[The undergraduate program in forensic science: a national challenge]. / La Licenciatura en Ciencia Forense, un reto nacional.

The challenge in achieving an ideal state of justice is that each "proof" has the highest degree of reliability. This is the main responsibility of the forensic scientist. Up to now, criminal investigations in Mexico have been supported by forensic work from a wide variety of disciplinary backgrounds that give testimony in a particular area, even though they may have become forensic witnesses in a complementary and experiential manner. In January 2013, the Universidad Nacional Autónoma de México (UNAM) approved the "Forensic Science" undergraduate program that, in collaboration with various academic entities and government institutions, will develop forensic scientists trained in science, law, and criminology. This is focused on contributing to the national demand that the justice system has more elements to procure and administer justice in dealing with crime.

[The role of educational institutions in the transformation of the Mexican health system]. / El papel de las instituciones educativas en la transformación del sistema de salud en México.

The vocation of any medical school is educate the physicians that the country needs to address current and future health challenges, and able to work effectively in the gradual transformation of the health system of our country. The reason for the inclusion of this topic in this symposium is to ask whether this has been happening and if has been appropriate, and if so, to what extent medical education institutions establish actions and directions for the better and more quickly achieve the desired goal.

[Perspectives for the near future]. / Perspectivas en el futuro cercano.

A rapid balance of these 75 years in which Medicine has contributed with medical students in Social Service to the National Health System, with positive results is presented here as a basis to discuss and reflect on the conditions and characteristics that should be present in the Social Service performed by medical students. Some changes to the conditions under which the Social Service is performed are necessary, as well as improving the medical services to enhance medical continuing education. The main problems to deal with are: redefining sites characteristics, the gradual creation of different alternatives, regionalization, and the creation of double-vacancies in marginal rural zones, among others. In the intermediate term, it is necessary: adjust the legal situation, implementing continuous supervision and tutorship, and in the long term that general practitioners are in charge of all primary care in marginal and urban areas, and become tutors to the students in Social Service. These measures would allow us to strengthen continuing education and a more efficient collaboration to train human resources for the health care of our population.

[Towards a new curriculum for the faculty of medicine of the National University of Mexico (UNAM)]. / Hacia un nuevo Plan de Estudios de la facultad de medicina de la Universidad Nacional Autónoma de México (UNAM).

The 2010 undergraduate medical degree curriculum at the Faculty of Medicine of the Universidad Nacional Autonoma de Mexico (UNAM) is the result of eight years of collegiate work, which started under the leadership of Dr. Jose Narro Robles, our current Dean. In order to fulfill the aim of integrally developing a physician in the scientific, technical, social and human aspects, this academic plan considered the adaptations from a self-assessment test, the opinions expressed during academic workshops with professors from different disciplines, the work of committees and the results of external evaluations, as well as national and international health issues. New areas of knowledge that arose from whirling changes were also included in this plan, new technologies were adopted, the student was considered responsible for his own learning, and the development of unprecedented competences was considered. All this resulted in a departmental infrastructure that is our Faculty of Medicine's strength.An education model was defined by subjects with an outline of two years of basic sciences and two-and-a-half years of clinical work aside from internship and social service. In order to achieve this and seek a better curricular organization, three curricular axes were settled: bio- and sociomedical clinic integration, medicine/information technology link, and the ethical/humanistic professional combination. We are certain that the 2010 Academic Curriculum will draw the graduates we need to train and to the professional requisites for our society in the XXI century.

[Medical education and health systems]. / Educación médica y los sistemas de salud.

I was asked to develop in this symposium the topic of medical education and health systems. The analysis is relevant because the ultimate goal of medical schools is to train physicians to be useful for the current health system, regardless of the country and the health system organization in question. The interaction between the education system in health and National Health System has great importance to define the direction of medical education. Certainly, the more closely this relationship, the more efficient the training of doctors that the country demands and best opportunities in entering the labor market. The issue requires a series of questions: is there really a close relationship between the health system and national medical education? Is it, rather, a causal relationship, the result of the interest of the parties? If so, how consistent is the training of doctors, both general and specialists, with the country's needs? And finally, how should improve the relationship to make medical education more efficient and effectively respond to the needs of the health system?

[The 2010 curriculum of the faculty of medicine at the National University of Mexico]. / Plan de Estudios 2010 de la facultad de medicina de la Universidad Nacional Autónoma de México.

