Accuracy in osteotomy drilling using a new universal and disposable drill-stop device for dental implant drills: an in vitro study using a bovine rib model.

BACKGROUND: This study aimed to evaluate the surgical accuracy of a new universal disposable stop system for implant drills (FCA Universal Drill Stop). MATERIAL AND METHODS: A total of 60 bovine ribs were included in this in vitro study. The ribs were randomized into three study groups (n=20 ribs per group). In each study group (Group1: drills without stop or control group, Group 2: prefabricated drills with stop or gold standard group, and Group 3: drills with FCA Universal Drill Stop) a total of 100 osteotomies were performed with implant drills in each group, following the drilling sequence for the placement of a dental implant of 10 mm length and 4 mm diameter. The accuracy of the depth of the osteotomies was quantified clinically (with periodontal probe) and radiologically, using ImageJ version 1.48v software. RESULTS: The order of highest to lowest accuracy (clinical and radiological) in the depth of osteotomies was: FCA Universal Drill Stop> prefabricated drills with a stop>drills without stop, with statistically significant differences being observed between both systems with stop with respect to the control group, although not between them. CONCLUSIONS: The new universal disposable stop system for implant drills, offers similar accuracy to prefabricated drills with stop, with both systems being much more accurate than implant drills without stop. Although this experimental evaluation showed favourable results, further clinical studies are necessary.

Evaluación de nivel de conocimientos sobre cuidado para pacientes neurocríticos en personal de enfermería / Evaluation of the level of knowledge about caring for neurocritical patients in nursing staff

Introducción: Los pacientes neurocríticos son aquellos con afectaciones en el sistema nervioso central y otros sistemas vitales, principalmente como consecuencia de traumatismos severos o complicaciones graves derivadas de enfermedades degenerativas. Su atención es fundamental durante el ingreso a las Unidades de Cuidados Intensivos (UCI), y su correcta realización por parte del personal de enfermería puede ser un factor decisivo para reducir efectos colaterales. Objetivo: Reconocer los niveles de conocimientos sobre el cuidado de pacientes neurocríticos del personal de enfermería de la UCI del Centro Médico Naval. Materiales y métodos: Se adaptó un instrumento para la evaluación de los cuidados en pacientes neurocríticos y se conformaron trece reactivos en forma de indicadores sobre tipo de conocimientos. Además, se aplicó una prueba no paramétrica de chi-cuadrada para variables cualitativas y una prueba exacta de Fisher. Resultados: El estudio arrojó una correlación entre un mayor nivel de conocimientos y los años de experiencia (p<0.005), el nivel de estudios (p<0.001) y la edad (p<0.002). No se encontraron asociaciones con el sexo o el turno de servicio. Conclusiones: En 22.5% de los casos se obtuvo un nivel regular de conocimientos, 2.5% tuvo un nivel deficiente y el 75% restante obtuvo un nivel de conocimientos por encima de lo esperado. La asociación entre el nivel de conocimientos sobre el cuidado de pacientes neurocríticos y el nivel de estudios, así como los años de experiencia en servicio, permiten mejorar las técnicas de atención a través de la capacitación continua del personal de enfermería.

Introduction: Neurocritical patients are those who suffer injuries in the central nervous system and other vital systems, mainly as a result of severe trauma or serious complications derived from degenerative diseases. The adequate care of these patients is essential during their admission to the Intensive Care Units (ICU); correct nursing staff performance is determinant to reduce collateral effects. Objective: To assess the level of neurocritical care expertise of the nursing staff of the ICU in the Centro Médico Naval. Materials and methods: An instrument for the evaluation of neurocritical care was adapted and 13 test items were used as indicators. In addition, a nonparametric chi-square test for qualitative variables and a Fisher exact test were applied. Results: The study showed a significant correlation between a higher level of knowledge and years of experience (p<0.005), level of education (p<0.001) and age (p<0.002). No associations were found between gender and nursing shift. Conclusions: 22.5% of the nursing staff had an average level of knowledge, 2.5% had a deficient level, and the remaining 75% had an unexpectedly high level of knowledge. The association between neurocritical care expertise and educational background, as well as the years of experience, generate an improvement in care skills through the continuous training of nursing staff.

