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PURPOSE: Real-world evidence on locally advanced or metastatic urothelial carcinoma (la/mUC) management in Spain is limited. This study describes patient characteristics, treatment patterns, survival, and health care resource utilization (HCRU) in this population. METHODS/PATIENTS: This retrospective observational study included all adults with a first diagnosis/record of la/mUC (index date) from January 2015 to June 2020 at nine university hospitals in Spain. Data were collected up to December 31, 2020 (end of study), death, or loss to follow-up. Patient characteristics, treatment patterns, median overall survival (OS) and progression-free survival (PFS) from index date (Kaplan-Meier estimates), and disease-specific HCRU were described. RESULTS: Among 829 patients, median age at diagnosis was 71 years; 70.2% had ≥ 1 comorbidity, and 52.5% were eligible for cisplatin. Median follow-up was 12.7 months. Most (84.7%) patients received first-line systemic treatment; of these, 46.9% (n = 329) received second-line and 16.6% (n = 116) received third-line therapy. Chemotherapy was the most common treatment in all lines of therapy, followed by programmed cell death protein 1/ligand 1 inhibitors. Median (95% confidence interval) OS and PFS were 18.8 (17.5-21.5) and 9.9 (8.9-10.5) months, respectively. Most patients required ≥ 1 outpatient visit (71.8%), inpatient admission (56.6%), or emergency department visit (56.5%). CONCLUSIONS: Therapeutic patterns were consistent with Spanish guideline recommendations. Chemotherapy had a role in first-line treatment of la/mUC in Spain during the study period. However, the disease burden remains high, and new first-line treatments recommended in the latest European guidelines should be made available to patients in Spain.

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Urinary tract infections (UTIs) constitute one of the main complications in kidney recipients, increasing both morbidity and mortality. Due to the resurgence of antimicrobial resistance, new prophylactic approaches are being investigated. Nitrofurantoin is an antibiotic from the nitrofuran group that is effective against several Gram-negative and Gram-positive organisms; hence, there has been a resurgence in its prescription for treating MDR pathogens. Objectives: This study aims to assess the effectiveness of nitrofurantoin as an add-on to conventional therapy (amikacin + ceftriaxone or cefotaxime) for the treatment of urinary tract infections in kidney recipients. Methods: In a prospective cohort study, we included patients who received a kidney in a tertiary-care hospital. According to the intensive care specialist, group 1 patients were treated with the conventional prophylactic treatment plus nitrofurantoin as an add-on. Group 2 patients were treated only with the conventional prophylactic treatment. They were followed-up for 3 months, and the incidence of urinary tract infections was reported. Results: The UTI incidence for group 1 at 3 months was 20.6%, and for group 2, it was 20.0%; no statistical difference between treatments was observed (p = 0.9). The most commonly isolated pathogens were E. coli (28.5) and K. pneumonie (28.5%). The factor most associated with developing a UTI was female gender (aHR: 7.0; 95% IC 2.3-20.9, p < 0.001). Conclusions: In our cohort study, nitrofurantoin as an add-on in conventional therapy did not prove to be effective in preventing UTI development; therefore, other treatment options should be considered as a part of prophylactic treatment.

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Background: Rheumatoid arthritis (RA) in elderly population represents a challenge for physicians in terms of therapeutic management. Methotrexate (MTX) is the first-line treatment among conventional synthetic-disease-modifying anti-rheumatic drugs (cs-DMARDs); however, it is often associated with adverse events (AEs). Therefore, the objective of this study was to identify the incidence and risk factors of MTX discontinuation due to AEs in elderly patients with RA in a long-term retrospective cohort study. Methods: Clinical sheets from elderly RA patients taking MTX from an outpatient rheumatology consult in a university centre were reviewed. To assess MTX persistence, we used Kaplan-Meir curves and Cox regression models to identify the risk of withdrawing MTX due to adverse events. Results: In total, 198 elderly RA patients who reported using MTX were included. Of them, the rates of definitive suspension of MTX due to AEs were 23.0% at 5 years, 35.6% at 10 years and 51.7% at 15 years. The main organs and system involved were gastrointestinal (15.7%) and mucocutaneous (3.0%). Factors associated with withdrawing MTX due to AEs were MTX dose ≥ 15 mg/wk (adjusted HR: 2.46, 95% CI: 1.22-4.96, p = 0.012); instead, the folic acid supplementation was protective for withdrawal (adjusted HR: 0.28, 95% CI: 0.16-0.49, p < 0.001). Conclusions: Higher doses of MTX increase the risk of withdrawals in elderly RA, while folic acid supplementation reduces the risk. Therefore, physicians working in therapeutic management for elderly patients using MTX must focus on using lower MTX doses together with the concomitant prescription of folic acid.

