Height growth of Mexican boys by geographic region: an evaluation based on nationally representative data of ENSANUT 2012 and 2018.

Existing research on human growth in Mexico is regionally focused, creating a gap in the understanding of growth patterns of children and adolescents at national level and regional variation. The objective of the present study was to characterize the height growth curve of the Mexican population by geographic area and to cluster the states of the Mexican Republic according to their somatic maturation characteristics, based on a national representative sample of boys. Data on age, height, socioeconomic level, and geographic area of 18,219 boys were obtained from the National Health and Nutrition Survey 2012 (ENSANUT) and ENSANUT 2018, carried out in 32 Mexican states. Both surveys had representative samples. Preece-Baines 1 model was applied to fit height growth curves. Biological parameters were estimated; principal component analysis and cluster analysis were performed to group Mexican states based on these biological parameters. The estimated age at peak height velocity (PHV) was 12.3 years in the sample. Significant regional differences in the timing and tempo of PHV among Mexican boys were observed. Boys in the northern region experienced PHV at an earlier age and had a shorter duration of growth compared with boys in the central and southern regions. Boys in the central region had a longer duration of growth and a later age of PHV compared with the boys in the southern region. The cluster that included the southern states of the country showed estimated lower adult height and earlier somatic maturation. A lower height was found in the low and low-middle socioeconomic levels compared with the medium-high and high socioeconomic levels. Future research in Mexico should focus on longitudinal studies to analyse the timing and tempo of growth and maturation, considering the impacts of environmental and genetic factors. Public health strategies should account for geographic variations.

Growth in height and its association with overweight and obesity in Mexican children: an evaluation based on a nationally representative sample (ENSANUT 2018).

The present study aimed to estimate the height growth curve for Mexican boys and girls based on their body mass index (BMI) status (normal and overweight/obese) and to develop a height Lambda, Mu, and Sigma (LMS) growth reference for Mexican children aged 2 to 18 years. Methods: Chronological age and height records (7,097 boys and 6,167 girls) were obtained from the Mexican National Survey of Health and Nutrition database. Height growth curves were fitted using the Preece-Baines 1 (PB1) model and the LMS method. Results: Age at peak height velocity (APHV) was 12.4 and 12.7 years for overweight-obese and normal-weight boys, respectively, and was 9.6 and 10.4 years for overweight-obese and normal-weight girls, respectively. Growth velocity was higher at the age of take-off (TO) in overweight-obese children than in normal-weight children (5.2 cm/year vs. 5 cm/year in boys and 6.1 cm/year vs. 5.6 cm/year in girls); nevertheless, the growth velocity at APHV was higher for normal-weight children than for overweight-obese children (7.4 cm/year vs. 6.6 cm/year in boys and 6.8 cm/year vs. 6.6 cm/year in girls, respectively). Distance curves developed in the present study and by the World Health Organization (WHO) using LMS showed similar values for L and S parameters and a higher M value compared with the WHO reference values. Conclusion: This study concluded that overweight-obese children had earlier APHV and lower PHV than normal-weight children. Furthermore, Mexican children and adolescents were shorter than the WHO growth reference by age and sex.

Molecular Factors in PAD2 (PADI2) and PAD4 (PADI4) Are Associated with Interstitial Lung Disease Susceptibility in Rheumatoid Arthritis Patients.

Around 50% of rheumatoid arthritis (RA) patients show some extra-articular manifestation, with the lung a usually affected organ; in addition, the presence of anti-citrullinated protein antibodies (ACPA) is a common feature, which is caused by protein citrullination modifications, catalyzed by the peptidyl arginine deiminases (PAD) enzymes. We aimed to identify single nucleotide variants (SNV) in PADI2 and PADI4 genes (PAD2 and PAD4 proteins, respectively) associated with susceptibility to interstitial lung disease (ILD) in RA patients and the PAD2 and PAD4 levels. Material and methods: 867 subjects were included: 118 RA-ILD patients, 133 RA patients, and 616 clinically healthy subjects (CHS). Allelic discrimination was performed in eight SNVs using qPCR, four in PADI2 and four in PADI4. The ELISA technique determined PAD2 and PAD4 levels in serum and bronchoalveolar lavage (BAL) samples, and the population structure was evaluated using 14 informative ancestry markers. Results: The rs1005753-GG (OR = 4.9) in PADI2 and rs11203366-AA (OR = 3.08), rs11203367-GG (OR = 2.4) in PADI4 are associated with genetic susceptibility to RA-ILD as well as the ACTC haplotype (OR = 2.64). In addition, the PAD4 protein is increased in RA-ILD individuals harboring the minor allele homozygous genotype in PADI4 SNVs. Moreover, rs1748033 in PADI4, rs2057094, and rs2076615 in PADI2 are associated with RA susceptibility. In conclusion, in RA patients, single nucleotide variants in PADI4 and PADI2 are associated with ILD susceptibility. The rs1748033 in PADI4 and two different SNVs in PADI2 are associated with RA development but not ILD. PAD4 serum levels are increased in RA-ILD patients.