Evidencia que tres ciclos de prono aumentan la PaO2/FiO2 en el enfermo de neumonía por COVID-19 / Evidence that three prone cycles increase PaO2/FiO2 in patients with COVID-19 pneumonia

Introducción: Es posible deducir la mejoría o empeoramiento del intercambio gaseoso en el paciente con COVID-19 en ventilación mecánica invasiva mediante el índice PaO2/FiO2 tras el uso de la posición prono. Objetivos: Identificar los cambios en el índice PaO2/FiO2 tras el uso de tres ciclos de prono, y detallar las características sociodemográficas de los pacientes. Material y métodos: En este estudio descriptivo y retrospectivo se analizaron los expedientes clínicos de 60 pacientes con COVID-19, se tomaron en cuenta valores de PaO2/FiO2, saturación de oxígeno y datos sociodemográficos. Resultados: Con el uso de tres ciclos de posición prono de 24 horas cada uno, en promedio la PaO2/FiO2 aumentó 26.38 mmHg (20%) y la saturación de oxígeno aumentó un 6.3%. 66.7% de la población eran hombres, y el promedio de edad fue de 67.10 años. Limitación: Hubo limitaciones de carácter retrospectivo debido al contexto de la pandemia de COVID-19 y la alta carga de trabajo que imposibilitó la adecuada recolección de información relevante, como los tipos de tratamiento farmacológico y de soporte vital empleados. Conclusiones: El uso de la posición prono en el paciente orointubado con COVID-19 constituye una estrategia de primera línea, pues ha demostrado un aumento en la PaO2/FiO2, que resulta en una mejoría en la oxigenación/perfusión.

Introduction: The improvement or worsening of gas exchange in patients with COVID-19 on invasive mechanical ventilation can be determined through the PaO2/FiO2 index after using the prone position. Objectives: To identify changes in the PaO2/FiO2 index after three prone cycles, and to describe the sociodemographic characteristics of the patients. Material and methods: In this descriptive and retrospective study, the clinical records of 60 patients with COVID-19 were analyzed, PaO2/FiO2 oxygen saturation values and sociodemographic data were considered. Results: With the use of three prone position cycles of 24 hours each, on average, the PaO2/FiO2increased by 26.38 mmHg (20.09%) and oxygen saturation increased by 6.3%. Male population represented 66.7%, and the average age was 67.10 years. Limitation: There was retrospective limitations due to the COVID-19 pandemic context and high workload, which made difficult to adequately record relevant information, including types of pharmacological and life support treatments used. Conclusions: The prone position used on orointubated patient with COVID-19 constitutes a first-line strategy; it has shown an increase in PaO2/FiO2 values, which leads to an improvement in oxygenation/perfusion.

Concordancia de valoraciones del dolor entre la Escala de Conductas Indicadoras del Dolor y Behavioral Pain Scale / Concordance of pain assessment between the Escala de Conductas Indicadoras de Dolor y Behavioral Pain Scale

Introducción: La valoración del dolor del paciente critico se basa en indicadores conductuales. Actualmente existen diversas escalas con diferencias en la forma de puntuar la presencia de dolor. Objetivo: Determinar la concordancia entre mediciones del dolor según la Escala de conductas indicadoras de dolor (ESCID) y la Behavioral Pain Scale (BPS). Métodos: Estudio observacional en pacientes con ventilación mecánica. Se aplicaron la BPS y la ESCID en reposo y durante aspiración de secreciones, a fin de determinar su concordancia mediante el coeficiente Kappa de Cohen y el nivel de dolor de la ESCID. Resultados: La concordancia estadística entre la BPS y la ESCID fue 0.23 según el coeficiente Kappa de Cohen, considerada "regular" de acuerdo con Landis y Koch. La BPS determinó presencia de dolor en 93.4% de pacientes durante la aspiración de secreciones, y la ESCID lo detectó en el 100%, clasificando 80% en nivel moderado­grave. Limitaciones de estudio: Muestra de 15 pacientes. El estudio se realizó en dos momentos. Originalidad: El resultado obtenido no tiene comparación con otro estudio, pues sólo se ha estudiado la concordancia entre observadores. Conclusiones: La concordancia entre las mediciones del dolor con ambas escalas se considera baja. La ESCID muestra mayor sensibilidad, aunque los niveles de puntuaciones bajas pueden ser causados por factores no relacionados con dolor. BPS muestra menor sensibilidad, pues considera la presencia de dolor con puntajes sin clasificaciones intermedias. Este estudio apoya el uso de ESCID como una escala confiable en las valoraciones del dolor.

