Retrocarotid dissection technique compared to the caudocranial approach for the surgical treatment of carotid body tumors: A 15-year experience.

INTRODUCTION: Carotid body tumors are rare neoplasms with malignant potential. We aim to follow up on our initial experience published in 2015 and compare the occurrence of complications and postoperative outcomes with the use of retrocarotid dissection (RCD) against the standard caudocranial (SCCD) technique. METHODS: This was an observational, case-control study in which we analyzed all of the carotid body tumor resections performed from 1986 to 2022. Parametric and nonparametric tests were used accordingly. Statistical analysis was performed on Stata 17. RESULTS: A total of 181 surgical procedures were included, mean age was 56 years (± 13.63), and 168 (93%) were performed in women. The mean medio-lateral diameter was larger in the RCD group (2.85 ± 1.57 cm vs 1.93 ±1.85 cm; p = 0.002) and presurgical embolization was more frequently performed in the SCCD group (27.5% vs 0.7%; p < 0.001). A total of 40 (22.09%) resections were performed using the SCCD technique. In contrast, in 141 (77.91%) procedures the RCD technique was used. The mean surgical time in the RCD group was lower (197.37 ± 70.56 min vs 232 ± 98.34 min; p = 0.01). No statistically significant difference was found between SCCD and RCD in terms of vascular lesions (n = 20 [11.04%], 15% vs 9%, respectively; p = 0.36), transient or permanent nerve injuries (25% vs 33%, respectively; p = 0.31), or mean intraoperative bleeding (SCCD: 689.95 ± 680.05 mL vs RCD: 619.64 ± 837.94 mL; p > 0.05). CONCLUSIONS: RCD appears to be a safe and equivalent alternative to the standard caudocranial approach in terms of intraoperative bleeding or vascular lesions, with a sustained, significant decrease in surgical time.

Secular trends in the anthropometric characteristics of children in a rural community in Yucatan, Mexico.

OBJECTIVE: To analyze changes in height, weight, and body mass index (BMI = kg/m2 ) from 1986 to 2022 in 3-11 year old children from Dzeal, a rural Maya community in Yucatan, Mexico. MATERIALS AND METHODS: From October-2022 to February-2023 (third-wave survey), we obtained anthropometric measurements of children (n = 80) and family socioeconomic data and compared them with data obtained in 1986 (n = 38) and 2000 (n = 76). Comparisons of anthropometric parameters by sex between years of measurement were performed graphically and through one-way ANOVA, splitting children into two age groups: 3-7 and 8-11. Bonferroni adjustments for multiple comparisons were used when ANOVAs were statistically significant (p < .05). RESULTS: In girls, significant increases in height and weight between surveys were found in 3-7 and 8-11 age groups; in boys, significant increases were only found in the 8-11 age group. Regarding BMI, there were increases in 2022 compared with 1986/2000 in both sexes from 8 years onwards. Differences indicate increases of 3.9 and 4.4 cm per decade in girls aged 3-7 and 8-11, respectively, and increases in weight of 1.1 and 3.3 kg per decade, respectively. Increases in boys 8-11 years were 2.3 cm and 2.4 kg per decade. CONCLUSION: Significant increases in growth parameters were observed in specific-age children in the community studied in the context of changes in livelihoods and improvements in household material conditions.

Fifteen Years of Experience with Surgical Management of Bilateral Non-familial Carotid Body Tumors.

BACKGROUND: Bilateral carotid body tumors (CBTs) clinical manifestation is infrequent. We conducted this work to describe our experience in the surgical treatment of bilateral CBT and to analyze our results. METHODS: A retrospective, observational study. We analyzed the totality of bilateral CBT resections that had been performed in our institution from January 2008 to September 2023. Data was obtained from medical records and anonymized, ethics approval was obtained from our institution committee. As the number of observations was less than those required by the central limit theorem our sample was considered nonparametric. Statistical analysis was performed on Stata 17. RESULTS: We evaluated 16 patients with a total of 32 CBT; surgical resection was performed in 28 cases (87.50%). Median age of the patients was 60 years (interquartile range [IQR] 46-64). Regarding the Shamblin classification, 9 CBTs (32.14%) were classified as Shamblin I, 11 (39.29%) as Shamblin II, and 8 (28.57%) as Shamblin III. The median Distance to the Base of the Skull (DTBOS) was 3.5 cm (IQR 2.7-5.1), and the median tumor volume was 11.25 cc (IQR 3.4-18.7). The median bleeding volume was 300 ml (IQR 200-500), and the median surgical time was 190 min (IQR 145-240). All surgeries were performed using the Retrocarotid Dissection technique. We documented 9 (32.14%) cases of nerve injuries, all of which were transitory. In the median regression a statistically significant association was found between DTBOS, Shamblin classification and tumor volume with intraoperative bleeding and length of stay. CONCLUSIONS: Surgical treatment remains safe and should be considered the gold standard for accurate histologic diagnosis. DTBOS and tumor volume, in addition to Shamblin classification, must be considered in preoperative planning to predict bleeding and hospital stay.

