Primates in the Hood (Primates en el Barrio): Improving knowledge of threatened primates through schools science projects in rural settings in San Martin, Peru.

We aimed to improve knowledge among high school students on local environmental issues, with emphasis on the ecology and threats to primates in the Alto Mayo Valley of San Martin Region, Peru. The Alto Mayo Valley is home to at least 8 species of primate, including the endemic and Critically Endangered San Martín titi monkey (Plecturocebus oenanthe). San Martin is also the most deforested region of Peru. We used two participatory teaching methods: Experiential learning and inquiry-based education. The learning experiences were activities that guided students to look for solutions to real-life situations. The project consisted of 8 lessons co-designed by us and the participating school teachers, and implemented by the same teachers with our guidance. Lesson 5 was a field trip to a local community conservation area to apply primatological field techniques and gather scientific data. The students' final product was a video presentation and a poster of their results. One hundred percent of students acknowledged they learned something new about their local environment, primates, conservation, and research. Experiential learning techniques are effective in developing awareness, knowledge and self-advocacy amongst school students. Our inquiry-based method placed students and teachers closer to scientists, helping them to see the role of science in their neighbourhood. This method can be easily adapted to other regions in Peru and globally.

Acercamiento a la salud mental de inmigrantes en Chile: revisión de la bibliografía / Approach to the mental health of immigrants in Chile: review of the bibliography

Migrants in Chile are a group of health users with particular needs, at least in mental health, they are faced with factors that can influence their psyche. Thus, the present work summarized the bibliography available in scientific search engines with the aim of summarizing them and associating them with mental symptoms. From it, it can be deduced that 9 factors can influence this group, among them, acculturation, poor access to health and mistreatment. The consequences of these are summarized in the generation of depressive and anxious symptoms, which are often not treated.

Proteína C reactiva como biomarcador predictivo de fuga anastomótica en cirugía oncológica colorrectal: estudio de cohorte retrospectivo / C-reactive protein as a predictive biomarker of anastomotic leak in colorectal cancer surgery: A retrospective cohort study

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación

Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) in Chile: lessons learned from challenging cases.

BACKGROUND: Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Associated Disease (MOGAD) is an emerging disorder recognized as a clinical entity distinct from Multiple Sclerosis and Aquaporin-4-positive Neuromyelitis Optica Spectrum Disorders (NMOSD-AQP4+), and its phenotypic spectrum continues to expand. Most information about its clinical course has emerged from retrospective studies, and treatment response both in acute and chronic-relapsing disease is still limited. We aimed to describe the clinical and paraclinical characteristics of monophasic and relapsing, paediatric and adult patients with MOGAD under regular clinical care in Chile, highlighting some challenging cases that are far from being considered benign. METHODS: Observational, retrospective, and prospective longitudinal multicentre study including patients with positive serum MOG-IgG assessed by cell-based assay. RESULTS: We include 35 patients, 71% women, median age at onset 30 years (range 1-68), 23% had paediatric onset, with a median disease-duration 24 months (range 12-348). In the whole cohort, the most frequent symptoms at onset were isolated optic neuritis (ON) (34%) and myelitis (22%). Encephalitis with seizures or encephalomyelitis was the most common presentation in paediatric-onset patients 75% (n = 6), compared to 11% (n = 3) of the adult-onset patients (p < 0.001). A relapsing course was observed in 34%, these patients were younger (25 vs. 34 years, p = 0.004) and with a longer disease duration (64 vs. 6 months, p = 0.004) compared to monophasic patients. Two patients developed encephalitis with seizures/status epilepticus, with concomitant positive CSF anti-NMDAR-IgG. Chronic immunotherapy was ever prescribed in 77%, the most frequent was rituximab (35%). Relapses under chronic immunotherapy occurred in 5/27 patients (18.5%), two of them under rituximab, one paediatric patient who started combined therapy with monthly IVIG and one adult patient that switched to satralizumab plus mycophenolate. The median EDSS at the last follow-up was 1.5 (range 0-6.0). CONCLUSION: In Chile, patients with MOGAD exhibit a wide spectrum of clinical presentations at disease onset and during relapses. Close monitoring is needed, particularly in younger patients with short follow-up periods.