Introduction: Pain assessment in critical patients is based on behavioral indicators. Currently, there are various scales that differ in their pain-scoring systems. Objective: To determine the concordance between pain measurements according the Behavioural Indicators of Pain Scale (ESCID, by its acronym in Spanish) and Behavioral Pain Scale (BPS). Methods: Observational study in patients subjected to mechanical ventilation. The BPS and the ESCID were applied at rest and during aspiration of secretions, in order to determine their concordance using Cohen's kappa coefficient and pain level according to ESCID. Results: The statistical concordance between the BPS and ESCID was 0.23 according to Cohen's kappa coefficient, considered "regular" as stated by Landis and Koch. BPS determined the presence of pain in 93.4% of patients during aspiration of secretions, and ESCID detected it in 100% of patients, with 80% in the moderate-severe level. Study limitations: Sample of 15 patients. The study was performed two times. Originality: The obtained results have no comparison with other studies, since they only analyze inter-observer concordance. Conclusions: The concordance between pain measurements with both scales is considered low. ESCID shows higher pain sensitivity, although low score levels may be caused by factors not related to pain. BPS shows lower sensitivity, since it considers the presence of pain with scores without intermediate classifications. This study supports the use of ESCID as a reliable scale for pain assessment

Erosion directionality and seasonality study using the anisotropy matrix. Application in a semiarid Mediterranean climate (SE Spain).

This paper is based on the fact that some climatic variables show a preferential directionality and grant a markedly anisotropic character to the weathering system acting on rocks. The aim of this work is to quantify the anisotropic degree of the weathering system and its effects on rock erosion. For this purpose, a new methodology based on the vector analysis of directional and time-dependent parameters is proposed to quantify the annual or seasonal anisotropy of the weathering system. Results show that, on the one hand, wind-driven rain and solar radiation are the most anisotropic variables, being north and east the most intense directions for wind-driven rain and southeast for solar radiation, in the case of the San José Tower, the reference monument of this study. On the other hand, the ranking from the most to the least eroded façades of the tower are: east (maximum recession depth of 26.77 mm) > south (15.53 mm) ≈ west (13.56 mm) > north (6.37 mm). Solar radiation and indirect processes arising therefrom are the most important weathering agents in the semiarid Mediterranean climate, whilst wind-driven rain is the main erosion factor especially due to its torrential character. According to our results, weathering and erosion agents are strongly anisotropic, which emphasizes the importance of integrating the anisotropic character of the weathering system in preventive strategies against surface deterioration of monuments. In this sense, this paper advances the United Nations' 2030 Agenda for Sustainable Development.

[Megalencephalic leukoencephalopathy with cysts -the clinical importance in the genetic era]. / Leucoencefalopatía megalencefálica con quistes: importancia de la descripción clínica en la era genética.

INTRODUCTION: Megalencephalic leukoencephalopathy with cysts is a leukodystrophy of genetic origin that produces an alteration in the water and ion homeostasis in the brain, generating vacuolar forms and chronic oedema in the white matter with progressive neurological deterioration. It should be suspected in infants who present progressive macrocephaly during the first year of life, motor retardation and characteristic findings in magnetic resonance brain scans. CASE REPORT: We report the case of a girl who was followed up from the age of 9 months due to progressive macrocephaly and delayed psychomotor development and brain MRI findings consistent with megalencephalic leukoencephalopathy with cysts, and the appearance of epilepsy during its development. The usual genetic studies (new generation sequencing and array) were negative, but as the diagnostic criteria were met, a complementary messenger RNA and DNA study was conducted, which confirmed the presence of two pathogenic variants in MLC1. CONCLUSIONS: Megalencephalic leukoencephalopathy with cysts is a rare condition. Progressive macrocephaly in the first year of life, the absence of deterioration or slow deterioration, and the possibility of developing epilepsy, spasticity and ataxia are characteristic signs in its course. It is important for these patients to undergo an imaging test that shows findings that characterise this condition, which, together with the clinical features, makes it possible to differentiate it from other leukodystrophies and to establish a confirmatory diagnosis. Genetic studies can confirm the associated mutation that makes it possible to predict the clinicoradiological phenotype.