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Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1-patients with sepsis treated with conventional treatment without vitamin C; Group 2-patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31-0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis.

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PURPOSE: Post hoc analysis of the JAVELIN Bladder 100 trial of avelumab maintenance in locally advanced/metastatic urothelial carcinoma (la/mUC) to determine the interaction by programmed death ligand 1 (PD-L1) status for overall survival (OS), and additional analyses of survival per a different PD-L1 expression cutoff of ≥ 1% in tumor cells or immune cells (TC/IC). METHODS: JAVELIN Bladder 100 data were used for the analysis of the interaction by PD-L1 status (per cutoff used in the trial) for OS and, additionally, OS and progression-free survival (PFS) analyses per a different ≥ 1% TC/IC PD-L1 expression cutoff (Ventana SP263 assay). RESULTS: No significant interaction between treatment and PD-L1 status was observed for OS. Clinically meaningful and robust survival data were observed in favor of avelumab using the different ≥ 1% TC/IC PD-L1 expression cutoff. CONCLUSIONS: These results demonstrate the benefit of avelumab maintenance in la/mUC regardless of PD-L1 expression, consistent with approved labels.

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INTRODUCTION: Metabolic syndrome (MS) is associated with abnormalities in atrial mechanics, atrial remodeling, and an increased risk of heart rhythm disorders. One of the most commonly used approaches to the prevention of cardiac remodeling in arterial hypertension is the administration of renin-angiotensin system (RAS) inhibitors. Therefore, this study aimed to investigate the effects of RAS inhibitors on atrial mechanics parameters in patients with MS. METHODS AND MATERIALS: This longitudinal observational study included 55 patients with hypertension and MS, as defined by the ATP III criteria. The patients were evaluated at the start of antihypertensive treatment with an RAS inhibitor. The patients' clinical characteristics, chosen pharmacological treatment, and transthoracic echocardiography findings were recorded at baseline and 6 months thereafter. A student's dependent sample t-test was used for comparisons between groups. Pearson correlation was used to evaluate the relationships between variables. RESULTS: Patients with MS had higher peak atrial longitudinal strain (PALS) values at 6 months than at baseline. Meanwhile, systolic strain and peak late strain rates were lower at follow-up than at baseline. The different antihypertensive treatments had comparable effects on the PALS changes during the follow-up period. Higher high-density lipoprotein levels at baseline were correlated with changes in PALS. CONCLUSION: The administration of RAS inhibitors improved atrial mechanics parameters in the early stages of antihypertensive management in MS.

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Promoting neglected and underutilized crop species is a possible solution to deal with the complex challenges of global food security. Chayote is a Neglected and Underutilized Cucurbit Species (NUCuS), which is recognized as a fruit vegetable in Latin America and is widely grown in Asia and Africa. However, basic biological knowledge about the crop is insufficient in scientific sources, especially outside of its center of origin. In this study, limited observations on reproductive characters were conducted, differentiating accessions from Mexico, Japan, and Myanmar. Cytological evaluation among Mexican and Japanese accessions showed that the relative nuclear DNA content is 1.55 ± 0.05 pg, the estimated genome size is 1511 at 2C/Mbp, and the observed mitotic chromosomal number is 2n = 28. The genetic diversity of 21 chayote accessions was also examined using six microsatellite markers. A global low genetic heterozygosity (Ho = 0.286 and He = 0.408) and three genetic groups were detected. The results established the basis to provide insights into chayote arrival history in Asia by looking at the crop's reproductive morphology, cytology, and genetic diversity status outside its origin center. This could help in developing sustainable utilization and conservation programs for chayote.

