Las Topográfias Médicas: una aportación de la Medicina Rural a la Salud Pública / Medical Topographies: A Contribution of Rural Medicine to Public Health

Las Topografías Médicas (TM) o Geografías Médicas, son un género de la literatura médica, cuyos orígenes pueden encontrarse en el tratado de Hipócrates, Sobre los aires, aguas y lugares. El objetivo básico de las TM fue simplemente describir la salud de la población de un lugar determinado, aunque pronto ampliaron su campo de acción, para investigar la influencia del entorno físico y social en las enfermedades que padece la población en zonas geográficas o localidades. El inicio de su desarrollo tiene lugar en el contexto de la Medicina de la Ilustración, y adquirirán su mayoría de edad durante el siglo xix y las primeras décadas del siglo xx, para finalizar su producción en los años setenta del pasado siglo. Las Reales Academias de Medicina tuvieron una importancia decisiva en el desarrollo de las TM, proponiendo una metodología y un contenido homogéneo para la redacción de las mismas y estableciendo premios anuales para las obras galardonadas, lo que permitió mejorar su calidad y homogeneidad. El texto de las TM incluía generalmente un esbozo histórico de la población, la geografía de la zona, la descripción de la flora y de la fauna, con frecuencia de forma muy detalladas, el estudio del clima, de las vías públicas y las viviendas, la descripción de las enfermedades más frecuentes y epidemias, así como la demografía y situación socioeconómica de la población, entre otros. ... En el presente artículo se describe la evolución histórica de las TM, sus contenidos principales, su distribución por autonomías y años, y algunos personajes ilustres relacionados con ellas; aportándose alguna iconografía y copias de los documentos más interesantes por su valor médico o artístico. (AU)

Medical Topographies (TM) or Medical Geographies, are a genre of medical literature, whose origins can be found in Hippocrates’ treatise, On Airs, Waters and Places. The initial objective of TM was simply to describe the health of the population of given place, although they soon expanded their field of action to investigate the influence of the physical and social environment on the diseases suffered by the population in geographical areas or localities. The beginning of their development took place in the context of Enlightenment Medicine, and they came of age during the 19th century and the first decades of the 20th century, ending their production in the seventies of the last century. The Royal Academies of Medicine had a decisive importance in the development of TM, proposing a methodology and homogeneous content for their writing and establishing annual prizes for the award-winning works, which allowed them to improve their quality and homogeneity. The text of the TM generally included a historical outline of the population, the geography of the area, the description of the flora and fauna, often in very detailed form, the study of the climate, public roads and homes, the description of the most frequent diseases and epidemics, as well as the demographics and socio-economic situation of the population, among others. ... This article describes the historical evolution of the TM, its main contents, its distribution by autonomies and years, and some illustrious people related to them, providing some iconography and copies of the most interesting documents due to their medical or artistic value. (AU)

Influence of the Extraction Method on the Polyphenolic Profile and the Antioxidant Activity of Psidium guajava L. Leaf Extracts.

The leaves of Psidium guajava L. are an agro-industrial by-product with an outstanding content of polyphenolic compounds; however, there are many factors which can affect the phytochemical profile when valuing this type of plant material, such as temperatures and extraction times involving in the extraction methods applied. In this context, this study analyzed the impact of different extraction methods (Soxhlet, maceration and ultrasound-assisted extraction) on the phytochemical profile (FTIR and UPLC-MS) and the antioxidant activity (ABTS, FRAP and Folin-Ciocalteu) of guava leaf extracts. A yield of phenolic compounds per gram of guava leaf was obtained within the range of 16 to 45 mg/g; on the other hand, the IC50 values determined with the ABTS assay ranged between 78 ± 4 to 152 ± 12 µg/mL. The methanolic extract obtained by Soxhlet was the one with the best reducing power, both in the FRAP assay and in the Folin-Ciocalteu assay. Finally, bioactive compounds such as quercetin, kaempferol and avicularin were identified in the guava leaf extract. It was concluded that the purification of polyphenolics compounds improves the antioxidant capacity, and that the extraction method greatly influences the phytochemical profile and activity of the extracts.

Candelilla Wax Extracted by Traditional Method and an Ecofriendly Process: Assessment of Its Chemical, Structural and Thermal Properties.

A comparative study was carried out on the chemical, structural and thermal properties of candelilla wax from four wax-producing communities in Mexico, which was obtained by two extraction processes, the conventional one using sulfuric acid (SA) and an eco-friendly alternative process using citric acid (CA) as the extracting agent. The waxes were analyzed by basic chemistry (acidity, saponification, ester indexes, and others), color, Fourier transform infrared spectroscopy (FTIR), Raman micro-spectroscopy, X-ray diffraction (XRD), differential scanning calorimetry (DSC), and hardness and brittleness measurements. The waxes obtained by the environmentally friendly process showed differences in their physicochemical properties when compared to waxes from the conventional process. In addition, they showed some improvements, such as lighter shades and harder waxes, suggesting that the new environmentally friendly process is a viable option.

