High prevalence of t895 and t9364 spa types of methicillin-resistant Staphylococcus aureus in a tertiary-care hospital in Mexico: different lineages of clonal complex 5.

BACKGROUND: Staphylococcus aureus is a leading cause of broad-spectrum infections both in the community and within healthcare settings. Methicillin-resistant Staphylococcus aureus (MRSA) has become a global public health issue. The aim of this study was to examine the clinical and molecular characteristics of Staphylococcus aureus isolates and to define the population structure and distribution of major MRSA clones isolated in a tertiary-care hospital in Mexico. RESULTS: From April 2017 to April 2018, 191 Staphylococcus aureus isolates were collected. The frequency of MRSA was 26.7%; these strains exhibited resistance to clindamycin (84.3%), erythromycin (86.2%), levofloxacin (80.3%), and ciprofloxacin (86.3%). The majority of MRSA strains harbored the SCCmec type II (76.4%) and t895 (56.8%) and t9364 (11.7%) were the most common spa types in both hospital-associated MRSA and community-associated MRSA isolates. ST5-MRSA-II-t895 (New York /Japan clone) and ST1011-MRSA-II-t9364 (New York /Japan-Mexican Variant clone) were the most frequently identified clones. Furthermore, different lineages of Clonal Complexes 5 (85.4%) and 8 (8.3%) were predominantly identified in this study. CONCLUSION: Our study provides valuable information about the epidemiology of MRSA in a city of the central region of Mexico, and this is the first report on the association between t895 and t9364 spa types and ST5 and ST1011 lineages, respectively. These findings support the importance of permanent surveillance of MRSA aimed to detect the evolutionary changes of the endemic clones and the emergence of new strains.

Electrosurgery for the Treatment of Moderate or Severe Rhinophyma. / Tratamiento con electrocirugía del rinofima moderado-grave.

Rhinophyma, a rare and progressive disfiguring condition, is thought to be the final stage of rosacea. Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser. The last 2 techniques are the most effective for the management of rhinophyma. We describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolivar and in private clinics in Bogota, Colombia, between 2012 and 2016. The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. Three patients presented hypertrophic scars that were treated with steroid injections and silicone gel sheeting. Two patients presented persistent erythema. However, there were no serious infections and none of the patients required further surgery. Electrosurgery is one of the simplest and most cost-effective techniques currently available for the treatment of rhinophyma by dermatologists.

Determination of the vertical profile of particle number concentration adjacent to a motorway using an unmanned aerial vehicle.

A quantitative assessment of the vertical profile of traffic pollution, specifically particle number concentration (PNC), in an open space adjacent to a motorway was possible for the first time, to the knowledge of the authors, using an Unmanned Aerial Vehicle (UAV) system. Until now, traffic pollution has only been measured at ground level while the vertical distribution, is limited to studies conducted from buildings or fixed towers and balloons. This new UAV system demonstrated that the PNC sampled during the period form 10 a.m. to 4 p.m., outside the rush hours with a constant traffic flow, increased from a concentration of 2 × 104 p/cm3 near the ground up to 10 m, and then sharply decreased attaining a steady value of 4 × 103 p/cm3 beyond a height of about 40 m. While more comprehensive investigations would be warranted under different conditions, such as topography and vehicle and fuel type, this finding is of great significance, given that it demonstrates the impact of traffic emissions on human exposure, but less so to pollution within the upper part of the boundary layer.

Complete Genome Sequence of Human Coronavirus OC43 Isolated from Mexico.

We report the complete genome sequence of the first Mexican human coronavirus (HCoV) OC43, obtained by new-generation sequencing and a metagenomic approach, isolated from a child hospitalized with pneumonia. The genome is closely related to the other OC43 genome sequences available, ranging from 99.8% to 98.2% nucleotide sequence identity.

Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study) / Eventos adversos relacionados con procedimientos endoscópicos gastrointestinales en niños bajo cuidado anestésico: modelo predictivo de riesgo (estudio AEGEP)

Background. Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. Methods. We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. Results. GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n = 1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p < 0.05). Conclusions. AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients (AU)

Antecedentes. Múltiples estudios han analizado los eventos adversos (EA) relacionados con procedimientos endoscópicos gastrointestinales (PEG) en niños cuando la sedación profunda es la técnica preferida sobre la anestesia general pero no en el caso contrario. Métodos. Revisamos nuestra base de datos en busca de niños < 12 años sometidos a PEG bajo cuidado anestésico durante un periodo de 5 años. Se registraron las condiciones preoperatorias, las características del procedimiento, el manejo de la vía aérea y los enfoques anestésicos y se construyó un modelo de regresión logística para determinar su relación con EAs grave y no graves. Resultados. La anestesia general fue preferida sobre la sedación (77,8 frente a 22,2% en 2.178 PEG bajo cuidado anestésico [n = 1742]). Se encontraron 96 EA en 77 pacientes, incluyendo hipoxemia (1,82%), broncoespasmo (1,14%) y laringoespasmo (0,91%) como los más frecuentes. Hubo 2 casos de bradicardia severa relacionada con laringoespasmo/hipoxemia y un caso de aspiración que resultó en hospitalización no planeada, pero no se registraron casos de muertes intraoperatorias o posoperatorias. La edad < 1 año, infecciones del tracto respiratorio superior < 1 semana antes del procedimiento y bajo peso para la edad (BPE) se identificaron como factores de riesgo independientes, y la ventilación con mascarilla facial, como factor protector (p < 0,05). Conclusiones. En niños bajo cuidado anestésico para PEG, los EAs en general son poco frecuentes en un entorno donde se prefiere la anestesia general. Estos son usualmente de tipo ventilatorio y dependen primordialmente de condiciones mórbidas y biométricas, independientemente de los fármacos anestésicos elegidos. La edad < 1 año, el antecedente de infecciones del tracto respiratorio superior en la semana previa al procedimiento y el bajo peso para la edad son factores de riesgo independientes para EA en estos pacientes (AU)

A single pipeline embolization device is sufficient for treatment of intracranial aneurysms.

BACKGROUND AND PURPOSE: The Pipeline Embolization Device has emerged as an important treatment option for intracranial aneurysms. The number of devices needed to treat an aneurysm is uncertain and is the subject of vigorous debate. The purpose of this study was to compare rates of complications, aneurysm occlusion, and outcome in patients treated with a single-versus-multiple Pipeline Embolization Devices. MATERIAL AND METHODS: One hundred seventy-eight patients were treated with the Pipeline Embolization Device at our institution. Patients were divided into 2 groups: a single-device group (n = 126) and a multiple-device group (n = 52). RESULTS: There was no statistically significant difference between the 2 groups with respect to baseline characteristics except for age and aneurysm size (higher with multiple Pipeline Embolization Devices). Complications occurred more frequently with multiple (15%) versus a single device (5%, P = .03). In multivariate analysis, the use of multiple devices independently predicted complications. A similar proportion of patients achieved adequate aneurysm obliteration at follow-up in the single-device (84%) and the multiple-device groups (87%, P = .8). In multivariate analysis, age and follow-up time predicted obliteration. At follow-up, a significantly higher proportion of patients treated with a single device (97%) achieved a favorable outcome compared with those treated with multiple devices (89%, P = .03). In multivariate analysis, there was a strong trend for the use of a single device to predict favorable outcomes (P = .06). CONCLUSIONS: Treatment with a single Pipeline Embolization Device provides similar occlusion rates with less complications and better overall outcomes. These findings suggest that a single Pipeline Embolization Device is sufficient for treatment of most intracranial aneurysms.

Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study).

BACKGROUND: Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. METHODS: We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. RESULTS: GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05). CONCLUSIONS: AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.

NKG2C gene deletion in the Mexican population and lack of association to respiratory viral infections.

Expansion of a natural killer (NK) cell population that expresses NKG2C has been associated with cytomegalovirus and other viral infections. It has been suggested that this cell population may play a role in infection control. Deletion of the NKG2C gene (homozygous or heterozygous) has been reported with high prevalence in European and Asian populations. However, the effect of NKG2C genotype on NK cell responses to infection remains poorly defined. We determined the prevalence of the NKG2C deletion in a Mexican population (n = 300) and in a group of patients (n = 131) to assess whether NKG2C genotype affects the incidence of symptomatic viral infections caused by influenza or respiratory syncytial virus. The frequency of the NKG2C deletion haplotype in Mexican mestizos was significantly lower (10.3%) than that reported in other populations (17.5-21.9%). No difference in the prevalence of NKG2C deletion was observed in subjects with viral infections compared with the reference population. In addition, no differences in clinical characteristics and infection outcome were observed between patients with and without the NKG2C gene deletion. Our results indicate that copy number variation in the NKG2C gene has no impact on the severity of respiratory viral infections.

