Ten years of experience of the Mexican Academy of Surgery in the promotion of the next generations of researchers.

OBJECTIVE: To describe the productivity of the research works presented in the Interuniversity and resident doctors Competition of the Mexican Academy of Surgery since its origin in 2010. METHOD: Observational cross-sectional descriptive study in which the variables are considered: category of participation (university/resident) type of work (research, clinical case, etc.), university and institution of origin, type of presentation [poster/oral]) Descriptive statistics was used. RESULTS: Since 2010, 9 interuniversity competitions and 8 resident doctors have been developed. A total of 974 papers were presented, predominantly residents (65.29%), oral presentations (54.51%) and original works (58.11%). 8.9% of the published works. CONCLUSIONS: The Contest is a good forum to disseminate research in the new generations of doctors.

OBJETIVO: Describir los primeros 10 años del Concurso Interuniversitario y de Médicos Residentes de la Academia Mexicana de Cirugía. MÉTODO: Estudio observacional de tipo transversal descriptivo en el que se consideran las variables categoría de participación (universitario/residente), tipo de trabajo (investigación, caso clínico, etc.), universidad e institución de procedencia, y tipo de presentación (cartel/oral). Se empleó estadística descriptiva. RESULTADOS: Desde 2010 se han desarrollado nueve concursos interuniversitarios y ocho de médicos residentes. En total se han presentado 974 trabajos, predominando los de residentes (65.29%), las presentaciones orales (54.51%) y los trabajos originales (58.11%). El 8.9% de los trabajos han sido publicados. CONCLUSIONES: El Concurso es un buen foro para difundir la investigación de las nuevas generaciones de médicos.

Academic-assistance activities registered by the graduates of the specialty of Emergency of the Regional Hospital No. 25 of the Instituto Mexicano del Seguro Social (1991-2018).

OBJECTIVE: To describe the academic-assistance activities of the graduates of the specialty of emergencies in the Regional General Hospital 25 of the Mexican Institute of Social Security. METHOD: Observational descriptive type study in which the 25 generations graduated from the specialty will be analyzed. The scientific, teaching and care productivity of its graduates was analyzed, as well as the subsequent training and the managerial positions held. RESULTS: From 1991 to 2018 238 residents entered, of which 88.65% concluded the specialty. 57.34% are male. 78.67% of the graduates work exclusively in the IMSS and 68.72% do it in more than one institution. 72% of them have certification. They published 112 scientific articles and 4 books. 12.32% of the graduates attended a second specialty, being the predecessor of patient care in the critical state (84.61%). Among the main achievements of the headquarters are in the first emergency room of the country in the Quality Postgraduate Program of Consejo Nacional de Ciencia y Tecnología. 53% of these specialists work or perform in management positions. CONCLUSIONS: This office is considered a reference in the specialty of emergencies in Latin America.

OBJETIVO: Describir las actividades académico-asistenciales de los egresados de la especialidad de urgencias en el Hospital General Regional 25 del Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional de tipo descriptivo en el que se analizaron las 25 generaciones egresadas de la especialidad. Se analizó la productividad científica, docente y asistencial de sus egresados, así como la formación posterior y los puestos directivos desempeñados. RESULTADOS: De 1991 a 2018 ingresaron 238 residentes, de los cuales el 88.65% concluyó la especialidad. El 57.34% son de sexo masculino. El 78.67% de los egresados laboran exclusivamente en el IMSS y el 68.72% lo hacen en más de una institución. El 72% cuentan con certificación. Publicaron 112 artículos científicos y 4 libros. El 12.32% de los egresados cursaron una segunda especialidad, siendo la predominante la de Atención del Paciente en Estado Crítico (84.61%). Entre los logros principales de la sede están el de ser la primera sede de urgencias del país en ser incluida en el Programa de Posgrados de Calidad del Consejo Nacional de Ciencia y Tecnología. El 53% de estos especialistas se desempeñan o han desempeñado en puestos directivos. CONCLUSIONES: Esta sede se constituye como un referente dentro de la especialidad de urgencias en Latinoamérica.

