Percepciones de los estudiantes de ciencias de la salud sobre el aprendizaje cooperativo en la modalidad virtual

Objetivo: Identificar las percepciones de los estudiantes de primer año de estudios de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos (UNMSM) sobre la aplicación del aprendizaje cooperativo en la modalidad virtual durante el semestre académico 2021-II. Materiales y métodos: El diseño de investigación aplicado en este estudio fue descriptivo y transversal. La población estuvo conformada por 592 estudiantes pertenecientes a las escuelas profesionales de Medicina Humana, Enfermería, Obstetricia, Nutrición y Tecnología Médica. Se realizó un muestreo probabilístico aleatorio y se obtuvo una muestra de 429 estudiantes. Para la recolección de datos, se empleó como instrumento el Cuestionario de Aprendizaje Cooperativo, con un formato de respuesta en escala Likert, que consta de 8 indicadores y fue elaborado por McLeish. El instrumento es confiable y válido; fue aplicado a la muestra de estudiantes al finalizar la asignatura de manera virtual mediante Google Forms. Los datos cuantitativos se analizaron descriptivamente con el programa SPSS 22. La estadística descriptiva que se aplicó incluye frecuencias, promedios y desviación estándar. Resultados: De los estudiantes que conformaron la muestra, el 65,9 % fueron mujeres y el 34,1 %, hombres. La mayor parte de los participantes tuvo percepciones favorables hacia el aprendizaje cooperativo en la modalidad virtual, y se obtuvieron promedios entre 3,77 y 4,53. Se identificaron percepciones favorables hacia esta metodología, principalmente en las dimensiones calidad del proceso de interacción del grupo, enseñanza de habilidades interpersonales en grupos pequeños e interdependencia positiva. Conclusiones: Los estudiantes tuvieron percepciones favorables hacia el aprendizaje cooperativo en la modalidad virtual, ya que contribuyó a mejorar su socialización, favoreció su actitud hacia el trabajo en grupo, permitió su participación en las sesiones con agrado, ayudó a mejorar sus interacciones con sus pares, desarrolló su creatividad y habilidades interpersonales, por lo cual se recomienda su aplicación y análisis de los logros en los entornos virtuales.

Objective: To identify the perceptions of implementing online cooperative learning during the 2021 II academic semester by first-year students of Universidad Nacional Mayor de San Marcos (UNMSM) School of Medicine. Materials and methods: A descriptive and cross-sectional research design was used in this study. The population consisted of 592 students from the professional schools of Human Medicine, Nursing, Obstetrics, Nutrition and Medical Technology. A random probability sampling was carried out and a sample of 429 students was obtained. The Cooperative Learning Questionnaire with an 8-point Likert scale response format developed by McLeish was used as an instrument for data collection. It is a reliable and valid instrument that was administered online to the sample of students at the end of the course using Google Forms. The quantitative data were analyzed descriptively using IBM SPSS Statistics V22. The descriptive statistics included frequencies, averages and standard deviation. Results: Out of the students in the sample, 65.9 % were females and 34.1 % were males. Most participants had favorable perceptions of online cooperative learning, with averages between 3.77 and 4.53. Favorable perceptions of this methodology were mainly identified in the dimensions quality of the group interaction process, teaching of interpersonal skills in small groups and positive interdependence. Conclusions: The students had favorable perceptions of online cooperative learning because it helped them to improve their social skills, favored their attitude toward group work, allowed them to participate in the sessions with enthusiasm, helped them to improve peer interaction, and promoted the development of their creativity and interpersonal skills. Therefore, its implementation and analysis of achievements in online environments are recommended.

Congenital Ophthalmoplegia and Late-Onset Limb Weakness Caused by MUSK Mutations.

Congenital myasthenic syndromes are clinically and genetically heterogeneous disorders characterized by a neuromuscular transmission defect. Mutations in novel genes have been described in recent years. Among these, MUSK gene mutations are extremely rare, with only 8 families identified worldwide to date. We report a Spanish case, a carrier of one known hetero-allelic missense mutation and one newly identified MUSK gene variant. Our patient presented with congenital onset ophthalmoplegia and palpebral ptosis associated with limb-girdle weakness and exercise intolerance without prominent fatigability, developed during his twenties. He was misdiagnosed as mitochondrial myopathy because of paraclinic and histologic findings, but detailed clinical examination prompted us to reassess him with repetitive stimulation technique, demonstrating decremental response and suggesting myasthenic syndrome. A genetic study confirmed the clinical diagnosis allowing us to started treatment with excellent clinical response.

