Thermal threshold and interspecific competition help explain intertidal hermit crab assemblages.

Habitat heterogeneity promotes species diversity by providing a variety of abiotic and biotic conditions, whose impact on performance varies among species. Then, mobile species would be expected to move to areas whose conditions maximize their fitness. However, biotic pressures such as interspecific competition can push subordinate species into suboptimal areas, impeding this matching. The tropical hermit crab Clibanarius albidigitus occupies mostly upper intertidal sites where they can experience extreme environmental conditions. Meanwhile, its stronger agonistic competitor, Calcinus californiensis, mostly inhabits more moderate conditions at the mid intertidal. We estimated the avoidance threshold of the two hermit crab species to increasing water temperatures to help explain their intertidal distribution. We also compared the avoidance threshold of Cli. albidigitus to rising temperatures when presented alone and in the presence of chemical cues of its competitor to assess potential competitive niche exclusion. The avoidance threshold was measured in experimental tanks with a ramp that led from the water to an air-exposed platform; the threshold was defined as the temperature at which individuals emerged and remained air-exposed. Clibanarius albidigitus emerged at a higher temperature than its competitor, showing a higher thermal tolerance and potentially explaining its distribution in the upper intertidal. In the presence of Cal. californiensis, Cli. albidigitus emerged at lower temperature than when alone, likely as a strategy to reduce competition with stronger agonistic competitors, even at the cost of coping with harsh conditions. Our results support the hypothesis that competitive habitat exclusion contributes to explaining hermit crab assemblages.

Leptin and its receptor are overexpressed in breast cancer tissue of postmenopausal Mexican-Mestizo women with obesity.

The aim of this study was to investigate the expression of leptin (LEP) and its receptor (LEPR) in breast cancer tissue of postmenopausal women with different body mass indexes (BMI), as well as the relationship of this expression with the rate of recurrence free survival (RFS). Leptin and LEPR expression, determined by immunohistochemistry, were studied in breast cancer tissues of 154 patients. Qualitative and semi-quantitative analysis of protein expression was performed by the H-Score method, through the ImageJ's IHC Profiler software. Kaplan-Meier survival analysis and log-rank statistic were used to estimate RFS differences. Protein expression of LEP, was significantly higher in women with overweight or with obesity, when compared to women with normal BMI (P = 0.032 and P = 0.013, respectively). We also observed a significantly higher expression of LEPR in breast tumor cells of women with obesity (58.8%), when compared to women with normal BMI (32.7%) (P = 0.007). Five-year survival rate, regarding LEPR expression, was 82.4% when positive and 94% when negative (P = 0.024). In the Cox proportional-hazards regression model, LEPR expression represented a risk factor for disease recurrence after adjustment for confounding factors (HR = 4.67; 95% CI: 1.13-19.31; P = 0.033). In conclusion, postmenopausal women with obesity and breast cancer present higher LEP and LEPR expression in breast tumors, when compared to women with normal BMI. Independently from BMI, women with tumors LEPR positive have worst RFS, when compared to women with tumors LEPR negative.

SNAP23 is essential for platelet and mast cell development and required in connective tissue mast cells for anaphylaxis.

Degranulation, a fundamental effector response from mast cells (MCs) and platelets, is an example of regulated exocytosis. This process is mediated by SNARE proteins and their regulators. We have previously shown that several of these proteins are essential for exocytosis in MCs and platelets. Here, we assessed the role of the SNARE protein SNAP23 using conditional knockout mice, in which SNAP23 was selectively deleted from either the megakaryocyte/platelet or connective tissue MC lineages. We found that removal of SNAP23 in platelets results in severe defects in degranulation of all three platelet secretory granule types, i.e., alpha, dense, and lysosomal granules. The mutation also induces thrombocytopenia, abnormal platelet morphology and activation, and reduction in the number of alpha granules. Therefore, the degranulation defect might not be secondary to an intrinsic failure of the machinery mediating regulated exocytosis in platelets. When we removed SNAP23 expression in MCs, there was a complete developmental failure in vitro and in vivo. The developmental defects in platelets and MCs and the abnormal translocation of membrane proteins to the surface of platelets indicate that SNAP23 is also involved in constitutive exocytosis in these cells. The MC conditional deletant animals lacked connective tissue MCs, but their mucosal MCs were normal and expanded in response to an antigenic stimulus. We used this mouse to show that connective tissue MCs are required and mucosal MCs are not sufficient for an anaphylactic response.