Coiling of large and giant aneurysms: complications and long-term results of 334 cases.

BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome. MATERIALS AND METHODS: A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. RESULTS: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. CONCLUSIONS: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.

Influence of exposure to tobacco cigarette smoke on the eosinophil count in the nasal mucosa of young patients with perennial allergic rhinitis.

BACKGROUND: To assess the influence of exposure to tobacco cigarette smoke on the eosinophil count and the frequency of apoptosis of eosinophils in the nasal mucosa of teenagers with perennial allergic rhinitis. METHODS: Fifty patients were evaluated (aged 10 to 19 years old): 25 patients with and 25 patients with no recent exposure to tobacco cigarette smoke, by means of The Global Youth Tobacco Survey and cotinine/creatinine ratio. After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of nasal symptoms; then, a nasal sample was processed to identify the eosinophil count and the frequency of apoptosis of eosinophils. RESULTS: Patients with active exposure to tobacco cigarette smoke had higher eosinophil counts than patients with no exposure to the smoke. In the two groups, apoptosis of eosinophils in the nasal mucosa was scarce and no significant correlation was observed between the frequency/severity of the nasal symptoms and the eosinophil count. CONCLUSION: Teenagers with perennial allergic rhinitis and active exposure to tobacco cigarette smoke may show increased eosinophil counts in the nasal mucosa, which might not be related to apoptosis of eosinophils or to the frequency/severity of nasal symptoms.

Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases.

Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and died as a result of migration of the Pipeline Embolization Device, and another patient presented with complete MCA occlusion and was left severely disabled. Mismatch in arterial diameter between inflow and outflow vessels was a constant finding. Migration of the Pipeline Embolization Device was managed conservatively, with additional placement of the device, or with parent vessel occlusion. Obtaining complete expansion of the embolization device by using a longer device, increasing vessel coverage, using adjunctive aneurysm coiling, and avoiding dragging and stretching of the device are important preventive measures. Neurointerventionalists should be aware of this potentially fatal complication and take all necessary preventive measures.

Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes.

BACKGROUND AND PURPOSE: Stent-assisted coiling and balloon-assisted coiling are 2 well-established techniques for treatment of wide-neck intracranial aneurysms. A direct comparative analysis of angiographic outcomes with the 2 techniques has not been available. We compare the angiographic outcomes of wide-neck aneurysms treated with stent-assisted coiling versus balloon-assisted coiling. MATERIALS AND METHODS: A retrospective review was conducted on 101 consecutive patients treated at our institution, 69 with stent-assisted coiling and 32 with balloon-assisted coiling. Two multivariate logistic regression analyses were performed to determine predictors of aneurysm obliteration and predictors of progressive aneurysm thrombosis at follow-up. RESULTS: The 2 groups were comparable with respect to all baseline characteristics with the exception of a higher proportion of ruptured aneurysms in the balloon-assisted coiling group (65.6%) than in the stent-assisted coiling group (11.5%, P < .001). Procedural complications did not differ between the stent-assisted coiling group (6%) and the balloon-assisted coiling group (9%, P = .5). The rates of complete aneurysm occlusion (Raymond score 1) at the most recent follow-up were significantly higher for the stent-assisted coiling group (75.4%) compared with the balloon-assisted coiling group (50%, P = .01). Progressive occlusion of incompletely coiled aneurysms was noted in 76.6% of aneurysms in the stent-assisted coiling group versus 42.8% in the balloon-assisted coiling group (P = .02). Retreatment rates were significantly lower with stent-assisted coiling (4.3%) versus balloon-assisted coiling (15.6%, P = .05). In multivariate analysis, stented aneurysms independently predicted both complete aneurysm obliteration and progression of occlusion. CONCLUSIONS: Stent-assisted coiling may yield lower rates of retreatment and higher rates of aneurysm obliteration and progression of occlusion at follow-up than balloon-assisted coiling with a similar morbidity rate.

