Characterization of Homicides in Mexico: Analysis of 2015-2022.

BACKGROUND: In Mexico, homicides are the leading cause of death among men aged 15 to 44 years; however, despite their increase in recent decades, the study of this issue is insufficient, given its magnitude and impact. Therefore, this study aimed to characterize the spatial and temporal patterns and associated factors of homicides in Mexico from 2015 to 2022. METHODS: An analytical cross-sectional study was conducted, analyzing death records from the National Institute of Statistics and Geography's general mortality databases. Simple frequencies and incidence rates per 100,000 inhabitants by sex, year, and state of the Mexican Republic were calculated. Mortality was evaluated by age groups and geographic areas, and bivariate logistic regression models with sociodemographic variables were performed. RESULTS: Records of 229,182 homicides in Mexico were analyzed, with a median age of 33 years, interquartile range 18. A total of 203,898 (88.96%) were men and 25,284 (11.04%) were women. The majority of deaths occurred in public places and were caused by firearms; women had a higher percentage of homicides at home. States with high incidence rates for both sexes were Chihuahua, Zacatecas, Michoacán, Colima, and Estado de México. The total years of life lost were 9.19 million years. The national incidence of homicides in men showed an upward trend from 2015 to 2019; however, in the case of women, this incidence increased in various age groups during the study period. Occupation, education, marital status, and place of occurrence had significant associations in the logistic regression models. CONCLUSIONS: This study provides a spatial-temporal characterization of homicides in Mexico between 2015 and 2022, highlighting the high incidence in men and the upward trend in certain age groups among women. These findings underscore the need for preventive measures and public policies to address this issue in a multisectoral manner.

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study.

BACKGROUND: Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. OBJECTIVE: This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. METHODS: To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. RESULTS: MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. CONCLUSION: Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.

Stabilizing Effect of a 4c/6e Hypervalent Bond in Dinitrodiphenyl Disulfides and Their Thermochemical Properties: Experimental and Computational Approach.

Thermochemical properties and intramolecular interactions of 2,2'-dinitrodiphenyl disulfide (2DNDPDS) and 4,4'-dinitrodiphenyl disulfide (4DNDPDS) were determined and analyzed. Their standard molar formation enthalpies in the gas phase (ΔfHm°(g)'s) were experimentally determined; theoretically, they were computed using the G4 composite method and atomization reactions. Specifically, ΔfHm°(g)'s were obtained by combining formation enthalpies in the condensed phase and enthalpies of phase change. Formation enthalpies in the condensed phase were determined experimentally through combustion energies, which in turn were found by means of a rotatory bomb combustion calorimeter. Sublimation enthalpies were derived from thermogravimetric experiments, measuring the rate of mass loss and using Langmuir and Clausius-Clapeyron equations. Fusion enthalpies and heat capacities of the solid and liquid phases were measured as functions of temperature by differential scanning calorimetry, and the heat capacities of the gas phase were calculated via molecular orbital calculations. Theoretical and experimental ΔfHm°(g)'s differed by <5.5kJ·mol-1, and isomerization enthalpies are discussed. In addition, using theoretical tools [natural bond orbitals (NBO) and quantum theory of atoms in molecules (QTAIM)], intramolecular interactions were analyzed. An uncommon hypervalent four-center six-electron interaction of type O···S-S···O was found in 2DNDPDS. This hypervalent interaction, in addition to the extent of conjugation between the aryl and NO2 moieties and the formation of intramolecular C-H···S hydrogen bonds, counteracts the repulsion caused by steric repulsions. Hydrogen bonding was confirmed through geometric parameters as well as QTAIM.