Assessment of Collateral Circulation Using Perfusion CT in Middle Cerebral Artery Thrombectomy-Treated Patients.

INTRODUCTION: The prognostic value of leptomeningeal collateral circulation in thrombectomy-treated patients remains unclear. We evaluated the construct validity of assessing leptomeningeal collateral circulation using a new regional perfusion CT source image-based approach, the Perfusion Acquisition for THrombectomy Scale (PATHS). We also compared the prognostic value of PATHS with a further 6 scales based on various techniques: CT-angiography, perfusion CT, and digital subtraction angiography. Additionally, we studied the relationship between the scores for the different scales. PATIENTS AND METHODS: We performed a retrospective study of consecutive patients with stroke and M1/terminal carotid occlusion treated with thrombectomy in our center. Leptomeningeal collateral circulation was prospectively evaluated using 7 scales: Tan and Miteff (CT Angiography); Calleja, Cao, American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology, and PATHS (perfusion); and Christoforidis (Digital Subtraction Angiography). Correlations were studied using the Spearman method. RESULTS: The study population comprised 108 patients. All scales predicted the modified Rankin Scale at 3 months (P ≤ .02) and all but 1 (Christoforidis) correlated with 24-hour brain infarct volume (P ≤ .02). These correlations were higher with PATHS (rho = -0.47, P < .001 for 3-month modified Rankin Scale; rho = -0.35, P < .001 for follow-up infarct volume). The multivariate analysis showed PATHS to be an independent predictor of modified Rankin Scale at 3 months less than equal to 2. A crosscorrelation analysis revealed a better correlation between scales that used the same techniques. CONCLUSIONS: PATHS can be used to assess leptomeningeal collateral circulation. PATHS had better prognostic value than other scales; therefore, it might be considered for assessment of leptomeningeal collateral circulation in candidates for thrombectomy. The moderate correlation between scales suggests that scores are not interchangeable.

Prevalencia de manifestaciones musculoesqueléticas y discapacidad asociada en una población peruana urbana habitante a gran altura. Estudio COPCORD. Estadio I / Prevalence of musculoskeletal manifestations and related disabilities in a Peruvian urban population living at high altitude. COPCORD Study. Stage I

Objetivo: Estimar la prevalencia de manifestaciones musculoesqueléticas y discapacidad en la población urbana habitante a gran altura de Juliaca, Puno, Perú; utilizando el cuestionario COPCORD y HAQ-DI. Métodos: Se realizó un estudio transversal en muestra de 1.095 personas. En cada entrevista se desarrolló la metodología COPCORD y el Health Assessment Questionnaire (HAQ) Disability Index (DI). El plano urbano fue dividido en ocho sectores. Resultados: Fueron evaluadas 614 (56,1%) mujeres; 44% pertenecieron a la raza quechua y 5,1% a aymara. Reportaron dolor ME en los últimos 7 días 347 personas (31,69%; IC 95% 28,36-35,02), con predominio en mujeres (218; 35,5%; IC 95% 30,8-40,2); y 132 personas, antes de los 7 días (12,05%; IC 95% 9,99-14,11). Las patologías reumáticas más frecuentes fueron AR: 1,27%, gota de 0,64%, OA de manos: 2,83%, OA de rodillas: 1,55%, OA de cadera 0,37%, fibromialgia: 1,09%, reumatismo de partes blandas: 8,86%. La evolución del HAQ-DI tuvo un incremento progresivo proporcional a la edad. El promedio de HAQ-DI de la población fue 0,18 (±0,36). De ciento setenta y cinco personas con una condición reumática, 10 (5,71%) acudían al servicio de un chamán. Conclusión: Es el primer estudio COPCORD en una población originaria urbana habitante a gran altura en el Perú. La población afectada de una enfermedad reumática crónica, prefería la atención profesional en lugar a la tradicional; población que a su vez contaba con escasa oferta de servicios médicos. El deterioro de la capacidad funcional medida por HAQ-DI se asoció con el incremento de la edad

Objective: Estimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) disability index. Methods: A cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors. Results: In all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99-14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36-35.02) who were predominately women (218; 35.5%; 95% CI 30.8-40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman. Conclusion: It is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age

Prevalence of musculoskeletal manifestations and related disabilities in a Peruvian urban population living at high altitude. COPCORD Study. Stage I. / Prevalencia de manifestaciones musculoesqueléticas y discapacidad asociada en una población peruana urbana habitante a gran altura. Estudio COPCORD. Estadio I.

