,4%) pacientes que recibieron tratamiento quirúrgico y endovascular, respectivamente (OR:0.84, IC 95%: 0.46­1.53; p=0.505). Se presentaron complicaciones neurológicas en 37 (36,3%) y 34 (34.7%) pacientes sometidos a tratamiento microquirúrgico y endovascular, respectivamente (OR: 1.07, IC 95%: 0.60­1.91; p=0.912). La estancia hospitalaria promedio fue 19,55±13.85 y 14.06±14.97 días, para pacientes con tratamiento quirúrgico y endovascular, respectivamente (p<0.008). La mortalidad fue 11,8% y 11,2%, con ligera predominancia en el grupo tratado quirúrgicamente (OR: 1.05, IC 95%: 0.44­2.52; p=0.904). Conclusiones: No existe diferencia significativa respecto al resultado funcional a los 12 meses, complicaciones y mortalidad entre ambos tipos de tratamiento en el caso de aneurismas rotos. Los pacientes sometidos a terapia endovascular tuvieron de forma significativa menor estancia hospitalaria

Background: Posterior communicating segment aneurysms represent about the 25% of all intracranial aneurysms and the 50% of the internal carotid artery aneurysms. The objective of the study was to evaluate the efficacy of the surgical and endovascular treatments in the management of the aneurysms of this localization. Methods: Comparative and retrospective study. Clinical charts of patients with aneurysms of the posterior communicating segment were reviewed during the period from 2010 to 2017 in the Guillermo Almenara Hospital. Hospital stay, complications, mortality and functional status at 12 months were compared among endovascular and surgical treatment. Results: Two hundred and fifty-six patients were evaluated, 111 (43,36%) were treated with surgery and 145 (54,64%) with endovascular therapy. Among ruptured aneurysms, functional independence status was reached in 68 (66,7%) and 69 (70,4%) of the patients who were treated with surgery and embolization respectively (OR:0.84, IC 95%: 0.46­1.53; p=0.505). Neurological complications were found in 37 (36,3%) and 34 (34,7%) patients treated with surgery and embolization respectively (OR: 1.07, IC 95%: 0.60­1.91; p=0.912). The mean hospital stay was 19,55±13.85 and 14.06±14.97 days of the patients treated with surgery and embolization respectively. Mortality was 11,8% and 11,2%, with a slight predominance in the surgically treated group (OR: 1.05, IC 95%: 0.44­2.52; p=0.904). Conclusions: There is no significant difference according to functional status at 12 months, complications and mortality among both type of treatments in the group of ruptured aneurysms. Patients treated with endovascular therapy had lower hospital stay with statistical difference

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Resumen El stroke isquémico agudo es una de las principales causas de morbilidad y mortalidad en el mundo. Si existe compromiso de vaso grande, la trombectomía mecánica es la técnica endovascular que ha demostrado los mejores resultados. Presentamos el caso de un paciente con trombosis de la arteria cerebral media izquierda de 5 horas de evolución, con afasia mixta y hemiplejía, la escala ASPECTS 7, score NIHSS 14 y escala de Rankin modificada (mRS) de 4. Se realizó trombectomía mecánica con stents Solitaire AB y ERIC, aspiración manual de coágulo con jeringa de 60cc e instilación de alteplase intra-arterial. La reperfusión inmediata fue total (TICI 3). El mRS posterior al tratamiento fue de 2.

Summary Acute stroke is one of the most common causes of morbidity and mortality worldwide. Mechanical thrombectomy is the endovascular procedure that has shown better results in patients with a large vessel involvement. We present here a case of a patient who had a five-hour history of thrombosis of the left mid cerebral artery who developed mixed aphasia and hemiparesis, ASPECTS scale of five, NIHSS score of 14 and a modified Rankin scale (mRS) of 4. A mechanical thrombectomy was performed with stents Solitaire AB and ERIC and manual aspiration of the clot with a 60cc syringe plus instillation of intra-arterial alteplase. Immediate reperfusion was complete (TICI 3). The mRS after the procedure was 2.