TITLE: Leucoencefalopatía megalencefálica con quistes: importancia de la descripción clínica en la era genética.Introducción. La leucoencefalopatía megalencefálica con quistes es una leucodistrofia de origen genético que produce una alteración de la homeostasis del agua e iones en el cerebro, generando formas vacuolares y edema crónico en la sustancia blanca con deterioro neurológico progresivo. Debe sospecharse en los lactantes que presentan macrocefalia progresiva durante el primer año de vida, retraso motor y hallazgos característicos en la resonancia magnética cerebral. Caso clínico. Niña en seguimiento desde los 9 meses por macrocefalia progresiva y retraso del desarrollo psicomotor con presencia en la resonancia magnética cerebral de hallazgos compatibles con leucoencefalopatía megalencefálica con quistes, y aparición de epilepsia en su evolución. Los estudios genéticos habituales (secuenciación de nueva generación y array) fueron negativos, pero, al cumplir los criterios diagnósticos, se procedió al estudio del ARN mensajero y el ADN complementario, que confirmó la presencia de dos variantes patogénicas en MLC1. Conclusiones. La leucoencefalopatía megalencefálica con quistes es una entidad infrecuente. Es característica la macrocefalia progresiva en el primer año de vida, la ausencia de deterioro o deterioro lento, y la posibilidad de desarrollar epilepsia, espasticidad y ataxia en su evolución. Cobra importancia en dichos pacientes la realización de una prueba de imagen que muestre hallazgos propios de la entidad, lo que, junto con la clínica, permite diferenciarla de otras leucodistrofias y establecer un diagnóstico confirmatorio. Los estudios genéticos pueden constatar la mutación asociada que posibilita predecir el fenotipo clinicorradiológico.

Stability of focusing regions and its vortex-solitonic properties.

Focusing regions, also known as caustic regions, are the singular solutions to the amplitude function of optical fields. Focusing regions are generated by the envelope curve of a set of critical points, which can be of attractor or repulsor type. The nature of the critical point depends on the refractive index. An important property of the critical points is that they present charge-like features. When a focusing region is generated in media with a random refractive index, current-like effects appear, and the evolution of the focusing regions follows a diffusion behavior. The morphology of the focusing regions may generate vortices or "eternal solutions" of solitonic type in a nonlinear medium. Herein, the condition under which these effects occur is analyzed and experimentally corroborated.

[What is the diet of the immigrant population resident in Spain? Results based on a systematic review]. / ¿Cómo es la alimentación de la población inmigrante residente en España? Resultados a partir de una revisión sistemática.

Diet is a principal determinant of health and is interrelated with socioeconomic factors and the acculturation of immigrants. The aim of this study was to examine the existing evidence on food, nutrition, and diet amongst immigrant populations in Spain, its relationships with their countries of origin, and to evaluate the methodological quality of these studies. A systematic review was carried out that included seventeen cross-sectional studies, 71% of them were of average quality and only one was excellent; seven dealt with adolescents and ten dealt with adults, with a total of 9,871 participants. Insights on immigrant diet and nutrition were heterogeneous because the participant groups in these studies were from several different countries, each of which has distinct cultural and geographical characteristics. Adolescent diet was of lower quality, positively correlated to socioeconomic level; acculturation and length of residence were related to both positive (such as healthier dietary patterns, better adhesion to intake recommendations) and negative aspects (higher intake of meat or bakery products, lower intake of vegetables or fish, among others). Adults show a better intake of macronutrients, but a lower intake of micronutrients and non-observance of some intake recommendations; acculturation and length of residence were related to healthier dietary patterns, significantly related to type of employment. Immigrants from Mediterranean countries show a healthier diet than other immigrants, although the quality of their diet is worse than that of their peers in their countries of origin. Finally, the quality of the diet of non-Mediterranean immigrants improves when they become resident in Spain.

[The relationship between unemployment rates and lost work time due to sickness absence in an economic recession]. / Relación entre las tasas de desempleo y los indicadores de absentismo por incapacidad temporal durante periodos de crisis económica.