OBJECTIVE: Estimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) disability index. METHODS: A cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors. RESULTS: In all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99-14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36-35.02) who were predominately women (218; 35.5%; 95% CI 30.8-40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman. CONCLUSION: It is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age.

Effectiveness of serological markers of eosinophil activity in monitoring eosinophilic esophagitis.

BACKGROUND: it is necessary to find serological markers accessible in clinical practice to prevent the need to perform repeated endoscopies. OBJECTIVE: to assess the efficacy of eosinophil activity markers in monitoring eosinophilic esophagitis (EoE). MATERIAL AND METHODS: thirty patients were included prospectively, all under dietary treatment -diets excluding 6 foods, and allergy test based diet (skin prick test and specific IgE). The variables assessed were demographic parameters, eosinophil cationic protein (ECP) levels (µg/mL), total IgE (KU/L), peripheral blood eosinophils (PBE) (U/mm³), and the maximum peak of eosinophils/hpf in esophageal biopsies. The variation found between these figures was assessed in line with response to dietary treatment. RESULTS: thirty patients (66.7% males; mean age 33.43 years) were included in the study, 22 responders and 8 non-responders. Ninety percent presented a personal history of atopy. No significant decrease was detected in serum total IgE and ECP after diet in responder and nonresponders. However, the PBE decreased significantly in responders but not in nonresponders, PBE in responders (pre-diet. 397.27 vs. post-diet 276.81, p = 0.024) and non-responders PBE (pre-diet. 460 vs. post-diet 317.5, p = 0.23). CONCLUSION: serum total IgE and ECP do not act as markers for EoE activity. However PBE may play a role in this regard, bearing in mind that this parameter may be influenced by concomitant atopic conditions.

Dose and aging effect on patients reported treatment benefit switching from the first overactive bladder therapy with tolterodine ER to fesoterodine: post-hoc analysis from an observational and retrospective study.

BACKGROUND: Previous randomized studies have demonstrated that fesoterodine significantly improves the Overactive Bladder (OAB) symptoms and their assessment by patients compared with tolterodine extended-release (ER). This study aimed to assess the effect of aging and dose escalation on patient-reported treatment benefit, after changing their first Overactive Bladder (OAB) therapy with tolterodine-ER to fesoterodine in daily clinical practice. METHODS: A post-hoc analysis of data from a retrospective, cross-sectional and observational study was performed in a cohort of 748 OAB adults patients (OAB-V8 score ≥8), who switched to fesoterodine from their first tolterodine-ER-based therapy within the 3-4 months before study visit. Effect of fesoterodine doses (4 mg vs. 8 mg) and patient age (<65 yr vs. ≥65 yr) were assessed. Patient reported treatment benefit [Treatment Benefit Scale (TBS)] and physician assessment of improvement with change [Clinical Global Impression of Improvement subscale (CGI-I)] were recorded. Treatment satisfaction, degree of worry, bother and interference with daily living activities due to urinary symptoms were also assessed. RESULTS: Improvements were not affected by age. Fesoterodine 8 mg vs. 4 mg provides significant improvements in terms of treatment benefit [TBS 97.1% vs. 88.4%, p < 0.001; CGI-I 95.8% vs. 90.8% p < 0.05)], degree of worry, bother and interference with daily-living activities related to OAB symptoms (p <0.05). CONCLUSIONS: A change from tolterodine ER therapy to fesoterodine with dose escalation to 8 mg in symptomatic OAB patients, seems to be associated with greater improvement in terms of both patient-reported-treatment benefit and clinical global impression of change. Improvement was not affected by age.

Conocimientos y adherencia a las nuevas recomendaciones de la SEGO para la prevención del cáncer de cuello de útero, por parte de los ginecólogos españoles en la práctica diaria / Knowledge and adherence to SEGO recommendations for the prevention of cervical cancer by Spanish gynecologists in daily practice