De la Higiene a la Salud pública. Apuntes para la historia / From Hygiene to Public Health. Notes for history

La Higiene ha sido motivo de preocupación para el hombre desde la más remota antigüedad, focalizándose en las enfermedades infecciosas, que fueron siempre un verdadero azote para el ser humano. Sólo en los últimos siglos ha derivado en la moderna Salud Pública, al incorporar los programas frente al resto de patologías e incorporar elementos de desarrollo y promoción de la salud. En la edad antigua, destacan las figuras de Moisés (siglo XIV a. de C.), Licurgo (siglo VII a C) e Hipócrates (siglo V a. de C.) que, desde distintas perspectivas, fueron desarrollando la Higiene y contribuyeron a su avance. El Imperio Romano supo incorporar el conocimiento de todas las naciones conquistadas, por lo que conoció un esplendor nunca visto en materia de organización social y sanitaria que. Sin embargo, sufrió un serio retroceso en el 313 de nuestra era con el Edicto de Milán y la visión resignada de la enfermedad y de la muerte que aportaba el cristianismo. La Edad Media, supone un largo periodo de oscurantismo, donde prácticas como la quiromancia, la influencia de los astros o las panaceas, entre otras, estuvieron muy arraigadas en la sociedad de la época. La invasión musulmana, aportó de nuevo a España un gran desarrollo de la Higiene y de las ciencias, al confluir en ella el saber grecolatino, hebreo y oriental. Es un periodo de terribles epidemias, como las de lepra y la de la peste de 1346, en la que falleció alrededor de la cuarta parte de la población de Europa. El descubrimiento de América supuso un incremento extraordinario del comercio y de los viajes, y la invención de la imprenta permitió una gran difusión del conocimiento. Al principio de la Edad Moderna, el Renacimiento supone un periodo brillante en la historia de España, con gran desarrollo de las ciencias y de la Medicina, la cual experimenta grandes avances en la Anatomía, al tiempo que Fracastoro funda la Epidemiología moderna.(AU)

Hygiene has been a matter of concern for mankind since ancient times, with its focus mainly on infectious diseases, which have always been a true scourge for human beings. Only in recent centuries has it derived in modern Public Health, by incorporating programs against other pathologies and incorporating elements of development and health promotion In ancient times, the figures of Moses (14th century BC), Licurgo (4th century BC) and Hippocrates (5th century BC) stand out, who, from different perspectives, developed the hygiene and contributed to its advancement. The Roman Empire knew how to incorpórate the knowledge of all the conquered nations, and as a consequence knew a splendor never seen before in terms of social and healthorganization. However, it suffered a serious setback in 313 AD. C. with the Edict of Milan and Christianity’s compliant view of illness and death. The Middle Ages, supposes a long period of obscurantism, where practices such as palmistry, the influence of the stars or panaceasamong others, were deeply rooted in the society of the time. The Muslim invasion once again brought to Spain a great development of hygiene and science, as Greco-Latin, Hebrew and Oriental knowledge converged in it. It is a period of terrible epidemics, such as leprosy and the plague of 1346, in which around a quarter of the population of Europe died. The discovery of America meant an extraordinary increase in trade and travel, and the invention of the printing press allowed for a great spread of knowledge. At the beginning of the Modern Age, the Renaissance represents a brilliant period in the history of Spain, with great development ofscience and Medicine, which experienced great advances in anatomy, at the time that Fracastoro founded modern epidemiology. Some private hygiene works are published, only intended for high society or the nobility. The 17th and 18th centuries brought exceptional progress to the medical sciences.(AU)

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

Monitoring of meso and microplastic debris in Playa Grande beach (Tenerife, Canary Islands, Spain) during a moon cycle.

The occurrence and composition of meso (5-25 mm) and microplastics (1-5 mm) in Playa Grande beach (Tenerife, Canary Islands, Spain) was monitored during a complete moon cycle on the different moon phases between 17th June and 16thJuly 2019. A total of 10 points were sampled each day finding an average content of mesoplastics of 18 g/m2 (0.36 g/L) and of microplastics of 13 g/m2 (1277 items/m2 or 1.6 g/L). Polypropylene and polyethylene accounted for 19% and 76% of the total, respectively. Tar was also found in the 1-5 mm fraction (2% of the total). Among the particles found, 83% were fragments, 11% pellets, 4% fibres and 2% films. The obtained results revealed that microplastic presence could not be related in this case with the tides but with the orientation and strength/speed of the wind.