Endovascular treatment of posterior communicating artery aneurysms with oculomotor nerve palsy: clinical outcomes and predictors of nerve recovery.

BACKGROUND AND PURPOSE: ONP is a well-known presentation of PcomA aneurysms. Reports on recovery of ONP with endovascular coiling have been limited to small case series. We assessed the safety and efficacy of endovascular therapy in a series of PcomA aneurysms with ONP. MATERIALS AND METHODS: We reviewed 37 patients with ONP who underwent endovascular treatment in our institution between 2005 and 2011. Published studies were also reviewed to determine the overall rate of ONP recovery with endovascular therapy. RESULTS: Nineteen patients (51.4%) presented with complete ONP, and 18 (48.6%), with partial ONP. Conventional coiling was performed in 31 (83.8%) patients; stent-assisted coiling, in 4 (10.8%); and balloon remodeling, in 2 (5.4%). There was 1 (2.7%) procedural complication (a transient thromboembolic event). Twenty-seven (73%) patients were treated within 3 days from symptom onset. At the last available clinical follow-up, ONP resolution was complete in 14 (37.8%) patients and partial in 19 (51.4%). Only 4 (10.8%) patients showed no signs of nerve recovery. In multivariate analysis, partial ONP and longer follow-up durations were predictors of complete nerve recovery. Treatment timing, type of endovascular embolization, subarachnoid hemorrhage, and initial degree of aneurysm occlusion were not predictors of nerve recovery. Of 169 patients reported in the literature (including ours), ONP resolved completely in 73 (43.2%) patients and partially in 73 (43.2%). CONCLUSIONS: Endovascular therapy is a safe and highly efficient alternative to surgical clipping for PcomA aneurysms with ONP.

Intracranial vertebral artery dissections: evolving perspectives.

Intracranial vertebral artery dissection (VAD) represents the underlying etiology in a significant percentage of posterior circulation ischemic strokes and subarachnoid hemorrhages. These lesions are particularly challenging in their diagnosis, management, and in the prediction of long-term outcome. Advances in the understanding of underlying processes leading to dissection, as well as the evolution of modern imaging techniques are discussed. The data pertaining to medical management of intracranial VADs, with emphasis on anticoagulants and antiplatelet agents, is reviewed. Surgical intervention is discussed, including, the selection of operative candidates, open and endovascular procedures, and potential complications. The evolution of endovascular technology and techniques is highlighted.

Superior hypophyseal artery aneurysms have the lowest recurrence rate with endovascular therapy.

BACKGROUND AND PURPOSE: Given the challenges posed by surgical clipping, endovascular techniques have been increasingly used to treat SHA aneurysms. The purpose of this study was to assess the safety and efficacy of endovascular techniques in the treatment of SHA aneurysms. MATERIALS AND METHODS: Medical charts and initial and follow-up angiograms were reviewed retrospectively for all patients treated with endovascular procedures at our institution between January 2006 and February 2011. RESULTS: We identified 87 patients with SHA aneurysms who were treated with endovascular techniques. Of these patients, 79 were women and only 8 were men (90.8% female predominance). Thirty-five patients were treated with coil embolization; 45, with stent-assisted coiling; 4, with balloon-assisted coil embolization; and 3, with a flow-diversion technique. Minor complications occurred in 2 patients (2.2%). None of the patients had a major complication. The mortality and permanent morbidity rates related to the procedure were 0%. Imaging follow-up was available for 89.4% of patients (DSA in 65, MRA in 11 patients) at a mean time point of 10.4 months (range, 6-60 months). Of the 76 patients with available follow-up, 3 patients had a recurrence (3.9%) and only 1 required further intervention (1.3%). Stent-assisted coiling was associated with lower recurrence rates than simple coil embolization. CONCLUSIONS: SHA aneurysms have the lowest recurrence rate with endovascular treatment compared with aneurysms in other locations by using historical data. Because of its safety and efficacy, endovascular therapy should be considered the procedure of choice for the treatment of SHA aneurysms.