Birthweight and its association with cardiometabolic risk parameters in rural Maya children from Yucatan, Mexico.

BACKGROUND: Knowledge about the influence of early developmental factors on cardiometabolic health in the Maya is limited. AIM: To analyse the relationship between birthweight (BW) and cardiometabolic parameters in a sample of rural Maya children from Yucatan, Mexico. SUBJECTS AND METHODS: We took anthropometric measurements and obtained data on BW and fasting blood samples in a sample of 75 children aged 5-14 years. Dependent variables were: fat mass index (FMI), body mass index (BMI), glucose (G), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), LDL/HDL and TC/HDL ratios and metabolic index (TGxG/HDL2). Outcomes were transformed to y = 100 log(e)x and the resulting estimates are interpreted as symmetrical percentage differences. The main independent variable was BW z-score. Multiple linear regression analyses were used to assess the relationship between BW and outcomes. RESULTS: An increase of one standard deviation in BW predicted 6.6% (95% CI [-11.6, -1.6]) decrease in HDL and 11% (95% CI [3.7, 18.4]), 7.8% (95% CI [2.3, 13.2]) and 19.6% (95% CI [3.1, 36]) increases in LDL/HDL, TC/HDL and metabolic index, respectively. CONCLUSION: Higher birthweights were associated with adverse levels of biochemical parameters in this sample of rural Maya children.

Mortality and hospitalization trends for aortic aneurysms and dissections in Mexico.

BACKGROUND: In Mexico, there is a paucity of evidence on mortality and hospitalization patterns associated with aortic aneurysms and dissections. OBJECTIVE: To analyze national databases and describe the epidemiological characteristics of different aortic pathologies. MATERIAL AND METHODS: Retrospective, cross-sectional, observational study, in which mortality and hospitalization attributed to aortic aneurysms and dissections were analyzed. Statistical analysis was performed on Stata 16. RESULTS: A total of 6,049 deaths were documented in the general population, which included 2,367 hospitalizations and 476 (20.1%) in-hospital deaths. In addition, a statistically significant age difference was found between mean age at death in the general population (69.5 years) and the in-hospital death group (64.1 years, p < 0.001). As for hospitalizations secondary to ruptured abdominal aortic aneurysms, 149 cases were identified, with a mean age of 65.6 years, out of whom 53 (35.5%) were under 65 years of age, with a mean age of 47.8 years. CONCLUSIONS: Epidemiological reports of aortic pathology in Mexico are scarce; therefore, implementation of screening and detection programs for aortic pathologies is necessary in order to address the disparities identified in this analysis.

ANTECEDENTES: Existe evidencia escasa en México respecto a la mortalidad y patrones del ingreso hospitalario asociados a aneurismas y disecciones aórticos. OBJETIVO: Analizar las bases de datos nacionales y describir las características epidemiológicas de diferentes patologías aórticas agudas. MATERIAL Y MÉTODOS: Estudio transversal y observacional de una base de datos retrospectiva, en el que se analizó la mortalidad y hospitalización atribuidas a aneurismas y disecciones aórticos. El análisis estadístico se realizó en Stata 16. RESULTADOS: Se documentaron 6049 muertes en la población general, 2367 hospitalizaciones y 476 muertes intrahospitalarias. Adicionalmente, se encontró una diferencia estadísticamente significativa entre las medias de edad de fallecimiento de la población general (65.5 años) y de los pacientes que murieron en el hospital (64.1 años), p < 0.001. En cuanto a las hospitalizaciones secundarias a aneurisma de aorta abdominal roto, 149 casos fueron evidenciados con una media de edad de 65.6 años; 53 (35.5 %) de estos tenía menos de 65 años, con una media de edad de 47.8 años. CONCLUSIONES: Los reportes epidemiológicos de patología aórtica en México son escasos, por ello la implementación de programas de tamizaje y la detección de patologías aórticas son necesarias para mejorar las disparidades encontradas en este análisis.