Prevalence of pulmonary thromboembolism in patients undergoing abdominopelvic surgery with respiratory distress.

OBJECTIVE: To determine the prevalence of pulmonary thromboembolism (PET) and identify it's risk factors in patients operated on a scheduled basis, in the general surgery service from the High Specialty Medical Unit Hospital de Especialidades de Puebla, of the Mexican Social Security Institute. METHOD: Descriptive, retrospective and cross sectional study of 52 patients' records with PET and pulmonary angiotomography whose indication was respiratory distress; from 2612 operated patients from November 2015 to March 2018, the sampling was not probabilistic. The statistics was descriptive, with measures of central tendency and dispersion. Fisher test, and Rho Spearman were used. RESULTS: There were association between the development of PET and trans-surgical time (p = 0.018), with the D Dimer (p = 0.014), there was correlation between PET and Wells scale (p=0.001) and blood transfusion (p=0.044). Age, gender, body mass index, preoperative diagnosis, thromboprophylaxis, blood transfusion and surgical approach were not risk factors. CONCLUSION: The prevalence of postoperative PET in patients with respiratory distress after surgical procedure is 5.7% and the mortality is 33.3%.

OBJETIVO: Determinar la prevalencia de la tromboembolia pulmonar (TEP) e identificar sus factores de riesgo en los pacientes intervenidos en el servicio de cirugía general de manera programada de la Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, del Instituto Mexicano del Seguro Social. MÉTODO: Estudio descriptivo, retrospectivo y transversal de 52 expedientes de pacientes con TEP y angiotomografía pulmonar cuya indicación fue la dificultad respiratoria, de 2612 pacientes operados de noviembre de 2015 a marzo de 2018. El muestreo fue no probabilístico. La estadística fue descriptiva, con medidas de tendencia central y de dispersión. Se utilizó prueba de Fisher para riesgo y Rho de Spearman. RESULTADOS: Hubo asociación entre el desarrollo de TEP y el tiempo transquirúrgico (p = 0.018), y con el dímero D (p = 0.014); hubo correlación entre la TEP y con la escala de Wells (p = 0.001) y con la transfusión de hemoderivados (p = 0.044). La edad, el sexo, el índice de masa corporal, el diagnóstico preoperatorio, la tromboprofilaxis, la transfusión de hemoderivados y el abordaje quirúrgico no fueron factores de riesgo. CONCLUSIÓN: La prevalencia de TEP posquirúrgica en pacientes que cursan con dificultad respiratoria después del procedimiento quirúrgico es del 5.7% y la mortalidad es del 33.3%.

Diagnostic histopathological-ultrasonographic correlation in patients categorized as BI-RADS 4.

OBJECTIVE: To correlate ultrasonographic and histopathological diagnosis in patients categorized as breast imaging reporting and data system (BI-RADS) 4. METHOD: Cross-sectional study, performed on patients with BI-RADS 4 (A, B or C) diagnosed by ultrasonography in the high specialty medical unit, hospital of specialties, Centro Médico Nacional General de División Manuel Ávila Camacho, of the Instituto Mexicano del Seguro Social. Age, ultrasonographic and histopathological diagnosis, menarquia, menopause, gestations, lactation, use of contraceptives and family history of breast cancer were evaluated. RESULTS: 101 patients categorized BI-RADS 4 were included; average age was 53.0 ± 8.3 years old, 6.9% of the patients were nulliparous, 92.2% with positive breastfeeding and 25.7% had a family history of breast cancer. By ultrasonography, 55.4% of the cases were BI-RADS 4A, 22.8% 4B and 21.8% 4C. 75.2% of the biopsies performed on the patients were benign and 24.8% were malignant. The overall ultrasonographic-histopathological concordance index was 0.25; 0.11 for BI-RADS 4A, 0.22 for BI-RADS 4B and 0.63 for BI-RADS 4C. CONCLUSION: The ultrasound-histopathological correlation is weak and inferior to that reported in the literature.

