Salud mental en adultos atendidos en un centro de referencia en Chiapas, México, 2012-2018 / Mental Health in Adults Attended at a Reference Center in Chiapas, México, 2012-2018

RESUMEN Objetivo: Determinar la frecuencia de trastornos mentales y su relación con variables demográficas, antecedentes familiares y consumo de alcohol y drogas en adultos atendidos en la Unidad de Atención a la Salud Mental San Agustín, de Tuxtla Gutiérrez, Chiapas, México, durante el período 2012-2018. Material y métodos: Estudio de diseño transversal que incluyó el registro de 4612 adultos, de entre 18 y 60 años de edad, vistos en el servicio de consulta externa de la unidad de atención referida durante el período 2012-2018. Resultados: El 50 % de los probandos fueron mujeres; y el 60 % tenían entre 18 y 39 años. Los trastornos más frecuentes encontrados fueron esquizofrenia (31,2 %), trastornos del estado de ánimo (24,1 %) y trastornos de ansiedad (21,9 %). Las variables de edad, sexo, antecedentes familiares, consumo de alcohol y drogas ilícitas se asociaron definidamente con los trastornos más frecuentes, destacando el hecho de que los trastornos del ánimo presentaron mayor prevalencia entre los jóvenes y las mujeres. Conclusión: Los hallazgos respecto a los trastornos más prevalentes, así como algunos de los factores asociados a los mismos en este estudio, son consistentes con los encontrados en otros países de la región. Esto puede constituirse en un componente importante de estrategias que mejoren perspectivas y procedimientos en la atención a la población chiapaneca con problemas de salud mental.

ABSTRACT Objective. To determine the frequency of mental health disorders and their relationship with socio-demographic variables and consumption of alcohol and tobacco in adults seen at the Mental Health Care Unit "San Agustín" in Tuxtla Gutiérrez, Chiapas, during the period 2012-2018. Method. Cross-sectional study that included 4612 adults within a range of 18-60 years old attended at Unit's outpatient service during the above mentioned period. Results. Fifty percent of the total of probands were women, 60% within a range of 18-39 years old. The most frequent disorders were schizophrenia (31.2%), mood (24.1%), and anxiety (21.9%). Variables such as age, sex, family history, and alcohol and illicit drug use were associated with the presence of the most frequent disorders. Similarly, mood disorders presented a higher prevalence among young people and women. Conclusion. The trend regarding the most prevalent disorders in this study, as well as some associated factors are consistent with those found in other countries of the region, which, in turn, can be considered as a relevant component of better strategies to improve care procedures for the Chiapas population's sectors excperiencing mental health problems.

Highly conserved thermal performance strategies may limit adaptive potential in corals.

Increasing seawater temperatures are expected to have profound consequences for reef-building corals' physiology. Understanding how demography changes in response to chronic exposure to warming will help forecast how coral communities will respond to climate change. Here, we measure growth rates of coral fragments of four common species, while exposing them to temperatures ranging from 19°C to 31°C for one month to calibrate their thermal-performance curves (TPCs). Our results show that, while there are contrasting differences between species, the shape of the TPCs was remarkably consistent among individuals of the same species. The low variation in thermal sensitivity within species may imply a reduced capacity for rapid adaptive responses to future changes in thermal regimes. Additionally, interspecific differences in thermal responses show a negative relationship between maximum growth and thermal optima, contradicting expectations derived from the classic 'warmer-is-better' hypothesis. Among species, there was a trade-off between current and future growth, whereby most species perform well under current thermal regimes but are susceptible to future increases in temperature. Increases in water temperature with climate change are likely to reduce growth rates, further hampering future coral reef recovery rates and potentially altering community composition.

[Paravalvular leak closure using off - label devices: a useful resource]. / Cierre de parafuga valvular con dispositivos off - label: un recurso valioso.

We present the case of a patient with a paravalvular leak of mechanical prosthesis in aortic position. Due to a recent previous surgery, it was decided to perform a percutaneous repair to reduce perioperative risk, under an off-label indication using a device for ventricular septal defect closure, successful and without complications in the follow-up.

An enigmatic population of Alsodes (Anura, Alsodidae) from the Andes of central Chile with three species-level mitochondrial lineages.