Caracterización demográfica y clínica de pacientes críticos con neumonía por influenza A H1N1 / Demographic and clinical characterization of critically ill patients with influenza A H1N1 pneumonia

INTRODUCCIÓN. La epidemia de influenza y sus complicaciones profundizaron el estudio de las neumonías virales en cuidados intensivos. En nuestro país hay pocos datos sobre este tema. OBJETIVOS. Realizar una caracterización demográfica y clínica de pacientes críticos con neumonía por Influenza A H1N1 en un hospital de tercer nivel de complejidad. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, con análisis univariante y multivariante. Población de 293 y muestra de 44 datos de historias clínicas electrónicas de pacientes diagnosticados con A H1N1 ingresados a la Unidad de cuidados intensivos del Hospital de Especialidades Carlos Andrade Marín en el período enero 2016 a diciembre de 2018. Como criterios de inclusión se consideró a todos los pacientes adultos mayores de 18 años que ingresaron a la UCI, con el diagnóstico de neumonía comunitaria grave con confirmación por reacción de cadena de polimerasa en tiempo real para influenza A H1N1 en hisopado nasal o aspirado traqueal. Se excluyó a pacientes embarazadas con diagnóstico de influenza A H1N1, pacientes con más de 48 horas de ingreso hospitalario previo a su ingreso a UCI, pacientes con datos insuficientes en los registros. Los datos se obtuvieron del sistema AS-400. El análisis estadístico se realizó en el programa Statistical Package for Social Sciences, versión 22. El nivel de significación fue una p<0.05. RESULTADOS. La prevalencia en pacientes críticos de neumonía por influenza A H1N1 durante 2016-2018 fue de 16,72%, la mediana de edad fue de 55 años, 25% masculinos, 34% obesos, 34% con hipertensión arterial. Escala "Acute Physiology and Chronic Health Evaluation II" 23,50, "Simplified Acute Physiologic Score III" 54, "Sepsis related Organ Failure Assessment" 11,50, Lactato deshidrogenasa 99,50, Procalcitonina 0,99; 9 días de ventilación mecánica invasiva, 10,50 días de estancia en la unidad. El 91% presentó shock séptico, 59% lesión renal aguda. El 89% tuvo Síndrome de Distrés Respiratorio del Adultos, 69% fue grave, 87% usó ventilación mecánica, 38,50% corticoides, 36% posición prona, Presión parcial de oxígeno/Fracción inspirada de oxígeno 74, volumen tidal/kilogramo de 7 mililitros, presión plateau de 27,50 centímetros de agua. La mortalidad general en la Unidad de Cuidados Intensivos fue de 38,63% y a los 28 días de 63,60%, en shock séptico fue 42,50% y en Síndrome de Distrés Respiratorio del Adultos del 41,02%. El análisis de regresión logística multivariable identificó como factores independientes asociados a mortalidad el incremento de Lactato deshidrogenasa (OR 2,69, 9% IC 1,090-6,642) y Procalcitonina (OR 2,51, IC 1,005-6,272). CONCLUSIONES. Las características, frecuencia y mortalidad de este grupo de pacientes críticos con neumonía por influenza A H1N1 son similares a lo reportado en la literatura mundial.

INTRODUCTION. The influenza epidemic and its complications deepened the study of viral pneumonias in intensive care. In our country there is little data on this subject. OBJECTIVES. To perform a demographic and clinical characterization of critical patients with pneumonia due to pneumonia due to Influenza A H1N1 in a third level hospital. MATERIALS AND METHODS. Observational, analytical, retrospective study, with univariate and multivariate analysis. We compared the groups of dead patients and survivors. The significance level was p<0,05. RESULTS. The prevalence in critically ill patients of influenza A H1N1 pneumonia during 2016-2018 was 16,72%, 44 cases were collected, median age 55 years, 25% male, 34% obese, 34% with arterial hypertension. APACHE II 23,50, SAPS III 54, SOFA 11,50, LDH 99,50, PCT 0,99, 9 days of invasive mechanical ventilation, 10,50 days of unit stay. 91% presented septic shock, 59% with acute kidney injury 89% had ARDS, 69% were severe, 87% used mechanical ventilation, 38,50% corticosteroids, 36% prone position, PaO2/FiO2 74, tidal volume/kg of 7 ml, plateau pressure of 27,50 cmH2O. Overall mortality in the ICU was 38,63% and at 28 days was 63,60%, in septic shock it was 42,50% and in Adult Respiratory Distress Syndrome it was 42,50%. was 42,50% and 41,02% in Adult Respiratory Distress Syndrome. The ultivariate logistic regression analysis identified as independent factors associated with mortality, the increase in LDH (OR 2,69, 9% CI 1,090-6,642) and PCT (OR 2,51, CI 1,005-6,272). CONCLUSIONS. The characteristics, frequency and mortality of this group of critical patients with pneumonia due to influenza A H1N1 are similar to those reported in the world literature.