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Introducción: En la actualidad la tuberculosis pulmonar continúa siendo uno de los procesos infecciosos más observados en el mundo. Objetivo: Diseñar un programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar. Métodos: Se realizó un estudio de tipo descriptivo transversal en el consultorio 9 del Policlínico Docente Mario Antonio Pérez Mollinedo durante el periodo de noviembre de 2015 a marzo de 2017. Se seleccionó una muestra de 56 pacientes de una población de 125 dispensarizados con riesgo de tuberculosis. La estrategia de selección se basó en el muestreo no probabilístico intencional por criterios. Se aplicaron diferentes métodos y técnicas, como el análisis documental y cuestionarios. Para el procesamiento de la información se empleó la estadística descriptiva. Resultados: Los factores de riesgo a los que se encontraban expuestos los pacientes eran: el hábito de fumar (57,1 por ciento); el consumo de bebidas alcohólicas (46,4 por ciento); residir en condiciones de hacinamiento (44,6 por ciento); viviendas con malas condiciones (33,9 por ciento); estar expuestos a más de 2 factores de riesgo (58,9 por ciento); padecer de diabetes mellitus (14,2 por ciento), asma bronquial y enfermedad pulmonar obstructiva crónica (21,4 por ciento); y bajo nivel de conocimiento sobre la tuberculosis pulmonar (83,9 por ciento). Conclusiones: El programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar, según la evaluación de los especialistas, es pertinente y factible. En la actualidad se encuentra en fase de aplicación en el área de salud donde se realizó la investigación(AU)

Introduction: Nowadays, lung tuberculosis is still one of the most important infectious processes in the world. Objective: To design a project of community intervention directed to patients with risk of lung tuberculosis. Methods: It was carried out a descriptive cross-sectional's type study in the Family Doctor's Office #9 belonging to Mario Antonio Pérez Mollinedo Teaching Policlinic from November, 2015 to March, 2017. It was selected a sample of 56 patients from a population of 125 patients classified as with risk of Tuberculosis. The selection's strategy was based in an intentional non-probabilistic sampling by criteria. Different methods and techniques were applied as documentary analysis and questionnaires. Descriptive statistic and the analysis of qualitative data were used for processing information. Results: The risk factors that these patients were exposed were: smoking habit (57.1 percent); consumption of alcoholic beverages (46.4 percent); to live in overcrowding conditions (44.6 percent); housings with bad conditions (33.9 percent); to be exposed to more than 2 risk factors (58.9 percent); suffering Diabetes Mellitus (14.2 percent); bronchial asthma and COPD (21.4 percent); and low level of knowledge on lung tuberculosis (83.9%). Conclusions: The project of community intervention directed to patients with risk of Lung Tuberculosis, according to the specialists' assessment, it is pertinent and feasible. At the moment is in the application phase in the health area where it was carried out the investigation as part of a thesis of specialty(AU)

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Introducción: La artroplastía cervical es una cirugía que implica el uso de implantes discales con la capacidad de conservar el movimiento del segmento. Constituye un reto para paises como el nuestro desarrollar alternativas a los altos costos de los mencionados implantes, con diseños patentado, elaborado viables de manufacturar, con biocompatibilidad, seguridad, y que simule lo máximo posible los movimientos cervicales fisiológicos. Objetivo: Desarrollar la geometría y mecánica de un diseño discal patentado, elaborado, sea por manufactura aditiva de titanio ELI, así como verificar su compatibilidad con la fisiología de los movimientos cervicales. Métodos: El diseño del estudio tuvo tres etapas iterativas: la primera, el desarrollo de la geometría del implante y el estudio de elementos finitos utilizando como referencia normas internacionales; en segundo lugar, se desarrollaron estudios de metalografía, caracterización del material incluyendo pruebas de fatiga del implante; finalmente, se utilizó un modelo animal cadavérico para confirmar la compatibilidad del implante con los movimientos cervicales. Resultados: Se demostró que el implante elaborado sea por manufactura aditiva o por forja, fue compatible con las normas internacionales. Se realizaron 84 estudios de rayos X en 18 cuellos de porcino. En el 100% de las columnas cervicales de los porcinos, el rango en flexión fue menor que el de extensión. Existió mayor rango de movimiento cuando se utilizaron dos implantes y cuando el implante fue más grande. Conclusiones: El implante cervical flexible elaborado por forja o por manufactura aditiva de titanio ELI presentó resultados prometedores, por lo que podría postularse su uso experimental en pacientes tributarios de artroplastía cervical.

Introduction: Cervical arthroplasty is a surgical procedure that involves the use of disc implants with the capacity of preserving segmental movement. It is a challenge for countries like ours to develop alternatives to the high costs of the aforementioned implants, with patented designs, feasible to manufacture, with biocompatibility, safety, and that simulates as much as possible the physiological cervical movements. Objectives: To develop the geometry and mechanics of a patented disc design elaborated with titanium ELI by additive manufacturing, as well as, to verify its compatibility with the physiology of cervical movements. Methods: The study design had three iterative stages: the first one was the development of the implant geometry and the finite-element study using international standards as a reference. In second place, studies of metallography, characterization of the material and fatigue tests of the implant were developed. Finally, a cadaverous animal model was used to confirm the compatibility of the implant with cervical movements. Results: The implants manufactured by forging or by additive manufacturing are compatible with international standards. 84 x-ray studies were performed on 18 pig necks. In 100% of the cervical columns of the pigs, the range in flexion was smaller than that of extension. There was a greater range of motion when two implants were used and when the implant was larger. Conclusions: The flexible cervical implant made by forging or a titanium-ELI additive manufacturing have promising results, because of that, an experimental use in patients, who needs cervical arthroplasty, could be considered.