INTRODUCTION: Different countries have shown an inverse relationship between unemployment rates (UR) and indicators of sickness absence during periods of economic recession. OBJECTIVE: To evaluate the relationship between indicators of sickness absence and unemployment in Spain during 2009-2015. METHODS: We obtained incidence and absenteeism rates of non-work related sickness absence (NWSA) from Social Security data, and UR from the National Institute of Statistics. The relationship between indicators of NWSA and UR in the period 2009 to 2015 was graphically described using time trend plots. Scatter plots of NWSA indicators were also made against UR. Finally, we fitted linear regression models. RESULTS: Incidence (IR) and absenteeism rates (AR) of NWSA showed downward trends in 2009-2013 (IR 2009=28.07%, IR 2013=20.41%; AR 2009=2.53% and AR 2013=1.86%), changing to an upward trend up to 2015 (IR 2015=22.52%, AR 2015=2.12%). Unemployment rates trended upward in 2009-2013 (UR 2009=17.86%, UR 2013=26.10%), and then changed to a downward trend through 2015 (UR 2015=22.06%). There was an inverse relationship between UR and NWSA indicators. CONCLUSIONS: As in previous international studies, we found an inverse relationship between unemployment rates and indicators of sickness absence in Spain. More detailed studies are needed to evaluate explanatory hypotheses, such as those associated with the effects of discipline, selection and/or changes in the workforce.

INTRODUCCIÓN: Estudios realizados en varios países presentan una relación inversa entre las tasas de desempleo (TD) y los indicadores de absentismo por incapacidad temporal (IT) durante periodos de crisis económica. OBJETIVO: Evaluar la relación entre indicadores de absentismo y el desempleo en España (2009-2015). MÉTODOS: Se obtuvieron tasas de incidencia (TI) y absentismo (TA) por IT de origen común (ITcc) a partir de datos de la Seguridad Social, así como las TD según datos del Instituto Nacional de Estadística. Se describió gráficamente la evolución temporal de los indicadores de ITcc y el desempleo en el periodo 2009-2015. Para explorar dicha relación también se realizaron gráficos de dispersión de los indicadores frente a las TD. Posteriormente, se ajustaron modelos de regresión lineal simple. RESULTADOS: Las TI y TA descienden en 2009-2013 (TI 2009=28,07%, TI 2013=20,41%, TA 2009=2,53%, TA 2013=1,86%) momento en que cambia su tendencia, iniciando una fase ascendente hasta 2015 (TI 2015=22,52%, TA 2015=2,12%). La TD asciende en 2009-2013 (TD 2009=17,86%, TD 2013=26,10%), pasando a descender hasta 2015 (TD 2015=22,06%). Las TD y los indicadores de absentismo presentan una relación lineal inversa. CONCLUSIONES: Se observó una relación inversa entre el desempleo y los indicadores de absentismo en España. Son necesarios estudios específicos para poder evaluar hipótesis explicativas como las asociadas a los efectos de disciplina, selección y/o cambios en la fuerza de trabajo.

Solución del caso 37. Rabdomiólisis por cocaína / Solution to case 37. Cocaine-induced rhabdomyolysis

No disponible

Tratamiento del osteoma osteoide mediante radiofrecuencia guiada por tomografía computarizada / Treatment of osteoid osteoma by means of CT-guided radiofrequency

Objetivos: Presentar los resultados obtenidos en el tratamiento del osteoma osteoide mediante resección percutánea con radiofrecuencia guiada por tomografía computarizada (TC), exponer la técnica utilizada y mostrar las ventajas económicas del procedimiento, comparado con la técnica quirúrgica tradicional. Pacientes y metodología: Se estudiaron 21 pacientes que presentaban un osteoma osteoide localizado en el fémur (11 casos), la tibia (7 casos), la pelvis (un caso), el astrágalo (un caso) y la mano (un caso), entre octubre de 2001 y julio de 2007. Se introdujo un electrodo de punta fría guiado por TC en el centro del nidus y se conectó a un generador de radiofrecuencia. Los pacientes permanecieron ingresados 10h y volvieron a su actividad habitual de forma inmediata. Se realizó un estudio económico comparativo con la técnica convencional que elimina el fragmento óseo que contiene el tumor a cielo abierto y la descrita en este trabajo. Resultados: Los resultados obtenidos muestran la desaparición completa de la sintomatología en 20 casos y el caso restante mejoró al repetir el procedimiento. El estudio económico revela un ahorro de costes hospitalarios para el procedimiento realizado con radiofrecuencia. Conclusiones: Es una técnica fácil, percutánea y ambulatoria. Está indicada en casi todas las localizaciones. No se han descrito complicaciones importantes y proporciona buenos resultados (AU)