Anestesia para transplante hepático: comportamiento hemodinámico durante su manejo transoperatorio / Anesthesia for liver transplant: hemodinamic profile during trans-operative period

El presente trabajo titulado "Anestesia pata Trasplante Hepático, comportamiento Hemodinamico durante su Manejo Transoperatorio" es un trabajo descriptivo, serie de casos de 15 pacientes sometidos a trasplante ortotópico de hilado en la Fundación Clínica Valle del Lili, en Santiago de Cali, Colombia. La anestesia que recibieron los pacientes estuvo guiada por el protocolo diseñado por los anestesiólogos del grupo de trasplante hepático de la institución, se realizaron mediciones hemodinámicas en las diferentes fases del trasplante, preanhepática, anhepática y neohepática, los resultados obtenidos fueron sometidos a análisis estadístico mediante el programa Epi-Info 6.1 y el programa STATSM, dentro de las variables medidas se tomaron la frecuencia cardiaca, presión arterial media, presión cavo pulmonar, índice cardiaco, índice volumen sistólico, índice de resistencia vascular sistólica. Se compararon dos técnicas quirúrgicas empleadas en un grupo, se realizo clampeo total de la vena cava inferior, y en otro grupo se realizo clampeo parcial de la vena cana inferior como parte de la técnica de Piggy - Back, encontrándose que en los pacientes a los que se les realizo clampeo total de la vena cava inferior presentaron en la fase neohepática un mayor aumento de la presión en cuna pulmonar, menor índice de volumen sistólico y mayor resistencia vascular sistémica. Los cambios analizados no presentaron significancia estadística cuando se comparan con el clampeo parcial, lo que podría explicarse posiblemente por el tamaño pequeño de la muestra

Brote grave en paciente con encefalitis aguda diseminada recurrente por vacuna contra la hepatitis B.¿A favor o en contra de la vacunación? / A severe episode in a patient with recurrent disseminated acute encephalitis due to vaccination against hepatitis b. For or against vaccination?

Introducción. Varios estudios han informado de casos nuevos de desmielinización del SNC o de reactivación de la esclerosis múltiple (EM) después de una vacunación contra la hepatitis B (HB). A la inversa, algunos autores han llegado a la conclusión de que se desconoce el riesgo de desarrollar un fenómeno de desmielinización del SNC tras una vacunación HB. Pacientes y métodos. Hemos observado el caso de un hombre de 40 años de edad con diabetes mellitus (DM) del tipo I e historia previa de encefalomielitis con desmielinización aguda recurrente (EDA-r). Había experimentado tres episodios de disfunción neurológica y cumplido los criterios de EM clínicamente definida, pero la RM mostró lesiones en el tallo cerebral y en el cerebelo sin criterio de EM por RM. El análisis del LCR mostró bandas oligoclonales. Había permanecido estable clínicamente durante los últimos seis años, sin mostrar actividad alguna de la enfermedad. Ingresó en clínica por EM porque padecía mareos, náuseas, vómitos y diplopía, seis semanas después de las dos primeras inyecciones contra la hepatitis, dentro del programa nacional de vacunación de los pacientes de DM del tipo I. El examen clínico mostró oftalmoplejía intranuclear, pérdida de visión del ojo izquierdo y afectación de los signos cerebelares y piramidales previos. La RM mostró un aumento de las viejas lesiones, con señales de alta intensidad en las secuencias de imágenes en T2 y aumento de posgadolinio en los sitios de las secuencias de imágenes en T1 del tronco cerebral y el mesencéfalo. La DM se deterioró con cetoacidosis, por lo que se aumentaron las dosis de insulina. Empeoró y desarrolló ataques convulsivos motores parciales. A los 15 días mejoró, pero todavía sufría afectación de los sistemas cerebelares y piramidales, y mareos ocasionales. Conclusiones. Parece razonable, como medida de precaución, evitar la vacunación HB en pacientes con historia personal o familiar de síntomas sugestivos de una enfermedad desmielinizante del SNC (AU)

[Transforming growth factor alpha (TGF-alpha) and epidermoid growth factor (EGF) in polycystic ovary syndrome: potential role in the decrease of apoptosis mechanisms in the follicle]. / El factor de crecimiento transformante-alpha (TGF-alpha) y el factor de crecimiento epidermoide (EGF) en el síndrome de ovarios poliquísticos: posible papel en la disminución de los mecanismos apoptóticos en el folículo.