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One of the most important causes of disease and premature death in the world is environmental pollution. The presence of pollutants in both water and air contributes to the deterioration of the health of human populations. The Mexico City Metropolitan Area is one of the most populous and affected by air pollution worldwide; in addition, in recent years there has been a growing demand for water, so urban reservoirs such as the Madin dam are vital to meet the demand. However, this reservoir is highly polluted due to the urban settlements around it. Therefore, the aim of the present study was to evaluate oxidative stress in clinically healthy subjects by means of the degree of lipoperoxidation, as well as the modification of serum enzyme levels, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase associated with air and drinking water pollutants from three zones of the Mexico City Metropolitan Area, two of them related to Madin Dam. This descriptive cross-sectional study was conducted between March 2019 and September 2021 in 142 healthy participants (age range 18-65 years). Healthy subjects were confirmed by their medical history. The results showed that chronic exposure to air (SO2) and water pollutants (Al and Fe) was significantly associated with elevated levels of lipoperoxidation. There was evidence that contamination from the Madín dam can generate oxidative stress and affect the health status of people who receive water from this reservoir or who consume fish that inhabit it.

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The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky-Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (p = 0.019), the presence of other comorbidities (p = 0.047), and the use of complementary therapies (p = 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06-7.63, p = 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies.

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Background: Myostatin is a regulator of muscle size. To date, there have been no published studies focusing on the relation between myostin levels and myopenia in rheumatoid arthritis (RA). Objective: Evaluate the value of serum myostatin as a biomarker of cachexia and low skeletal muscle mass (LSMM) in RA patients, along with whether high serum myostatin is associated to these conditions after adjusting for potential confounders. Methods: This cross-sectional study included 161 female RA patients and 72 female controls. In the RA group, we assessed several potential risk factors for LSMM and rheumatoid cachexia. Dual-energy X-ray absorptiometry was used to quantify the skeletal muscle mass index (SMMI) (considering LSMM ≤ 5.5 kg/m2) and the presence of rheumatoid cachexia (a fat-free mass index ≤ 10 percentile and fat mass index ≥ 25 percentile of the reference population). Serum myostatin concentrations were determined by ELISA. To identify a cut-off for high serum myostatin levels, we performed ROC curve analysis. Multivariable logistic regression analysis was used to identify the risk factors for LSMM and rheumatoid cachexia. The risk was expressed as odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: Compared to the controls, the RA group had a higher proportion of LSMM and exhibited high serum myostatin levels (p < 0.001). ROC curve analysis showed that a myostatin level ≥ 17 ng/mL was the most efficient cut-off for identifying rheumatoid cachexia (sensitivity: 53%, specificity: 71%) and LSMM (sensitivity: 43%, specificity: 77%). In the multivariable logistic regression, RA with high myostatin levels (≥17 ng/mL) was found to increase the risk of cachexia (OR = 2.79, 95% CI: 1.24-6.29; p = 0.01) and LSMM (OR = 3.04, 95% CI: 1.17-7.89; p = 0.02). Conclusions: High serum myostatin levels increase the risk of LSMM and rheumatoid cachexia. We propose that high myostatin levels are useful biomarkers for the identification of patients in risk of rheumatoid cachexia and myopenia.

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Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin-gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended.

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OBJECTIVE: To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS: Using the National Satisfaction and Responsiveness Survey (ENSATA) 2009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS: A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82% for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77%, with a range of 30 to 96%). Patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in SESA hospitals the average was only 56.2%, with a large variance among states (13 to 94%). The median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). CONCLUSIONS: The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

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OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Adecuado (ENSATA) de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82 por ciento. Los hospitales de los Servicios Estatales de Salud (SESA) mostraron una disponibilidad de 77 por ciento (variación de 30 a 96 por ciento). El surtimiento completo de recetas fue de 97 por ciento en las instituciones de seguridad social, cifra que contrasta con 56.2 por ciento de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94 por ciento) La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1 por ciento gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas.

OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82 percent for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77 percent, with a range of 30 to 96 percent). Patients discharged at social security hospitals received in 97 percent of cases a complete prescription filling, while in SESA hospitals the average was only 56.2 percent, with a large variance among states (13 to 94 percent). The median inpatient spending was 150 pesos in national currency (1 percent spent over 10 000 pesos). CONCLUSIONS. The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

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Bycatch fish species from shrimp industrial fishery in the Gulf of California, Mexico. The shrimp fishery in the Gulf of California is one the most important activities of revenue and employment for communities. Nevertheless, this fishery has also created a large bycatch problem, principally fish. To asses this issue, a group of observers were placed on board the industrial shrimp fleet and evaluated the Eastern side of the Gulf during 2004 and 2005. Studies consisted on 20kg samples of the capture for each trawl, and made possible a systematic list of species for this geographic area. Fish represented 70% of the capture. A total of 51 101 fish were collected, belonging to two classes, 20 orders, 65 families, 127 genera, and 241 species. The order Perciformes was the most diverse with 31 families, 78 genera, and 158 species. The best represented families by number of species were: Sciaenidae (34) and Paralichthyidae (18) and Haemulidae and Carangidae (16 each). The best represented genera in number of species were Symphurus (nine) and Diplectrum and Cynoscion (six); other important genera were Larimus and Porichthys with five species each. The best represented species in number were Syacium ovale, Pseudupeneus grandisquamis, Haemulopsis nitidos, Diplectrum pacificum, Synodus scituliceps, Balistes polylepis, Eucinostomus currani, Eucinostomus gracilis, Porichthys analis, Chloroscombrus orqueta, Selene peruviana, Orthopristis reddingi, Etropus crossotus, Scorpaena sonorae and Urobatis halleri. The number of recorded species is notably high, compared with demersal fauna of other areas of the Mexican Pacific, such as Gulf of Tehuantepec (178), Nayarit, Michoacán, Guerrero (174, 120 and 166), Jalisco and Colima (161 species), and those of the Western coast of the Baja California Peninsula (220 species). Rev. Biol. Trop. 58 (3): 925-942. Epub 2010 September 01.

Composición taxonómica de peces integrantes de la fauna de acompañamiento de la pesca industrial de camarón del Golfo de California, México. La pesquería de camarón es la más importante en el Golfo de California y también la más problemática con respecto a las capturas incidentales en México. Dentro de la fauna de acompañamiento del camarón (FAC), el grupo de mayor abundancia son los peces. Se presenta listado sistemático de las especies de peces presentes en la FAC de la pesquería industrial de camarón en la costa oriental del Golfo de California. Durante 2004-2005 se implementó un sistema de observadores a bordo de la flota camaronera de Guaymas, Sonora, que recolectaron muestras de 20kg de la captura. Los peces representaron 70% de las capturas en número. Se recolectó un total de 51 101 ejemplares de peces, pertenecientes a dos clases, 20 órdenes, 65 familias, 127 géneros y 241 especies. El orden Perciformes fue el más diverso (31 familias, 78 géneros y 158 especies). Las familias mejor representadas en número de especies fueron: Sciaenidae y Paralichthyidae con 34 y 18 especies, Haemulidae y Carangidae aportaron 16 especies. Los géneros mejor representados fueron Symphurus con nueve y Diplectrum y Cynoscion con seis especies, otros géneros importantes fueron Larimus y Porichthys con cinco especies. El número de especies registrado es alto, comparado con la fauna demersal de otras áreas del Pacífico Mexicano. Esta alta riqueza de especies se puede atribuir a los sistemas de corrientes, surgencias, remolinos, topografía y batimetría únicas, que en conjunto originan un ecosistema dinámico con un amplio régimen térmico y una gran variedad de hábitats. Los resultados aqui presentados ponen de manifiesto que esta región del Golfo de California presenta una gran riqueza de especies, lo que abre diversas expectativas desde el punto de vista ecológico, pesquero, alimenticio y de manejo.