Strength and VO2max Changes by Exercise Training According to Maturation State in Children.

The health benefits of physical activity (PA) are widely recognized; however, biological maturation contributions are a subject that has been little studied, which is why the aim of this study was to analyze the effect of a six-week training program at moderate-intensity on the muscular strength and aerobic capacity in children between nine and 13 years (13 ± 1.0 years) according to their maturation state. Twenty-six schoolchildren (15 girls) participated in a six-week physical exercise program based on aerobic/anaerobic capacity and coordination skills. Maximal oxygen uptake (VO2max), trunk-lift, push-ups, curl-ups, and handgrip strength (both hands) were measured as response variables. Body mass index (BMI), skeletal maturity indicator (SMI), peak height velocity (PHV), age on peak height velocity (APHV) and sex were considered as covariates. The results of VO2max, push-ups, curl-ups, and handgrip strength were higher after the exercise program in the whole group (p < 0.05). The VO2max showed a greater increase in the normal-weight than in the overweight-obesity children (p = 0.001). Higher results in dominant handgrip strength were observed in girls (p = 0.003). The PHV before intervention presented a positive correlation with the dominant handgrip strength in all kids (r = 0.70, p = 0.001). As a conclusion, the six-week training program improved the physical fitness of children independent of the maturation state. Somatic maturation increases the physical abilities in schoolchildren.

Estilo de vida activo según nuevas directrices de la OMS: ¿una influencia sobre la aptitud física, composición corporal y calidad de vida en mujeres mayores? / Active lifestyle according to new WHO guidelines: an influence on fitness, body composition and quality of life in elderly women? / Estilo de vida ativo segundo as novas diretrizes da OMS: uma influência na aptidão física, composição corporal e qualidade de vida em mulheres idosas?

RESUMEN La presente investigación tuvo como objetivo determinar la relación de la actividad física realizada sobre la aptitud física, composición corporal y calidad de vida en una población de mujeres adultas mayores de México. Estudio retrospectivo correlacional en el cual se clasificó a las mujeres según su estilo de vida activo de acuerdo a si cumple o no con las directrices publicadas por la Organización Mundial de la Salud [OMS] en 2020 sobre actividad física y comportamiento sedentario. La evaluación de la actividad física se registró a través del Cuestionario IPAQ, la aptitud física a través de la batería Senior Fitness Test, la composición corporal se estimó mediante impedancia bioeléctrica y la calidad de vida con el Cuestionario SF36. Los resultados de aquellas mujeres mayores que tienen un mayor gasto energético y que cumplen con las recomendaciones del tiempo destinado a la actividad física, muestran una mejor aptitud física, composición corporal y mayor percepción de la calidad de vida, sin embargo, la mayoría no cumple con estas recomendaciones.

ABSTRACT The present research aimed to determine the relation of the physical activity carried out (active or inactive lifestyle) on physical fitness, body composition, and quality of life in a population of older adult women in Mexico. Retrospective correlational study in which women were classified according to their active lifestyle according to whether or not they comply with the guidelines published by the World Health Organization [WHO] in 2020 on physical activity and sedentary behavior. The evaluation of physical activity was recorded through the IPAQ Questionnaire, physical fitness through the Senior Fitness Test battery, body composition was estimated using bioelectrical impedance, and quality of life with the SF36 Questionnaire. As a result, we find that those elderly women who have a higher energy expenditure and who comply with the recommendations of the time allocated to physical activity, show better physical fitness, body composition, and greater perception of quality of life, however, most do not comply with these recommendations.