Compensación dentro de la Evaluación Ambiental en la Secretaría Técnica Nacional Ambiental (SETENA), Costa Rica

Introducción: La ley Orgánica del Ambiente 7554, señala a la Secretaría Técnica Nacional Ambiental (SETENA) como la institución encargada de evaluar y dar seguimiento a las medidas de compensación ambiental en Costa Rica. Objetivo: Exponer el marco jurídico y legislación que rige y aplica la SETENA en el tema de compensación ambiental. Métodos: Se describe brevemente un caso de estudio sobre como la compensación ha sido implementada en el país. Resultados: SETENA interpreta la compensación ambiental como un conjunto de medidas y acciones generadoras de beneficios ambientales que: 1) son proporcionales a impactos o perjuicios ambientales causados por el desarrollo de los proyectos siempre que no se puedan adoptar medidas de prevención, corrección o mitigación; y 2) constituyen una herramienta a utilizar durante la etapa de gestión ambiental, en la fase constructiva u operativa, cuando se evidencien incumplimientos a los compromisos ambientales adquiridos, faltas a la normativa ambiental, o daños ambientales identificados después de obtener la licencia ambiental para el proyecto. Conclusión: SETENA define los Planes de Compensación Ambiental como un procedimiento que sirve de guía para establecer la toma de acciones. Las medidas de compensación se establecen de acuerdo con el tipo de proyecto y hallazgos encontrados durante el monitoreo, por lo que no hay una estandarización para estos planes de compensación.

Introduction: The Organic Law of the Environment No. 7554 designates the National Environmental Technical Secretary (Spanish Acronym - SETENA) as the institution in charge of evaluating and following up on environmental compensation measures in Costa Rica. Objective: To expose the legal framework and legislation that governs and applies SETENA about environmental compensation in this country. Methods: A case study on how compensation has been implemented in the country is briefly described. Results: SETENA interprets environmental compensation as a set of measures and actions that generate environmental benefits that: 1) are proportional to the environmental impacts or damages caused by the development projects, provided that prevention, correction, or mitigation measures cannot be adopted; and 2) is a tool to be used during the environmental management stage, in the construction or operational phase, when there is evidence of non-compliance with the acquired environmental commitments, lack of environmental regulations, or environmental damage identified after reaching environmental approval for the project. Conclusion: SETENA defines the Environmental Compensation Plan as a procedure that serves as a guide to establish the actions to take. The compensation measures are dictated concerning the type of project and the findings encountered during its monitoring, which is why there is no standardization of these compensation plans.

Recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida / Evidence-based recommendations on nutrition and hydration in the last days of life

Resumen: Introducción: Los cuidados paliativos en México son contemplados como una necesidad en todos los niveles de atención. La nutrición e hidratación en estos enfermos hacia sus últimos días de vida es controversial. Objetivo: Identificar las recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida. Material y métodos: Se realizó una búsqueda documental sobre la nutrición e hidratación hacia el final de la vida tomando como marco temporal las últimas horas y/o los últimos días de vida del enfermo en el contexto hospitalario. Resultados: Con los criterios de búsqueda seleccionados se identificaron 83 documentos. No se encontraron metaanálisis. Existen dos revisiones sistematizadas de la literatura, un ensayo clínico, cuatro guías de práctica clínica, cuatro reportes de caso y 17 revisiones. Se desglosan los resultados relevantes de lo seleccionado. Conclusiones: Se identifica que existen controversias de fondo sobre la alimentación al final de la vida. Sobre la hidratación existe cierto consenso. Es indispensable contar con un nutriólogo dentro de los servicios de cuidados paliativos de la Nación.

Abstract: Introduction: Palliative care in Mexico is considered a necessity at all levels of care. Nutrition and hydration in these patients towards the last days of life is controversial. Objective: To identify evidence-based recommendations on nutrition and hydration in the last days of life. Material and methods: A documentary search on nutrition and hydration towards the end of life was carried out taking as a time frame the last hours and/or the last days of life of the patient in the hospital context. Results: With the selected search criteria, 83 documents were identified. No meta-analyses were found. There are two systematized literature reviews, one clinical trial, four clinical practice guidelines, four case reports and 17 reviews. The relevant results of the selected documents are broken down. Conclusions: It is identified that there are fundamental controversies about feeding at the end of life. On hydration there is some consensus. It is essential to have a nutritionist within the palliative care services of the Nation.

Yeast Surface Display System: Strategies for Improvement and Biotechnological Applications.