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Bycatch fish species from shrimp industrial fishery in the Gulf of California, Mexico. The shrimp fishery in the Gulf of California is one the most important activities of revenue and employment for communities. Nevertheless, this fishery has also created a large bycatch problem, principally fish. To asses this issue, a group of observers were placed on board the industrial shrimp fleet and evaluated the Eastern side of the Gulf during 2004 and 2005. Studies consisted on 20kg samples of the capture for each trawl, and made possible a systematic list of species for this geographic area. Fish represented 70% of the capture. A total of 51 101 fish were collected, belonging to two classes, 20 orders, 65 families, 127 genera, and 241 species. The order Perciformes was the most diverse with 31 families, 78 genera, and 158 species. The best represented families by number of species were: Sciaenidae (34) and Paralichthyidae (18) and Haemulidae and Carangidae (16 each). The best represented genera in number of species were Symphurus (nine) and Diplectrum and Cynoscion (six); other important genera were Larimus and Porichthys with five species each. The best represented species in number were Syacium ovale, Pseudupeneus grandisquamis, Haemulopsis nitidos, Diplectrum pacificum, Synodus scituliceps, Balistes polylepis, Eucinostomus currani, Eucinostomus gracilis, Porichthys analis, Chloroscombrus orqueta, Selene peruviana, Orthopristis reddingi, Etropus crossotus, Scorpaena sonorae and Urobatis halleri. The number of recorded species is notably high, compared with demersal fauna of other areas of the Mexican Pacific, such as Gulf of Tehuantepec (178), Nayarit, Michoacán, Guerrero (174, 120 and 166), Jalisco and Colima (161 species), and those of the Western coast of the Baja California Peninsula (220 species).

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The goal of Seguro Popular (SP) in Mexico was to improve the financial protection of the uninsured population against excessive health expenditures. This paper estimates the impact of SP on catastrophic health expenditures (CHE), as well as out-of-pocket (OOP) health expenditures, from two different sources. First, we use the SP Impact Evaluation Survey (2005-2006), and compare the instrumental variables (IV) results with the experimental benchmark. Then, we use the same IV methods with the National Health and Nutrition Survey (ENSANUT 2006). We estimate naïve models, assuming exogeneity, and contrast them with IV models that take advantage of the specific SP implementation mechanisms for identification. The IV models estimated included two-stage least squares (2SLS), bivariate probit, and two-stage residual inclusion (2SRI) models. Instrumental variables estimates resulted in comparable estimates against the "gold standard." Instrumental variables estimates indicate a reduction of 54% in catastrophic expenditures at the national level. SP beneficiaries also had lower expenditures on outpatient and medicine expenditures. The selection-corrected protective effect is found not only in the limited experimental dataset, but also at the national level.

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Taxonomic composition and zoogeographic relations of demersal in the western coast of Baja California Sur, Mexico. The composition of demersal fish along the western coast of the State of Baja California Sur, México, including the limit of the northern distribution of the ichthyofauna of the eastern tropical Pacific, is presented. The survey was carried out on four oceanographic cruises between autumn 2004 and March 2006. Of 220 species in 132 genera and 73 families, 26.3% are species of wide distribution from San Diego County, USA to Panama and 21.7% are species restricted to the eastern tropical Pacific. Six species are new findings for the area or range expansions. The families with the most species are Paralichthyidae and Scorpaenidae, each with 16 species. The most frequent genus was Sebastes, with nine species. We present a table with common Spanish names, size range and status of each species inside the community. Rev. Biol. Trop. 56 (4): 1765-1783. Epub 2008 December 12.

Se presenta la composición sistemática de peces demersales de la costa occidental de Baja California Sur, límite de distribución norte de la ictiofauna del Pacífico Oriental Tropical. Se realizaron cuatro cruceros oceanográficos durante otoño de 2004 a marzo de 2006. Este listado incluye 220 especies, 132 géneros y 73 familias. El 26.3% corresponde a especies de amplia distribución desde la Provincia de San Diego a la Provincia Panámica y el 21.7% son especies restringidas a la región del Pacífico Oriental Tropical. Seis especies representan nuevos registros para la zona o ampliación de su ámbito de distribución. Las familias mejor representadas en número de especies fueron Paralichthyidae y Scorpaenidae, con 16 especies cada una. El género mejor representado fue Sebastes con 9 especies. Se presentan los nombres comunes, intervalo de tallas y el estatus de cada especie dentro de la comunidad.

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The composition of demersal fish along the western coast of the State of Baja California Sur, Mexico, including the limit of the northern distribution of the ichthyofauna of the eastern tropical Pacific, is presented. The survey was carried out on four oceanographic cruises between autumn 2004 and March 2006. Of 220 species in 132 genera and 73 families, 26.3% are species of wide distribution from San Diego County, U.S.A. to Panama and 21.7% are species restricted to the eastern tropical Pacific. Six species are new findings for the area or range expansions. The families with the most species are Paralichthyidae and Scorpaenidae, each with 16 species. The most frequent genus was Sebastes, with nine species. We present a table with common Spanish names, size range and status of each species inside the community.

