Siete años de experiencia en pacientes intervenidos por patología proctológica bajo modalidad cirugía mayor ambulatoria y estudio del grado de satisfacción usuaria

Objetivo: Exponer los resultados de 7 años de cirugía proctológica por cirugía mayor ambulatoria (CMA) y determinar el grado de satisfacción usuaria. Material y Método: Se realizó un estudio observacional descriptivo de pacientes sometidos a cirugía proctológica bajo modalidad CMA en el Hospital Regional de Concepción entre los años 2012 y 2019. Se realizó la encuesta telefónica de satisfacción SUCMA-14. Resultados: Se evaluaron a 632 pacientes en el período de estudio. Con diferencias estadísticamente significativas entre patologías para edad, género e IMC. Se aplicó la encuesta a 270 pacientes que contestaron y respondieron. Los resultados mostraron que en general la percepción de los pacientes es positiva salvo puntuales excepciones, como el dolor postoperatorio para condilomas y hemorroides, y las complicaciones postoperatorias para la enfermedad pilonidal. Cuando se realiza el análisis multivariado a los datos correspondientes a la encuesta, no se logran diferencias significativas entre los diagnósticos, pero al aplicarlo a las variables clínico-quirúrgicas se evidencia, claramente, que existe una distinción entre éstas, en especial para la enfermedad pilonidal. Discusión: Las diferencias en términos de tiempos quirúrgicos, complicaciones y re-hospitalizaciones, no necesariamente afectan la percepción que los pacientes tienen de la CMA, ya que ésta depende de otros factores y no solo de los resultados quirúrgicos. Conclusión: Se obtuvieron resultados acorde a la literatura internacional, con peores resultados para enfermedad pilonidal. La satisfacción usuaria fue positiva en general, sin una clara distinción por patologías. Creemos que la CMA es recomendable en patología proctológica tanto por sus resultados, como por la satisfacción que genera en los pacientes.

Objective: To present the results of 7 years of colorectal surgery on mayor ambulatory surgery (MAS) and to determine patient satisfaction. Methods: A descriptive observational study of patients undergoing proctological surgery under the MAS modality was carried out at Regional Hospital of Concepción between 2012 and 2019. The SUCMA-14 satisfaction survey was applied. Results: 632 patients were evaluated in the study period. With statistically significant differences between pathologies for age, gender and BMI. The survey was applied to 270 patients who answered and responded. The results showed that, in general, the perception of the patients is positive, with exceptions, such as postoperative pain for warts and hemorrhoids, and postoperative complications for pilonidal disease. When the multivariate analysis corresponding to the survey is performed, it does not allow distinguishing between the diagnoses, but when applied to the surgical variables, it clearly shows that there is a distinction between them, with a disadvantage for pilonidal disease. Discussion: The differences in terms of surgical times, complications and re-hospitalizations do not necessarily affect the perception that patients have of the MAS, since it depends on other factors and not only on the surgical results. Conclusion: Results were concordant to what is described in the international literature, with worse results for pilonidal disease. Patient satisfaction was positive in general, without a clear distinction by pathology. We believe that MAS is recommended in proctological pathology both for its results and for the satisfaction it generates in patients.

Cambio del modelo asistencial en una unidad de uroginecología de un hospital de tercer nivel: impacto de la pandemia por COVID-19 en la presencialidad / Update of the care model in a urogynaecology unit of a tertiary hospital: impact of the COVID-19 pandemic on face-to-face care

La pandemia por la COVID-19 generó un cambio de forma brusca en la práctica asistencial habitual de nuestra unidad de uroginecología, y a raíz de esta situación se ideó un nuevo modelo asistencial para adaptarnos a la nueva etapa epidemiológica. Se acordó, como eje central del nuevo modelo, la disminución de la presencialidad hospitalaria, ofreciendo la misma calidad asistencial mediante la introducción de la telemedicina.Para conseguir tal fin, se elaboró un modelo con tres tipos de visitas nuevas: primera visita médica telemática, visitas de seguimiento de tratamientos conservadores y farmacológicos telemáticas, y creación de visita pack (pack STUI, el pack posparto y el pack postalta) que incluye visitas y pruebas diagnósticas uroginecológicas que se realizan todas el mismo día.El pack STUI va dirigido a todas las pacientes con síntomas del tracto urinario inferior, asociados o no a prolapso de órganos pélvicos. Consta de dos visitas (enfermería y médica), y dos pruebas diagnósticas avanzadas (urodinamia y ecografía de suelo pélvico).El pack posparto va dirigido a mujeres con síntomas de incontinencia urinaria, incontinencia anal, prolapso y/o alteraciones de la sexualidad tras el parto. También incluye mujeres asintomáticas con antecedente de trauma perineal obstétrico. Consta de una visita médica, una ecografía de suelo pélvico y una visita por la fisioterapeuta.El pack postalta se realiza al mes de la cirugía e incluye dos pruebas (ecografía de suelo pélvico y flujometría) y una visita médica.Los tratamientos de fisioterapia y otras visitas que por motivos médicos lo requirieran, han mantenido su presencialidad.(AU)