OBJETIVO: Correlacionar el diagnóstico ultrasonográfico con el histopatológico en pacientes categorizadas como BI-RADS 4. MÉTODO: Estudio transversal en pacientes con BI-RADS 4 (A, B o C) diagnosticado por ultrasonografía en la Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional General de División Manuel Ávila Camacho, del Instituto Mexicano del Seguro Social. Se evaluaron la edad, el diagnóstico ultrasonográfico, el resultado histopatológico, la edad de primera y última menstruación, el número de gestas, la lactancia, el uso de anticonceptivos y los antecedentes familiares de cáncer de mama. RESULTADOS: Se incluyeron 101 pacientes con BI-RADS 4, con una edad promedio de 53.0 ± 8.3 años. El 6.9% de las pacientes eran nulíparas. El 92.2% habían realizado lactancia. El 25.7% tenían antecedentes familiares de cáncer de mama. Por ultrasonografía, el 55.4% de los casos eran BI-RADS 4A, el 22.8% eran 4B y el 21.8% eran 4C. El 75.2% de las biopsias realizadas a las pacientes fueron benignas y el 24.8% fueron malignas. El índice de concordancia global ultrasonográfica-histopatológica fue de 0.25; para BI-RADS 4A fue de 0.11, para BI-RADS 4B fue de 0.22 y para BI-RADS 4C fue de 0.63. CONCLUSIÓN: La correlación ultrasonográfica-histopatológica es débil e inferior a la reportada en la literatura.

Diagnóstico y tratamiento de la hipertensión intracraneal / Diagnosis and Treatment of Intracranial Hypertension

La presión intracraneal elevada es una complicación devastadora de la lesión neurológica, que puede complicar el trauma, los tumores del sistema nervioso central, la hidrocefalia, la encefalopatía hepática y el flujo venoso del SNC alterado. El adecuado tratamiento consta de un rápido reconocimiento, utilizar material de monitoreo neurológico invasivo y su manejo para reducir la hipertensión intracraneal y sus múltiples causas subyacente. A continuación presentamos una revisión de sus principales características y principios de abordaje diagnóstico-terapéutico

Intracranial pressure is a devastating complication of neurological damage, which can complicate trauma, central nervous system disorders, hydrocephalus, hepatic encephalopathy, and altered CNS venous flow. The appropriate treatment consists of a rapid recognition, the use of an invasive neurological system and its management to reduce intracranial hypertension and its multiple underlying causes. Below we present a review of its main characteristics and principles of diagnostic-therapeutic approach.

[Evacuation of critical care areas due to an initial outbreak of fire in a second level hospital]. / Evacuación de áreas críticas por conato de incendio en un hospital de segundo nivel.

In this letter to the editor, it is exposed an initial outbreak of fire that affected a secondary care center in Córdova, Veracruz, Mexico, and, most of all, the lack of a hospital fire evacuation plan in the presence of a fire event.

En la presente carta al editor, se expone un conato de incendio ocurrido en un hospital de segundo nivel de atención en Córdova, Veracruz, México, y, sobre todo, la carencia de un plan hospitalario de evacuación ante un evento de este tipo.

[Hospitales del Instituto Mexicano del Seguro Social durante los sismos de septiembre de 2017. Análisis desde la perspectiva del Programa Hospital Seguro].