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Resumen ANTECEDENTES: Aunque la hernia umbilical es relativamente frecuente en la población africana, la mayoría de los casos cursan asintomáticos. La situación en la que un útero grávido entra en un saco herniario representa una complicación excepcional de la hernia umbilical. CASO CLÍNICO: Paciente de 30 años, con antecedentes médicos de hernia umbilical y obstétricos de 5 embarazos, 4 partos y 1 aborto espontáneo. Acudió a consulta por dolor en la parte baja del vientre, de tres días de evolución. En el interrogatorio refirió amenorrea de 5 meses; 2 semanas antes percibió movimientos fetales y ausencia de los mismos 3 días previos a la consulta médica. Al examen físico se observó el abdomen con aumento de volumen irreductible, de 30 cm de diámetro, de forma pendular, que se protruía a través de un gran anillo herniario umbilical y llegaba hasta la mitad de los muslos; se palpó el feto, pero no se escucharon latidos cardiacos. Por los antecedentes médicos, hallazgos clínicos y ecográficos se estableció el diagnosticó de muerte fetal intrauterina, como complicación de útero grávido en una hernia umbilical. Se decidió la interrupción del embarazo mediante cesárea de urgencia. La hernia umbilical se reparó con reforzamiento del defecto mediante colgajos fascio-aponeuróticos, según la técnica de Mayo. La evolución de la paciente fue satisfactoria. CONCLUSIONES: El tratamiento de pacientes embarazadas con hernia umbilical incluye una conducta conservadora, control prenatal estricto, colocación de un corsé para rectificar el útero grávido, programación de la cesárea y reparación del defecto herniario.

Abstract BACKGROUND: Although umbilical hernia is relatively common in African patients, the majority of cases are asymptomatic. The situation in which a gravid uterus enters a hernia sac is one of the rarest complications of umbilical hernia. CLINICAL CASE: 30-year-old pregnant woman with a history of umbilical hernia and obstetric of 5 pregnancies, 4 deliveries and 1 spontaneous abortion. She reported pain in the abdomen that appeared 3 days ago, absence of menstruation 5 months ago, with fetal movements referred 2 weeks ago and absence of them 3 days ago. At the physical examination, an irreducible volume increase of approximately 30 cm in diameter with a pendulum shape that protruded through a large umbilical hernia ring and reached the middle of the thighs, fetal parts were palpated and absence of fetal heartbeats. Due to the antecedents, the clinic and the obstetric ultrasound, an intrauterine fetal death was diagnosed as a complication of a gravid uterus in an umbilical hernia. The interruption of pregnancy was performed by emergency caesarean section. The umbilical hernia was repaired with reinforcement of the defect using fascio-aponeurotic flaps, according to the Mayo technique. The evolution was satisfactory until hospital discharge. CONCLUSIONS: The treatment of pregnant patients with umbilical hernia includes a conservative behavior, strict prenatal control, placement of a brace to rectify the pregnant uterus, programming of the cesarean and repair of the hernia defect.

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BACKGROUND: The Pantosteus plebeius-nebuliferus species-group is a group of freshwater fishes distributed in endo- and exorheic drainage basins in the Mexican Sierra Madre Occidental mountain range system and central North Mexico. The geological history of this region is considered an important factor in explaining the evolutionary history of low vagility animals like freshwaters fishes. The aim of this study was to examine the phylogenetic relationships and describe the evolutionary history of the species-group. We hypothesized that the genetic structure and distribution of the main clades of Pantosteus plebeius-nebuliferus are associated with the geological history of Northern Mexico. To this end, we obtained DNA sequences of mitochondrial and nuclear genes and performed phylogenetic and phylogeographic analyses. Divergence time estimation and ancestral area reconstruction were also carried out to propose a biogeographical hypothesis, and species boundaries within the species-group were also tested. RESULTS: We identified four clades within the Pantosteus plebeius-nebuliferus species-group in both markers. Divergence ranged from 5.9% to 9.2% for cytb and 0.1% to 0.9% for GHI. We observed significant genetic structure and no shared haplotypes between clades. We estimated that the clades diverged during the last 5.1 Myr, with a biogeographic scenario suggesting eight vicariant and four dispersal events through the historic range of the species-group. We found that the best species-delimitation model is when four species are assumed, which correspond to the main clades. We identified nine evolutionary significance units (ESUs), pertinent to the conservation of the group, each representing populations present in distinct drainage basins. CONCLUSIONS: The evolutionary history of the Pantosteus plebeius-nebuliferus species-group is characterized by vicariant post-dispersal processes, linked to geological changes in the Sierra Madre Occidental and central Northern Mexico since the Pliocene. This is congruent with biogeographic patterns described for other co-distributed fish species. We propose a new phylogenetic hypothesis for the species-group, clarifying the taxonomy of this evolutionarily complex group. Our results suggest that the species-group consists of at least four clades with independent evolutionary histories, two of which may represent new undescribed species. Our identification of ESUs provides a basis upon which conservation measures can be developed for the species-group.