Yeast surface display (YSD) is a "whole-cell" platform used for the heterologous expression of proteins immobilized on the yeast's cell surface. YSD combines the advantages eukaryotic systems offer such as post-translational modifications, correct folding and glycosylation of proteins, with ease of cell culturing and genetic manipulation, and allows of protein immobilization and recovery. Additionally, proteins displayed on the surface of yeast cells may show enhanced stability against changes in temperature, pH, organic solvents, and proteases. This platform has been used to study protein-protein interactions, antibody design and protein engineering. Other applications for YSD include library screening, whole-proteome studies, bioremediation, vaccine and antibiotics development, production of biosensors, ethanol production and biocatalysis. YSD is a promising technology that is not yet optimized for biotechnological applications. This mini review is focused on recent strategies to improve the efficiency and selection of displayed proteins. YSD is presented as a cutting-edge technology for the vectorial expression of proteins and peptides. Finally, recent biotechnological applications are summarized. The different approaches described herein could allow for a better strategy cascade for increasing protein/peptide interaction and production.

Microbial prospection of communities that produce biosurfactants from the water column and sediments of the Gulf of Mexico.

Microbial communities capable of hydrocarbon degradation linked to biosurfactant (BS) and bioemulsifier (BE) production are basically unexplored in the Gulf of México (GOM). In this work, the BS and BE production of culturable marine bacterial hydrocarbonoclasts consortia isolated from two sites (the Perdido Fold Belt and Coatzacoalcos area) was investigated. The prospection at different locations and depths led to the screening and isolation of a wide variety of bacterial consortia with BS and BE activities, after culture enrichment with crude oil and glycerol as the carbon sources. At least 55 isolated consortia presented reduction in surface tension (ST) and emulsifying activity (EI24 ). After colony purification, bacteria were submitted to polyphasic analysis assays that resulted in the identification of different strains of cultivable Gammaproteobacteria Gram (-) Citrobacter, Enterobacter, Erwinia, Pseudomonas, Vibrio, Shewanella, Thalassospira, Idiomarina, Pseudoalteromonas, Photobacterium, and Gram (+) Staphylococcus, Bacillus, and Microbacterium. Overall, the best results for ST reduction and EI24 were obtained with consortia. Individually, Pseudomonas, Bacillus, and Enterobacter strains showed the best results for the reduction of ST after 6 days, while Thalassospira and Idiomarina strains showed the best results for EI24 (above 68% after 9 days). Consortia isolates from the GOM had the ability to degrade crude oil by up to 40-80% after 24 and 36 months, respectively. In all cases, biodegradation of crude oil was related to the reduction in ST and bioemulsifying activity and was independent from the depth in the water column.

Muerte Súbita en Epilepsia (SUDEP): Encuesta a familiares de pacientes con epilepsia y a profesionales de la salud / Sudden unexpected death in epilepsy (SUDEP): Epilepsy Family and Survey health professionals

Sudden unexpected death in epilepsy (SUDEP), definida como la muerte brusca, inesperada, con o sin testigos, no traumática ni por ahogo, que ocurre en circunstancias benignas, en un individuo con epilepsia, con o sin evidencias de crisis, pero sin estado epiléptico. En general, afecta sobre todo a pacientes con epilepsia refractaria. La incidencia es de 4-7/1000 pacientes al año. En nuestra región, no contamos con muchos datos epidemiológicos de SUDEP, lo cual es un desafío a investigar, ya que sabemos que el 85% de los pacientes con epilepsia viven en países en desarrollo. Es muy importante que los pacientes y/o familiares conozcan sobre SUDEP, ya que ayuda a lograr mejor lo objetivos de tratamiento, promueve mejor el reporte médico-paciente, disminuye ansiedad, filtra la información inadecuada y creencias inapropiadas. Pero es necesario preguntarles a ellos, cuanto saben de SUDEP, cómo, que y cuando recibir esta información. Existen países y culturas donde está vedado hablar de SUDEP. Tampoco conocemos cómo los médicos manejamos el tema, cuando decirlo, que contar y cómo hacerlo. Por otro lado, hay controversias entre los epileptólogos, en qué momento tratar la temática. Por este motivo, se realiza una encuesta a pacientes con epilepsia y/o familiares, además de especialistas médicos. El objetivo es evaluar si los colegas especialistas están hablando del tema y por otro lado constatar los conocimientos de SUDEP en los pacientes y/o familiares. Los resultados de la encuesta, arrojan que la mayoría de los médicos no habla del tema y la mayor parte de los familiares de pacientes con epilepsia desea conocer la temática al inicio de la enfermedad, contada por el médico. Gran número de ellos se ha informado por redes sociales y creen que es prevenible.