The 2010 undergraduate medical degree curriculum at the faculty of medicine of the Universidad Nacional Autonoma de Mexico (UNAM) constitutes an important curricular reform of medical education in our country. It is the result of an institutional reflective process and academic dialog, which culminated in its approval by UNAM's Academic Council for the Biology, Chemistry, and Health Sciences areas on February 2nd, 2010. Some distinguishing characteristics of the new academic curriculum are: organization by courses with a focus on outcome competencies; three curricular axes that link three knowledge areas; four educational phases with achievement profiles; new courses (biomedical informatics, basic-clinical and clinical-basic integration, among others); and core curriculum. The aforementioned curriculum was decided within a framework of effective teaching strategies, competency oriented learning assessment methods, restructuring of the training of teaching staff, and establishment of a curriculum committee follow-up and evaluation of the program. Curricular change in medical education is a complex process through which the institution can achieve its mission and vision. This change process faces challenges and opportunities, and requires strategic planning with long-term foresight to guarantee a successful dynamic transition for students, teachers, and for the institution itself.

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine.

BACKGROUND: The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution. METHODS: A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country. RESULTS: There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning. CONCLUSIONS: There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources.

[Teaching surgery at the UNAM and some educational concepts.]

Nowadays surgery cannot be conceived as independent from medicine; consequently, surgical education cannot be far from the main principles of medical education. This review underlines the characteristics of medical training in the field of surgery. General physicians should be trained to perform surgical procedures under particular situations. A new lesson plan was implemented at the Facultad de Medicina in Mexico City (UNAM), comprised of eight fundamental surgical skills. A well-structured surgical program implies clear and exact definitions of the skills to be acquired during training as well as an appropriate follow-up, knowledge reinforcement, continuing educational skills, application of medical tests for patient care and evaluation of the learning process.

Uso del hialuronato sodico (healon) en el transplante de córnea / The use of sodium hialuronate (Healon) in the cornea transplantation

Doce córneas provenientes de seis donantes fueron transplantadas. Cada par de córneas se transplantó el mismo día en diferentes receptores. En cada par, una córnea donadora se estudió con HaNa y en la otra que sirvió como testigo se utilizó SSB al tiempo de la cirugía. En la córnea que se usó HaNa, éste se aplicó sobre el diafragma iridocristalineano y bordes de la herida, permitiendo la salida de HaNa sobrante, la cámara anterior se reformó con HaNa durante el proceso de sutura, retirándolo al término de la cirugía. La córnea par se aplicó sobre un lecho receptor humedecido en SSB y la cámara anterior se reformó con aire durante el proceso de sutura. Se compararon resultados. Para el grupo de córneas donde se usó HaNa el grosor corneal al 3er. día fue de 615 vs. 67 en aquellas en que se usó aire, a la 6a. semana el grosor de las córneas tratadas con HaNa era de 58 vs. 67 del grupo con aire y hacia el 3er. mes era de 59ñ 5 para el grupo HaNa, y de 65 ñ 8 para el grupo tratado con aire. La presión intraocular mostró una elevación discreta a las 24 horas en el grupo HaNa, que tendió a normalizarse hacia las 72 horas

Experiencia personal en queratotomía radiada: análisis de cuatro años / Radial keratotomy, personal experience: a four years analysis

Se presenta la experiencia de 21 casos, operados durante el período comprendido enre 1982-1986, que puedieron ser evaluados dentro de un rango de cuatro años y cuatro meses, de acuerdo a su máximo tiempo de seguimiento. Se encontró queel grupo de miopes entre 1.5-3 D, alcanzó un 20/40 o mejor en el 81% de los casos. En el grupo de miopes medios de 3.5 a 6 D, la AV mejor dee 20/40 se presentó en el 65% de los casos y el grupo de miopes altos de 6.25 a 13 D, una AV mejor de 20/40 se presentó en sólo el 20% de los casos. Subcorrecciones ocurrieron en el 15% de los miopes bajos y en el 9% de los miopes medios. Se discuten el rango y promedio de subcorrecciones y sobrecorrecciones, resultados con la queratotomía radiada y con la cirugía de Ruíz.

Resultados de queratoplastía penetrante con donantes ancianos / Results of penetrating keratopaties with donars aged

Presentamos los resultados de 13 queratoplastías penetrantes provenientes de córneas de donadores con edades de 61-83 años. Todas ellas fueron preservadas en medio M-K y tomadas del cadáver antes de las primeras 96 horas de ocurrida la defunción (con una media de 56 horas). El 84% de los trasplantes permanecieron claros, después de un seguimiento de 11 meses. El promedio del grosos corneal durante la primera semana postoperatoria fue de 0.635 mm y la medida media al mayor tiempo de seguimiento fue de 0.556 mm. Los botones corneales provenientes de córneas de donadores con una edad de 60 a 70 años (media de 64 años) fueron comparadas con las de provenientes de donadores con edades de 70 a 83 años (media de 80 años). El grosor corneal en los dos grupos al máximo tiempo de seguimiento no tuvo significancia estadística diferente (0.574 en el primer grupo de 0.563 en el segundo)

Resultados de la queratoplastía penetrante en queratocono / Results of the penetrating Keroplasty in Keratoconus