INTRODUCTION: The function of hospitals during major emergency or disaster is vital. Their response capacity depends on their geographic location, adequate organization, structural safety and safety of non-structural elements. After September 2017 earthquakes, self-assessment and Safe Hospital Program assessment results were compared in disabled hospitals belonging to the Mexican Institute of Social Security. OBJECTIVE: To compare the Hospital Safety Index (HIS) with self-assessments carried out by the units. METHOD: HIS and the Pan-American Health Organization/World Health Organization checklist were used. The comparison was carried out in 3 hospitals that were disabled after September 2017 earthquakes. RESULTS: Variability was observed in HIS, which revealed self-assessment biases: no hospital obtained a HIS score lower than 0.35, although all 3 were disabled in the immediate phase after the seismic events. CONCLUSIONS: Result variability depends on who applies the instrument. Quick HIS assessment provides an immediate idea of the probability for a hospital to continue functioning in case of disaster and allows determining mitigation actions to increase health facilities' resilience and safety.

INTRODUCCIÓN: La función de los hospitales durante una emergencia mayor o desastre es vital. Su capacidad de respuesta depende de su ubicación geográfica, adecuada organización, seguridad estructural y seguridad de elementos no estructurales. Después de los sismos de septiembre de 2017 se compararon los resultados de las autoevaluaciones y la evaluación del Programa Hospital Seguro en los hospitales inhabilitados pertenecientes al Instituto Mexicano del Seguro Social. OBJETIVO: Comparar el Índice de Seguridad Hospitalaria (ISH) contra las autoevaluaciones realizadas por las unidades. MÉTODO: Se utilizó el ISH y la Lista de Verificación de la Organización Panamericana de la Salud/Organización Mundial de la Salud. La comparación se realizó en tres hospitales inhabilitados posterior a los sismos de septiembre de 2017. RESULTADOS: Se observó variabilidad en los ISH, lo que evidenció sesgos en la autoevaluación: ningún hospital obtuvo una calificación inferior a 0.35 en su ISH aunque tres quedaron inhabilitados en la fase inmediata posterior a los eventos sísmicos. CONCLUSIONES: La variabilidad en los resultados depende de quien aplica el instrumento. La evaluación rápida con ISH proporciona una idea inmediata de la probabilidad de que un hospital continúe funcionando en caso de desastre y permite determinar las acciones de mitigación para incrementar la resiliencia y seguridad de las instalaciones de salud.

[Tecnologías de la información en la formación de evaluadores del Programa Hospital Seguro en México]. / Information technologies in the training of evaluators of the Safe Hospital Program in Mexico.

OBJETIVO: Describir el proceso para la formación de evaluadores del Programa Hospital Seguro centrado en el uso de las tecnologías de la información. MÉTODO: Estudio observacional descriptivo en el que se analiza la participación dentro del nuevo curso de evaluadores del Programa Hospital Seguro. RESULTADOS: Se inscribieron 1323 participantes, de los cuales aprobaron 298 (18%); la calificación media fue de 8.85. CONCLUSIONES: La plataforma educativa tipo Moodle fue de utilidad para la capacitación del Programa Hospital Seguro. Se tendrían que mejorar los criterios de participación de los alumnos a fin de incrementar la eficiencia terminal. OBJECTIVE: To describe the process for the training of evaluators of the safe hospital program in the use of ICT. METHOD: Descriptive observational study in which the participation in the new course of appraisers of the safe hospital program is analyzed. RESULTS: 1323 participants registered of which 298 (18%) passed; the average grade was 8.85. CONCLUSIONS: The Moodle type educational platform was useful for the training of the Safe Hospital Program. The criteria for student participation would have to be improved in order to increase terminal efficiency.

[The experience of a medical emergency team belonging to the Mexican Social Security Institute during the earthquake in Mexico in September 2017Experiência de uma equipe médica de emergência do IMSS no terremoto do México em setembro de 2017]. / Experiencia de un equipo médico de emergencia del IMSS durante el sismo en México en setiembre de 2017.