Las vacunas en el siglo XIX / No disponible

Durante la mayor parte del siglo XIX, la única vacuna disponible fue la antivariólica, utilizada desde 1796. Casi un siglo después, en la década de los 80 del siglo XIX, las aportaciones de Pasteur contribuyeron decisivamente a mejorar la situación, al descubrir, en 1885, la vacuna antirrábica: ese mismo año, Jaime Ferrán descubrió la vacuna anticolérica, la primera obtenida frente a una enfermedad bacteriana. En la década siguiente, los avances logrados permitieron disponer de dos nuevas vacunas, y así finalizó el siglo, con cinco nuevas vacunas descubiertas: frente a la viruela, la rabia, el cólera, la fiebre tifoidea y la peste. Eran los primeros pasos de una investigación que en el siglo XX tendría un desarrollo extraordinario en la prevención de distintas enfermedades infecciosas y en la reducción de la morbilidad y mortalidad de algunas enfermedades que habían sido un azote para la humanidad en los siglos anteriores

The only vaccine used for the most part of the XIX century was that of the vaccine against smallpox, used since 1796. In the decade of the 80s of the XIX century, almost a century after its discovery, Pasteur's research allowed to obtain the vaccine against rabies. Jaime Ferrán discovered the vaccine against cholera in that very same year, first vaccine used against a disease caused by bacteria. New vaccines were discovered in the following decade bringing to five the number of vaccines known at the end of that century. That allowed immunization against small-pox, cholera, rabies, typhoid fever and plague. Thus, a period began in the XX century, that would bring an extraordinary development in the prevention of several infectious diseases. Along with it came a substantial reduction in the morbidity and mortality that some of these diseases had caused humanity du-ring the centuries before

La rabia en la Historia. Prevención y tratamiento / No disponible

La rabia es una zoonosis conocida desde la más remota antigüedad, siendo ya citada en el Código de Eshunna, en el siglo XX antes de Cristo. Durante siglos, la mortalidad, una vez iniciados los síntomas, fue del 100%, lo que la convirtió en una enfermedad muy temida en la población, puesto que no se disponía de ningún tratamiento eficaz, salvo la cura de la herida y su posterior cauterización. Las terribles características de la enfermedad han fomentado un miedo atávico en la población, que ha desarrollado múltiples leyendas y mitos inspirados en gran medida en esta enfermedad. Actualmente, todavía fallecen alrededor de 60.000 personas cada año de la enfermedad, la mayor parte de las cuales pertenecen a países en vías de desarrollo, en los que no se han establecido programas eficaces que hayan logrado erradicar la rabia canina. Hasta finales del siglo XIX no se pudo disponer de una profilaxis eficaz como consecuencia del descubrimiento realizado por Louis Pasteur de la vacuna, que modificó radicalmente el pronóstico de la enfermedad. En 1885, se administró con éxito, la primera vacuna a un niño que había sido mordido por un perro rabioso. Desde entonces, las distintas modificaciones realizadas en la vacuna junto con el uso generalizado de la inmunoglobulina específica, desde mediados del siglo pasado, han permitido mejorar los resultados en la profilaxis de la enfermedad en humanos. El éxito definitivo ha llegado con la implementación por la OMS y la FAO de efectivos programas de vacunación canina en los países desarrollados y, en menor medida, en los países en desarrollo, donde todavía representa un importante problema de salud. Algunos recientes tratamientos (Protocolo de Milwaukee) parecen aportar un poco de esperanza a la curación de los enfermos ya sintomáticos, pero su efectividad sigue siendo todavía muy baja

Rabies is a zoonotic disease known since ancient times, already cited in the Code of Eshunna in the XX century BC. For centuries, mortality, after symptom onset, was 100%, which made her a much-feared disease in the population, since no effective treatment was available, except wound healing and subsequent cauterization The terrible disease characteristics have fostered an atavistic fear in the population, hich has developed many legends and myths inspired largely in this disease. Currently, about 60,000 people still die each year from the disease, most of which belong to developing countries, which have not established effective programs that have achieved eradication of canine rabies. Until the end of the nineteenth century it could not have an effective prophylaxis, as a result of the discovery by Louis Pasteur vaccine, which radically changed the prognosis of the disease. In 1885, he successfully managed the first vaccine to a child who had been bitten by a rabid dog. Since then, various modifications to the vaccine along with the widespread use of specific immunoglobulin, since mid-last century, have improved the results in the prevention of disease in humans. The ultimate success has come with the implementation by WHO and FAO effective dog vaccination programs in developed countries and, to a lesser extent in developing countries, where it still represents a major health problem. Some recent treatments (the Milwaukee Protocol) seem to bring some hope to cure the already symptomatic patients, but their effectiveness is still very low

Prevalence of chondrocalcinosis in a Mexican tertiary care institution of musculoskeletal disorders.

INTRODUCTION/OBJECTIVES: The prevalence of chondrocalcinosis (CC) was reported as variable according to the geographic populations. However, there are no data regarding its prevalence in Mexico. Thus, we decided to investigate the Mexican prevalence of CC in a cohort of patients from a tertiary health care institution. METHODS: A retrospective analysis of radiographs of knees and wrists from our institution was performed. Inclusion criteria included patients > 50 years old having radiographs of knees and wrists. Radiographic presence of CC was classified according to a dichotomous evaluation assayed by two rheumatologists experts on the area. RESULTS: A total of 3.350 radiographs from 1.602 patients were evaluated. Forty-seven patients showed calcifications in at least one knee or wrist for an overall prevalence of 3%, of which 23.4% were men and 76.6% women. The knee was more commonly affected than the wrist (85.1% and 14.9% respectively). The prevalence according to gender was 2.9% in women, whereas, it was 3.2% in men. Only two patients (4.3%) showed a contemporaneous presence of CC in both hands and both knees. At knee level, the prevalence was 2.7%, whereas at the wrist, we reported a prevalence of 4.9%. CONCLUSIONS: The prevalence of CC for Mexican population had not been reported so far. This a starting point to break the silence and encourage the knowledge of how this disease is associated with possible risk factors in Mexican population. Key Points •The prevalence of chondrocalcinosis in Mexico was 3%. •The prevalence of knee chondrocalcinosis increases according to the age in women's. •The nixtamalized meals could be a protective factor for CC in Mexican population.