The impact of COVID-19 on the number of births in Yucatan, Mexico.

OBJECTIVE: To analyze the impact of COVID-19 on the number of births in Yucatan, Mexico during 2020 and 2021. MATERIAL AND METHODS: A total of 470 651 live births occurred in Yucatan from January 1st, 2008, to December 31st, 2021, and were included in the analysis. The monthly number of births observed during January 2008-February 2020 was used to describe pre-pandemic trends. Time-series analysis was applied to examine whether the number of births observed from December 2020 (9 months after the beginning of the pandemic) to December 2021 differed from the expected values. Trends in the number of births according to maternal age, parity and education were examined to identify changes differentiated by sociodemographic characteristics. RESULTS: The number of births in 2021 decreased by 18% (5869 births) compared with 2019, which represents a reduction from 12.89 to 12.48 per thousand inhabitants. The observed number of births from December 2020 to July 2021 was significantly lower than the figure expected. April (expected = 2863 vs. observed = 1722), May (expected = 2948 vs. observed = 1990), and June (expected = 2997 vs. observed = 1978) 2021 showed the largest differences between expected and observed values. Then, from August to December 2021, the observed number of births fell within the expected range. Birth decline was slightly more pronounced among mothers between 20 and 29 years of age and in those without previous offspring. CONCLUSION: We provide evidence of birth decline in Yucatan during the COVID-19 pandemic. Birth rate reduction in Yucatan doubled the world average and young women without children were the most affected.

Five-year survival after retroperitoneal oncologic resection with and without vascular surgeon intervention.

OBJECTIVES: Retroperitoneal tumor resection commonly disturbs major vessels; therefore, surgical teams can recruit vascular surgeons to prevent injuries and improve the prognosis of oncologic patients. The objective of the present study is to establish long-term survival after retroperitoneal tumor resection surgery with an emphasis on the potential impact of preventing or repairing major vessel injuries when tumors are adjacent to the aorta or vena cava. METHODS: Retrospective case series including all cases of surgical removal of retroperitoneal tumors between 2007 and 2020 in a highly specialized hospital in Mexico City. Long-term survival was defined as 5 years after surgical intervention. Descriptive statistics, group-comparison tests, and regression analysis were performed using Stata 16. RESULTS: From a total of 70 cases, vascular injury occurred in 30 (42.8%) and the vascular surgeon intervened in 19 (27.1%) of them, 4 (21%) were performed by a vascular surgeon with planned intervention, and in 9 (47.3%) cases the vascular surgeon was called to join the surgery due to emergency. Intraoperative bleeding was 2-fold greater in the group with an emergent participation of vascular surgery in contrast with the planned intervention group (4, 235 mL vs 2, 035 mL, p = 0.04). The regression model revealed a significant association between the intervention of a vascular surgeon and long-term survival (OR 59.3, p = 0.03) after adjusting for sociodemographic and characteristics of oncologic nature. CONCLUSIONS: Planned intervention of vascular surgeons in retroperitoneal tumor resection may have a positive impact not only in trans-operatory period, but also on long-term survival.

Development of birthweight and length for gestational age and sex references in Yucatan, Mexico.

OBJECTIVE: To develop sex- and gestational age specific reference percentiles and curves for birth weight and length for Yucatec neonates using data from birth registers of infants born during 2015-2019. MATERIAL AND METHODS: Observational, descriptive, epidemiologic study in a 5-year period including every registered birth in the state of Yucatan, Mexico using birth registries. A total of 158 432 live, physically healthy singletons (76 442 females and 81 990 males) between 25 and 42 weeks of gestation were included in the analysis. We used the LMS method to construct smoothed reference centiles (3rd, 10th, 25th, 50th, 75th, 95th, and 97th) and curves for males and females separately. RESULTS: Mean maternal age was 26 (SD = 6.22) years. Fifty-two percent of births occurred by vaginal delivery, 37% were firstborn and similar proportions were second (33%) and third or more (30%) born. 5.5% of newborns included in the references corresponds to neonates born before 37 weeks of gestation (5.9% boys and 5.1% girls). In both sexes, the percentage of infants with a birthweight less than 2500 g was 6.7%. The birthweight at the 50th percentile for males and females at 40 weeks of gestation in this cohort was 3256 and 3167 g, respectively, and the corresponding values for birth length were 50.23 and 49.84 cm (mean differences between sexes: 89 g and 0.40 cm, respectively). CONCLUSION: The reference percentile and curves developed in this study are useful for research purposes and can help health practitioners to assess the biological status of infants born in Yucatán.