Instrumentos para evaluar bienestar en adolescentes en Chile: una revisión exploratoria / Instruments to evaluate well-being in Chilean adolescent population: a scoping review

En la actualidad, el bienestar es un área de estudio fundamental para la psicología debido a su estrecha relación con la salud física y mental, especialmente en grupos adolescentes, que son considerados prioritarios en el cuidado de la salud. Sin embargo, aún no existe consenso en cuanto a cómo definir y medir el bienestar, lo que ha generado una gran variedad de instrumentos con diferentes bases teóricas. En Chile se han validado instrumentos para evaluar el bienestar, pero no se ha realizado una sistematización que permita identificar y describir los instrumentos en función de sus perspectivas teóricas y propiedades psicométricas, particularmente en población adolescente. Por este motivo se realizó un Scoping Review de los instrumentos utilizados para medir bienestar en este colectivo. Para ello se llevó a cabo una búsqueda sistemática de acuerdo con la declaración PRISMA. Los resultados arrojaron un total de 25 instrumentos validados en esta población que presentaron adecuadas propiedades psicométricas desde diversos constructos teóricos. Se concluye que existen diversos instrumentos validados en Chile para evaluar la multidimensionalidad que implica el concepto de bienestar en población adolescente.

Currently, well-being is a crucial study area for psychology due to its close relationship with physical and mental health, especially among adolescents, who are considered a priority in health care. However, there is still no consensus on how to define and measure wellbeing, which has resulted in the generation of various measurement instruments with different theoretical bases. In Chile, instruments have been validated to assess well-being. However, there has been no systematisation to identify and describe the instruments in terms of their theoretical perspectives and psychometric properties, particularly in the adolescent population. For this reason, a Scoping Review of the instruments used to measure well-being in adolescents was carried out using a systematic search according to the PRISMA statement. The results yielded 25 instruments validated in this population that presented adequate psychometric properties from different theoretical constructs. In conclusion, several validated instruments in Chile assess the multidimensionality implied by the concept of well-being in the adolescent population.

Classical and Quantum H-Theorem Revisited: Variational Entropy and Relaxation Processes.

We propose a novel framework to describe the time-evolution of dilute classical and quantum gases, initially out of equilibrium and with spatial inhomogeneities, towards equilibrium. Briefly, we divide the system into small cells and consider the local equilibrium hypothesis. We subsequently define a global functional that is the sum of cell H-functionals. Each cell functional recovers the corresponding Maxwell-Boltzmann, Fermi-Dirac, or Bose-Einstein distribution function, depending on the classical or quantum nature of the gas. The time-evolution of the system is described by the relationship dH/dt≤0, and the equality condition occurs if the system is in the equilibrium state. Via the variational method, proof of the previous relationship, which might be an extension of the H-theorem for inhomogeneous systems, is presented for both classical and quantum gases. Furthermore, the H-functionals are in agreement with the correspondence principle. We discuss how the H-functionals can be identified with the system's entropy and analyze the relaxation processes of out-of-equilibrium systems.