Purpose: To present the results obtained in the treatment of osteoid osteoma by percutaneous resection using computerized tomography-guided radiofrequency. We discuss the technique used and report on the economic advantages of the procedure, as compared with the traditional surgical technique. Patients and methodology: Between October 2001 and July 2007, twenty-one patients were analyzed who presented with an osteoid osteoma located in the femur (11 cases), tibia (7 cases), pelvis (1 case), talus (1 case) and hand (1 case). A CT-guided cool-tip electrode was introduced into the center of the nidus, connecting it to a radiofrequency generator. Patients stayed in hospital for 10h and immediately afterwards returned to their usual activities. A study was carried out to compare the cost/effectiveness of the CT-guided RF technique as compared with the conventional technique, whereby open surgery is performed to remove the bone fragment contained by the tumor. Results: The results obtained show complete remission of symptoms in 20 cases; the remaining case improved when the procedure was repeated. The cost/effectiveness study revealed hospital cost savings for the RF procedure. Conclusions: This is a simple percutaneous technique that can be carried out on an outpatient basis. It is indicated in nearly all locations. No significant complications have been reported and the results obtained have been satisfactory (AU)

Meningioma lipomatoso: una forma de presentación atípica de los meningiomas / No disponible

No disponible

[Spontaneous spinal subdural hematoma: MRI findings in two cases]. / Hematoma subdural espinal espontáneo: hallazgos en resonancia magnética a propósito de dos casos.

Spontaneous spinal subdural hematoma is an uncommon finding. This report of two cases of spinal subdural hematoma (one hyperacute and one subacute) discusses the current theory of how it develops, the MRI findings, its differentiation from spinal epidural hematoma, and the value of MRI in monitoring patients undergoing conservative treatment. The most significant MRI findings in the hyperacute phase were isointense signal on T1-weighted sequences and hyperintense signal on T2-weighted sequences. Moreover, T2-weighted gradient-echo sequences showed a hypointense peripheral ring. In the subacute phase, a hyperintense signal was seen on T1-, T1-fat-suppression, and T2-weighted sequences.

Hematoma subdural espinal espontáneo: hallazgos en resonancia magnética a propósito de dos casos / Spontaneous spinal subdural hematoma: MRI findings in two cases

El hematoma subdural espinal espontáneo es un hallazgo poco frecuente. En este artículo, a propósito de dos casos de hematoma subdural espinal (hiperagudo y subagudo), se describe la teoría actual del desarrollo del hematoma subdural espinal espontáneo, sus hallazgos en la resonancia magnética, su diferenciación del hematoma epidural espinal y el valor de la resonancia magnética en la monitorización de pacientes en los cuales se decidió un tratamiento conservador. Los hallazgos de la resonancia magnética más destacados eran en la fase hiperaguda una señal isointensa en las secuencias T1 e hiperintensa en T2. Además en las imágenes de eco de gradiente ponderadas en T2 se observó un anillo periférico hipointenso. En la fase subaguda se veía una señal hiperintensa en las secuencias T1, T1 con supresión grasa y T2

Spontaneous spinal subdural hematoma is an uncommon finding. This report of two cases of spinal subdural hematoma (one hyperacute and one subacute) discusses the current theory of how it develops, the MRI findings, its differentiation from spinal epidural hematoma, and the value of MRI in monitoring patients undergoing conservative treatment. The most significant MRI findings in the hyperacute phase were isointense signal on T1-weighted sequences and hyperintense signal on T2-weighted sequences. Moreover, T2-weighted gradient-echo sequences showed a hypointense peripheral ring. In the subacute phase, a hyperintense signal was seen on T1-, T1-fat-suppression, and T2-weighted sequences

Epidemiology of central nervous system tumors at the Instituto Nacional de Neurología y Neurocirugía in Mexico City.