Se presentan los resultados de 45 queratoplastías penetrantes en queratocono, en un análisis retrospectivo de aquellos pacientes que pudieron ser evaluados de 1979 a 1984, operados en el Instituto de Oftalmología Fundación Conde de Valenciana. Se encontró un 97% de injertos transparentes al término de un año y agudeza visual final con corrección de un 20/40 o mejor en el 82% de los casos. Se presentaron reacciones inmunes en el 15.5%, pudiendo ser en su mayoría controladas. En un caso (2.2%) el rechazo inmune fue irreversible. Se hacen consideraciones sobre la evolución de las complicaciones y su manejo. Se analizan resultados comparativos

Autoinjerto corneal rotatorio / Corneal rotatorig autotransplantation

Diversas técnicas de autotransplante, mediante rotación han sido descritas en el pasado. Se han intentado injertos circulares, cuadrangulares, triangulares, de doble semicírculo, etc., con el fin de sustituir el tejido opaco por transplante, sin necesidad de tejido donador. Dichas técnicas han tenido buenos resultados, en manos de sus autores, sin embargo, al ser realizadas por otros cirujanos, no se ha conseguido el mismo éxito debido en gran parte a la pobre reproductibilidad de dichos procedimientos. El presente artículo, describe una modificación de estas técnicas y el desarrollo de un nuevo marcador, que tiene la finalidad de estandarizar la técnica y facilitar su reproducción.

Hallazgos morfométricos endoteliales en cirugía de catarata: estudio comparativo extracapsular vs. intercapsular / Endothelial morphometric findings in cataract surgery: extracapsular/intercapsular prospective study

Se realizó un estudio prospectivo de 60 pacientes con catarata senil, de los cuales a 30 se les practicó extracción intercapsular de catarata. El grupo control fue sometido a cirugía extracapsular para definir el daño ocasionado al endotelio corneal. En todos los casos se implantó LIO de cámara posterior y se utilizó hialuronato de sodio. El propósito es el de valorar el papel de protección que tiene la técnica intercapsular ya que se supone la cápsula anterior juega un papel protector durante la cirugía de catarata. Al analizar los dos grupos se observó que con la técnica intercapsular la pérdida celular fue de 7 por ciento mientras que aquellos sometidos a extracción extracapsular resultó en 17 por ciento. En ambos existe una pérdida pero la diferencia es estadísticamente significativa (p < 0.05). Tomando en cuenta lo observado, sería de gran utilidad el valorar a largo plazo el comportamiento de la morfología endotelial para analizar la permanencia del daño.

Por qué ser médico hoy: puentes entre la formación y la práctica de la medicina

Contenido: Más allá del arte de curar. El desafío de formarse como médico. Formación de un espíritu científico. Carta a un joven estudiante de medicina. Entre la evidencia y la narrativa. Medicina, "edad de oro" y después... Reflexiones sobre el ser médico. ¿Tratamiento de algo o tratamiento de alguien?. Escuchar. El médico: ¿operario o artesano de la salud?. Recuperar el humanismo. Los territorios ignotos de nuestra mente. Vocación en el siglo XXI. Luces y sombras de una decisión crucial. Los cambios en el ejercicio de la medicina, su influencia en la profesión médica y en el cuidado de la salud. Una apasionante decisión...

Oftalmología: en la práctica de la medicina general / Ophthalmology: in the practice of the general medicine

Contiene información específica y especializada sobre el sistema óptico y de los diversos padecimientos a que está expuesto. Los temas abordados son : 1) Estructura y función; 2) Agudeza visual; 3) El ojo como sistema óptico; 4) Los párpados y sus enfermedades; 5) Enfermedades del aparato lagrimal; 6) Movilidad ocular y estrabismo; 7) Ambliopía; 8) Exploración de la conjuntiva; 9) Conjuntivitis; 10) La conjuntivitis del recién nacido (oftalmia neonatorum); 11) Síndrome de ojo seco; 12) Quemaduras oculares; 13) Neoformaciones frecuentes de la conjuntiva; 14) La córnea y sus alteraciones; 15) Exploración del fondo de ojo; 16) La uveitis; 17) El cristalino y sus alteraciones patológicas; 18) Leucocoria; 19) Presión intraocular y glaucoma; 20) Campos visuales; 21) Retinopatía hipertensiva; 22) Retinopatía diabética; 23) La mácula y su patología; 24) Desprendimiento de retina; 25) Exploración de los reflejos pupilares; 26) El nervio óptico y su patología; 27) La órbita y sus alteraciones; 28) Radiología en oftalmología; 29) Diagnóstico diferencial del ojo rojo; 30) Urgencias frecuentes en oftalmología; 31) Pérdida súbita de la visión; 32) Pérdida crónica de la visión; 33) Medicamentos en oftalmología.