Objetivo. Valorar el grado de conocimiento y la aplicación en la práctica clínica de las nuevas recomendaciones auspiciadas por la Sociedad Española de Ginecología y Obstetricia (SEGO), para la prevención del cáncer de cuello de útero y la vacunación frente al virus del papiloma humano (VPH), por parte de los ginecólogos españoles. Métodos. Estudio transversal (desde noviembre de 2010 a marzo de 2011) en el que a través de una plataforma on line los participantes cumplimentaron una encuesta de conocimientos y de práctica clínica real sobre la epidemiología de la infección por el VPH, cribado del cáncer de cuello uterino y la vacuna frente al VPH, desarrollada previamente por el Comité Científico Nacional. Resultados. Un total de 454 ginecólogos participaron en el estudio. Se observó un buen conocimiento sobre la transmisibilidad del VPH, volumen de enfermedad relacionado con VPH, mortalidad por cáncer de cuello de útero, demostración de memoria inmune, seguridad y eficiencia de las vacunas frente a VPH y espectro de protección de la vacuna tetravalente. Los conocimientos sobre la tasa de mujeres sexualmente activas positivas al VPH a los 5 años, diferencia entre eficacia y eficiencia del cribado citológico e intervalos de control seguros en mujeres con doble test negativo (citología y VPH) fueron deficientes. Asimismo, la actitud proactiva de la vacunación frente al VPH en el segmento de edad prioritario (<27 años) fue pobre, con una tasa de encuestados del 63% recomendando la vacunación. Sorprendentemente, un 4% recomendaba la vacuna en mujeres mayores de 45 años. El 15% manifestaba no disponer de tiempo para explicar que el control trienal citológico es seguro y el 27% lo consideraba inseguro. El 35% declaró no tener disponible el test de VPH en su medio. En un 12% de los casos, la colposcopia se usaba como complemento de la citología en la revisión inicial. Conclusiones. Aunque los conocimientos de la epidemiología y vacunas frente al VPH eran adecuados, la actitud proactiva de vacunación en el grupo etario preferente fue pobre. Solo un 38% de los participantes demostró un seguimiento completo de las recomendaciones de la SEGO. Es indispensable diseñar e implementar estrategias a nivel nacional para difundir y mejorar la aplicación clínica de dichas recomendaciones (AU)

Objective. To assess the degree of knowledge of the new recommendations of the Spanish Society of Obstetrics and Gynecology (Sociedad Española de Ginecología y Obstetricia [SEGO]) for the prevention of cervical cancer and vaccination against human papilloma virus (HPV) among Spanish gynecologists and implementation of these recommendations in daily clinical practice. Methods. A cross-sectional survey (from November 2010 to March 2011) was carried out, in which participants used an online platform to complete a questionnaire previously developed by the National Scientific Committee on knowledge of the epidemiology of HPV infection, cervical cancer screening and HPV vaccines, and activities related to these issues in daily clinical practice. Results. A total of 454 gynecologists participated in the study. The gynecologists showed good knowledge of HPV transmission, HPV disease load, mortality due to cervical cancer, demonstration of immune memory, safety and efficiency of HPV vaccines, and the spectrum of protection by the tetravalent vaccine. Knowledge of the rate of sexually-active HPV-positive women at 5 years, differences between the efficacy and efficiency of cytological screening, and safe screening intervals in women with a double negative test (cytology and HPV) was deficient. Proactive attitudes to HPV vaccination in the priority age group (<27 years) was poor, with 63% of the surveyed physicians recommending vaccination. Surprisingly, 4% recommended vaccination in women older than 45 years. Fifteen percent reported they lacked time to explain that cytological testing every 3 years was safe, and 27% considered this practice unsafe. Thirty-five percent reported that the HPV test was unavailable in his/her environment. In 12% of cases, colposcopy was used to complement cytology at the initial visit. Conclusions. Although knowledge of HPV epidemiology and vaccines was adequate, proactive attitudes to HPV vaccination in the preferential age group were scarce. Complete adherence to SEGO recommendations was found in only 38% of participants. Nationwide strategies should be designed and introduced to spread and improve the implementation of these recommendations in daily clinical practice (AU)

[Septic shock by Vibrio vulnificus at the coast Gulf of Mexico]. / Choque séptico por Vibrio vulnificus en las costas del Golfo de México.

Vibrio vulnificus is a Gram-negative bacterium which is found in marine environments and where there is a partly enclosed coastal body of water with one or more rivers or streams flowing into it, and with a free connection to the open sea. The infection by these bacteria can cause primary septicemia by two mechanisms: upon consuming crustaceans, mollusks and some fish (filtering shellfish) raw or barely cooked or by an open injury in contact with seawater. The patients with infections of the primary injury by Vibrio vulnificus developed contaminated painful cellulitis that progresses quickly as well as a marked local inflammation with signs of hemorrhaging. We described a case of Vibrio vulnificus sepsis, with emphasis on the clinical picture, the epidemiological background and lab findings; finally we did a brief review of the literature related to the case.