Sudden unexpected death in epilepsy (SUDEP), is defined as sudden, unexpected death, with or without witnesses, neither traumatic nor by choking, occurring in benign circumstances in an individual with epilepsy, with or without evidence of crisis, but without epileptic status. In general, it mainly affects patients with refractory epilepsy. The incidence is 4-7/1000 patients per year. In our region, we do not have much epidemiological data about SUDEP, which is a challenge to investigate, as we know that 85% of epilepsy patients live in developing countries. It is important to ask patients and/or family members how much do they know about SUDEP and how as well as when to receive this information. It is important that parents and/or family members know about SUDEP, as it helps to better achieve treat ment goals, better promotes doctor-patient reporting, decreases anxiety, filters inadequate information and inappropriate beliefs. There are countries and cultures where it is forbidden to talk about SUDEP. We also do not know how doctors handle the subject, when to talk about it, what to tell and how to do it. On the other hand, there are controversies among epileptologists at which point to deal with this subject. For this reason, a survey is conducted on parents of children with epilepsy and/or family members, as well as medical specialists. The objective is to be able to evaluate how specialist colleagues are talking about the topic and on the other hand evaluate some parameters of SUDEP in parents and/or family members. Most doctors do not talk about it and most relatives of epilepsy patients want to know the topic of the onset of the disease form their doctor. Large numbers of them have gathered information on SUDEP through social networks and believe it is preventable.

Efectividad a 3 y 6 meses de una intervención integral para caries dental. En escolares de Santiago de María, Usulután; Ilobasco, Cabañas; Lourdes Colón, Santa tecla y Tamanique, La Libertad / Effectiveness at 3 and 6 months of an integral intervention for dental caries. In schoolchildren from Santiago de María, Usulután; Ilobasco, Cabins; Lourdes Colón, Santa Key and Tamanique, La Libertad

Objetivo: Determinar la efectividad a 3 y 6 meses de una intervención para prevenir y tratar la caries en dientes permanentes, en escolares de 9-11 años, atendidos por cinco establecimientos de salud en el año 2017. Metodología: Esta investigación fue una intervención comunitaria, de tipo cuasi-experimental con grupo control pre-post, en 150 escolares. En total fueron ejecutados 1,970 tratamientos; de los cuales 165 fueron remineralizaciones de flúor barniz; 1501 sellantes y 304 obturaciones; acompañados de educación en higiene oral. Las variables analizadas fueron: reducción de placa dentobacteriana; prevención y limitación del daño de lesiones cariosas y supervivencia de los tratamientos ejecutados. La prueba estadística utilizada fue la de Wilcoxon, el Análisis de la Varianza (ANOVA), tomando en cuenta la F de Fisher y la Significancia. Resultados: El diagnóstico de placa dentobacteriana óptimo fue de 52.67% en la evaluación inicial, el cual 6 meses después de la intervención incrementó a un 78.67%. En los SFF se encontró una supervivencia a los 3 y 6 meses de 97.25% y 82.27%, y en las obturaciones de 100% y 98.03% respectivamente. En cuanto a la afectación por caries dental inicial se identificó un 18.34%, luego de la intervención se redujo a 4.72%. Conclusión: La intervención mostró a 3 y 6 meses, ser efectiva para prevenir y tratar caries dental en dientes permanentes.

Objective: To determine the effectiveness to 3 and 6 months of an intervention to prevent and treat caries in permanent teeth, in schoolchildren of 9-11 years, attended by five health establishments in the year 2017. Methodology: This research was a community intervention, of quasiexperimental type with pre-post control group, in 150 schoolchildren. In total, 1.970 treatments were executed; of which 165 were remineralization of fluoride varnish; 1501 sealants and 304 fillings; accompanied by oral hygiene education. The variables analyzed were: reduction of dental plaque; prevention and limitation of damage to carious lesions and survival of the treatments performed. The statistical test used was that of Wilcoxon, the Kaplan Meier Survival Estimator, the variance analysis (ANOVA), taking into account Fisher's F and significance. Results: The dental plaque initial diagnosis was optimum with a 52.67% on first evaluation, this increased to a 78.67% after 6 months of intervention. In sealants were found a survival of 97.25% and 85.27% after 3 and 6 months of intervention; in fillings the survival was of 100% and 98.03% respectively. In regards of caries affectation, an 18.34% was identified on initial evaluation, after intervention this was reduced to a 4-72%. Conclusión: The intervention showed within 3 and 6 months, to be effective to prevent and treat dental caries in permanent teeth.