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Annual von Bertalanffy growth parameters of the Caribbean spiny lobster (Panulirus argus) in Cuban waters were estimated from a long term study (40 years) by length-based methods ELEFAN and the new version of SLCA. Data of around 800 000 lobsters (with carapace length ranging 14 to 199mm) were randomly sampled in artificial shelters (a non selective fishing gear very common in the lobster fishery), through the field monitory program established for this species since 1963 in 14 localities of southwestern Cuban shelf. The software ELEFAN showed problems to converge in an optimal combination of the instantaneous growth coefficient (K) and the asymptotic length of the von Bertalanffy equation, whereas the new SLCA software produced value estimates of K between 0.20 and 0.27 year-1 and values of asymptotic length between 177 and 190 mm carapace length, all within the range reported in the literature. The standardized anomalies of both parameters showed the presence of cycles along the analyzed time series. Decadal variability in growth parameters was revealed through the spectral analysis indicating cycles of 16 and 20 years for K and of 16 years for asymptotic length. The incidence of some factors such as biomass and temperature that modulate growth in this crustacean was explored, using a nonlinear multiple regression model. These combined factors explained 33% and 69% of the variability of K and asymptotic length respectively. The growth coefficient appeared to be maximum with annual mean sea surface temperature of 28.1º C and the largest asymptotic length is reached at a annual men biomass level of 23 000 t. These results should be the basis to understand the Cuban lobster population dynamics

Los parámetros de crecimiento anuales para la langosta espinosa del Caribe (Panulirus argus) en aguas cubanas se estimaron para una serie de 40 años de datos de composición por longitud, a través de los métodos indirectos basados en la talla ELEFAN y el nuevo SLCA. Las composiciones por talla de alrededor de 800 000 langostas (con un ámbito de longitud de cefalotórax entre 14 y 199 mm) fueron obtenidas en muestreos aleatorios, realizados en arrecifes artificiales (arte de pesca muy común en esta pesquería cubana), a través del programa de monitoreo de campo establecido para esta especie desde 1963 en 14 localidades del Golfo de Batabanó, plataforma suroccidental de Cuba. El método ELEFAN mostró problemas para convergir en una combinación óptima del coeficiente de crecimiento (K) y el largo asintótico de la ecuación de von Bertalanffy, mientras que el método nuevo SLCA proporcionó valores de K entre 0.20 y 0.27 año-1 y de largo asintótico entre 177 y 190 mm de longitud de cefalotórax, todos dentro del ámbito reportado en la literatura. Las anomalías estandarizadas de ambos parámetros mostraron la existencia de ciclos a lo largo de la serie de tiempo analizada. El análisis espectral demostró una variabilidad decadal en los parámetros de crecimiento, con ciclos significativos de 16 y 20 años para K y de 16 años para largo asintótico. La incidencia de algunos factores, que modulan el crecimiento en este valioso crustáceo, como la biomasa y la temperatura fue explorada usando un modelo nolineal de regresión múltiple. Los resultados indicaron que ambos factores combinados explican el 33% y el 69% de la variabilidad de la K y del largo asintótico respectivamente. El coeficiente de crecimiento alcanzó su máximo con temperaturas medias anuales de superficie del mar de 28.1º C y el mayor valor de L 8se alcanza con niveles en la biomasa media anual de 23 000 t. La consideración de estos resultados debe ser la base para estudios posteriores en el conocimiento y predicción de la dinámica de la población de langosta en Cuba

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OBJECTIVE: Present information on the magnitude and composition of private health expenditure (PHE) in Mexico. MATERIAL AND METHODS: Total PHE by state was calculated using the System of National Health Accounts and National Performance Assessment Survey 2002-2003 by means of elasticities and growth relative contributions. RESULTS: 58% of the total PHE was private and 90% of this was out-of-pocket expenditure. Most of the latter is expenditure in ambulatory care and drugs. 60% of the PHE was concentrated in only six states. PHE was lower than public expenditure in six states. CONCLUSIONS: The magnitude of out-of-pocket expenditure in health is worrying, since it is the most unfair, inefficient and regressive way of financing health care. Health authorities should look for alternative ways to finance health care, like the Popular Health Insurance.

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