Ethnic and sociodemographic correlates of developmental dysplasia of the hip in newborns from Yucatan, Mexico.

OBJECTIVES: To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects. METHODS: Retrospective, population-based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model. RESULTS: Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first-borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section. CONCLUSION: Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015-2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.

Cephalopelvic disproportion as primary diagnosis for cesarean section: Role of neonatal birthweight in relation to maternal height at a Hospital in Merida, Mexico.

OBJECTIVE: To analyze the association between newborn and maternal characteristics and the risk for cesarean section (CS) due to cephalopelvic disproportion (CPD) and non-CPD causes compared to vaginal deliveries (VD) in a sample of infants and mothers from Merida, Yucatan, Mexico. METHODS: The final sample consisted of 3453 single, live, and term infants born between January 2016 and May 2017 at the Maternal-Infant Hospital in Merida and their mothers (aged ≥19 years). The mode of delivery was established as the dependent variables: (a) VD, (b) CS due to CPD, and (c) non-CPD CS. Independent variables were maternal height and weight, the number of previous VD, newborn weight, and neonatal birthweight (BW) index/maternal height index. A multinomial regression model was used to analyze the association between newborn and maternal characteristics and outcome variable. RESULTS: By mode of delivery, 2124 (62%) births corresponded to VD, 1042 (30%) to non-CPDCS, and 287 (8%) to CS due to CPD. Mothers who had CS due to CPD weighed more at the end of their pregnancy and were shorter. Maternal age and weight increased the risk for having CS due to CPD compared to VD and maternal height, and the number of previous VD reduces the risk for experiencing CS due to CPD compared to vaginal births. The relative risk ratio for higher neonatal BW/maternal height index was significant for CS due to CPD and non-CPD CS. CONCLUSION: According to our results from a public hospital in Merida, Mexico, CPD is a result of the interrelation of maternal and fetal size, rather than an independent result of maternal height or BW.

Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year.

BACKGROUND: In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients' pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. METHODS: A retrospective surveillance study of the national maternal mortality was performed from February 2020-February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. RESULTS: Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). CONCLUSIONS: Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

Genetic variation of FTO: rs1421085 T>C, rs8057044 G>A, rs9939609 T>A, and copy number (CNV) in Mexican Mayan school-aged children with obesity/overweight and with normal weight.

OBJECTIVES: Genetic variation of the fat mass and obesity associated gene (FTO) has been identified as a risk factor for obesity and obesity traits. Distribution of FTO single nutleotide polymorphisms (SNPs) rs1421085T>C, rs9939609T>A, rs8057044G>A and copy number variation (CNV) was evaluated in association with childhood obesity or overweight status in children with Mayan ethnicity. METHODS: We included 318 school-aged children with obesity or overweight status (body mass index [BMI]: >85th percentile) and 303 children with normal weight (BMI: 15th-85th percentile). Genotyping was performed using real-time polymerase chain reaction (RT-PCR) with TaqMan probes. The cross-sectional study was carried out using univariate and multivariate logistic regression models adjusted for gender. RESULTS: FTO-SNP rs1421085 showed significant differences between children with obesity and children with normal weight for the heterozygous genotype (P = 0.003) and for allele frequencies (P = 0.023). Adjusting by gender, significant differences were found in frequencies of the hetezygous genotype of SNPs rs9939609 (P = 0.023) and rs1421085 (P = 0.003) as well as in allele frequencies (P = 0.042 and P = 0.013, respectively) between girls with obesity and girls without obesity. In contrast, SNP rs8057044 was significantly different only between heterozygous overweight versus normal weight boys (P = 0.035) and for the allele frequency of rs8057044 (P = 0.021). The mean relative CNV was significantly higher in male overweight children than in boys with normal weight (P = 0.000). CONCLUSIONS: The FTO SNP rs1421085 is a genetic factor associated with obesity in Mayan school-aged children. FTO SNPs rs1421085 and rs9939609 affect genetic susceptibility for obesity only in girls, whereas, SNP rs8057044 and CNV are associated with overweight status only in boys.