Polyphenolic Profile and Antioxidant Activity of Leaf Purified Hydroalcoholic Extracts from Seven Mexican Persea americana Cultivars.

Persea americana (avocado) is a fruit consumed worldwide; however, since avocado leaves are apparently a natural ingredient that can be used as a traditional medicine, they can be a potential source of bioactive compounds. This study aimed to analyze the antioxidant activity of seven Mexican avocado leaf extracts by DPPH•, ABTS•+, and lipid peroxidation (LPO), and to identify the compound profile by liquid chromatography coupled to mass spectrometry/electron spray ionization. The highest free radical-scavenging activity was observed for Platano Delgado and Criollo 6 avocado cultivars havin IC50 values of 271.86 ± 13.69 and 269.56 ± 6.53 for DPPH• and ABTS•+ radicals, respectively, while the best result for lipid oxidation inhibition was registered in Criollo 6 cultivar extract. In this study forty-one compounds were detected in avocado leaves of the the seven cultivars analyzed, and of these compounds, eighteen phenolics were identified for first time in such plant material. The present study demonstrated that Mexican cultivars of Persea americana possess diverse polyphenolic compounds with strong antioxidant activity, which might be useful in the food and pharmaceutical industries.

[Technical assistance in crisis times: Brucelosis in the country programs for Spain of the world health organization (1951-1972)]. / Ayuda técnica en tiempos de crisis: la brucelosis en los programas país para España de la organización mundial de la salud (1951-1972).

OBJECTIVE: Brucellosis was one of the most important health problems in post-Civil War Spain and in subsequent years. The objective of the study was to reconstruct the first programs that the WHO set up in this country, to address this problem, between 1951 and 1972 and their main outcomes. METHODS: On the basis of primary sources of diverse origin, especially unpublished reports on Spain from foreign experts, from the WHO Historical Archive, the contents related to the disease were analyzed, contextualizing them within the framework of both the history of Spanish Public Health during the period studied and the international public health strategies for the prevention and control of brucellosis between 1951 and 1972. RESULTS: Spain 0001 (E1), Spain 0012 (E12) programs were located. The first of them (E1), dedicated to the problem of endemoepidemic diseases (brucellosis, rabies and Q fever), developed between 1952 and 1956, offered assistance in the work of control of these diseases carried out by public health laboratories. The second was preceded by visits of experts between 1956-1958 and formally started in 1969 and ended in 1972. This program was specifically devoted to the fight against brucellosis and included the start-up of laboratory and epidemiological work, the training of specialists, vaccination experiences in goats and sheep and the initiation of studies on immunizations in humans. CONCLUSIONS: The presence of consultants and experts from the WHO, from the highest scientific authority in the field of brucellosis such as Sandford Elberg or Martin Kaplan, was decisive in, at least, two aspects: first, to have an external view that would allow to know the reality of the Spanish health situation in the matter of the control of this zoonosis and, secondly, to start up and develop laboratory techniques and training of specialists with the aim of creating, at least, a center of reference for the preparation of vaccines, which the experts placed, ideally, in the National School of Health in Madrid.

OBJETIVO: La brucelosis fue uno de los más importantes problemas de salud en la España de la postguerra civil y en los años posteriores. El objetivo del estudio fue reconstruir los primeros programas que la OMS puso en marcha en este país, para abordar dicho problema, entre 1951 y 1972 y sus consecuencias. METODOS: Sobre la base de fuentes primarias de diversa procedencia, en especial, informes inéditos sobre España de expertos extranjeros, procedentes del Archivo Histórico de la OMS, se analizaron los contenidos relativos a la enfermedad, contextualizándolos tanto en el marco de la historia de la salud pública española del periodo objeto de estudio como en el de las estrategias a nivel internacional desarrolladas en este campo. RESULTADOS: Se localizaron los programas España 0001 (E1) y España 0012 (E12). El primero de ellos (E1), dedicado al problema de las enfermedades endemo-epidémicas (brucelosis, rabia y fiebre Q), desarrollado entre 1952 y 1956, ofreció asistencia en las labores de control de estas enfermedades llevadas a cabo por los laboratorios de salud pública. El segundo, precedido de visitas de expertos, entre 1956-1958, se inició formalmente en 1969 y finalizó en 1972, se consagró específicamente a la lucha contra la brucelosis e incluyó la puesta en marcha de trabajos de laboratorio y epidemiológicos, formación de especialistas, experiencias vacunales en ganado caprino y ovino e inicios de estudios sobre inmunizaciones en humanos. CONCLUSIONES: La presencia de consultores y expertos de la OMS de la máxima autoridad científica en el campo de la brucelosis, como Sandford Elberg o Martin Kaplan, fue decisiva en dos aspectos al menos, en primer lugar, para poder disponer de una mirada externa que permitiera conocer la realidad de la situación sanitaria española en el tema del control de dicha zoonosis y, en segundo lugar, para la puesta en marcha y el desarrollo de técnicas de laboratorio y de formación de especialistas con el objetivo de crear, al menos, un centro de referencia para la confección de vacunas, que los expertos situaban, de forma idónea, en la Escuela Nacional de Sanidad en Madrid.