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.(AU)

[Update of the care model in a urogynaecology unit of a tertiary hospital: impact of the COVID-19 pandemic on face-to-face care]. / Cambio del modelo asistencial en una unidad de uroginecología de un hospital de tercer nivel: impacto de la pandemia por COVID-19 en la presencialidad.

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.

Direct costs of a home parenteral nutrition programme.

BACKGROUND & AIMS: Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS: Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS: Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS: The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.

A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study.

PURPOSE: Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN: This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS: CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS: The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.

Nutrición en el paciente con ictus / Nutrition for stroke patients

La desnutrición es frecuente en los pacientes con ictus y se asocia con un aumento de la morbimortalidad y un mayor riesgo de discapacidad. La disminución de la ingesta es uno de los factores etiológicos más importantes de desnutrición en estos pacientes. La disfagia es especialmente frecuente y origina una alteración de la eficacia y la seguridad de la deglución, que da lugar a un mayor riesgo de desnutrición y deshidratación, aspiración, insuficiencia respiratoria y neumonía. La valoración del paciente con ictus requiere una evaluación del riesgo nutricional y de la presencia de disfagia. El soporte nutricional incluye la utilización de dieta oral adaptada, suplementos nutricionales orales o nutrición enteral, modalidad de elección en los pacientes con disfagia grave. En este trabajo se revisan los aspectos más relevantes sobre el riesgo nutricional de los pacientes con ictus, las pautas diagnósticas y las opciones terapéuticas, tanto en la fase aguda como en la rehabilitación (AU)

Malnutrition in common in patients with acute stroke and is associated with higher mortality, poor outcome and disability. Decreased intake is one of the most important factors leading to malnutrition in stroke patients. Dysphagia is especially common and is responsible of a decrease in safety and efficacy of swallowing that gives rise to an increased risk of malnutrition, dehydration, aspiration, pneumonia and respiratory failure. Clinical evaluation of stroke patients includes a nutritional risk and swallowing capacity assessment. Nutritional support may be necessary, with adapted oral diet, oral supplements. Enteral nutrition is needed in patients with severe dyaphagia. This article reviews the most relevant aspects regarding nutritional risk factors in stroke patients, evaluation and diagnosis and nutritional support, both in acute phase and during rehabilitation (AU)

[Home enteral nutrition in Spain: NADYA registry in 2010]. / Nutrición enteral domiciliaria en España: registro NADYA del año 2010.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st to December 31st 2010. RESULTS: We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. CONCLUSIONS: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.

Nutrición enteral domiciliaria en España: registro NADYA del año 2010 / Home enteral nutrition in spain: NADYA registry in 2010

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE del año 2010.Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero al 31 de diciembre de2010.Resultados: Se registraron 6.591 pacientes (51% varones) con 6.688 episodios de NED, procedentes de 32 hospitales. La edad media en los menores de 14 años (4%) fue de 1 ± 2 años (m ± DS) y de 69,9 ± 17,8 en los mayores de14 años. El 76% de los pacientes recibieron la NED por un tiempo superior a 2 años. La patología más prevalente fue la neurológica 42%, seguida de la neoplasia 28% (en su mayoría cáncer de cabeza y cuello 18%). La información referente a la vía de acceso sólo se recogió en 626 casos(9,4%), el 51% de los pacientes utilizaron sonda nasogástrica, 27% gastrostomías, 10% vía oral y 3% yeyunostomías. Sólo 251 episodios finalizaron a lo largo del año, siendo el motivo más frecuente el fallecimiento del paciente en el 57% de los casos y el paso a la alimentación oral en el 14%. El 29% de los pacientes presentaban una actividad limitada y el 39% estaba confinado en cama/sillón. El 68% de los adultos requerían ayuda total o parcial. El suministro del producto se realizó desde el hospital o la farmacia de referencia en el 63% y 34%, respectivamente. El suministro del material fungible se realizó desde el hospital o atención primaria en el 83% y 16%,respectivamente.Conclusiones: Los resultados obtenidos en el registro de NED del año 2010 muestran características muy similares a las recogidas en los años previos en cuanto al número y características de los pacientes registrados. Seguimos encontrando problemas en la recogida de datos relativos a la vía de acceso y finalización de los episodios (AU)