Dysbaric osteonecrosis associated with decompression sickness in a fishing diver

Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.

Emergency treatment for a venomous snakebite accident in rural southern Mexico.

In Latin America, 51 995 emergencies and 337 deaths are caused by snakebites yearly. Prompt and adequate treatment is crucial after an envenomation. We here report the case of a 40-year-old male agriculturalist, who was bitten by a venomous snake. Hours after the bite, he was admitted at the nearest clinic, diagnosed with type IV envenomation. After initial antivenom treatment he was transported to an urban hospital. Hemorrhage persisted and the patient developed compartmental syndrome and renal failure. The patient died 3 days after the accident. To reduce fatalities from snakebite envenomation, such as the case we here presented, there is a need for coordinated and multilevel approach, collaborative work and continual medical training.

Body mass index in association with decompression sickness events: cross-sectional study among small-scale fishermen-divers in southeast Mexico.

INTRODUCTION: Decompression sickness is endemic to small-scale fishermen-divers from coastal communities in southeast Mexico; overweight and obesity are also highly prevalent in the region. Existing literature suggests it is possible that fat tissue could play a role in decompression sickness pathophysiology. Our aim in this study is to describe the association between the number and severity of DCS events treated at the hyperbaric program and fishermen-diver body mass index. METHODS: In this cross-sectional study, we obtained anthropometric measurements of 105 fishermen-divers and reviewed clinical records of each participant at a hyperbaric program. RESULTS: Average BMI among participants was 34.5 ± 4.7, while 9.5% (n=10) were healthy-weighted, 28.6% (n=30) were overweight and 42.8% (n=65) were obese. Number of DCS events per diver was associated with BMI and severity of DCS in linear regression models. CONCLUSIONS: Overweight and obesity are highly preventable health problems; our results suggest that an association between these conditions and the frequency and the severity of DCS are an important topic to be further considered in longitudinal prospective studies.

Rapunzel syndrome with double simultaneous trichobezoar in a teenager: Clinical Case Report. / Síndrome de Rapunzel con doble tricobezoar simultáneo en una adolescente: Reporte de caso.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. OBJECTIVE: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. CASE REPORT: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. CONCLUSION: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

Decompression sickness among diving fishermen in Mexico: observational retrospective analysis of DCS in three sea cucumber fishing seasons.

The probabilities of decompression sickness (DCS) among diving fishermen are higher than in any other group of divers. Diving behavior of artisanal fishermen has been directed mainly to target high-value species. The aim of this study was to learn about the occurrence of DCS derived from sea cucumber harvesting in the Yucatán Peninsula, Mexico. We conducted a retrospective chart review of diving fishermen treated at a multiplace hyperbaric chamber in Tizimín, Mexico. In total, 233 recompression therapies were rendered to 166 diving fishermen from 2014 to 2016. The average age was 36.7 ± 9.2 years (range: 20-59 years); 84.3% had experienced at least one DCS event previously. There was a correlation between age and DCS incidents (F: 8.3; R2: 0.07) and differences in the fishing depth between seasons (H: 9.99; p⟨0.05). Musculoskeletal pain was the most frequently reported symptom. Three divers, respectively, suffered permanent hearing loss, spinal cord injury and fatal outcome. Diving fishermen experience DCS at an alarmingly high rate, probably due to the type of species targeted, given the requirements in each case. Understanding divers' behaviors and their incentives while in pursuit of high-value species such as sea cucumber could help to find ways to mitigate health risks and help enforce regulation.

350 años de la medicina hiperbárica: aspectos históricos, fisiopatogénicos y terapéuticos.

The early use of hyperbaric therapy started with the quest to relieve respiratory problems among inhabitants of large cities during the industrial revolution, and from this, we have explored the benefits of treatment with hyperbaric oxygen in different areas of medicine. With the advances of the medical sciences, our knowledge concerning the therapies with hyperbaric oxygenation certainly has broadened and hyperbaric medicine still intrigues the contemporary medical researchers that are in seek of improve the quality of life of their patients.