Anquilobléfaron y el tratamiento a las anomalías congénitas palpebrales y del ojo / Ankyloblepharon and the treatment of congenital palpebral and ocular anomalies

El anquilobléfaron es la fusión parcial o total de los bordes palpebrales. En dependencia de la localización, este puede clasificarse como medial o interno y lateral o externo. Es una malformación congénita que constituye una condición muy infrecuente. Puede estar genéticamente determinada, aunque su causa exacta o mecanismo de producción no se conoce claramente. El primer caso corresponde a una lactante femenina, de 57 días de nacida, antecedentes de madre con paladar hendido ya operado. Al examen oftalmológico se constata en el ojo derecho fusión a nivel de todo el borde palpebral y en el izquierdo brida hacia sector temporal, además de presentar paladar hendido. El segundo caso, es una paciente femenina de 24 meses de edad, que en el examen ocular se observa brida que fusiona ambos bordes palpebrales del ojo izquierdo, en zona temporal. Se confirma diagnóstico de anquilobléfaron. En el primer caso se decide, por la edad, mantener una conducta expectante y posponer el tratamiento quirúrgico hasta que se realice la cirugía de la fisura labial, la cual se realiza a los 3 meses. En ambos casos la conducta fue quirúrgica, con buenos resultados estéticos y funcionales. El diagnóstico de esta anomalía es clínico y el examen físico minucioso, el cual, unido a los conocimientos del especialista sobre estas anomalías, juega un papel primordial. El tratamiento siempre es quirúrgico, el procedimiento a ejecutar es sencillo, incluso cuando requiere de reconstrucción palpebral(AU)

Ankyloblepharon is the partial or total fusion of eyelid margins. According to its location, it may be classified as medial or internal and lateral or external. This congenital malformation is a very rare condition. Though it may be genetically determined, its exact cause or development mechanism is not clearly known. The first case is a 57-day-old female infant whose mother had undergone cleft palate surgery. Ophthalmological examination revealed fusion of the entire eyelid margin of the right eye and bridling toward the temporal sector of the left eye, as well as a cleft palate. The second case is a 24-month-old female patient whose ophthalmological examination revealed bridling fusing the two eyelid margins of the left eye in the temporal zone. Ankyloblepharon diagnosis was confirmed. In the first case, due to the patient's age it was decided to postpone surgical treatment until lip fissure surgery was performed at 3 months. In both cases management was surgical, with good esthetic and functional results. Diagnosis of this condition is based on meticulous clinical and physical examination, supported by the decisive role played by the specialist's knowledge about these anomalies. Treatment is always surgical and the procedure to be performed is simple, even when palpebral reconstruction is required(AU)

Anquilobléfaron y el tratamiento a las anomalías congénitas palpebrales y del ojo / Ankyloblepharon and the treatment of congenital palpebral and ocular anomalies

El anquilobléfaron es la fusión parcial o total de los bordes palpebrales. En dependencia de la localización, este puede clasificarse como medial o interno y lateral o externo. Es una malformación congénita que constituye una condición muy infrecuente. Puede estar genéticamente determinada, aunque su causa exacta o mecanismo de producción no se conoce claramente. El primer caso corresponde a una lactante femenina, de 57 días de nacida, antecedentes de madre con paladar hendido ya operado. Al examen oftalmológico se constata en el ojo derecho fusión a nivel de todo el borde palpebral y en el izquierdo brida hacia sector temporal, además de presentar paladar hendido. El segundo caso, es una paciente femenina de 24 meses de edad, que en el examen ocular se observa brida que fusiona ambos bordes palpebrales del ojo izquierdo, en zona temporal. Se confirma diagnóstico de anquilobléfaron. En el primer caso se decide, por la edad, mantener una conducta expectante y posponer el tratamiento quirúrgico hasta que se realice la cirugía de la fisura labial, la cual se realiza a los 3 meses. En ambos casos la conducta fue quirúrgica, con buenos resultados estéticos y funcionales. El diagnóstico de esta anomalía es clínico y el examen físico minucioso, el cual, unido a los conocimientos del especialista sobre estas anomalías, juega un papel primordial. El tratamiento siempre es quirúrgico, el procedimiento a ejecutar es sencillo, incluso cuando requiere de reconstrucción palpebral(AU)