Manejo clínico-terapéutico del donante multiorgánico / Multiorgan donor clinical-therapeutic management

La mayor parte de los potenciales do-nantes de órganos proceden de las Uni-dades de Emergencias y Cuidados Inten-sivos, lugar en donde se ubican la ma-yoría de los pacientes con trastorno neu-rológico agudo y grave1.Durante el diagnóstico de muerte ence-fálica (ME) comienza el auténtico man-tenimiento del donante, ya que hay mo-mentos críticos, como la realización del test de apnea. Durante la fase previa al es-tablecimiento de ME el paciente ha sido tratado de manera agresiva con todos los métodos a nuestro alcance, muchos de ellos encaminados a preservar la perfu-sión cerebral manitol, tiopental sódico, etc., nos encontramos a menudo con po-tenciales donantes con gran inestabilidad hemodinámica e importantes alteraciones del medio interno1.El mantenimiento del donante multior-gánico constituye un desafío para el equipo de la Unidad de Cuidados In-tensivos. Este proceso implica poner en práctica el conocimiento total del manejo de disfunción multiorgánica en un paciente muerto. El tiempo de dete-rioro de los órganos juega también un rol en el tratamiento de todas las compli-caciones que se presentan en este tipo de pacientes. La adherencia a un protocolo de manejo es fundamental para lograr que un mayor número de donantes se trasladen a quirófano para la extracción de órganos viables2.

INTRODUCTION:Most of the potential organ donors come from the Emergency and Intensive Care Units, where most of the patients with acute and severe neurological disorder are located1.During the diagnosis of brain death, the authentic maintenance of the donor begins, as there are critical moments, such as the apnea test. Since during the pre-establishment phase of brain death the patient has been treated aggressi-vely with all the methods at our dis-posal, many of them aimed at preser-ving cerebral perfusion manitol, thio-pental sodium, etc., we often find our-selves with potential donors with high hemodynamic instability and significant changes in the internal environment1.The maintenance of the multiorgan donor is a challenge for the Intensive Care Unit team. This process involves putting into practice the total knowledge of the management of multi-organ dys-function in a dead patient. The time of deterioration of the organs also plays a role in the treatment of all the complica-tions that occur in this type of patients. Adherence to a management protocol is essential to ensure that a greater number of donors are transferred to the opera-ting room for the extraction of viable organs2.

Can an n(O) → π* Interaction Provide Thermodynamic Stability to Naturally Occurring Cephalosporolides?

The stereocontrolled synthesis of naturally occurring products containing a 5,5-spiroketal molecular structure represents a major synthetic problem. Moreover, in a previous work, the stereocontrolled synthesis of cephalosporolide E (ceph E), which presumably was obtained from its epimer congener (ceph F) through an acid-mediated equilibration process, was reported. Consequently, we performed a theoretical investigation to provide relevant information regarding the title question, and it was found that the higher thermodynamic stability of ceph E, relative to ceph F, is caused by an n → π* interaction between a lone electron pair of the oxygen atom of the spiroketal ring (nO) and the antibonding orbital of the carbonyl group (π*C=O). Although similar stereoelectronic interactions have been disclosed in other molecular structures, its presence in ceph E, and very likely in other related naturally occurring products, represents a novel nonanomeric stabilizing effect that should be introduced into the chemical literature.

Surgical Results in Ocriplasmin Candidates With Symptomatic Vitreomacular Traction Syndrome.

PURPOSE: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy. MATERIALS AND METHODS: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records. RESULTS: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented. CONCLUSIONS: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.

Using Spherical-Harmonics Expansions for Optics Surface Reconstruction from Gradients.

In this paper, we propose a new algorithm to reconstruct optics surfaces (aka wavefronts) from gradients, defined on a circular domain, by means of the Spherical Harmonics. The experimental results indicate that this algorithm renders the same accuracy, compared to the reconstruction based on classical Zernike polynomials, using a smaller number of polynomial terms, which potentially speeds up the wavefront reconstruction. Additionally, we provide an open-source C++ library, released under the terms of the GNU General Public License version 2 (GPLv2), wherein several polynomial sets are coded. Therefore, this library constitutes a robust software alternative for wavefront reconstruction in a high energy laser field, optical surface reconstruction, and, more generally, in surface reconstruction from gradients. The library is a candidate for being integrated in control systems for optical devices, or similarly to be used in ad hoc simulations. Moreover, it has been developed with flexibility in mind, and, as such, the implementation includes the following features: (i) a mock-up generator of various incident wavefronts, intended to simulate the wavefronts commonly encountered in the field of high-energy lasers production; (ii) runtime selection of the library in charge of performing the algebraic computations; (iii) a profiling mechanism to measure and compare the performance of different steps of the algorithms and/or third-party linear algebra libraries. Finally, the library can be easily extended to include additional dependencies, such as porting the algebraic operations to specific architectures, in order to exploit hardware acceleration features.