The objective of this article is to describe the actions undertaken by the emergency medical team (EMT) of the Mexican Social Security Institute (MSSI) during the emergency caused by the earthquake of September 7, 2017 (magnitude 8.2; epicenter 133 km southwest of Pijijiapan, Chiapas, Mexico). After the initial intersectoral assessment of the emergency had been conducted, the health sector stepped in. As part of this response effort, and once it was determined that a large number of people had been injured and that the health risks facing the affected population were substantial, the MSSI deployed an EMT equipped and trained to provide support in the medical and surgical treatment of injured people. The actions of the EMT, composed of specialists in medical and surgical emergencies and disaster situations, included providing medical care to 252 patients, managing the transfer of 57 patients, and helping to set up an emergency hospital. To improve response efforts during disaster situations, it is necessary to follow the process of forming, registering, and training EMTs at the national and international levels.

O propósito deste artigo é descrever as ações empreendidas pela equipe médica de emergência (EMT) do Instituto Mexicano de Seguro Social (IMSS, instituição pública que presta serviços de saúde) na crise de emergência causada pelo terremoto de 7 de setembro de 2017, com magnitude de 8,2 graus e epicentro a 133 km a sudoeste de Pijijiapan, Chiapas, México. Após a avaliação intersetorial inicial de emergência, o setor da saúde foi ativado. Como parte da resposta, diante do elevado número de feridos e alto risco para a saúde pública da população afetada, o IMSS mobilizou uma EMT na região, capacitada e treinada para dar apoio à resposta de atendimento médica e cirúrgica das vítimas. A EMT, formada por especialistas em emergências médico-cirúrgicas e desastres, prestou atendimento médico a 252 pacientes, coordenou a transferência de 57 pacientes e também colaborou na preparação de um hospital provisório. A fim de melhorar a resposta a desastres, é necessário prosseguir com o processo de integração, cadastramento e capacitação das EMT ao nível nacional e internacional.

Experiencia de un equipo médico de emergencia del IMSS durante el sismo en México en setiembre de 2017 / The experience of a medical emergency team belonging to the Mexican Social Security Institute during the earthquake in Mexico in September 2017 / Experiência de uma equipe médica de emergência do IMSS no terremoto do México em setembro de 2017

RESUMEN El objetivo de este trabajo es describir las acciones desarrolladas por el equipo médico de emergencia (EMT por sus siglas en inglés) del Instituto Mexicano del Seguro Social (IMSS) durante la emergencia derivada del sismo del 7 de setiembre de 2017, el cual tuvo una magnitud de 8,2 grados con epicentro a 133 km al suroeste de Pijijiapan, Chiapas, México. Una vez realizada la evaluación inicial intersectorial de la emergencia, se activó el sector salud. Dentro de esta respuesta, y una vez determinado un número elevado de lesionados y un riesgo alto para la salud pública de la población afectada, el IMSS desplegó en la región un EMT capacitado y entrenado para apoyar en la respuesta de atención médica y quirúrgica de lesionados. Las acciones del EMT, conformado por especialistas en urgencias médico-quirúrgicas y desastres, incluyeron la atención médica de 252 pacientes, la gestión del traslado de 57 pacientes y la colaboración en la habilitación de un hospital provisorio. Para mejorar la respuesta en situaciones de desastres, se requiere seguir el proceso de integración, registro y capacitación de los EMT a nivel nacional e internacional.(AU)

ABSTRACT The objective of this article is to describe the actions undertaken by the emergency medical team (EMT) of the Mexican Social Security Institute (MSSI) during the emergency caused by the earthquake of September 7, 2017 (magnitude 8.2; epicenter 133 km southwest of Pijijiapan, Chiapas, Mexico). After the initial intersectoral assessment of the emergency had been conducted, the health sector stepped in. As part of this response effort, and once it was determined that a large number of people had been injured and that the health risks facing the affected population were substantial, the MSSI deployed an EMT equipped and trained to provide support in the medical and surgical treatment of injured people. The actions of the EMT, composed of specialists in medical and surgical emergencies and disaster situations, included providing medical care to 252 patients, managing the transfer of 57 patients, and helping to set up an emergency hospital. To improve response efforts during disaster situations, it is necessary to follow the process of forming, registering, and training EMTs at the national and international levels.(AU)