The purpose of this study was to determine the frequency of different Central Nervous System Tumors (CNST) diagnosed at the Instituto Nacional de Neurología y Neurocirugía (National Institute of Neurology and Neurosurgery) from Mexico City over a 10-year period (1990 to 1999) by means of a hospital survey. This institute is a reference hospital that provides medical attention to a very high number of adult neurological patients every year (approximately 6,000 new patients per year besides emergency cases). From a total number of 2,041 CNST cases, we found that the most frequent tumors were those affecting the neuroepithelial tissue (32.8 %), followed by tumors of the anterior pituitary gland (26.2 %) and tumors of the meninges and similar tissues (24.1 %). In both, male and female patients the higher frequency of CNST was found in patients whose age ranged from 25 to 44 years, and CNST were slightly more frequent in women than in men. Most of the CNST patients lived in the southern districts of Mexico City, it could be because of the great number of people living in the southern districts of the city, or perhaps due to the presence of certain yet unidentified environmental carcinogenic substance in this area. Since CNST are among the more frequent malignant neoplasms, it is necessary to improve the registration system to include frequency, prevalence, incidence and mortality of these diseases in Mexico, in order to plan health policies like in developed countries.

Epidemiología de los tumores del sistema nervioso central en el Instituto Nacional de Neurología y Neurocirugía de la Ciudad de México / Epidemiology of central nervous system tumors at the Instituto Nacional de Neurología y Neurocirugía in Mexico City

El objetivo de este estudio ha sido determinar la frecuencia de diferentes tumores del sistema nervioso central (TSNC) diagnosticados en el Instituto Nacional de Neurología y Neurocirugía en la Ciudad de México durante un período de 10 años (1990 a 1999) utilizando una encuesta hospitalaria. Este instituto es un hospital de referencia que proporciona cada año asistencia médica neurológica a un número elevado de pacientes adultos (aproximadamente 6.000 nuevos pacientes anuales además de los casos de emergencia).De un total de 2.041 casos de TSNC hemos encontrado que los tumores más frecuentes fueron aquellos que afectaban el tejido neuroepitelial (32,8 por ciento), seguidos de tumores de la glándula pituitaria anterior (26,2 por ciento) y tumores de las meninges y de los tejidos semejantes (24,1 por ciento). Se encontró la frecuencia más alta de TSNC en pacientes cuyas edades varían de 25 a 44 años, tanto en pacientes femeninos como masculinos, y los TSNC fueron ligeramente más frecuentes en mujeres que en hombres. La mayoría de los pacientes de TSNC vivían en los distritos del sur de la Ciudad de México. Esto puede deberse al mayor número de personas que vivían en los distritos del sur de la ciudad o quizá debido a la presencia de una sustancia carcinogénica ambiental hasta ahora no identificada en esta área.Ya que los TSNC se encuentran entre los neoplasmas malignos más frecuentes, es necesario mejorar el sistema de registro, incluyendo la frecuencia, prevalencia, incidencia y mortalidad de estas enfermedades en México, para planificar la política sanitaria tal y como se realiza en los países desarrollados. (AU)

[Good morning, Mr. Representative. Anything new to tell us about? Analysis of the pharmacological products introduced by the drugs industry into a health district]. / Buenos días, señor Visitador. ¿Algo nuevo que contar? Análisis de las especialidades farmacológicas presentadas por la industria farmacéutica en un área básica de salud.

OBJECTIVE: To study whether the visits of technical health representatives (ITS) mean that new drugs are introduced. Design. Prospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: The products presented by 137 ITS from 83 drug laboratories in weekly sessions for a year were studied. MAIN MEASUREMENTS: The products presented, the year they were first marketed, intrinsic value (IV), newness and use potential, cost per package and defined daily dose and material handed over were studied. RESULTS: 472 drug products were introduced. The most common ones belonged to the cardiovascular group (27.3%), digestion and metabolism (14.8%) and anti-infection drugs (13.3%). 65.5% had been on the market for <5 years. 84.3% had a high IV. Only 31 products (6.6%) were new (95% CI, 4.5-9.2). 71% of these supposed no or very slight therapeutic improvement, 25.8% a modest improvement and 3.2% a major improvement. Mean cost was 19.3 euros per package and 2 euros per DDD, with significant differences found (P<.006) on stratifying by date of marketing (more recently marketed products cost more). 61% of the products were presented with additional material (leaflets, monographs, journals), 21.6% with gifts of symbolic value, and 19.9% with samples of the product. There were significant differences (P<.03) between the new drugs and the normal prescriptions issued at the centre. In the new drugs, there were fewer products with high IV and cost per package and per DDD was higher. CONCLUSIONS: The products introduced by the reps do not include any important new drugs. They are presented with abundant back-up and are more expensive than those normally prescribed.