Ankyloblepharon is the partial or total fusion of eyelid margins. According to its location, it may be classified as medial or internal and lateral or external. This congenital malformation is a very rare condition. Though it may be genetically determined, its exact cause or development mechanism is not clearly known. The first case is a 57-day-old female infant whose mother had undergone cleft palate surgery. Ophthalmological examination revealed fusion of the entire eyelid margin of the right eye and bridling toward the temporal sector of the left eye, as well as a cleft palate. The second case is a 24-month-old female patient whose ophthalmological examination revealed bridling fusing the two eyelid margins of the left eye in the temporal zone. Ankyloblepharon diagnosis was confirmed. In the first case, due to the patient's age it was decided to postpone surgical treatment until lip fissure surgery was performed at 3 months. In both cases management was surgical, with good esthetic and functional results. Diagnosis of this condition is based on meticulous clinical and physical examination, supported by the decisive role played by the specialist's knowledge about these anomalies. Treatment is always surgical and the procedure to be performed is simple, even when palpebral reconstruction is required(AU)

Ayuda técnica en tiempos de crisis: la brucelosis en los programas país para España de la Organización Mundial de la Salud (1951-1972) / Technical assistance in crisis times: Brucelosis in the country programs for Spain of the World Health Organization (1951-1972)

Fundamentos: La brucelosis fue uno de los más importantes problemas de salud en la España de la postguerra civil y en los años posteriores. El objetivo del estudio fue reconstruir los primeros programas que la OMS puso en marcha en este país, para abordar dicho problema, entre 1951 y 1972 y sus consecuencias. Métodos: Sobre la base de fuentes primarias de diversa procedencia, en especial, informes inéditos sobre España de expertos extranjeros, procedentes del Archivo Histórico de la OMS, se analizaron los contenidos relativos a la enfermedad, contextualizándolos tanto en el marco de la historia de la salud pública española del periodo objeto de estudio como en el de las estrategias a nivel internacional desarrolladas en este campo. Resultados: Se localizaron los programas España 0001 (E1) y España 0012 (E12). El primero de ellos (E1), dedicado al problema de las enfermedades endemo-epidémicas (brucelosis, rabia y fiebre Q), desarrollado entre 1952 y 1956, ofreció asistencia en las labores de control de estas enfermedades llevadas a cabo por los laboratorios de salud pública. El segundo, precedido de visitas de expertos, entre 1956-1958, se inició formalmente en 1969 y finalizó en 1972, se consagró específicamente a la lucha contra la brucelosis e incluyó la puesta en marcha de trabajos de laboratorio y epidemiológicos, formación de especialistas, experiencias vacunales en ganado caprino y ovino e inicios de estudios sobre inmunizaciones en humanos. Conclusiones: La presencia de consultores y expertos de la OMS de la máxima autoridad científica en el campo de la brucelosis, como Sandford Elberg o Martin Kaplan, fue decisiva en dos aspectos al menos, en primer lugar, para poder disponer de una mirada externa que permitiera conocer la realidad de la situación sanitaria española en el tema del control de dicha zoonosis y, en segundo lugar, para la puesta en marcha y el desarrollo de técnicas de laboratorio y de formación de especialistas con el objetivo de crear, al menos, un centro de referencia para la confección de vacunas, que los expertos situaban, de forma idónea, en la Escuela Nacional de Sanidad en Madrid

Background: Brucellosis was one of the most important health problems in post-Civil War Spain and in subsequent years. The objective of the study was to reconstruct the first programs that the WHO set up in this country, to address this problem, between 1951 and 1972 and their main outcomes. Methods: On the basis of primary sources of diverse origin, especially unpublished reports on Spain from foreign experts, from the WHO Historical Archive, the contents related to the disease were analyzed, contextualizing them within the framework of both the history of Spanish Public Health during the period studied and the international public health strategies for the prevention and control of brucellosis between 1951 and 1972. Results: Spain 0001 (E1), Spain 0012 (E12) programs were located. The first of them (E1), dedicated to the problem of endemoepidemic diseases (brucellosis, rabies and Q fever), developed between 1952 and 1956, offered assistance in the work of control of these diseases carried out by public health laboratories. The second was preceded by visits of experts between 1956-1958 and formally started in 1969 and ended in 1972. This program was specifically devoted to the fight against brucellosis and included the start-up of laboratory and epidemiological work, the training of specialists, vaccination experiences in goats and sheep and the initiation of studies on immunizations in humans. Conclusions: The presence of consultants and experts from the WHO, from the highest scientific authority in the field of brucellosis such as Sandford Elberg or Martin Kaplan, was decisive in, at least, two aspects: first, to have an external view that would allow to know the reality of the Spanish health situation in the matter of the control of this zoonosis and, secondly, to start up and develop laboratory techniques and training of specialists with the aim of creating, at least, a center of reference for the preparation of vaccines, which the experts placed, ideally, in the National School of Health in Madrid

