RESUMO
INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.
Assuntos
Colecistectomia Laparoscópica , Laparoscopia , Idoso , Estudos de Casos e Controles , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Análise Fatorial , Feminino , Humanos , Laboratórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.
RESUMO
BACKGROUND: In low transmission settings early diagnosis is the main strategy to reduce adverse outcomes of malaria in pregnancy; however, microscopy and rapid diagnostic tests (RDTs) are inadequate for detecting low-density infections. We studied the performance of the highly sensitive-RDT (hsRDT) and the loop mediated isothermal DNA amplification (LAMP) for the detection of P. falciparum in pregnant women. METHODS: A cross-sectional study was conducted in two malaria-endemic municipalities in Colombia. We screened pregnant women in the context of an antenatal care program in health facilities and evaluated five tests (microscopy, conventional RDT, hsRDT, LAMP and nested polymerase chain reaction-PCR) for the detection of P. falciparum in peripheral blood, using a quantitative reverse transcription PCR (qRT-PCR) as the reference standard. Diagnostic performance of hsRDT and LAMP were compared with routine testing. RESULTS: The prevalence of P. falciparum was 4.5% by qRT-PCR, half of those infections were subpatent. The sensitivity of the hsRDT (64.1%) was slightly better compared to microscopy and cRDT (59 and 53.8% respectively). LAMP had the highest sensitivity (89.7%) for detecting P. falciparum and the ability to detect very low-density infections (minimum parasite density detected 0.08 p/µL). CONCLUSIONS: There is an underestimation of Plasmodium spp. infections by tests routinely used in pregnant women attending antenatal care visits. LAMP methodology can be successfully implemented at local hospitals in malaria-endemic areas. The relevance of detecting and treating this sub-patent P. falciparum infections in pregnant women should be evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT03172221 , Date of registration: May 29, 2017.
Assuntos
Malária Falciparum/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/métodos , Técnicas de Amplificação de Ácido Nucleico/normas , Plasmodium falciparum/isolamento & purificação , Complicações Parasitárias na Gravidez/diagnóstico , Adulto , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Malária Falciparum/epidemiologia , Técnicas de Diagnóstico Molecular , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Cuidado Pré-Natal , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Adulto JovemRESUMO
La capilaroscopia es un método no invasivo y seguro que permite la visualización de los capilares a nivel del lecho periungueal de los dedos de las manos. Es útil en la evaluación del Fenómeno de Raynaud y de las colagenopatías, principalmente de la esclerodermia; sin embargo, se conoce poco acerca de la prevalencia y distribución de los cambios capilaroscópicos en sujetos sanos, siendo el objetivo de este estudio evaluar y describir las alteraciones capilaroscópicas en este grupo. A 100 participantes seleccionados por criterios de inclusión y exclusión se les realizó una videocapilaroscopia del lecho ungueal del cuarto y quinto dedo de la mano no dominante; el 86% de la población estudiada presentó hallazgos capilaroscópicos como: capilares tortuosos, entrecruzados y arborificados. Además, las alteraciones capilaroscópicas fueron más frecuentes en sujetos que consumían tabaco, se encontró una relación significativa entre el tabaco y la presencia de arborificaciones. Este es el primer estudio descriptivo de alteraciones capilaroscópicas en sujetos sanos en el Ecuador.
Capillaroscopy is a noninvasive and safe method that allows visualizationof capillaries in the nailbed. It is useful in the assesment ofRaynauds phenomenon and collagen diseases, especially scleroderma;however, little is known about the prevalence and distributionof capillaroscopic changes in healthy subjects, hence the aim ofthis study was to assess and describe the microvascular alterationsin this group. 100 participants selected by inclusion and exclusioncriteria underwent videocapillaroscopy of the nailfold of the fourthand fifth fingers of the nondominant hand; 86% of the study populationpresented capillaroscopic findings such as tortuous capillaries,crisscrossing and arborifications. Also, the microvascular alterationswere more frequent in subjects who had history of tobaccosmoking: a significant relationship between smoking and the presenceof arborifications was found. This is the first descriptive studyof microvascular alterations in healthy subjects in Ecuador.