Meningococcal disease: is it a latent disease in Mexico?

Infection by Neisseria meningitidis occurs frst as an asymptomatic carrier before the disease with serious manifestations like meningitis, with or without expressions of fulminating purpura. This disease is caused by different serogroups, A, B, C, Y and W-135 being the most prevalent. Over time they have undergone epidemiological changes in different regions of the world. There is scant information in our country concerning both the carrier and the invading forms; however, it has been proven in some Mexican states that the incidence of carrier status and of invading forms is signifcant. Accordingly, the possibilities of invading and secondary cases derived from the carrier and through contact with invading forms are feasible. Therefore, increasing the epidemiological surveillance and determining the actual burden of meningococcal disease is required. As far as preventive measures are concerned, prophylaxis of contacts with the index case and vaccination to control outbreaks or in high-risk specific cases is recommended. It would be reasonable as well to establish the indications of the vaccines available in our country.

Prevención primaria y secundaria de los cánceres de cuello de útero y vulva: recomendaciones para la práctica clínica / Primary and secondary prevention of cancers of the cervix and vulva: recommendations for clinical practice

La demostración del papel etiológico del virus del papiloma humano (VPH) para todos los cánceres de cuello de útero y para una fracción alta de los de vulva permite establecer nuevas estrategias para su prevención primaria y secundaria. Esta revisión persigue adecuar la práctica clínica sobre la prevención primaria y secundaria de los cánceres de cuello de útero y vulva a las mejores evidencias científicas disponibles, a través de recomendaciones prácticas siguiendo la estrategia basada en la evidencia con metodología GRADE y el método de consenso. La vacunación frente al VPH cuenta con evidencias de alto nivel que confirman su seguridad y eficacia. Su aplicación preferencial a niñas preadolescentes y a mujeres hasta los 26 años es una recomendación firme. La metodología del cribado sufre cambios, a partir de la confirmación de la eficacia del control trienal citológico hasta los 30 años y la incorporación a partir de esta edad de la determinación del VPH. De la aplicación conjunta de una vacunación con alta cobertura y de un cribado rediseñado, con el test de VPH en primera línea, surge la mejor protección frente al cáncer de cuello de útero. Para el cáncer de vulva, la vacuna tetravalente ha demostrado ya una alta eficacia en la prevención de sus lesiones precursoras. Una cuidada valoración de los síntomas y signos vulvares, especialmente en mujeres mayores, es la mejor manera de prevenir secundariamente la aparición del cáncer de vulva (AU)

Proof of the etiological role of the Human Papilloma Virus (HPV) for all cervical cancers and for a high percentage of cancers of the vulva allows us to establish new strategies for their primary and secondary prevention. Vaccination against the HPV shows level I evidence confirming its safety and efficacy. Its preferential application on pre-teenage girls and young women up to 26 years old is strongly recommended. Cervical cancer’s screening recommendations have reached a point of inflexion since the efficacy of cytological screening every 3 years for women under 30 years old was confirmed, and the very high efficacy of the HPV test on women over 30 years of age. As a result of the joint implementation of a high coverage vaccine and a redesigned screening programme, with front line HPV testing, we have better protection against cervical cancer. For cancer of the vulva, the tetravalent vaccine has already proved to be highly efficient in the prevention of its previous lesions. A careful valuation of vulvar symptoms, specially in older women, is the best way of secondarily preventing the apparition of a cancer of the vulva (AU)

Vacuna frente al virus del papiloma humano y cribado de cáncer de cuello de útero / Human papilloma virus vaccine and screening for cervical cancer

La vacunación frente al virus del papiloma humano (VPH) es una estrategia preventiva primaria altamente eficaz y segura contra el cáncer de cuello de útero, pero no elimina la necesidad de seguir aplicando a las mujeres vacunadas un programa de prevención secundaria. El uso clínico de la vacuna determinará un número apreciablemente menor de resultados citológicos anormales, expresión de la alta eficacia de la vacunación frente a la infección incidente por VPH. En consecuencia, se deberá usar una prueba muy sensible en primera línea del cribado en sustitución de la citología, con problemas de sensibilidad. La prueba de determinación del VPH es muy sensible, y cuando se usa en el grupo de edad adecuado (> 30 años) es muy específico. El uso sinérgico de vacunación y cribado rediseñado se ha mostrado en los modelos de evaluación publicados como una estrategia altamente eficaz y muy eficiente (AU)