Miomectomía múltiple por vía abdominal / Multiple abdominal myomectomy

RESUMEN Se presentaron dos pacientes a las cuales se les realizó una miomectomía en los meses de enero y marzo de 2017, en la localidad de Luanda, Angola. Ambas fueron atendidas en la consulta de Ginecología por: aumento de volumen del abdomen, sangramiento genital durante la menstruación y fuera de ella, síntomas compresivos caracterizados por urgencia miccional y estreñimiento, además de infertilidad. Se les realizaron: exámenes de laboratorio, ultrasonido ginecológico y renal, así como histerosalpingografía. Después del análisis de estos exámenes se les diagnosticó una miomatosis uterina múltiple; fueron remitidas al salón de operaciones con previo consentimiento informado y se les practicó una miomectomía múltiple sin complicaciones transoperatorias. Se conservó el útero en ambas pacientes, las cuales tuvieron una recuperación postoperatoria satisfactoria. Una de estas pacientes logró un embarazo cinco meses después de la cirugía.

ABSTRACT We present two patients who had a myomectomy in January and March 2017, in Luanda, Angola. Both were treated in the Gynecology consultation due to increased abdominal volume, genital bleeding during and between periods, compressive symptoms characterized by urinary urgency, constipation and infertility. Laboratory tests, gynecological and renal ultrasound, as well as hysterosalpingography were performed. After the analysis of these tests, they were diagnosed with multiple uterine myomas, referred to the operating room with prior informed consent and underwent a multiple myomectomy without transoperative complications. The uterus was preserved in both patients, who had a satisfactory postoperative recovery. One of these patients got pregnant five months after surgery.

Different body mass indexes and their relation to prognosis of early-stage breast cancer in postmenopausal Mexican-Mestizo women.

It has been suggested that obesity increases the incidence of metastatic breast tumors, resulting in higher rates of recurrence, and increased mortality; for that reason, the aim of this study was to investigate if different body mass indexes modified the clinicopathologic characteristics of breast cancer; as well as, the recurrence-free survival in postmenopausal Mexican-Mestizo women. Two hundred twenty postmenopausal women with operable breast cancer were included. A structured questionnaire was applied to explore the existence of potential risk factors. Body mass index (BMI) was determined in each case and patients were grouped in accordance to their BMI in: normal weight, overweight, or obesity. Kaplan-Meier survival analysis and log-rank statistic were used to estimate recurrence-free-survival differences. Hormonal receptor(+)/HER2(-) was the most frequent breast cancer in all groups. Overweight women presented a statistically significant increased risk of this molecular subtype, with an odds ratio (OR) = 5.57; 95% confidence interval (CI) = 1.54-24.86; P = .004)). In addition, the triple-negative subtype was more frequent in women with a normal BMI in comparison to women with overweight (P = .016) or women with obesity. The heterogeneity in cancer subtypes regarding BMI was observed.

Adiponectin and adiponectin receptor 1 expression proteins levels are modified in breast cancer in postmenopausal women with obesity.

AIM: To analyse the expression of adiponectin (ADIPOQ), and its receptors ADIPOR1 and ADIPOR2, in breast cancer tissue of postmenopausal women with different body mass indexes (BMIs). SUBJECTS AND METHODS: One hundred and fifty postmenopausal Mexican-Mestizo women with breast cancer were included. BMI was determined in each case. To carry out qualitative and semiquantitative assessments of protein expression by immunohistochemistry, the H-Score method was used, through ImageJ's IHC Profiler software. Statistical power of the study was >80% with a p<0.05. RESULTS: Fifty women had a normal BMI, 50 presented overweight and 50 had obesity. The expression of ADIPOQ in breast cancer tissue of postmenopausal woman with normal BMI was higher in comparison to women with overweight or with obesity (p=0.002 and p<0.001, respectively). Furthermore, the expression of ADIPOR1 in breast cancer tissue of postmenopausal women with normal BMI was significantly lower when compared with women with overweight or with obesity (p=0.005 and p<0.001, respectively). Meanwhile, the expression of ADIPOR2 in breast cancer tissue, in the cytoplasm, was similar in all groups studied. CONCLUSIONS: We found that women with overweight or obesity had a lower expression of ADIPOQ and a higher ADIPOR1 expression in breast cancer tissue, when compared with women with a normal BMI.