Implantable MicroPump for Drug Delivery in Patients with Diabetic Macular Edema.

PURPOSE: To demonstrate the safety and surgical feasibility of the first-in-man ocular implant of a novel Posterior MicroPump Drug Delivery System (PMP) in patients with diabetic macular edema (DME) and to report on the device capabilities for delivering a programmable microdose. METHODS: This was a single center, single arm, open-label, prospective study. Eleven patients with DME and visual acuity equal to or worse than 20/40 were included. The PMP prefilled with ranibizumab was implanted into the subconjunctival space. After implantation, the PMP was wirelessly controlled to deliver a programmed microdose. Comprehensive ophthalmic exams and optical coherence tomography were performed biweekly for 90 days. At the end of the study, the PMP was explanted and the subjects thereafter received standard of care for DME (i.e., laser or intravitreal injections). RESULTS: All 11 surgical implantations were without complications and within the skill sets of a retinal surgeon. No serious adverse events occurred during the follow-up period. At no point were visual acuity and central foveal thickness worse than baseline in the implanted eye. The PMP delivered the programmed ranibizumab dosage in seven subjects. The remaining four patients received a lower than target dose, and the treatment was complemented with standard intravitreal injection. CONCLUSIONS: This study demonstrates the first-in-man safety of the Replenish MicroPump implant for a period of 90 days and its capability to deliver a microdose into the vitreous cavity. Further studies to enable longer-term safety and to demonstrate the feasibility of multiple programmable drug delivery are necessary.

Program for the epidemiological evaluation of stroke in Tandil, Argentina (PREVISTA) study: rationale and design.

The availability of population-based epidemiological data on the incident risk of stroke is very scarce in Argentina and other Latin American countries. In response to the priorities established by the World Health Organization and the United Nations, PREVISTA was envisaged as a population-based program to determine the risk of first-ever and recurrent stroke and transient ischemic attack incidence and mortality in Tandil, Buenos Aires, Argentina. The study will be conducted according to Standardized Tools for Stroke Surveillance (STEPS Stroke) methodology and will enroll all new (incident) and recurrent consecutive cases of stroke and transient ischemic attack in the City of Tandil between May 1st, 2013 and April 30, 2015. The study will include patients with ischemic stroke, non-traumatic primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack. To ensure the inclusion of every cerebrovascular event during an observation period of two years, we will instrument an 'intensive screening program', consisting of a comprehensive daily tracking of every potential event of stroke or transient ischemic attack using multiple overlapping sources. Mortality would be determined during follow-up for every enrolled patient. Also, fatal community events would be screened daily through revision of death certificates at funeral homes and local offices of vital statistics. All causes of death will be adjudicated by an ad-hoc committee. The close population of Tandil is representative of a large proportion of Latin-American countries with low- and middle-income economies. The findings and conclusions of PREVISTA may provide data that could support future health policy decision-making in the region.

Valores de proteinuria y daño vascular en gestantes sanas, preeclámpticas y con hipertensión no proteinúrica, evaluados por ultrasonografía vascular / Levels of proteinuria and vascular damage in healthy pregnant, preeclamptic, and non-proteinuric hypertensive women, assessed by vascular ultrasonography