Assuntos
Angioscopia Microscópica , Doença de RaynaudRESUMO
Epstein-Barr virus (EBV) is a persistent virus with oncogenic capacity that has been implicated in the development of aggressive B cell lymphomas, primarily in immunosuppressed individuals, although it can be present in immunocompetent individuals. Changes in the function and clonal diversity of T lymphocytes might be implied by viral persistence and lymphoma development. The aim of the present study was to evaluate the frequency, phenotype, function and clonotypical distribution of EBV-specific T cells after peripheral blood stimulation with a virus lysate in newly diagnosed patients with diffuse large B cell lymphoma (DLBCL) aged more than 50 years without prior histories of clinical immunosuppression compared with healthy controls. Our results showed impaired EBV-specific immune responses among DLBCL patients that were associated primarily with decreased numbers of central and effector memory CD8(+) T lymphocytes. In contrast to healthy controls, only a minority of the patients showed CD4(+)/tumour necrosis factor (TNF)-α(+) T cells expressing T cell receptor (TCR)-Vß17 and CD8(+)/TNF-α(+) T cells with TCR-Vß5·2, Vß9 and Vß18 in response to EBV. Notably, the production of TNF-α was undetectable among TCR-Vß5·3(+), Vß11(+), Vß12(+), Vß16(+) and Vß23(+) CD8(+) T cells. In addition, we observed decreased numbers of CD4(+)/TNF-α(+) and CD8(+)/TNF-α(+), CD8(+)/interleukin (IL)-2(+) and CD8(+)/TNF-α(+)/IL-2(+) T lymphocytes in the absence of T cells capable of producing TNF-α, IL-2 and IFN-γ after EBV stimulation simultaneously. Moreover, DLBCL patients displayed higher IL-10 levels both under baseline conditions and after EBV stimulation. These findings were also observed in patients with positive EBV viral loads. Prospective studies including a large number of patients are needed to confirm these findings.
Assuntos
Linfócitos T CD8-Positivos/imunologia , Infecções por Vírus Epstein-Barr/imunologia , Herpesvirus Humano 4/imunologia , Linfoma Difuso de Grandes Células B/imunologia , Idoso , Idoso de 80 Anos ou mais , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Linfócitos T CD8-Positivos/virologia , Infecções por Vírus Epstein-Barr/sangue , Infecções por Vírus Epstein-Barr/virologia , Feminino , Citometria de Fluxo , Herpesvirus Humano 4/fisiologia , Interações Hospedeiro-Patógeno/imunologia , Humanos , Interferon gama/imunologia , Interferon gama/metabolismo , Interleucina-10/imunologia , Interleucina-10/metabolismo , Interleucina-2/imunologia , Interleucina-2/metabolismo , Contagem de Linfócitos , Linfoma Difuso de Grandes Células B/sangue , Linfoma Difuso de Grandes Células B/virologia , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos T alfa-beta/imunologia , Receptores de Antígenos de Linfócitos T alfa-beta/metabolismo , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/metabolismo , Carga Viral/imunologiaRESUMO
Even though the Duchenne muscular dystrophy (DMD) gene product Dystrophin Dp71d is involved in various key cellular processes through its role as a scaffold for structural and signalling proteins at the plasma membrane as well as the nuclear envelope, its subcellular trafficking is poorly understood. Here we map the nuclear import and export signals of Dp71d by truncation and point mutant analysis, showing for the first time that Dp71d shuttles between the nucleus and cytoplasm mediated by the conventional nuclear transporters, importin (IMP) α/ß and the exportin CRM1. Binding was confirmed in cells using pull-downs, while in vitro binding assays showed direct, high affinity (apparent dissociation coefficient of c. 0.25nM) binding of Dp71d to IMPα/ß. Interestingly, treatment of cells with the microtubule depolymerizing reagent nocodazole or the dynein inhibitor EHNA both decreased Dp71d nuclear localization, implying that Dp71d nuclear import may be facilitated by microtubules and the motor protein dynein. The role of Dp71d in the nucleus appears to relate in part to interaction with the nuclear envelope protein emerin, and maintenance of the integrity of the nuclear architecture. The clear implication is that Dp71d's previously unrecognised nuclear transport properties likely contribute to various, important physiological roles.