[Brecha de género en la autoría de artículos publicados en el Boletín Médico del Hospital Infantil de México]. / Gender gap in the authorship of published articles in the Boletín Médico del Hospital Infantil de México.

Introducción: La participación de las mujeres en medicina ha incrementado en las últimas décadas, incluyendo mayor representatividad en la autoría de artículos científicos en diversos países y distintas especialidades. El objetivo del estudio fue analizar las diferencias de género en la autoría de artículos a través de la historia del Boletín Médico del Hospital Infantil de México. Métodos: Se realizó un análisis bibliométrico de los artículos originales publicados en los años 1953, 1963, 1973, 1983, 1993, 2003 y 2013. Se identificó el género de los autores, tipo de autoría (primer autor o autor correspondiente) y el diseño de estudio (descriptivo vs. analítico). Se evaluó la diferencia en la proporción de género y la tendencia en el tiempo. Resultados: Se incluyeron 272 artículos. Se observó una reducción en la brecha de género entre 1953 y 2013. La participación de las mujeres como primeras autoras incrementó del 2 al 63% (p < 0.001) y como correspondiente del 27 al 59% (p < 0.001). Al considerar únicamente estudios analíticos, el incremento fue del 25 al 50% como primera autora (p = 0.03), con un cambio similar como autor correspondiente, pero sin una tendencia significativa en el tiempo (p = 0.19). La reducción en la brecha de género fue más notoria a partir del periodo 1983-1993. Conclusiones: En las últimas décadas ha existido un incremento significativo en la autoría de las mujeres en el Boletín Médico del Hospital Infantil de México, llegando incluso a una mayor proporción en relación con el sexo masculino. Lo anterior es un reflejo del papel actual de las mujeres en la medicina; en particular, en el área pediátrica. Background: Women's participation in medicine has increased in the last decades, with greater representativeness in the authorship of scientific articles in many countries and different specialties. The objective of this research was to analyze the gender gap in the authorship of articles through the history of the medical journal Boletín Médico del Hospital Infantil de México. Methods: In a bibliometric analysis, we reviewed original articles published during the years 1953, 1963, 1973, 1983, 1993, 2003 and 2013. The gender of the author, type of authorship (first author or corresponding author) and the design of the study (descriptive vs analytic) were identified. We evaluated the difference between gender proportion and trends over time. Results: We included 272 articles. We observed a gender gap reduction between 1953 and 2013. The participation of women as first author increased from 2 to 63% (p < 0.001) and as corresponding author from 27 to 59% (p < 0.001). If we include only analytic studies, the increasing was 25 to 50% as first author (p = 0.03), with a similar tendency as corresponding author, but without a statistical significant on time (p = 0.19). We observed the most notable change since 1983-1993. Conclusions: In the last decades, there has been a significant increase in women´s authorship in the medical journal Boletín Médico del Hospital Infantil de México, even reaching a greater proportion against male gender. This reflects the present role of women in medicine, particularly in pediatrics.

Brecha de género en la autoría de artículos publicados en el Boletín Médico del Hospital Infantil de México / Gender gap in the authorship of published articles in the Boletín Médico del Hospital Infantil de México

Resumen Introducción: La participación de las mujeres en medicina ha incrementado en las últimas décadas, incluyendo mayor representatividad en la autoría de artículos científicos en diversos países y distintas especialidades. El objetivo del estudio fue analizar las diferencias de género en la autoría de artículos a través de la historia del Boletín Médico del Hospital Infantil de México. Métodos: Se realizó un análisis bibliométrico de los artículos originales publicados en los años 1953, 1963, 1973, 1983, 1993, 2003 y 2013. Se identificó el género de los autores, tipo de autoría (primer autor o autor correspondiente) y el diseño de estudio (descriptivo vs. analítico). Se evaluó la diferencia en la proporción de género y la tendencia en el tiempo. Resultados: Se incluyeron 272 artículos. Se observó una reducción en la brecha de género entre 1953 y 2013. La participación de las mujeres como primeras autoras incrementó del 2 al 63% (p < 0.001) y como correspondiente del 27 al 59% (p < 0.001). Al considerar únicamente estudios analíticos, el incremento fue del 25 al 50% como primera autora (p = 0.03), con un cambio similar como autor correspondiente, pero sin una tendencia significativa en el tiempo (p = 0.19). La reducción en la brecha de género fue más notoria a partir del periodo 1983-1993. Conclusiones: En las últimas décadas ha existido un incremento significativo en la autoría de las mujeres en el Boletín Médico del Hospital Infantil de México, llegando incluso a una mayor proporción en relación con el sexo masculino. Lo anterior es un reflejo del papel actual de las mujeres en la medicina; en particular, en el área pediátrica.