Objetivo: Comparar si la ultrasonografía vascular esmás eficaz en diagnosticar daño vascular que laproteinuria.Sujetos y métodos: A 40 gestantes sanas (GS), 35preeclámpticas (GP) y 35 con hipertensión inducidapor el embarazo, sin proteinuria (GNP), de loshospitales Yanahuara y Nacional del Sur, EsSalud, enArequipa, Perú, se les midieron los valores de presiónarterial y proteinuria, y se les realizó unaultrasonografía vascular para evaluar la dilataciónmediada por flujo (DMF). Se realizaron comparacionesentre los 3 grupos mediante las pruebas de ANOVA oKruskal-Wallis, dependiendo de su distribución normalo no, respectivamente; se consideró estadísticamentesignificativo a un valor de p < 0,05.Resultados: Se obtuvieron valores de proteinuria de0,05 g/24 h; 2,57 g/24 h y 0,21 g/24 h, y valores deDMF de 0,66, 0,25 y 0,45 mm para los grupos GS,GP y GNP, respectivamente. La comparación delDMF entre grupos mostró diferencias significativaspara cada grupo (p < 0,01), pero en el caso de laproteinuria los valores del grupo GNP aúnpertenecen a rangos considerados normales(< 0,03 g/24 h). No se encontró relación entre laDMF y proteinuria.Conclusiones: La DMF evaluada por ultrasonografíadetecta una alteración vascular, inclusive en elgrupo de gestantes con hipertensión inducida delembarazo sin proteinuria

Objective: To compare the effectiveness of vascularultrasonography and proteinuria in diagnosingsystemic vascular damage.Subjects and methods: Forty healthy pregnantwomen, 35 with preeclampsia, and 35 with nonproteinurichypertension in the Yanahuara andNacional del Sur hospitals in Arequipa (Peru)underwent measurement of blood pressure,proteinuria, and ultrasonographic studies in thehumeral artery to obtain their flow-mediated dilation(FMD). Comparisons between the three groups weremade using ANOVA or Kruskal-Wallis tests,depending on whether the distribution was normalor non-normal, respectively. Values of P<0.05 wereconsidered statistically significant.Results: Proteinuria values were 0.05 g/24 h, 2.57g/24 h and 0.21 g/24 h while FMD values showedmean values of 0.66mm, 0.25mm, and 0.45mm forhealthy pregnant women, women with preeclampsiaand women with non-proteinuric hypertension,respectively. Comparison of FMD among groupsshowed significant differences among the groups(P<.01). However, proteinuria values in the groupwith non-proteinuric hypertension were within thenormal range (<0.03 g/24 h). No relation was foundbetween FMD and proteinuria.Conclusions: Ultrasonographic evaluation of FMDdetected vascular damage even in the group ofpregnant women with pregnancy-induced hypertensionwithout proteinuria

Angiogénesis pulmonar mediada por adenosina vía CXL1/CXCR2 / Via CXCL1/CXCR2 adenosine-mediated pulmonary angiogenesis

Introducción: La enfermedad pulmonar inflamatoria crónica tiene como característica común el proceso de angiogénesis patológica. Recientes trabajos han relacionado a la adenosina, una molécula de señalización, y quimioquinas como reguladores de este proceso, aunque la relación y asociación entre estos factores no ha sido muy investigada. Objetivo: Determinar el papel de la adenosina en la angiogénesis sostenida en procesos pulmonares inflamatorios crónicos. Diseño: Experimental. Lugar: Bioterio del Grupo de Investigación en Inmunología de la Facultad de Medicina de la Universidad Nacional de San Agustín, Arequipa, Perú e Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México. Material biológico: Ratones deficientes en adenosina deaminasa (ADA) de la cepa C57BL/6J. Métodos y procedimientos: Se evaluó la relación entre los niveles de adenosina en pulmón y la angiogénesis traqueal utilizando patrones morfométricos, además de la expresión de la quimioquina CXCL1 y su receptor mediante ensayos de PCR y Elisa. Principales medidas de resultados: Niveles de adenosina en pulmón, angiogénesis traqueal y expresión a CXCL1 y su receptor. Resultados: Se demostró un significativo incremento de angiogénesis relacionado a dosis elevadas de adenosina y una regresión importante del proceso al administrar ADA de reemplazo. Se encontró también niveles de CXCL1 elevados de manera dependiente a la adenosina, en los ratones deficientes. La neutralización in vivo del receptor de CXCL1 (mCXCR2) mostró una marcada inhibición de la acción angiogénica. Conclusión: Nuestros hallazgos sugieren que la adenosina juega un rol importante en la inducción de angiogénesis pulmonar vía CXCL1/CXCR2, en la enfermedad pulmonar crónica.