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RESUMO

Biotherapeutic products which are derived from living organisms using recombinant DNA technology significantly contribute to the progress in the treatment of life-threatening and chronic diseases. The worldwide sale of biological drugs in 2016 was near US $263,700 million. In Latin America, where monoclonal antibodies market was worth US $7000 million, being Mexico the second largest market. Approval is one of the key aspects which influences the market of medicinal products, thus it is responsibility of the regulatory authority to establish a regulatory framework that ensure safety and efficacy of the products, and it is responsibility of the applicants to provide a high quality dossier in accordance with the registration requirements of the country. The applicants submitting registration requests in Mexico need to be aware of the requirements. Similar to many other countries, Mexico has adopted the Common Technical Document (CTD) structure for organizing dossier of the medicinal product for submission into main modules (i.e., quality, non-clinical, and clinical). This facilitates the submission process of medicinal products following a logical sequence aligned to the International Council on Harmonisation (ICH) guidelines. Moreover, this structure improves the transparency and clarity of the dossier in process of evaluation of medicinal products. In Mexico, the Ministry of Health has published a regulation, NOM-257-SSA1-2014, which established the general requirements to be followed by applicants to complete the registration of biotherapeutics. This regulation stipulates that the evaluation process is supported by a regulatory framework involving Good Manufacturing Practices, labeling, stability, clinical trials, biocomparability studies, pharmacovigilance, and a technical evaluation performed by a multidisciplinary team of experts in biotherapeutics development. Additionally, the Mexican regulatory agency, COFEPRIS, has published specific guidelines to facilitate the application process. Despite the availability of this information, the scope is limited to regulatory and administrative purposes, rather than technical-scientific supporting knowledge. The aim of this article is to provide concise information to improve and promote communication between industry and regulatory agencies. Herein, we describe the current process of COFEPRIS in regulating biotherapeutics in Mexico. This process explains the basis for the organization and structure of the technical-scientific information of biotherapeutics required for registration application.

RESUMO

During the examination of 913 fish specimens belonging to four families in the Campeche Bank (Gulf of Mexico), 23 gill ectoparasitic monogenean species were found, which belong to three families: Dactylogyridae, Microcotylidae and Diclidophoridae. The species Euryhaliotremaamydrum, E.carbuncularium, E.dunlapae, E.fajeravilae, E.fastigatum, E.longibaculum, E.paracanthi, E.tubocirrus, Haliotrematoidescornigerum, H.gracilihamus, H.heteracantha, H.longihamus, H.magnigastrohamus, H.striatohamus, Hamatopedunculariabagre, Neotetraonchusbravohollisae, and N.felis (all Dactylogyridae) were found on the hosts Lutjanussynagris, L.griseus, Ariopsisfelis, Bagremarinus, Archosargusrhomboidalis, and Haemulonplumieri. Additionally, Microcotylearchosargi, Microcotyle sp., and Microcotyloidesincisa (all Microcotylidae) were found on L.griseus and A.rhomboidalis; finally, Choricotyle sp. 1, Choricotyle sp. 2, and Choricotyle sp. 3 (all Diclidophoridae) were found on H.plumieri. The prevalence, abundance, mean intensity of infection, and supplementary taxonomic revisions for all monogeneans found are provided. Partial sequences of the 28S rRNA gene were also obtained for monogeneans of ariid, sparid, and haemulid host fishes to explore their systematic position within the Monogenea. New locality and host records for some previously described species of Euryhaliotrema, Hamatopeduncularia, Microcotyle, and Choricotyle from lutjanid, ariid, sparid, and haemulid hosts were reported. The present study adds evidence supporting the interoceanic occurrence of the same monogenean species (on lutjanids) on the west-east Atlantic and Pacific Oceans (= amphiamerican species). As previously suggested, there are at least, two possibilities to explain that parasite distribution: differentiation of morphological features in these monogeneans have resulted in only slight to insignificant morphological changes developing over the extended period of 3.2 mya (when the Isthmus of Panama was closing) and/or speciation is only evident at molecular level.