Assuntos
Núcleo Celular/metabolismo , Dineínas/metabolismo , Distrofina/genética , Carioferinas/metabolismo , Distrofia Muscular de Duchenne/genética , Receptores Citoplasmáticos e Nucleares/metabolismo , alfa Carioferinas/metabolismo , beta Carioferinas/metabolismo , Animais , Sequência de Bases , Linhagem Celular , Primers do DNA , Camundongos , Microtúbulos/metabolismo , Transporte Proteico , Ratos , Proteína Exportina 1RESUMO
INTRODUCCIÓN: La escrofuloderma es una manifestación extrapulmonar de la tuberculosis, siendo su incidencia menor al 1 por ciento de los casos de tuberculosis no pulmonar. Actualmente, la escrofuloderma se presenta con mayor frecuencia en personas inmunocomprometidas o en pacientes que viven en condición de hacinamiento, recintos tales como hogares de ancianos, cárceles o en viviendas de estratos socioeconómicos más bajos. PRESENTACIÓN DEL CASO: A continuación, se presenta el caso de un paciente de 29 años que vive en condiciones de hacinamiento en un recinto penitenciario. Es derivado a policlínico de Medicina Broncopulmonar para estudio con fibrobroncoscopía ante la sospecha de tuberculosis pulmonar. Se pesquisa lesión nodular subcutánea supurativa, asociada a placas cicatriciales rojo-violáceas que, según contexto del paciente, características de las lesiones y resultado de biopsia se diagnosticaron como escrofuloderma. Se inició tratamiento antituberculoso con buena respuesta clínica de las lesiones cutáneas. DISCUSIÓN: Debido al proceso de eliminación que está sufriendo la tuberculosis en Chile, las manifestaciones extrapulmonares de la tuberculosis, entre ellas las cutáneas, representan hoy en día un desafío diagnóstico principalmente por el bajo índice de sospecha que se tiene sobre ellas.
INTRODUCTION: Scrofuloderma is a manifestation of extrapulmonary tuberculosis, being its incidence less than 1 percent of the non-pulmonary cases. Nowadays, scrofuloderma is presented more frequently in immunosuppressed people or in patients living in overcrowded conditions, in enclosures such as nursing homes, prisons or houses from the lowest socioeconomic status. CASE REPORT: We present a clinical case of a 29-year-old patient living in overcrowded conditions in a penitentiary facility. The patient is referred to the neumology Outpatients Unit for study with fibrobronchoscopy for suspected pulmonary tuberculosis. A nodular subcutaneous suppurative lesion is found, associated to purpurish red cicatricial plaques that according to the clinical context of the patient, characteristics of the lesions and biopsy results, were diagnosed as scrofuloderma. Antituberculosis treatment was initiated, with a positive clinical response of the skin lesions. DISCUSSION: Due to the process of elimination that tuberculosis is suffering in Chile, the extrapulmonary manifestations, being the cutaneous manifestations among them, represent a diagnosis challenge principally because of the low index of suspicion.
Assuntos
Humanos , Masculino , Adulto , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Antituberculosos/uso terapêuticoRESUMO
UNLABELLED: This study reports on acute renal failure (ARF) due to multiple stings by Africanized bees (AB) occurring in 43 cases collected between 1982 and 2007 (at the Nephrology Section, University of Antioquia School of Medicine and San Vicente de Paul University Hospital, Medellin, Colombia). No intervention on patient care was performed except for responding the Nephrology consult and prescribing dialysis. Data obtained from the medical records included demography; clinical presentation; laboratory results on admission; evolution of renal function to document improvement and normalization; intervals between stings and outcomes; number of dialysis sessions; length of follow-up and hospitalization; survival; and mortality. Not all patients had complete data and therefore, the number of observations is included where required. Mean age was 56 ± 26 yr (range 2-96); 37 (86%) were men; 38 (of 41 cases) came from rural areas (91%); 22 (of 39) were farmers (56.4%); 33 (of 41) lived in Medellin or in the department of Antioquia (80.5%). Number of stings per patient: ~ 900. Interval between stings and ARF < 48 hours: in 31 cases (72.1%; mean 2.6 ± 2.6 days; range 1-12); 37 (of 43) required dialysis (86%); mean number of sessions: 4.7 ± 3.3 (range 1-12). Survival occurred in 36 cases (83.7%) and mortality, in 7, all > 60 yr (16.3%). At last follow-up, renal function improvement was documented in 36 (83.7%) and normalization in 15 of them (41.7%). Interval until initiation of diuresis: 10.6 ± 6.8 days (range 1-25). Duration of hospitalization: 16.9 ± 8.7 days (range 1-39). FOLLOW-UP: 25.2 ± 18.3 days (range 1-75). Hematuria and oliguria occurred before 24 hours; there was an increase of CPK in 90%, of ALT in 96%, of AST in 89%, of DHL in 95%, and of BUN and creatinine in 100%. Based on our findings and on the review of the available information, we propose that this type of ARF occurs as a result of rhabdomyolysis with subsequent myoglobinuria, which lead to nephrotoxic acute tubular necrosis; a variable degree of direct nephrotoxicity, not quantifiable with current diagnostic methods, is also probably involved. A better knowledge of this entity by the medical community could improve care and prognosis of the patients who develop it.