Introduction: Chronic lung disease's feature is pathological angiogenesis, a still little understood process in this and other diseases. Recently adenosine, a signaling molecule, and chemokines have been considered regulators of this process. Though, relationship between these factors has not been investigated. Objective: To determine the role of adenosine in the induction of angiogenesis during pulmonary chronic inflammation. Design: Experimental. Setting: Bioterio, Immunology Research Group, Facultad de Medicina, Universidad Nacional de San Agustin, Arequipa, Peru, and Biomedical Research Institute, Universidad Nacional Autonoma de Mexico. Biologic material: C57BL/6J adenosine deaminase (ADA)-deficient mice. Methods and interventions: By morphometric analysis we determined relationship between adenosine levels in lung and tracheal angiogenesis, and expression to CXCL1 and its receptor by PCR and Elisa assays. Main outcome measures: Lung adenosine levels, tracheal angiogenesis, and expression to CXCL1 and its receptor. Results: We demonstrated a significant increase of angiogenesis related to high doses of adenosine and an important inhibition of the process when we administered replacement ADA. In the ADA-deficient mice CXCL1 levels rose depending on adenosine levels. CXCL1 receptor (CXCR2) in vivo neutralization showed dramatic inhibition of angiogenic activity. Conclusions: Adenosine may play an important role, via CXCL1/CXCR2, in the induction of pulmonary angiogenesis in pulmonary chronic disease.

Aplicaciones de toxina botulínica en neurología: resultados de la I Reunión de Expertos en el uso de toxina botulínica / Use of botulinum in neurology: results of the first meeting of experts in botulinum toxin

La presente comunicación es el resultado de una reunión de neurólogos con experiencia en el uso de toxina botulínica tipo A (TB-A) en donde después de revisarse la literatura existente y de un intercambio de opiniones y experiencias, se propone algunos parámetros a seguir para la aplicación de TB-A en pacientes con blefaroespasmo, distonía cervical, espasmo hemifacial y espasticidad. Se intenta así el primer paso hacia la confección de una guía práctica para el uso de TB-A en Neurología en el Perú.

Migraña en el Perú: a propósito de una serie de casos / Hemicrania in Peru: with regard to a series of cases

El presente artículo describe las características clínicas de una serie de pacientes peruanos dentro de un estudio clínico multicéntrico internacional, al momento de presentación en el consultorio externo con cuadro de migraña aguda. Resultados: 93 pacientes con cuadro de migraña aguda moderada (53 por ciento) a severa (47 por ciento) fueron evaluados, la edad promedio fue de 36.7 años, 86 por ciento fueron de sexo femenino. El 90 por ciento de pacientes no presentó aura durante el ataque de migraña, y los síntomas acompañantes de la migraña fueron fotofobia, fonofobia, naúseas y vomitos en 56, 56, 51 y 8 por ciento respectivamente. Se apreció incapacidad funcional de grado leve moderada y severa durante la fase aguda de la migraña en un 38.7, 38.7 y 19.3 por ciento respectivamente. Conclusiones: Se presenta las características clínicas de los cuadros de migraña aguda en una serie de pacientes peruanos dentro de un estudio clínico internacional. Durante el cuadro agudo se vió un marcado grado de incapacidad funcional.

Serotonina y dolor / Serotonin and pain

Revisamos la participación de la serotonina en relación al dolor, poniendo énfasis en los mecanismos de control central. Se discute la vía descendente serotoninérgica de los núcleos del rafe y mecanismos periféricos como la sensibilización de los nociceptores y la fisiopatología en el dolor agudo y crónico. Finalmente, los posibles mecanismos de producción de la migraña, la fisiopatología vascular y las drogas usadas para su control son analizados.