La gonococia. Prevención y tratamiento a lo largo de la historia / No disponible

Las infecciones de transmisión sexual (ITS) han adquirido una extraordinaria importancia, constituyendo actualmente uno de los principales problemas de salud pública a nivel mundial. La OMS estima que en 2012 hubo alrededor de 350 millones de ITS curables entre hombres y mujeres de 15 a 49 años de edad, de las cuales, más de 78 millones (22,3%) correspondieron a casos de gonococia. Un grave problema, además de las secuelas, complicaciones y elevado coste económico de esta enfermedad, es, desde hace décadas, la capacidad de Neisseria gonorrhoeae de desarrollar resistencia a los distintos antimicrobianos utilizados como tratamiento empírico de primera línea. Con el fin de dar respuesta a esta situación, la OMS puso en marcha un programa, a comienzos de 1990, para vigilar la tendencia de las resistencias antimicrobianas de Neisseria gonorrhoeae, y garantizar la efectividad de los antimicrobianos recomendados para su tratamiento

Sexually transmitted infections (STI) have acquired an extraordinary importance. They are one of the main problems in public health currently worldwide. The WHO estimates that there were around 350 million curable infections in men and women between 15 and 49 years old. Of these, 78 million (22,3%) were gonorrea infections. Besides the multiple complications and the high economic costs of this infectious disease, the resistance developed by Neisseria gonorrhoea to the antimicrobial drugs used against it, has become a major problem. The WHO developed a program in 1990 to observe this resistance of Neisseria gonorrhoea. It was aimed to guarantee the effect of the antimicrobial drugs reccommended for its treatment

Impact of extraction techniques on antioxidant capacities and phytochemical composition of polyphenol-rich extracts.

In this work, impact of extraction methods (maceration, decoction, MAE, and UAE) on TPC, antioxidant activity, and the mass fraction of phenolics in several plant extracts (Punica granatum, Juglans regia, Moringa oleifera, and Cassia fistula) was investigated. The results showed that, despite the nature of matrix, the highest values of TPC in all samples were obtained by MAE as follows: PP (18.92±0.11), ML (15.19±0.11), HL (12.69±0.16), and WS (12.80±0.11) mg GAEg-1 respectively, and exhibited potent antioxidant activity (from 0.28±0.01 to 5.34±0.02mgGAEg-1), representing sources of powerful antioxidants. The LC-MS2 analysis revealed a wide range of phenolics, highlighting their content in phenolic acids, flavonoids and lignans. The presence of different phenol molecules demonstrated that the extraction method had influence on phytochemical profile. Finally, due to its high extraction efficiency, MAE was the more effective extraction technique.

Terapia de Resgate com Nifurtimox e Dipiridamol na Miocardite Chagásica Aguda Grave com Insuficiência Cardíaca em Camundongos NMRI / Rescue Therapy with Nifurtimox and Dipyridamole for Severe Acute Chagas Myocarditis with Congestive Heart Failure in NMRI Albino Mice

Fundamento: A doença de Chagas é um problema de saúde global, sendo necessário o desenvolvimento de novos protocolos terapêuticos. Nosso grupo demonstrou recentemente que o nifurtimox associado ao dipiridamol tem efeitos curativos em camundongos com doença de Chagas aguda. Neste estudo, avaliamos o efeito deste protocolo terapêutico em camundongos chagásicos com insuficiência cardíaca. Objetivo: Avaliar se o nifurtimox e o dipiridamol são úteis no tratamento de resgate em camundongos com miocardite chagásica aguda com insuficiência cardíaca. Métodos: Foram divididos em três grupos 42 camundongos com miocardite chagásica aguda e insuficiência cardíaca congestiva: Controle Chagas (n = 11); Nif-Dip, tratados com nifurtimox e dipiridamol (n = 14); e Nif-Dip-Insuficiência Cardíaca, tratados com nifurtimox e dipiridamol, associados com digoxina, furosemida e captopril (n = 17). As doses de nifurtimox e dipiridamol foram de 40 e 30mg/kg/dia, respectivamente, durante 6 semanas. Os camundongos foram submetidos a avaliações clínicas, eletrocardiográficas, hemoparasitológicas e histopatológicas. Resultados: Observou-se menor mortalidade no Grupo Nif-Dip (n = 4; 28,57%) em relação ao Controle Chagas (n = 6; 54,54%) e ao Nif-Dip-Insuficiência Cardíaca (n = 9; 52,9%). Clinicamente, os camundongos tratados com nifurtimox e dipiridamol aumentaram o peso corporal e melhoraram a insuficiência cardíaca, sem mostrar esplenomegalia. Nestes grupos, foram erradicadas as parasitemias e os parasitas teciduais; a fibrose, a miocitólise, o infiltrado de células inflamatórias e os mastócitos diminuíram. Os distúrbios de repolarização, os intervalos QRS e o QT prolongados, o aumento da amplitude da onda S e a dissociação atrioventricular foram revertidos pelo tratamento. Conclusão: O tratamento com nifurtimox e dipiridamol pode ser usado no resgate em camundongos com doença chagásica aguda grave, já que o nifurtimox teve atividade tripanocida, e o dipiridamole potenciou seu efeito. O dipiridamol seria útil na insuficiência cardíaca chagásica