The genus Alsodes is the most diverse amphibian taxon of southern Andes, where a series of endemic species occur from north to south (∼33° to 48°30'S), mainly on the western slopes (Chile), with little overlap of geographic ranges. In this study, we describe a new population of Alsodes from the western slopes of the Andes (Fundo El Rosario, 36°52'S), located in a section of this mountain range where it is not clear which congeneric species inhabit. Phylogenetic analyses show that this population presents a mix of mitochondrial DNA related to three nominal species, A. hugoi, A. igneus and A. pehuenche, although the last is mainly present. However, the population presents external characteristics attributable to A. hugoi and A. igneus, differing notably from A. pehuenche. The population inhabits a stream surrounded by temperate deciduous forests at 1130 m elevation, an environment similar to that of A. hugoi and A. igneus, but very different from that of A. pehuenche (high Andean steppe environments between 2000 and 2500 m). This finding represents an enigma from the evolutionary and biogeographical point of view, because it might involve hybridization and/or introgression phenomena between more than two species. As the taxonomic status of this population cannot be determined with the available genetic and morphological evidence, we speculate about its probable origin, taking into account the scarce knowledge of the geographic distributions of the species of Alsodes in the area.

Evaluating methods for phylogenomic analyses, and a new phylogeny for a major frog clade (Hyloidea) based on 2214 loci.

Phylogenomic approaches offer a wealth of data, but a bewildering diversity of methodological choices. These choices can strongly affect the resulting topologies. Here, we explore two controversial approaches (binning genes into "supergenes" and inclusion of only rapidly evolving sites), using new data from hyloid frogs. Hyloid frogs encompass ∼53% of frog species, including true toads (Bufonidae), glassfrogs (Centrolenidae), poison frogs (Dendrobatidae), and treefrogs (Hylidae). Many hyloid families are well-established, but relationships among these families have remained difficult to resolve. We generated a dataset of ultraconserved elements (UCEs) for 50 ingroup species, including 18 of 19 hyloid families and up to 2214 loci spanning >800,000 aligned base pairs. We evaluated these two general approaches (binning, rapid sites only) based primarily on their ability to recover and strongly support well-established clades. Data were analyzed using concatenated likelihood and coalescent species-tree methods (NJst, ASTRAL). Binning strongly affected inferred relationships, whereas use of only rapidly evolving sites did not (indicating ∼87% of the data contributed little information). The optimal approaches for maximizing recovery and support of well-established clades were concatenated likelihood analysis and the use of a limited number of naive bins (statistical binning gave more problematic results). These two optimal approaches converged on similar relationships among hyloid families, and resolved them with generally strong support. The relationships found were very different from most previous estimates of hyloid phylogeny, and a new classification is proposed. The new phylogeny also suggests an intriguing biogeographical scenario, in which hyloids originated in southern South America before radiating throughout the world.

Connectivity and systemic resilience of the Great Barrier Reef.

Australia's iconic Great Barrier Reef (GBR) continues to suffer from repeated impacts of cyclones, coral bleaching, and outbreaks of the coral-eating crown-of-thorns starfish (COTS), losing much of its coral cover in the process. This raises the question of the ecosystem's systemic resilience and its ability to rebound after large-scale population loss. Here, we reveal that around 100 reefs of the GBR, or around 3%, have the ideal properties to facilitate recovery of disturbed areas, thereby imparting a level of systemic resilience and aiding its continued recovery. These reefs (1) are highly connected by ocean currents to the wider reef network, (2) have a relatively low risk of exposure to disturbances so that they are likely to provide replenishment when other reefs are depleted, and (3) have an ability to promote recovery of desirable species but are unlikely to either experience or spread COTS outbreaks. The great replenishment potential of these 'robust source reefs', which may supply 47% of the ecosystem in a single dispersal event, emerges from the interaction between oceanographic conditions and geographic location, a process that is likely to be repeated in other reef systems. Such natural resilience of reef systems will become increasingly important as the frequency of disturbances accelerates under climate change.

[Fusarium species associated with basal rot of garlic in North Central Mexico and its pathogenicity]. / Patogenicidad de especies de Fusarium asociadas a la pudrición basal del ajo en el centro norte de México.