Objective: To describe the results of the home enteralnutrition (HEN) registry of the NADYA-SENPE group in2010.Material and methods: We retrieved the data of the patients recorded from January 1st to December 31st2010.Results:We registered 6,591 patients (51% males) with6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in29% of the patients and 39% of them were bed- or chair ridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and16% of the cases, respectively. Conclusions: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes (AU)

Gestación multifetal yatrogénica / Iatrogenic multifetal pregnancy

Los embarazos múltiples ocurren de forma espontánea, en una de cada 90 gestaciones en el caso de las gemelares, y en una de cada 8.100 en las triples. Sin embargo, desde el desarrollo de las unidades de reproducción humana se ha identificado un incremento del 52% de gestaciones gemelares y del 404% en las de mayor orden. Ante la elevada morbimortalidad perinatal y materna de estos embarazos y con el fin de incrementar las posibilidades de supervivencia de los fetos resultantes y minimizar la morbilidad a largo plazo en los recién nacidos, surge la embriorreducción selectiva. A pesar de ser una técnica rentable, puede implicar compromisos éticos y es un procedimiento no exento de riesgos. Por todo esto, consideramos que la actitud más eficaz ante las gestaciones múltiples es su prevención primaria (AU)

Multiple pregnancies spontaneously occur in one out of 90 pregnancies for twins and in one out of 8,100 for triplets. However, since the introduction of human reproduction units, there has been a 52% increase in twins, and a 404% increase in high-order pregnancies. Given the high perinatal and maternal morbidity and mortality in these pregnancies, selective embryo reduction was developed to increase fetal survival and reduce long-term morbidity in neonates. Although effective, this procedure represents a technical and ethical challenge for the practitioner. Consequently, we believe that the most effective approach to multifetal pregnancies is primary prevention (AU)

Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study.

BACKGROUND/OBJECTIVES: The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. SUBJECTS/METHODS: Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ(2)-test to assess differences between the tests and the κ statistic to assess agreement between the tests. RESULTS: The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA κ=0.491, NRS-2002-SGA κ=0.620 and MUST-SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. CONCLUSIONS: The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.

Clinical and pathological effects of different acrylic intracorneal ring segments in corneal additive surgery.

The objective of this work was to evaluate the potential use of less stiff materials based on acrylic copolymers of methyl methacrylate/2-ethylhexyl acrylate (MMA/EHA) as devices to correct, stabilize and improve the effect of poly(methyl methacrylate) (PMMA) intracorneal ring segments. MMA/EHA and PMMA intracorneal ring segments were surgically implanted in the corneas of Lohmann Classic hens. The effects of the intracorneal ring segments were assessed by optical measurements and corneal tolerance was evaluated through biomicroscopic examination over a 90-day observation period and by conventional histology. The experimental results demonstrated that the intracorneal ring segments made of MMA/EHA copolymers provided a significant change in the corneal curvature and an improved in vivo response compared to those obtained for PMMA rings, which was attributed to the higher flexibility of the copolymeric materials, indicating that these systems might be considered suitable as an alternative to those currently used, for application in clinical practice.

Omissions in the synthetic theory of evolution.

The Synthetic Theory of Evolution is the most unifying theory of life science. This theory has dominated scientific thought in explaining the mechanisms involved in speciation. However, there are some omissions that have delayed the understanding of some aspects of the mechanisms of organic evolution, principally: 1) the bridge between somatic and germinal cells, especially in some phylum of invertebrates and vertebrates; 2) horizontal genetic transferences and the importance of viruses in host adaptation and evolution; 3) the role of non-coding DNA and non-transcriptional genes; 4) homeotic evolution and the limitations of gradual evolution; and 5) excessive emphasis on extrinsic barriers to animal speciation. This paper reviews each of these topics in an effort to contribute to a better comprehension of organic evolution. Molecular findings suggest the need for a new evolutionary synthesis.