Abstract Background: Women's participation in medicine has increased in the last decades, with greater representativeness in the authorship of scientific articles in many countries and different specialties. The objective of this research was to analyze the gender gap in the authorship of articles through the history of the medical journal Boletín Médico del Hospital Infantil de México. Methods: In a bibliometric analysis, we reviewed original articles published during the years 1953, 1963, 1973, 1983, 1993, 2003 and 2013. The gender of the author, type of authorship (first author or corresponding author) and the design of the study (descriptive vs analytic) were identified. We evaluated the difference between gender proportion and trends over time. Results: We included 272 articles. We observed a gender gap reduction between 1953 and 2013. The participation of women as first author increased from 2 to 63% (p < 0.001) and as corresponding author from 27 to 59% (p < 0.001). If we include only analytic studies, the increasing was 25 to 50% as first author (p = 0.03), with a similar tendency as corresponding author, but without a statistical significant on time (p = 0.19). We observed the most notable change since 1983-1993. Conclusions: In the last decades, there has been a significant increase in women´s authorship in the medical journal Boletín Médico del Hospital Infantil de México, even reaching a greater proportion against male gender. This reflects the present role of women in medicine, particularly in pediatrics.

Revisión de modelos para el análisis de dilemas éticos / Review of models for the analysis of ethical dilemmas

Resumen:En la práctica médica pediátrica es frecuente encontrar a pacientes en circunstancias que representan un dilema ético para los profesionales de la salud. Un dilema corresponde a una situación en la que los preceptos morales o las obligaciones de similar obligatoriedad ética se encuentran en conflicto, de forma que cualquier solución posible al dilema es moralmente intolerable.Una revisión de la literatura permitió identificar diferentes modelos que abordan esta clase de dilemas. Se localizaron artículos utilizando las bases de datos Ebsco Host, ProQuest, Ovid e InMex, así como metabuscadores como metacrawler. Algunos de los modelos analizados fueron los siguientes: el Modelo de Anne Davis, el Método de Nijmegen, el Método de Diego Gracia, el Método Integral, el Modelo del Centro de Ética Médica de Bochum, el Modelo de Brody y Payton, el Modelo de Curtin y Flaherty, el Modelo de Thompson y Thompson, la Fórmula SAD, el Modelo de Javier Morata, el Modelo de Elaine Congress, el Modelo IFSW, el Modelo de Loewenberg y Dolgoff, el Modelo de la Ley Social, el Método DOER, el Modelo de Brommer, el Modelo de Corey y Callanan, el Modelo de Pope y Vasquez, el Modelo de Bush, Connell y Denney, el Modelo de Ferrell, Gresham y Fraedrich y el Modelo de Hunt y Vitell.Los criterios compartidos entre los diferentes modelos fueron los siguientes: a) la especificación del dilema ético; b) la descripción de los hechos a considerar; c) la definición de valores, principios y la postura ética que será tomada en consideración; y d) la toma de decisiones con la identificación de alternativas de solución. De acuerdo con la literatura revisada, se explican algunos modelos con el fin de identificar y ejemplificar elementos críticos que pudieran ser utilizados de manera práctica por los Comités de Ética Clínica u Hospitalaria en las instituciones de salud pediátrica en México.

Abstract:In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations.A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell.The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.

[Review of models for the analysis of ethical dilemmas]. / Revisión de modelos para el análisis de dilemas éticos.

In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations. A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell. The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.

[Maternal anemia in Concepción province, Chile: association with maternal nutritional status and fetal growth]. / Anemia del embarazo en la Provincia de Concepción, Chile: relación con el estado nutricional materno y el crecimiento fetal.