Garlic in Mexico is one of the most profitable vegetable crops, grown in almost 5,451ha; out of which more than 83% are located in Zacatecas, Guanajuato, Sonora, Puebla, Baja California and Aguascalientes. Blossom-end rot caused by Fusarium spp is widely distributed worldwide and has been a limiting factor in onion and garlic production regions, not only in Mexico but also in other countries. The presence of Fusarium oxysporum has been reported in Guanajuato and Aguascalientes. Fusarium culmorum has been reported in onion cultivars of Morelos; and Fusarium proliferatum, Fusarium verticillioides, Fusarium solani and Fusarium acuminatum have been previously reported in Aguascalientes. The goal of this work was identifying the Fusarium species found in Zacatecas, Guanajuato and Aguascalientes, to assess their pathogenicity. Plants with disease symptoms were collected from hereinabove mentioned States. The samples resulted in the identification of: F. oxysporum, F. proliferatum, F. verticillioides, F. solani and F. acuminatum species; out of which Aguascalientes AGS1A (F. oxysporum), AGS1B (F. oxysporum) and AGSY-10 (F. acuminatum) strains showed higher severity under greenhouse conditions.

A review of techniques for detecting Huanglongbing (greening) in citrus.

Huanglongbing (HLB) is the most destructive disease of citrus worldwide. Monitoring of health and detection of diseases in trees is critical for sustainable agriculture. HLB symptoms are virtually the same wherever the disease occurs. The disease is caused by Candidatus Liberibacter spp., vectored by the psyllids Diaphorina citri Kuwayama and Trioza erytreae. Electron microscopy was the first technique used for HLB detection. Nowadays, scientists are working on the development of new techniques for a rapid HLB detection, as there is no sensor commercially accessible for real-time assessment of health conditions in trees. Currently, the most widely used mechanism for monitoring HLB is exploration, which is an expensive, labor-intensive, and time-consuming process. Molecular techniques such as polymerase chain reaction are used for the identification of HLB disease, which requires detailed sampling and processing procedures. Furthermore, investigations are ongoing in spectroscopic and imaging techniques, profiling of plant volatile organic compounds, and isothermal amplification. This study recognizes the need for developing a rapid, cost-effective, and reliable health-monitoring sensor that would facilitate advancements in HLB disease detection. This paper compares the benefits and limitations of these potential methods for HLB detection.

Patogenicidad de especies de Fusarium asociadas a la pudrición basal del ajo en el centro norte de México / Fusarium species associated with basal rot of garlic in North Central Mexico and its pathogenicity

El ajo en México es uno de los cultivos de hortalizas más rentables, más del 83% de esta superficie es aportada por los estados de Zacatecas, Guanajuato, Sonora, Puebla, Baja California y Aguascalientes. La pudrición basal ocasionada por Fusarium spp. se encuentra ampliamente distribuida a nivel mundial; esta enfermedad se ha convertido en una limitante en zonas productoras de cebolla y ajo, no solo en México, sino también en otros países, En México, se ha informado la presencia de Fusarium oxysporum en plantas en Guanajuato y en semillas de ajo en Aguascalientes. En el estado de Morelos se ha reportado la presencia de Fusarium culmorum en cultivares de cebolla. Asimismo, en Aguascalientes se tienen antecedentes de otras especies como Fusarium proliferatum, Fusarium verticillioides, Fusarium solani y Fusarium acuminatum. Para este trabajo se planteó como objetivo identificar las especies de Fusarium encontradas en los estados de Zacatecas, Guanajuato y Aguascalientes, y evaluar su patogenicidad. Se realizaron recolectas de plantas con síntomas de la enfermedad en los estados antes mencionados. De los muestreos realizados se identificaron las especies F. oxysporum, F. proliferatum, F. verticillioides, F. solani y F. acuminatum; las cepas de Aguascalientes identificadas como AGS1A (F. oxysporum), AGS1B (F. oxysporum) y AGSY-10 (F. acuminatum) fueron las que presentaron bajo condiciones de invernadero un mayor índice de severidad.