Assuntos
Injúria Renal Aguda/etiologia , Abelhas , Mordeduras e Picadas de Insetos/complicações , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Mordeduras e Picadas de Insetos/sangue , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Diálise Renal , Rabdomiólise/epidemiologia , Rabdomiólise/etiologia , Rabdomiólise/terapia , Especificidade da Espécie , Adulto JovemAssuntos
Moluscos/química , Hidrocarbonetos Policíclicos Aromáticos/farmacocinética , Poluentes Químicos da Água/farmacocinética , Animais , Monitoramento Ambiental , México , Oceano Pacífico , Hidrocarbonetos Policíclicos Aromáticos/análise , Distribuição Tecidual , Poluentes Químicos da Água/análiseRESUMO
A pesar de todo lo aprendido en los 20 años transcurridos desde la descripción de los primeros casos de SIDA y el desarrollo de esquemas terapéuticos efectivos, la epidemia causada por el Virus de Inmunodeficiencia Humana (VIH) sigue expandiéndose. Uno de los grupos más vulnerables es el de las mujeres, las cuales constituyen ahora el grupo poblacional en donde más rápidamente crece el problema. La discriminación económica, social y cultural, y restricciones en el acceso a los servicios de salud son algunas de las causas que potencian el riesgo. El contacto heterosexual es, desde 1991, la principal forma en que adquieren la infección. Favorecen el contagio la presencia de otras enfermedades de transmisión sexual, especialmente si cursan con úlcera genital, el coito durante la menstruación, la penetración anal y el embarazo. Disminuyen el riesgo el condón, los microbicidas tópicos y la educación a la mujer. El sarcoma de Kaposi, mucho más frecuente en los hombres que tienen sexo con hombres, y las enfermedades cérvicovaginales, dentro de las cuales la vaginitis recurrente por Candida spp. y la neoplasia intraepitelial cervical son las más comunes, representan las únicas diferencias en el espectro clínico entre los dos sexos. Aunque la progresión de la enfermedad es semejante, la carga viral inicial es significativamente inferior en ellas, lo que pudiera generar diferencias en los criterios de elegibilidad al momento de iniciar la terapia de acuerdo con el género. Algunos efectos adversos de los antirretrovirales parecen ser más frecuentes en las mujeres
Assuntos
Humanos , Feminino , Heterossexualidade , Infecções por HIV , Fatores de RiscoAssuntos
Monitoramento Ambiental/métodos , Ostreidae/química , Frutos do Mar/análise , Poluentes Químicos da Água/análise , Animais , Cobre/análise , Contaminação de Alimentos , Hexaclorobenzeno/análise , Chumbo/análise , México , Bifenilos Policlorados/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Zinco/análiseRESUMO
Con el propósito de determinar la localización y dimensiones de la estenosis de la vía aérea, mediante TAC Helicoidal, reconstrucción 3D y navegación virtual se evaluaron en forma prospectiva 16 enfermos con 21 exámenes y se correlacionaron con los hallazgos de la endoscopia o la cirugía. Se analizaron 9 casos de estenosis post-traumática, cinco tumoral, una inflamatoria y una congénita. En cinco pacientes, se hicieron evaluaciones repetidas por exigencia del tratamiento. En dos pacientes se evaluaron Stents traqueales, y en 4 tubos siliconados. Tres casos fueron a cirugía. Hubo lesión laríngea en el 44 por ciento de los enfermos. Se encontró desacuerdo frente a la endoscopia o a la cirugía, en tres casos con una sensibilidad de la prueba de 90 por ciento . Se concluyó que las técnicas helicoidales, los programas de reconstrucción 3D y la endoscopia virtual son útiles y promisorias para estudiar las estenosis de la vía aérea. Permiten evaluar áreas dístales a estenosis críticas. Se comenta la experiencia de los autores y las limitaciones de la técnica
Assuntos
Constrição Patológica/diagnóstico , Endoscopia , Tomografia Computadorizada por Raios X , Estenose TraquealRESUMO