RESUMO O propósito deste artigo é descrever as ações empreendidas pela equipe médica de emergência (EMT) do Instituto Mexicano de Seguro Social (IMSS, instituição pública que presta serviços de saúde) na crise de emergência causada pelo terremoto de 7 de setembro de 2017, com magnitude de 8,2 graus e epicentro a 133 km a sudoeste de Pijijiapan, Chiapas, México. Após a avaliação intersetorial inicial de emergência, o setor da saúde foi ativado. Como parte da resposta, diante do elevado número de feridos e alto risco para a saúde pública da população afetada, o IMSS mobilizou uma EMT na região, capacitada e treinada para dar apoio à resposta de atendimento médica e cirúrgica das vítimas. A EMT, formada por especialistas em emergências médico-cirúrgicas e desastres, prestou atendimento médico a 252 pacientes, coordenou a transferência de 57 pacientes e também colaborou na preparação de um hospital provisório. A fim de melhorar a resposta a desastres, é necessário prosseguir com o processo de integração, cadastramento e capacitação das EMT ao nível nacional e internacional.(AU)

Lean Healthcare en los Encuentros Médico Quirúrgicos de Oftalmología / EXPERIENCE OF APPLICATION OF LEAN HEALTHCARE WITHIN THE SURGICAL MEDICAL CONFERENCES OF OPHTHALMOLOGY

El sector de la atención en salud está necesitando un cambio fundamental a fin de mejorar significativamente los resultados y limitar al mismo tiempo los costos. La metodología Lean ha demostrado incrementar la calidad, y productividad en el ámbito industrial. Su aplicación en el ámbito de la salud (Lean Healthcare) pueden transformar los sistemas de salud ofreciendo servicios que mejoran de forma continua. Se presenta la experiencia de su aplicación dentro de los Encuentros Médico Quirúrgicos de oftalmología.

The health care sector is in need of fundamental change and a goal to improve outcomes while limiting costs. The Lean methodology has increased quality and productivity in the industrial field. Its application in the field of health (Lean Healthcare) can transform health systems by offering services that improve continuously. The experience of its application within the Surgical Medical Conferences of ophthalmology is presented

[Experience in training in emergencies, Division of Special Projects in Health, Instituto Mexicano del Seguro Social]. / Experiencia en capacitación en emergencias de la División de Proyectos Especiales en Salud, Instituto Mexicano del Seguro Social.

BACKGROUND: There has been interest in the Division of Special Projects in Health to offer the Instituto Mexicano del Seguro Social personnel resources for training and quality thereby respond to potential contingencies. Presented here is their experience in this field. OBJECTIVE: To describe and analyse the productivity in different training programs in emergencies and disasters developed by the Division of Special Projects in Health, Mexican Social Security Institute (IMSS). MATERIAL AND METHODS: Observational study in which different training activities conducted by the Division of Special Projects in Health between 1989 and 2014 are described. Descriptive statistics were used. RESULTS: In these 25 years have trained 20,674 participants; 19.451 IMSS and 1,223 other health institutions. The most productive courses were life support (BLS/ACLS) (47.17%), distance courses "Hospital medical evacuation plans and units" (14.17%), the workshop-run "Evacuation of hospital units with an emphasis on critical areas" (5.93%) and course "Programme Evaluators of Hospital Insurance" (8.43%). CONCLUSIONS: Although the Special Projects Division Health has primarily operational functions, it nevertheless has neglected its responsibility to maintain constantly trained and updated institute staff that every day is in a position to face any type of emergency and disaster. This increases the chance that the answer to any contingency is more organised and of higher quality, always to the benefit of the population.

[Surgical Medical Meetings in the Mexican Social Security Institute: 17 years of existence]. / Encuentros Médico Quirúrgicos en el Instituto Mexicano del Seguro Social, experiencia de 17 años.