Garlic in Mexico is one of the most profitable vegetable crops, grown in almost 5,451 ha; out of which more than 83% are located in Zacatecas, Guanajuato, Sonora, Puebla, Baja California and Aguascalientes. Blossom-end rot caused by Fusarium spp is widely distributed worldwide and has been a limiting factor in onion and garlic production regions, not only in Mexico but also in other countries. The presence of Fusarium oxysporum has been reported in Guanajuato and Aguascalientes. Fusarium culmorum has been reported in onion cultivars of Morelos; and Fusarium proliferatum, Fusarium verticillioides, Fusarium solani and Fusarium acuminatum have been previously reported in Aguascalientes. The goal of this work was identifying the Fusarium species found in Zacatecas, Guanajuato and Aguascalientes, to assess their pathogenicity. Plants with disease symptoms were collected from hereinabove mentioned States. The samples resulted in the identification of: F. oxysporum, F. proliferatum, F. verticillioides, F. solani and F. acuminatum species; out of which Aguascalientes AGS1A (F. oxysporum), AGS1B (F. oxysporum) and AGSY-10 (F. acuminatum) strains showed higher severity under greenhouse conditions.

Venezuelan geckos (Gekkonidae, Phyllodactylidae, Sphaerodactylidae) in the collection of the Universidad de Concepción in Chile, with description of the type series of Gonatodes ligiae and Gonatodes petersi (Sphaerodactylidae).

Herein we catalogue all geckos (Gekkonidae, Phyllodactylidae and Sphaerodactylidae) collected by Roberto Donoso-Barros in Venezuela between 1963 and 1964, deposited in the Universidad de Concepción in Chile. Donoso-Barros did not provide detailed descriptions of two species of Gonatodes named by him, despite both being valid species. We take the opportunity to do so and the type series of Gonatodes ligiae and G. petersi are described for the first time. We also present images in life of all species collected by Donoso-Barros in Venezuela.

Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources.

INTRODUCTION: Severe traumatic brain injury (sTBI) is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD) as the main procedure for damage control (DC) therapy, performed in a University Hospital in Colombia over a 4-year period. MATERIALS AND METHODS: A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS) at 12 months postinjury. This was used to generate a dichotomous variable with "favorable" (GOS of 4 or 5) or "unfavorable" (GOS of 1-3) outcomes; analysis of variance was performed with the Chi-square, Wilcoxon-Mann-Whitney and Fisher tests. RESULTS: An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4-5) was found in 70 patients (66.1%), Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score >16, obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department. CONCLUSION: Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS.

Anticipative management for coral reef ecosystem services in the 21st century.

Under projections of global climate change and other stressors, significant changes in the ecology, structure and function of coral reefs are predicted. Current management strategies tend to look to the past to set goals, focusing on halting declines and restoring baseline conditions. Here, we explore a complementary approach to decision making that is based on the anticipation of future changes in ecosystem state, function and services. Reviewing the existing literature and utilizing a scenario planning approach, we explore how the structure of coral reef communities might change in the future in response to global climate change and overfishing. We incorporate uncertainties in our predictions by considering heterogeneity in reef types in relation to structural complexity and primary productivity. We examine 14 ecosystem services provided by reefs, and rate their sensitivity to a range of future scenarios and management options. Our predictions suggest that the efficacy of management is highly dependent on biophysical characteristics and reef state. Reserves are currently widely used and are predicted to remain effective for reefs with high structural complexity. However, when complexity is lost, maximizing service provision requires a broader portfolio of management approaches, including the provision of artificial complexity, coral restoration, fish aggregation devices and herbivore management. Increased use of such management tools will require capacity building and technique refinement and we therefore conclude that diversification of our management toolbox should be considered urgently to prepare for the challenges of managing reefs into the 21st century.

Molecular characterization of endocarditis-associated Staphylococcus aureus.