Avances en el tratamiento de la enfermedad de Alzheimer / Advances treatment of the Alzheimer's disease

Se revisa los avances en el conocimiento de la fisiopatología de la Enfermedad de Alzheimer, con el objeto de presentar científicamente los enfoques terapéuticos actuales. En el tratamiento de los transtornos cognitivos de la enfermedad se destaca los agentes inhibidores de la acetilcolinoesterasa, los factores neurotróficos y los inhibidores de la MAO-B. Se presenta tambiénavances en el tratamiento de desórdenes no cognitivos, y finalmente la orientación de estudios en cursos y de las investigaciones futuras.

Epidemiología intrahospitalaria del Instituto de Ciencias Neurológicas durante 1992 / Inpatient hospital epidemiology at the Institute of Neurological Sciences

Se realiza un trabajo descriptivo, sobre las características demográficas y las causas de hospitalización en el Instituto de Ciencias Neurológicas (ICN) en Lima-Perú durante 1992. De la revision de las estadisticas de la oficina de estadística del ICN, se obtienen 1783 egresos, 48 por ciento mujeres y 52 por ciento varones, el 66 por ciento de los cuales compone la población economicamente activa, con una edad promedio de 38 años. Un tercio de los pacientes procedian del llamado "Cono Norte" de Lima y el resto, de la mayoria de distritos del país. Se observa en el ICN y en el Servicio de Neurologia del Hopspital Nacional Guillermo Almenara Irigoyen (HNGAI), que atiende a la población aegurada, una gran similitud en cuanto a diagnósticos de alta, figuran asi en orden de frecuencia: la enfermedad ("accidente") cerebrovascular, la epilepsia, la cefalea y la neurocisticercosis, en ambos centros. Es notoria la tendencia a una permanencia hospitalaria superior al promedio, con 15 días en el HNGAI y 26 en el ICN respectivamente; comparando a 9 dias del IPSS a nivel nacional y 14 del HNCH. Asi mismo se observa claramente una mayor mortalidad intrahospitalaria de las enfermedades neurológicas, pues estas superan el promedio internacional de 40 por mil para un hospital general y al promedio general del HNCH de 38 por mil, siendo de 48 por mil para el ICN y de 49 por mil para el HNGAI durante el mismo periodo estudiado. Resalta una diferencia importante entre los tipos de enfermedad cerebrovascular observados, asi en el ICN son eventos isquémicos el 81 por ciento, 13 por ciento hemorrágicos, y 6 por ciento hemorragias subaracnoideas; siendo en el HNGAI el 30 por ciento hemorragicos y el 70 por ciento isquémicos, sin considerar las hemorragias subaracnoideas. La explicación de estas diferencias, sea por métodos diagnósticos o por características distintas de la población asegurada y no asegurada, asi como otras características de las enfermedades señaladas por su frecuencia, es motivo de nuevos estudios intrahospitalarios y en población

Neuropatía facial periférica: Correlación clínica y neurofisiologíca de factores pronósticos en 32 pacientes

Siendo la parálisis facial periférica una unidad frecuente en la consulta externa neurológica, se estudiaron prospectivamente 32 pacientes (19 mujeres y 13 varones) cuyas edades fluctuaron entre 16 y 71 años (edad promedio 35.5) y que cursaban entre el quinto y decimoquinto día del inicio de sus síntomas, estableciendo una correlación entre la clínica, hallazgos neurofisiológicos, evolución y pronóstico a corto plazo. Se realizó: estimulación eléctrica del nervio y registro de su respuesta en los músculos frontal, orbicular de los párpados, orbicular de los labios y nasalis, comparando latencias y amplitudes con el lado sano, y electromiografía con aguja bipolar en los tres primeros músculos mencionados. El parámetro de mayor valor resultó la respuesta muscular al estímulo eléctrico, correlacionándose significativamente con el hallazgo electromiográfico y su mejor pronóstico a las seis semanas (p<0.03). La modificación de las latencias fue el parámetro menos importante, no así la amplitud del potencial de acción, que sí tuvo balor en la predicción del pronóstico.