The HPV vaccine is a primary preventive strategy against cervical cancer. It is highly effective and safe, but its implementation does not preclude the need to maintain a secondary prevention protocol for all vaccinated women. The clinical use of the vaccine will lead to a noticeably lower number of abnormal smear reports, as a result of the vaccine¿s high efficacy against the HPV infection. Consequently, a higher sensitivity test needs to be applied as a first-line screening test, instead of Pap smears, with lower sensitivity. The HPV test is highly sensitive, and when applied to the appropriate age group (30+), it is also very specific. In the published evaluation models, the combined use of the vaccine and the redesigned screening test has been proved to offer high levels of efficacy and efficiency (AU)

[Hysteroscopy findings in patients with postmenopausal genital bleeding]. / Hallazgos histeroscópicos en pacientes con sangrado genital posmenopáusico.

OBJECTIVE: To describe morphological and histological findings in postmenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS: An open, descriptive, observational, retrospective and cross sectional study was done at Clinica de Histeroscopia at Hospital Dr. Manuel Gea Gonzalez, in Mexico City. There were included 372 patients with postmenopausal abnormal uterine bleeding diagnosis without hormone replacement therapy. Hysteroscopy study was made with a 5 mm surgical hysteroscope using warm saline solution (280C) as a medium of distension, and a trans-hysteroscopy endometrial biopsy was taken for histopathological correlation. Statistic analysis was obtained using SPSS program version 10 for windows with a kappa test. In order to analyze more than two samples, we used the chi-square test. RESULTS: Endometrial atrophy was the most frequent hysteroscopic diagnosis (202 patients, 54.3%), followed by polyps (93 patients, 25%), cancer (14 patients, 4%) and hyperplasia (11 patients, 2.95%). Correlated results between hysteroscopic findings and hystopathological biopsy diagnosis obtained were: atrophy (157 cases, 63.3%), polyps (76 cases, 77.55%), endometrial cancer (14 cases, 93.05%), endometrial hyperplasia (10 cases, 90.63%) and miomatosis (three cases, 16.20%). CONCLUSION: It can be stated that there is a high level of concordance between findings of hysteroscopic studies and the directed endometrial biopsy. So, we recommend initially the use of hysteroscopy for diagnosis and treatment of endometrial cavity malignant and benign pathology.

Epidemiologic and ultrasonographic study of echinococcosis in a community in the state of Mexico.

No epidemiologic study for cystic echinococcosis in México has yet been described. The objective of this work was to determine the prevalence and distribution of human echinococcosis in a community of the state of México and its probable risk factors. A cross-sectional study was performed; household census was used to randomly select houses. The larval stage of Echinococcus was searched by ultrasound in liver, spleen, and kidney. A questionnaire was used for the investigation of risk factors. The study was performed with 401 persons, 64% were female. The prevalence of echinococcosis was 0.75%. Cases were distributed in the same sector of the community. The close distribution of cases suggests the same exposure source. There were 426 dogs in the community; feces were collected from 414 of these in search of cestode eggs. After treatment, 3 dogs had Taenia pisiformis but none had Echinococcus. This paper pioneers the search of human echinococcosis in México because it provides evidence of the presence of this tissue parasite at the community level.

Laboratory animal models for human Taenia solium.

Human beings are the only hosts of adult Taenia solium; thus, many aspects of the host-parasite relationship are unknown. The development of successful experimental models of taeniasis allows in-depth investigations of the host-parasite relationship. We established experimental models in hamsters, gerbils and chinchillas. Here we review our findings regarding the characteristics of the tapeworms, their anchoring site and development, as well as the humoral and cellular immune response they elicit. We also used statistics to analyze the data obtained in different infections performed along several years. Furthermore, we compared the size of T. solium rostellum and strobila recovered from hamsters and gerbils to those obtained from humans. Our data indicate that these rodents are adequate experimental models for studying T. solium in its adult stage; that parasites induce immune responses and that hamsters seem to be more permissive hosts than gerbils, since parasites survive for longer times, grow longer and develop more, and the inflammatory response in the intestinal mucosa against T. solium is moderate. Finally, chinchillas are the most successful experimental definitive model for adult T. solium, since tapeworms with gravid proglottids are obtained, and the life cycle can be continued to the intermediate host.

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico.

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.