Infective endocarditis (IE) is a life-threatening infection of the heart endothelium and valves. Staphylococcus aureus is a predominant cause of severe IE and is frequently associated with infections in health care settings and device-related infections. Multilocus sequence typing (MLST), spa typing, and virulence gene microarrays are frequently used to classify S. aureus clinical isolates. This study examined the utility of these typing tools to investigate S. aureus epidemiology associated with IE. Ninety-seven S. aureus isolates were collected from patients diagnosed with (i) IE, (ii) bloodstream infection related to medical devices, (iii) bloodstream infection not related to medical devices, and (iv) skin or soft-tissue infections. The MLST clonal complex (CC) for each isolate was determined and compared to the CCs of members of the S. aureus population by eBURST analysis. The spa type of all isolates was also determined. A null model was used to determine correlations of IE with CC and spa type. DNA microarray analysis was performed, and a permutational analysis of multivariate variance (PERMANOVA) and principal coordinates analysis were conducted to identify genotypic differences between IE and non-IE strains. CC12, CC20, and spa type t160 were significantly associated with IE S. aureus. A subset of virulence-associated genes and alleles, including genes encoding staphylococcal superantigen-like proteins, fibrinogen-binding protein, and a leukocidin subunit, also significantly correlated with IE isolates. MLST, spa typing, and microarray analysis are promising tools for monitoring S. aureus epidemiology associated with IE. Further research to determine a role for the S. aureus IE-associated virulence genes identified in this study is warranted.

Percutaneous implantation of thoracic and abdominal aortic prostheses in patients at high surgical risk

Introducción: el aneurisma aórtico es frecuente; su ruptura depende del diámetro. La cirugía es el manejo de elección; como alternativa está el implante intraluminal de stents. Objetivo: analizar el impacto del implante percutáneo de los stents aórticos en pacientes de alto riesgo quirúrgico con seguimiento mínimo de un año. Método: estudio descriptivo llevado a cabo desde diciembre de 2005 hasta marzo de 2010, en el que se incluyeron 125 pacientes con aneurisma de aorta torácica o abdominal, criterio quirúrgico por su diámetro y que además fueron rechazados por cirugía dado su alto riesgo. Los desenlaces fueron: muerte intraoperatoria, por cualquier causa y relacionada con el aneurisma a uno, seis y doce meses. Las complicaciones se definieron como las vasculares ocurridas durante los primeros treinta días. Resultados: el aneurisma abdominal fue más frecuente (70,4%). La mortalidad total a un seguimiento de 25,7 meses fue 14,8%; de este porcentaje 5,2% fallecieron por causas relacionadas con el aneurisma. Un paciente falleció durante la intervención. Se reintervinieron 4,3% por fugas. Hubo mayor mortalidad relacionada con el aneurisma en los torácicos (14,7 vs. 1,2% p=0,003) y tendencia en los de mayor diámetro (6,9 vs. 5,7 cm p=0,210). No hubo relación entre mortalidad y diabetes mellitus, tabaquismo, enfermedad coronaria, hipertensión arterial o dislipidemia. Conclusiones: la mortalidad relacionada con el aneurisma en pacientes intervenidos con stent graft aórtico es baja. Ésta se asoció a la torácica y al mayor diámetro aneurismático. Las complicaciones no significaron un aumento en mortalidad. En conclusión, en pacientes con aneurisma aórtico y alto riesgo quirúrgico rechazados para cirugía abierta, el abordaje percutáneo es un tratamiento seguro y eficaz a un seguimiento a mediano plazo.

Introduction: aortic aneurysm is common; its rupture depends on the diameter. Surgery is the treatment of choice, and intraluminal stent implantation is an alternative. Objective: to analyze the impact of percutaneous implantation of aortic stents in high-risk surgical patients with a minimum of one y ear follow-up. Method: Descriptive study conducted from December 2005 to March 2010 which included 125 patients with thoracic or abdominal aortic aneurysm, meeting surgical criteria by its diameter and that were rejected from surgery due to their high risk. The outcomes were intraoperative death from any cause and aneurysm-related at one, six and twelve months. Complications were defined as vascular occurred during the first thirty days. Results: Abdominal aneurysm was more frequent (70.4%). The overall mortality at 25.7 months follow-up was 14.8%. Of this percentage, 5.2% died from causes related to the aneurysm. One patient died during surgery. 4.3% were reoperated for leaks. There was higher aneurysm-related mortality in the thoracic (14.7 vs. 1.2% p = 0.003) and a trend in those of larger diameter (6.9 vs. 5.7 cm p = 0.210). There was no association between mortality and diabetes mellitus, smoking, heart disease, hypertension or dyslipidemia. Conclusions: aneurysm-related mortality in patients undergoing aortic stent graft is low. Mortality was associated with thoracic aneurysm and to its greater diameter. Complications did not imply an increase in mortality. In conclusion, in patients with aortic aneurysm and high surgical risk rejected for open surgery, percutaneous approach is a safe and effective treatment in a medium-term follow-up.