Breast cancer survival by immunohistochemistry-determined subtype: A retrospective study.

BACKGROUND: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. OBJECTIVE: To design future studies information on characteristics and survival of each subtype is essential. METHOD: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. RESULTS: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). CONCLUSIONS: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

[Supervivencia en cáncer de mama por subtipo mediante inmunohistoquímica: Un estudio retrospectivo].

BACKGROUND: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. OBJECTIVE: To design future studies information on characteristics and survival of each subtype is essential. METHOD: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. RESULTS: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). CONCLUSIONS: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

ANTECEDENTES: La clasificación del cáncer de mama en subtipos mediante la expresión de receptores hormonales (RH) y del receptor 2 del factor de crecimiento epidérmico humano (HER2) por inmunohistoquímica (IHQ) es una práctica estándar para la toma de decisiones terapéuticas. OBJETIVO: Conocer las características y supervivencia de cada subtipo de pacientes, que es indispensable para poder diseñar futuros estudios. MÉTODO: Realizamos un estudio retrospectivo evaluando las características clinicopatológicas y la supervivencia por subtipo mediante IHQ en mujeres con cáncer de mama. RESULTADOS: 211 mujeres con cáncer de mama RH(+)/HER2(­), 53 con RH(+)/HER2(+), 16 con HER2(+) y 23 con RH(­)/HER2(­), con una mediana de supervivencia global en meses de 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) y 26 (11-78), respectivamente, para un cociente de riesgo (HR por sus siglas en inglés, Hazard Ratio): 3.7 (IC 95%: 1.3-10.3) en el grupo triple negativo comparado con RH(+)/HER2(­) (p = 0.01). CONCLUSIÓN: Los subtipos con RH positivos por IHQ son los más frecuentes y este grupo de pacientes tienen una mejor supervivencia global comparada con las pacientes triple negativo.

Supervivencia en cáncer de mama por subtipo mediante inmunohistoquímica: Un estudio retrospectivo / Survival in breast cancer by subtype by immunohistochemistry: A retrospective study

Resumen Antecedentes: La clasificación del cáncer de mama en subtipos mediante la expresión de receptores hormonales (RH) y del receptor 2 del factor de crecimiento epidérmico humano (HER2) por inmunohistoquímica (IHQ) es una práctica estándar para la toma de decisiones terapéuticas. Objetivo: Conocer las características y supervivencia de cada subtipo de pacientes, que es indispensable para poder diseñar futuros estudios. Método: Realizamos un estudio retrospectivo evaluando las características clinicopatológicas y la supervivencia por subtipo mediante IHQ en mujeres con cáncer de mama. Resultados: 211 mujeres con cáncer de mama RH(+)/HER2(-), 53 con RH(+)/HER2(+), 16 con HER2(+) y 23 con RH(-)/HER2(-), con una mediana de supervivencia global en meses de 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) y 26 (11-78), respectivamente, para un cociente de riesgo (HR por sus siglas en inglés, Hazard Ratio): 3.7 (IC 95%: 1.3-10.3) en el grupo triple negativo comparado con RH(+)/HER2(-) (p = 0.01). Conclusión: Los subtipos con RH positivos por IHQ son los más frecuentes y este grupo de pacientes tienen una mejor supervivencia global comparada con las pacientes triple negativo.

Abstract Background: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. Objective: To design future studies information on characteristics and survival of each subtype is essential. Method: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. Results: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). Conclusions: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study.