The Surgical Medical Meetings Program aims to make highly specialized medical services to the marginalized rural population. Surgical Medical Encounters highlight the experience and results of an innovative strategy characterized by continuous improvement and the desire to continue transcending health for the most vulnerable populations. During 17 years of its inception, it is interesting to describe the evolution and achievements of the program.

El programa Encuentros Médico Quirúrgicos tiene la finalidad de poner a disposición de la población de zonas rurales marginadas servicios médicos de alta especialidad. Los Encuentros Médico Quirúrgicos ponen de relieve la experiencia y los resultados de una estrategia innovadora, caracterizada por la mejora continua y el afán de seguir trascendiendo a favor de la salud de la población más desprotegida. A 17 años de su inicio, resulta interesante describir la evolución y los logros del programa.

[Emergency and disaster response in critical care unit in the Mexican Social Security Institute: triage and evacuation]. / Atención en emergencias y desastres en las unidades de terapia intensiva del Instituto Mexicano del Seguro Social: triage y evacuación.

Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care.

La atención en emergencias y desastres implica mantener las unidades médicas en funcionamiento, pese al fenómeno perturbador al que se enfrente la comunidad; sin embargo, el conflicto ocurre cuando es la unidad médica la que necesita el apoyo y requiere ser evacuada, más aún cuando es indispensable la evacuación de los pacientes de las unidades de terapia intensiva. En la bibliografía mundial poco hay acerca de este tema, por lo general está enfocado a la reconversión de áreas e incremento de la capacidad para atención a saldo masivo de víctimas, pero no sobre cómo evacuar en caso necesario, y donde una decisión errónea puede traer consecuencias fatales. Por esto el Instituto Mexicano del Seguro Social encomendó a un grupo de trabajo, conformado por médicos especialistas del propio Instituto, evaluar y establecer un método para protocolizar la evacuación de estos pacientes con la salvaguarda correspondiente del personal y del paciente sin que los estándares de calidad en la atención se alteren.

[Specialized reconstructive surgery in rural zones of Mexico]. / Cirugía reconstructiva de alta especialidad en zonas rurales.

BACKGROUND: The Instituto Mexicano del Seguro Social program known as Surgical Encounters was created in 1996 to provide specialized medical and surgical care to the rural and indigenous population, the most marginalized group in the country, and to provide them health care at IMSS-Oportunidades rural hospitals by volunteer personnel. The aim of this paper is to describe the organization, logistics before, during and after the Encounter and the main results of operating room procedures. METHODS: Fifty-seven Surgical Encounters had been carried out. During each encounter, three basic courses were given: The ABC of Plastic Surgery for rural medical practitioners with workshops for local dentists; Surgical Principles for Rural Nurses, and a Cardio-Pulmonary Reanimation course. RESULTS: They included 7,700 patients who were diagnosed and 4306 of these underwent to a surgical intervention (55.9%) with a total of 5,025 surgical procedures. CONCLUSIONS: The importance of this interaction between physicians, rural nurses and specialists at the most marginalized populations areas in the country must be emphasize as an action that lead to equity in health services.

A proposed universal medical and public health definition of terrorism.

The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.

Terrorism in Mexico.

Even though Mexico is considered internationally as a pacifist country, its economic, social, and geopolitical characteristics during the last half of the 20th century have resulted in internal events that can be considered acts of terrorism. Most of the acts of terrorism during the last 15 years have had to do either with political movements or drug-dealing actions. After the 11 September 2001 attacks in the United States, Mexican Health Authorities have strengthened the epidemiological surveillance system. More than 1,372 calls asking for information or reporting suspicious envelopes were received between 16 October and 21 October 2001. Following the earthquake in 1985 that caused great damage and many deaths in Mexico, the National Civil Protection System was created in 1986. This protection system is led by the President and the Secretary of Government. It was developed to improve preparedness for disaster coordination more than for terrorism responses. In addition, the emergency medical systems continue to lack organization, even though some states have shown significant progress in their emergency medical system.