Omissions in the synthetic theory of evolution

The Synthetic Theory of Evolution is the most unifying theory of life science. This theory has dominated scientific thought in explaining the mechanisms involved in speciation. However, there are some omissions that have delayed the understanding of some aspects of the mechanisms of organic evolution, principally: 1) the bridge between somatic and germinal cells, especially in some phylum of invertebrates and vertebrates; 2) horizontal genetic transferences and the importance of viruses in host adaptation and evolution; 3) the role of non-coding DNA and non-transcriptional genes; 4) homeotic evolution and the limitations of gradual evolution; and 5) excessive emphasis on extrinsic barriers to animal speciation. This paper reviews each of these topics in an effort to contribute to a better comprehension of organic evolution. Molecular findings suggest the need for a new evolutionary synthesis.

[Registry of home-based enteral nutrition in Spain for the year 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Enteral Domiciliaria en España en el año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS: Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS: During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS: Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.

Rabies-vaccination coverage and profiles of the owned-dog population in Santa Cruz de la Sierra, Bolivia.

The Bolivian government issued a regulation for rabies control in November 2005, owing to increasing the prevalence of dog and human rabies cases in recent years. An assessment of rabies-vaccination coverage and other factors that might influence the success of the on-going vaccination campaign was needed. The objective of this study was to investigate dog rabies vaccination coverage and risk factors associated with dogs being unvaccinated against rabies, and profiles of the owned-dog population in Santa Cruz de la Sierra, Bolivia, where dog rabies was endemic. Mainly due to logistical reasons, the WHO's expanded programme on immunization cluster-survey method was used. The 390 households were included in the study. Information about dog population and management characteristics was obtained for 542 dogs from 301 households. On average, households had 1.4 dogs and 1.8 dogs per dog-owning household (median = 1). The human-to-dog ratio was 4.6 : 1. During the last 1 year prior to the study, of the 539 dogs aged >or=1 month, 463 (85%; 95% CI 79-91; design effect 3.6) were classified as vaccinated. Amongst the study dogs, dogs aged 1-11 months were the higher risk of dogs not being vaccinated (OR = 8.2; 95% CI 4.3-15.6; P < 0.01). Almost two-thirds of the study dogs were allowed to roam freely throughout the day or in part. Community education efforts should address the importance of dog ownership and movement restriction, and the need to vaccinate young dogs.

Seudocoartación de aorta asociada a vena innominada retroaórtica / Aortal pseudocoarctation of the aorta associated with a retroaortic innominate vein

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The phylogeny of the gene, from the "lower" naked structural genes to "higher" non transcriptional genes.

Within the nuclear eukaryotic genome there are two different information areas. One of these zones corresponds to coding DNA in which "structural genes" or "lower genes" can be found. On the other hand, disperse in the genome, there is the non-coding DNA, where redundant DNA can be found. In the latter area there are non-transcriptional genes or "higher genes" which arose with eukaryotic organisms as a result of coevolution. Viruses could have had an important role as natural vectors in the genomic evolution.

The history of the Mendelian gene.

The concept of heredity arose when the ancient philosophers and scientists felt the need to explain the variation and organic evolution phenomena. The ideas about inheritance developed before Mendel were significant in the construction of the Mendelian concept of gene. From Mendelian hereditary principles to molecular genetics there have been many different concepts and also many definitions of gene. In the first corpuscular concept of gene, mutation was quite crucial to explain the different alternative genotype and phenotype expression in the progeny. From the rediscovery of Mendelian Principles to 1961, Morgan's idea that a gene is not divisible by recombination prevailed. Nevertheless it was later demonstrated that there are different units of recombination and mutation within the gene, and in a determinate gene different "functional units" can exist. In 1977, surprisingly, Sharp and Roberts found out that genes are fragmented into "exons" and "introns". At present time, with the discovery of iRNA, non coding RNA, importance of introns, transposable elements, pseudogenes, endogenous viral DNA, repeated DNA, superposed genes, non-transcriptional genes and epigenesis, ancient questions return: what is a gene? where is the program? what is the true role of mutations in the organic evolution?