Background: Chagas disease is a global health problem; therefore, the development of new therapeutic protocols is necessary. Our group recently demonstrated that nifurtimox associated with dipyridamole has curative effects in mice with acute Chagas disease. In this study, we assess the effect of this therapeutic protocol in chagasic mice with heart failure. Objective: To evaluate whether nifurtimox and dipyridamole are useful to rescue mice with severe acute chagasic myocarditis with heart failure. Methods: 42 mice with acute chagasic myocarditis and congestive heart failure were divided into three groups: control chagas (n = 11), Nif-Dip treated with nifurtimox and dipyridamole (n = 14) and Nif-Dip-heart failure treated with nifurtimox and dipyridamole associated with digoxin, furosemide, and captopril (n = 17). Nifurtimox and dipyridamole doses were 40 and 30 mg/kg/day, respectively, for 6 weeks. Mice underwent clinical, electrocardiographic, hemoparasitological and histopathological assessments. Results: Lower mortality in Nif-Dip (28.57%; n = 4) compared to control chagas (54.54%; n = 6) and Nif-Dip-heart failure (52.9%; n = 9) was observed. Clinically, nifurtimox and dipyridamole-treated mice increased body weight and improved heart failure without splenomegaly. In these groups, parasitemia and tissue parasites were eradicated; fibrosis, myocytolysis, inflammatory cell infiltrate and mast cells decreased. Repolarization disorders, prolonged QRS and QT intervals, increase of S wave amplitude and atrioventricular dissociation were reversed by the treatment. Conclusion: Nifurtimox with dipyridamole can rescue NMRI mice from severe acute chagas disease, as nifurtimox showed trypanocidal activity and dipyridamole potentiated its effect. Dipyridamole would be useful in chagasic heart failure

Impacto psicológico de la mamografía de cribado en mujeres con resultados no concluyentes / Psychological impact of screening mammography in women with inconclusive results

Objetivo. Valorar el impacto emocional en las mujeres del programa de cribado del cáncer de mama que precisan una repetición de la mamografía a los 6 meses para clarificar un resultado no concluyente. Metodología. Ciento cinco mujeres que habían realizado la mamografía de cribado y conocían su resultado BI-RADS fueron evaluadas con la Escala de Ansiedad y Depresión Hospitalaria, escalas categoriales de ansiedad y malestar físico ante la mamografía, y calidad de vida (SF-36.) tras recibir los resultados de la mamografía, y 72 de estas mujeres fueron evaluadas de nuevo 6 meses después, una vez realizada la mamografía de seguimiento. Conclusiones. Los niveles de ansiedad y depresión, la calidad de vida y el malestar físico ante la mamografía eran satisfactorios, sin diferencias entre los 2 momentos de medida. La mamografía de cribado no ocasiona malestar emocional. Las campañas de cribado de mama deben enfatizar estos resultados (AU)

Objective: To assess the impact of mammographic screening on anxiety, depression, and quality of life in women requiring a second mammogram 6 months after an inconclusive biennial screening mammogram. Methodology: A total of 105 women were interviewed after they had been informed of the BIRADS results of their screening mammography. Of these women, 72 were interviewed for a second time, after they had received a negative result of the follow-up mammogram. The assessment scales used were the Hospital Anxiety and Depression Scale, and the Medical Outcomes Short- Form General Health Survey (SF-36). Anxiety and perceived physical comfort during the screening and follow-up mammograms were also evaluated through two questions specifically designed for this study. Conclusions: Levels of anxiety and depression, quality of life and physical discomfort were satisfactory, with no differences between the two time points of measurement. Mammography screening does not cause emotional distress. These results should be emphasized by breast screening campaigns (AU)

El consentimiento en las actuaciones médicas en las Comunidades Autónomas españolas: regulación actual / The consent in the medical interventions in the spanish autonomous regions: current regulations

Se compara la forma en la que el derecho del paciente a dar el consentimiento informado en las actuaciones médicas está regulado en España y sus Comunidades Autónomas (CC.AA.), analizando el/los artículos que regulan el consentimiento informado, tomando como referencia la Ley 41/2002, de ámbito estatal y 15 normativas autonómicas. Para ello se han seleccionado algunas variables, como las situaciones ante las que se debe obtener el consentimiento, la forma de manifestarlo, la posible revocación del mismo, excepciones a su exigencia y algunas especificaciones de interés, entre otras. La comparativa nos lleva a seleccionar las normas más acertadas en su redacción, concluyendo que hay unanimidad en la protección legal a la autonomía del paciente en todas las CC.AA. españolas, y que es de suma importancia cumplimentar correctamente el documento de consentimiento informado para la consecución y amparo del derecho a la autonomía de la voluntad del paciente(AU)

A comparison was made of the way the right of the patient to give informed consent is used in medical interventions, and which is legally regulated in Spain and its autonomous regions. We also analysed the articles that regulate the informed consent, taking the national Law 41/2002 and fifteen autonomous regulations into account. For this comparative, we have selected some of the Variables, such as the situations when the consent must be obtained, the way of demonstrating it, the possible withdrawing of this consent, exceptions to the exigency of the consent, and some specifications of interest, are also compared. The results lead us to declare the most correct rules for this purpose, concluding that the legal protection of patient freedom is unanimous in all Spanish autonomous regions, and that it is very important to complete the consent document correctly to achieve and protect the right to autonomy of the patient(AU)