Arteria coronaria descendente anterior doble: reporte de un caso y revisión de la literatura / Dual left anterior descending coronary artery: a case report and literature review

La arteria coronaria descendente anterior es la arteria coronaria con el trayecto más constante; sin embargo en algunas ocasiones puede presentarse un sistema doble. Se reporta y se realiza una revisión de la literatura de un caso de un paciente con arteria coronaria descendente anterior doble tipo 1, con bloqueo de rama izquierda pero sin lesiones ateromatosas significativas.

The left anterior descending coronary artery has one of the most constant anatomy course of all coronary arteries. Rarely however, interventional cardiologists might be facing with a dual left anterior descending artery during routine angiography. A case of a patient presenting with left bundle branch block and a coronary angiography showing a rare anatomic variant of a type 1, dual left anterior descending coronary artery is reported. The available literature was also reviewed.

Spatial patterns of parrotfish corallivory in the Caribbean: the importance of coral taxa, density and size.

The past few decades have seen an increase in the frequency and intensity of disturbance on coral reefs, resulting in shifts in size and composition of coral populations. These changes have lead to a renewed focus on processes that influence demographic rates in corals, such as corallivory. While previous research indicates selective corallivory among coral taxa, the importance of coral size and the density of coral colonies in influencing corallivory are unknown. We surveyed the size, taxonomy and number of bites by parrotfish per colony of corals and the abundance of three main corallivorous parrotfish (Sparisoma viride, Sparisoma aurofrenatum, Scarus vetula) at multiple spatial scales (reefs within islands: 1-100 km, and between islands: >100 km) within the Bahamas Archipelago. We used a linear mixed model to determine the influence of coral taxa, colony size, colony density, and parrotfish abundance on the intensity of corallivory (bites per m(2) of coral tissue). While the effect of colony density was significant in determining the intensity of corallivory, we found no significant influence of colony size or parrotfish abundance (density, biomass or community structure). Parrotfish bites were most frequently observed on the dominant species of reef building corals (Montastraea annularis, Montastraea faveolata and Porites astreoides), yet our results indicate that when the confounding effects of colony density and size were removed, selective corallivory existed only for the less dominant Porites porites. As changes in disturbance regimes result in the decline of dominant frame-work building corals such as Montastraea spp., the projected success of P. porites on Caribbean reefs through high reproductive output, resistance to disease and rapid growth rates may be attenuated through selective corallivory by parrotfish.

Alteraciones oculares por tamoxifen en pacientes con cáncer mamario / Ocular alterations induced for the tamoxifen in patients with breast cancer

Objetivo: Identificar las alteraciones oculares inducidas por el tamoxifen en pacientes con cáncer mamario. Diseño del estudio: transversal, analítico y observacional. Material y métodos: Se estudiaron 74 pacientes divididos en dos grupos, Grupo I (n = 37) pacientes que han tomado tamoxifen 20 mg diarios por 3 meses a 5 años y grupo II (n = 37) recibieron sólo quimioterapia. Se les realizó una exploración oftalmológica completa para identificar alteraciones oculares. Los resultados se analizaron con medidas de resumen de tendencia central y de dispersión. Análisis no paramétrico para determinar la diferencia en los grupos. Resultados: No se encontró diferencia significativa en la agudeza visual de ambos grupos (p > 0.05), 15 pacientes que tomaron tamoxifen presentaron disminución de la agudeza visual promedio de -X de 0.37 ñ 0.25. En tres pacientes (8 por ciento), se estableció el diagnóstico de retinopatía por tamoxifen caracterizada por disminución de la agudeza visual, edema macular bilateral y cristales paramaculares.Conclusiones: Toda paciente con cáncer mamario debe ser evaluada periódicamente. El tamoxifen a dosis de 20 mg diarios no se asocia con alteraciones oculares graves.