PURPOSE: Understanding how the convergence between chronic and complex diseases-such as cancer-and emerging conditions of older adults-such as frailty-takes place would help in halting the path that leads to disability in this age group. The objective of this manuscript is to describe the association between a past medical history of cancer and frailty in Mexican older adults. METHODS: This is a nested in cohort case-control study of the Mexican Health and Aging Study. Frailty was categorized by developing a 55-item frailty index that was also used to define cases in two ways: incident frailty (incident >0.25 frailty index score) and worsening frailty (negative residuals from a regression between 2001 and 2012 frailty index scores). Exposition was defined as self-report of cancer between 2001 and 2012. Older adults with a cancer history were further divided into recently diagnosed (<10 years) and remotely diagnosed (>10 years from the initial diagnosis). Odds ratios were estimated by fitting a logistic regression adjusted for confounding variables. RESULTS: Out of a total of 8022 older adults with a mean age of 70.6 years, the prevalence of a past medical history of cancer was 3.6 % (n = 288). Among these participants, 45.1 % had been diagnosed with cancer more than 10 years previously. A higher risk of incident frailty compared to controls [odds ratio (OR) 1.53 (95 % confidence interval (CI) 1.04-2.26, p = 0.03); adjusted model OR 1.74 (95 % CI 1.15-2.61, p = 0.008)] was found in the group with a recent cancer diagnosis. Also, an inverse association between a remote cancer diagnosis and worsening frailty was found [OR = 0.56 (95 % CI 0.39-0.8), p = 0.002; adjusted model OR 0.61 (95 % CI 0.38-0.99, p = 0.046)]. CONCLUSIONS: Cancer is associated with a higher frailty index, with a potential relevant role of the time that has elapsed since the cancer diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors may be more likely to develop frailty or worsening of the health status at an older age. This relationship seems especially evident among individuals with a recent oncological diagnosis. Health professionals in charge of older adult care should be aware of this association in order to improve outcomes of older adults who survived cancer.

Expectativas de laborar en el primer nivel de atención de salud de los estudiantes de una facultad de medicina de Lima, Perú / Expectations of students from a faculty of medicine in Lima, Peru, for working in first-level health care

La situación sanitaria del Perú requiere que más profesionales de la salud brinden atención en los establecimientos de salud del primer nivel de atención, ubicados principalmente en las zonas periféricas, rurales o más pobres del país. Objetivo: Identificar expectativas laborales y personales de los futuros profesionales de la salud que son formados en una facultad de medicina de Lima, particularmente trabajar en el primer nivel de atención de salud. Diseño: Estudio observacional, descriptivo y exploratorio. Lugar: Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Estudiantes pre internado de las Escuelas Académico Profesionales. Intervenciones: El muestreo fue por conveniencia y se incluyó a 278 estudiantes de las 5 escuelas que conforman la facultad de medicina. Se aplicó un cuestionario ad hoc donde se preguntó aspectos relativos a las expectativas laborales, económicas y visión de los estudiantes como futuros profesionales. Se calculó promedios, desviación estándar, distribución de frecuencias, los intervalos de confianza al 95 por ciento con la prueba de Poissón y chi cuadrado. Principales medidas de resultados: Expectativa de laborar en el primer nivel de atención de salud. Resultados: El 50 por ciento de los estudiantes manifestó que les gustaría desarrollarse en el área asistencial; solo 14,5 por ciento expresó su intención de trabajar en el primer nivel de atención de salud (puestos y centros de salud), 87,1 por ciento consideró que estudiar en una universidad emblemática es una fortaleza que favorece su vida profesional y 57,6 por ciento que seguirá estudios de posgrado; 58,6 por ciento de los estudiantes señaló la intención de trabajar en Lima, 21,9 por ciento en provincias y 16,2 por ciento en el extranjero. El promedio de expectativa económica mensual fue el equivalente a 1 577 nuevos soles o poco más de sueldos mínimos vitales previstos para el 2012. Conclusiones: La expectativa de los...

Remote rural areas of the country need more health professionals. Objectives: To identify job and personal expectations of health profession students, particularly those related to work at primary care level. Design: Observational, descriptive and exploratory study. Setting: Faculty of Medicine, Universidad Nacional de San Marcos, Lima, Peru. Participants: Students of a medical school. Interventions: The convenience sample included 278 students from the 5 health professional schools. A questionnaire with questions related to job and financial expectations and on future professional perspective was applied. Main outcome measures: Intention to work at primary care level. Results: Half of students stated they would like to work in hospitals: Only 14.5 per cent expressed their intention to work in first level facilities. Most (87.1 per cent) considered the university prestige as an asset for their future professional practice. More than half (57.6 per cent) said they would pursue post-graduate training. Almost 60 per cent expressed an intention to work in Lima, 21.9 per cent in provinces and 16.2 per cent abroad. Average monthly salary expectation was equivalent to 1 577 nuevos soles, slightly more than 2 minimum vital wages for 2012. Conclusions: Expectation of future health professionals for working at primary care level was low in the group studied...