Previous studies in Santiago, Chile have established that anemia in the earliest stages of pregnancy is a public health issue. The situation in other parts of the country is unknown. The purpose of this study is to establish the prevalence of anemia in pregnant women in the province of Concepcion and evaluate its association with maternal nutricional status and fetal growth. The study included 1782 women with singleton pregnancies who began prenatal check-ups in 2004 at the public primary health care centers. Anemia was established using the following criteria: from WHO (Hb < 11 g / dl) and from the USA Center for Disease Control (CDC) (Hb < percentile 5 for each gestational week). Anemia prevalence was compared in relation to independent study variables: maternal age, parity, morbidity and smoking habit, and mother and child anthropometry. A multivariable logistic regression model studied the possible effect of anemia on fetal growth. The prevalence of anemia was 10.9% and 14.5% using the WHO and CDC criteria, respectively. The mother's nutritional status was significantly associated with anemia. However, anemia according to WHO and CDC criteria at the beginning of pregnancy was not significantly associated to fetal growth in the univariate and multivariate analyses. The prevalence of anemia in the province of Concepcion constitutes a public health problem that needs to be addressed and it is slightly higher to that recently observed in the county of Puente Alto, Santiago.

A nonopioid analgesic acts upon the PAG-RVM axis to reverse inflammatory hyperalgesia.

Metamizol (dipyrone) and other nonsteroidal anti-inflammatory drugs (NSAIDs) induce antinociception by acting upon peripheral tissues and upon central nervous system structures, notably the periaqueductal grey matter (PAG) and the spinal cord. Inflammation-induced hyperalgesia is prevented by spinal application of NSAIDs before the inflammation, but once central sensitization is established the spinal effect of NSAIDs is uncertain. The present study examines whether the action upon the PAG contributes to the attenuation of inflammation-induced spinal hyperalgesia by NSAIDs. In deeply anaesthetized rats, responses of spinal multireceptive neurons to mechanical stimulation of the ipsilateral paw and leg were recorded. An inflammation in the paw was induced with carrageenan. Fifty minutes later, neuronal responses to innocuous and noxious stimulation had, respectively, increased to 206 and 304% for paw, and 160 and 190% for leg. When metamizol (150 microg in 0.5 microL) was microinjected into PAG before the inflammation, neuronal hyperexcitability was delayed for approximately 60 min and was much reduced by 215 min. More interestingly, microinjection of metamizol into PAG when hyperexcitability was fully developed depressed neuronal responses down to baseline for approximately 1 h. The effect of PAG metamizol was reversed by microinjection of a GABA(A) agonist into the rostral ventromedial medulla (RVM), which indicates that RVM relays the metamizol effect from PAG onto the spinal cord. These results suggest that, upon clinical administration of NSAIDs, a joint action upon PAG and spinal cord contributes to preventing the development of hyperalgesia but it is mainly the action upon PAG which contributes to reducing fully established hyperalgesia.

Efecto del peróxido de carbamida sobre el esmalte dentario a diferentes concentraciones y tiempos de exposición (estudio in vitro) / The effects of carbamide peroxide on the dental enamel at different concentrations and exposure times (in vitro study)

El propósito de este estudio fue evaluar la variación de la morfología superficial, estructura histológica y color del esmalte de las caras vestibulares de piezas dentarias anteriores expuestas a diferentes concentraciones y tiempos de exposición de peróxido de carbamida. El estudio se llevó a cabo en 21 piezas dentarias extraídas que fueron divididas en tres grupos y sometidos a distintas concentraciones de peróxido de carbamida: grupo uno al 5 por ciento; grupo dos al 10 por ciento; y el grupo número tres al 20 por ciento. La cara vestibular de cada diente fue dividida en cuatro cuadrantes, los cuales se expusieron a 5, 20, y 40 horas de blanqueamiento, mientras que un cuadrante fue el grupo control. Los resultados fueron sometidos a la prueba de Friedman para establecer diferencias estadísticas. Se concluyó que morfológicamente, las variaciones en el aspecto superficial fueron mínimas con el gel al 5 por ciento durante las 5, 20 y 40 horas de exposición. Los grupos dos y tres mostraron variaciones significativas ya que su aspecto externo se tornó irregular. Histológicamente, en el grupo uno no hubo cambios significativos en la dirección de los prismas, pero en los grupos dos y tres hubieron cambios en la dirección de los prismas y aumento de las micro porosidades.