Knowledgement on ovary function regulation is advancing. Classic concept about endocrine regulation by sexual hormones and gonadotrophin has turning to an hypothesis: autocrine and paracrine factors as intra-ovarian regulators. Follicular growth and steroidogenesis are mainly driven by follicle stimulating hormone (FSH), luteine hormone (LH) and steroids. On the other hand, the presence of intra-ovarian growth factors have an important role in modulation of gonadotrophin effects on ovarian functions. The influence of this factors on follicle growth are described.

[Most of the complaints in gynecology and obstetrics care are generated by perceptions stemming from unavoidable results]. / La mayoría de las quejas por atención ginecológica y obstétrica se generan por percepciones derivadas de resultados inevitables.

UNLABELLED: The annual rises in the cost of claims suffered by some countries had led to increases in: costs of the attention; malpractice premiums; health personnel stress level; risks for the patients with difficult problems, and lack of opportune attention. The intricate interaction between clinical state, responses variability and medical procedures flaws makes impossible stop unavoidable outcomes (UO). Though UO are not derived from negligence or inability, patients and relatives can see it as a malpractice result. OBJECTIVE: To determine the proportion of complaints generated by UO related perceptions (UORP) and their distribution in obstetric and gynecologic stages of care. MATERIAL AND METHODS: A search for claims derived from gynecologic or obstetric care was undertaken in the Medical Arbitrition National Commission (CONAMED) database, those presented between Jun. 1, 1996, and Nov. 30, 1998, were chosen. Some claims were derived directly from UORP (D-UORP claims), others were derived indirectly (UORP clamis); claims were grouped for stage of the attention in which they were originated; non D-UORP claims were grouped also by motives. RESULTS: In 625 claims (98.6% of total) was possible obtain precise information as required for the study. 79% of complaints were derived from UORP; 17% from perceptions generated for medical activities unrelated to UO (MAU-UO claims) and 4% by perception originated from care system (CS claims). 46% of complaints concerned surgical treatment, 27% medical treatment, 14% initial study, 2.1% delivery, in 10% a specific stage of the attention was not mentioned. The motives of the non D-UORP complaints were: 1) I-UORP claims; a) opportunity of the action, when the patient referred delay or inopportuneness as cause of the complaint (17%, overall); b) Professional quality, when questioned de outcomes or medical criteria (23%); 2) MAU-UO claims: a) Professional capacity when patient questions ability, or complaint of error in diagnosis (failure to diagnose or incorrect diagnosis), wrong removal, unnecessary treatment or other actions outside of the norm (13%); b) Improper information (3%); c) Inappropriate manner (0.8%); 3) CS claims: a) Resources (1%); b) Accessibility (2.9%). COMMENTS: The damage risk attributable to medical negligence is very low among patients who had received obstetrical or gynecological care, most of the complaints are UORP generated. In obstetrical care--from 1997 national statistics and described results--a benefit was procured to 1,705,161 persons and were produced 17 possible wrong attentions by professional capacity, five by improper information and one by inappropriate manner; the rest, 123 complaints, were derived from perceptions induced by UO. Undoubtedly there is low complaint registration, however, even at worst the wrong attention effect is lower than the impact attained if the possibility of economic benefit search through medical demands is not totally canceled. The damage risk derived from cost of claims is greater, as suffered on many countries. Medical associations in countries without professional liability problems must accomplish negotiations so that the legislation does not establish compensations by medical care results, the request may be based in: a) the deleterious consequences derived from cost of claims; and, b) the low probability of affecting the patients interests, in Mexico complaints derived from perceptions about the professional capacity are one in 103,022 obstetrical care attentions, the improper information derived one in 316,989 and the inappropriate manner generated one in 1,373,620. These organizations and other health related could assume the commitment to abate the foreseeable complaints and to do research on feasible forms to forecast UO, technically this must be long-range and though international collaboration.

Factibilidad, seguridad y determinación de la distancia piel-espacio epidural en pacientes pediátricos / Anesthetic management of the skin-epidural distance relationship in pediatric patients

El presente estudio muestra sesenta niños a quienes se les realizó punción epidural dorsal o lumbar, como parte del manejo anestésico. Es una técnica segura en manos de anestesiólogos con entrenamiento previo en este tipo de procedimientos. La mejor manera de aproximación para relacionar la distancia piel - peridural en columna lumbar es el peso del paciente (r=0.88), mientras que a nivel de columna dorsal es la edad del paciente (r=0.79)