Entre 1984 y 1999 se realizaron veintiocho embolizaciones arteriales transcateter en 26 pacientes con hemorragia vaginal severa secundaria a cáncer de cérvix avanzado. El estadio del cáncer cervical fue IIIB en 24 pacientes, IIB en una paciente y IV en una paciente. Se realizó angiografía de las arterias pélvicas con embolización de las arterias hipogástricas usando Gelfoam (n= 19, espirales de alambre metálicos y Gelfoam (n= 1), partículas de alcohol polivinilo (PVA) y espirales de alambre (n=4) y partículas de PVA únicamente (n=4). El sangrado agudo fue controlado en 23 pacientes con estabilización de la condición clínica. Embolizaciones repetidas fueron necesarias en tres pacientes. Complicaciones mayores incluyeron trombosis arterial (n= 1), complicaciones neurológicas mayores secundarias a la embolización accidental de nervios de las extremidades inferiores (n=2) y necrosis de grandes miomas requiriendo histerectomía (n=1). El seguimiento fue posible en 16 pacientes. Ocho pacientes murieron entre 1-14 meses después del procedimiento. No hubo episodios significativos de resangrado tardío en ninguna de las pacientes. La embolización arterial transcateter es un método efectivo para controlar la hemorragia severa refractaria al manejo conservador en pacientes con carcinoma cervical avanzado
Assuntos
Angiografia , Embolização Terapêutica , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Hemorragia UterinaRESUMO
Se evalúa la técnica de conización cervical con radiofrecuencia como método Terapéutico para el manejo de la neoplasia intraepitelial cervical grado III (NIV III), en la clínica Profamilia de Medellín, Colombia, entre 1994 y 1995. El cono LLETZ se realizó en 30 pacientes con diagnostico de Nic III por biopsia previa y se les hizo un seguimiento colposcópico a los tres meses y citología trimestral por un año. La edad promedio fue de 34 años; la duración del procedimiento fue de 11 minutos en promedio. El procedimiento fue indoloro en el 34.4 por ciento de las pacientes y levemente doloroso en el 46.9 por ciento. No hubo sangrado en el 18.8 por ciento y sangrado leve a moderado en el 78 por ciento de los pacientes. La unión escamocolumnar fue visible en el 53.1 por ciento. Hubo una discrepancia histológica entre la biopsia previa y el cono LLETZ en el 28.1 por ciento de los casos. Uno de cada cinco conos tuvo compromiso de los bordes. Se obtuvo curación en el 89.6 por ciento de las pacientes. En cuanto a complicaciones sólo una paciente presentó sangrado tardío. Se muestra que el cono LLETZ es un método altamente afectivo para el tratamiento del NIC III...
Assuntos
Feminino , Displasia do Colo do Útero , Conização , RadiocirurgiaRESUMO
This article describes a distant curricular methodology of the Universidad del Valle Nursing Department. With such a modality over 500 professionals were able to reach the nursing licenciateship degree, without leaving their jobs and working in different cities of the country. The backgrounds offered refer to the programs of the southwestern region in Colombia and the results of the evaluation, which made it possible to provide a new nursing curriculum, more in accordance with the needs both of the community and of the region and the country. Two main factors are emphasized which underly the educational model: learning while rendering services and solving medical care problems of the institution, and at the same time fulfilling the quality level of the learning model for stimulating creativity, critical discussion, facilitating the active work of the learners. Finally, a summary is made of the method used and the results in terms of the model experimentation and implementation in five universities around the country.
Assuntos
Bacharelado em Enfermagem , Modelos de Enfermagem , Cuba , Currículo , UniversidadesRESUMO
El presente documento trata de la estructura urbana de Bolivia que debe ser analizado desde el punto de vista de la estructura socioeconómica sobre la estructura espacial. El crecimiento de la población urbana es un fenómeno mundial incontrolable, la población de las áreas rurales se siente atraída por la ciudad, ya sea porque en el medio no existen facilidades culturales, educación y salud o por fuentes de trabajo y como consecuencia del aumento de la población urbana y por crecimiento vegetativo y por las migraciones masivas,las ciudades se hallan congestionadas, en contraposición con las poblaciones ruales que se encuentran sin los recursos necesarios