Parto fisiológico en pacientes con cesárea previa / Physiological birth in patients with previous cesarean section

Se realizó un estudio descriptivo transversal en la Maternidad del Hospital Central de Windhoek en el período comprendido desde enero a diciembre de 2008. El universo de estudio estuvo constituido por 528 pacientes cesareadas que fueron atendidas durante el año correspondiente con el objetivo de reducir el número de cesáreas que se realizan. Se revisaron las historias clínicas para obtener la información necesaria, se creó una base de datos que permitió el análisis estadístico y se consideraron varias variables: la edad, el tipo de parto, la indicación de la primera cesárea, el peso del recién nacido y las complicaciones. Se concluyó que el mayor número de pacientes se encontraban entre 20 y 25 años de edad, que hubo un predominio de pacientes con parto por cesárea en segundo embarazo (62.9 por ciento) y con parto fisiológico (37.1por ciento) en el segundo embarazo, que predominó el peso adecuado -de 3000-3999gramos (42.9 por ciento)- y que las complicaciones fueron más frecuentes en las pacientes que presentaron parto por cesárea (37 por ciento) y resultó en un 20 por ciento para las que tuvieron parto fisiológico; estos resultados fueron expresados en tablas y luego de una exhaustiva revisión bibliográfica se emitieron conclusiones y recomendaciones(AU)

Javier Mariátegui Chiappe, psiquiatra y maestro peruano y latinoamericano / Javier Mariátegui Chiappe, Peruvian and Latin American psychiatrist and master

La obra de Javier Mariátegui abarcó áreas que demostraron claramente su compromiso con la psiquiatría de América Latina y las circunstancias históricas y sociales del continente. En este artículo se examinan cinco temas importantes en los cuales sus contribuciones fueron medulares: el contexto socio-cultural del uso del alcohol, la psiquiatría social, la investigación psiquiátrica, investigación etno-histórica sobre el uso de etanol y agentes psicotrópicos y la psiquiatría institucional latinoamericana. La perspectiva mariateguiana sin duda arroja luz sobre el polémico tema de la identidad de nuestra psiquiatría.

Javier Mariátegui's main areas of work clearly demonstrated his commitment to Latin American psychiatry and to its consideration within the historical and social circumstances in the continent. This article examines five important topics in which his contributions were extremely relevant: socio-cultural context in the use of alcohol, social psychiatry, psychiatry research, ethno-historical research on the use of etanol and psychotropic agents, and institutional psychiatry in Latin American. Mariátegui's perspective undoubtedly enlightens the polemical topic of the identity of our psychiatry.

Chamanismo: consideraciones históricas y contemporáneas / Shamanism: historical and contemporary considerations

Se revisan las principales características del chamanismo tradicional histórico, ejemplificadas mediante el relato de 3 casos obtenidos en la literatura especializada (mapuche, andino y mazateco). Luego se analizan ciertas características adquiridas por el chamanismo tradicional actual en la región hispanoamericana, según 2 casos de conocimiento directo del autor (machi migrado a Santiago y sanador espiritualista trinitario mariano, de Chiapas, México). En tercer lugar se agregan otras referencias generales a desarrollos chamánicos actuales no tradicionales, obtenidas de diferentes fuentes bibliográficas (también denominados genéricamente neochamanismo). Luego de esta revisión, se proponen algunas consideraciones sobre el actual estado de la actividad.

Solitary infantile gastrointestinal myofibroma: case report.

We report a case of a 7-year-old child who required emergency surgery for acute abdomen and suspected acute appendicitis. During surgery a tumor located in the small bowel that caused intestinal occlusion was found. Histopathologic analysis showed a solitary gastrointestinal myofibroma. This is a very rare tumor, especially as a single lesion, because in world literature, there are less than 10 cases reported.

Tuberculosis en nuevos escenarios: establecimientos penitenciarios / Tuberculosis new scenery: prison establishments

Los autores revisan la incidencia de tuberculosis (TBC) y virus de inmunodeficiencia humana (VIH) en las personas privadas de su libertad. En los principales establecimientos penitenciarios del Perú, estas incidencias son más altas que en la población general. Se revisa las condiciones que contribuyen dichas tasas y se propone una estrategia diferenciada para dichas poblaciones de riesgo: una intervención de capacitación en los profesionales de la salud, formación de promotores de salud y un intenso uso de la información, educación y comunicación en salud.

Los derechos en salud: proceso y debate / Health´s right: challenge and discussion

Se discute la necesidad de introducir en el debate de salud pública la vigencia de los Derechos en Salud como parte de los derechos de todo ciudadano. En las últimas décadas se han dado avances en la legislación relacionados al derecho a la salud, sin embargo la política del Sector Salud se ha caracterizado por avances y retrocesos. Para poder hablar de un estado legítimo es necesario que el estado asuma la capacidad de incorporar las normas y valores culturales de la colectividad nacional en su sistema jurídico. Considerando la vigencia de un país multicultural y multi lingue. En derechos humanos los Estados tienen dos obligaciones esenciales: las obligaciones de respetar y las de garantizar. La obligación de respetar exige que el Estado y sus agentes no violen los derechos humanos reconocidos internacionalmente. La obligación de garantizar exige al estado organizar todo el sector salud, de tal manera que los servicios de salud públicos, deben de ser capaces de asegurar el libre y pleno ejercicio de un acceso a servicios eficientes sin diferencias de género, culturales ni económicos. El derecho a la salud es un derecho fundamental, que debe sustentarse en cuatro elementos fundamentales que se encuentran interrelacionados: Disponibilidad, Accesibilidad, Aceptabilidad, y Calidad.

Primera protesta estudiantil médica en Perú / First medical students' protest in Peru

Los años iniciales de la República, 1821-1830, estuvieron signados por continuas guerras civiles y conflictos internacionales, con una agricultura y comercio exterior paralizados, lo que originó grave crisis fiscal. En este marco societal, el Colegio de Medicina sufrió una grave crisis con periodos de cierres y cambios en su programa de enseñanza inicial. En este contexto se presenta un manuscrito inédito sobre la primera protesta estudiantil de medicina en 1829. Los reclamos eran de corte académico y por mejores condiciones de estudio, los cuales no fueron atendidos por las autoridades del colegio.

The early years of the Peruvian Republic (1821 - 1830) were characterized by continuous civil wars and international conflicts that stalled agriculture and commerce and originated a serious fiscal crisis. With this social environment frame, the College of Medicine suffered a serious crisis with shut-down periods and changes in academic programs. Within this context, an unpublished manuscript on the first medical studentsÆ civil protest was presented in 1829. The claims refered to academic issues and better learning conditions, claims unattended by the College authorities.

Sistematización: construcción de un sistema municipal de información en violencia / Systematization: construction of a municipal information system in violence

El primer capitulo intenta recuperar lo esencial de la construcción del proyecto con sus dos ejes fundamentales: la propuesta de boleta municipal de registro de violencia y la constitución de redes locales de prevención y atencion a victimas; en el segundo capitulo presenta las primeras actividades de capacitación y validación de la boleta de registro; en el tercer y cuarto capitulo muestran la experiencia de los talleres de supervisión capacitantes y comité de análisis de información

Sistematización del seminario "Presentación de experiencias de abordaje de violencia sexual en Bolivia": elaboración de normas para la atención integral de violencia sexual en adolescentes: ficha técnica

En el marco de la elaboración de las normas y protocolos para la atención integral a víctimas y sobrevivientes de violencia sexual, impulsado por el UNFPA desde el proyecto "fortalecimiento e institucionalización del Modelo transectorial de atención a los y las adolescentes" en apoyo al Vice ministerio de la Mujer e Ipas-Bolivia como la institución encargada de estas normas. Se propuso una sistematización de las experiencias en abordaje de la violencia sexual en Bolivia