RESUMO O objetivo desta pesquisa foi determinar a relação da atividade física realizada na aptidão física, composição corporal e qualidade de vida em uma população de mulheres idosas no México. Estudo retrospectivo correlacional em que as mulheres foram classificadas de acordo com seu estilo de vida ativo de acordo com as diretrizes publicadas pela Organização Mundial da Saúde [OMS] em 2020 sobre atividade física e comportamento sedentário. A avaliação da atividade física foi registrada através do Questionário IPAQ, a aptidão física através da bateria Senior Fitness Test, a composição corporal foi estimada através da bioimpedância elétrica e a qualidade de vida com o Questionário SF36. Os resultados daquelas idosas que possuem maior gasto energético e que cumprem as recomendações do tempo destinado à atividade física, evidenciam melhor aptidão física, composição corporal e maior percepção da qualidade de vida, porém, a maioria não cumpre, com estas recomendações.

Genetic Variants in Smoking-Related Genes in Two Smoking Cessation Programs: A Cross-Sectional Study.

Previous studies have identified variants in genes encoding proteins associated with the degree of addiction, smoking onset, and cessation. We aimed to describe thirty-one single nucleotide polymorphisms (SNPs) in seven candidate genomic regions spanning six genes associated with tobacco-smoking in a cross-sectional study from two different interventions for quitting smoking: (1) thirty-eight smokers were recruited via multimedia to participate in e-Decídete! program (e-Dec) and (2) ninety-four attended an institutional smoking cessation program on-site. SNPs genotyping was done by real-time PCR using TaqMan probes. The analysis of alleles and genotypes was carried out using the EpiInfo v7. on-site subjects had more years smoking and tobacco index than e-Dec smokers (p < 0.05, both); in CYP2A6 we found differences in the rs28399433 (p < 0.01), the e-Dec group had a higher frequency of TT genotype (0.78 vs. 0.35), and TG genotype frequency was higher in the on-site group (0.63 vs. 0.18), same as GG genotype (0.03 vs. 0.02). Moreover, three SNPs in NRXN1, two in CHRNA3, and two in CHRNA5 had differences in genotype frequencies (p < 0.01). Cigarettes per day were different (p < 0.05) in the metabolizer classification by CYP2A6 alleles. In conclusion, subjects attending a mobile smoking cessation intervention smoked fewer cigarettes per day, by fewer years, and by fewer cumulative pack-years. There were differences in the genotype frequencies of SNPs in genes related to nicotine metabolism and nicotine dependence. Slow metabolizers smoked more cigarettes per day than intermediate and normal metabolizers.

¿El 20 % de los pacientes oncológicos fallece por caquexia? / Do 20 % of cancer patients die from cachexia?

No disponible

Crisis de opioides: ¿nos afecta? / Opioid crisis: does it affect us?

No disponible

Entrenamiento de la capacidad aerobia en prepúberes. Revisión sistemática / Trainability of aerobic capacity in prepubescent: Systematic review / Treinamento da capacidade aeróbica em pré-púberes: revisão sistemática

El incremento de la capacidad aerobia en prepúberes beneficia a la salud y favorece la iniciación deportiva. Sin embargo, existe controversia sobre sí tales mejoras y en qué medida pueden ser inducidas por un entrenamiento físico en prepúberes. El objetivo fue realizar una revisión sistemática para identificar los cambios en la capacidad aerobia por efecto del entrenamiento en prepúberes. Se revisaron seis bases de datos electrónicas, acorde al cumplimiento de la declaración PRISMA. Solo 11 artículos cumplieron con los criterios establecidos para su inclusión. Se encontró mejoría de la capacidad aerobia en el 73 % de los estudios; y solo en tres estudios no se observaron cambios debido a detalles metodológicos. Sin embargo, es necesario unificar los programas de entrenamiento, así como el diseño de los estudios para establecer con contundencia el entrenamiento de la capacidad aerobia en prepúberes

Increase of aerobic capacity in children and adolescents is associated with greater health benefits and promotes the sport initiation. However, it has not been determined whether these changes could be attributed to the physical training or are really induced by the natural maturation process in prepubertal children. The aim of this study was to do a systematic review to identify the changes in aerobic capacity by a physical training program in prepubescents. A systematic review in six electronic databases was performed, according to the accomplishment of the PRISMA declaration. Only 11 articles were selected. Increases in aerobic capacity were found in 73 % of the included articles in the present review; and only in three studies changes were not seen due methodological issues. However, it is necessary to unify training protocols, as well as studies design to establish the aerobic capacity training in prepubescents

A melhora da capacidade aeróbica em pré-púbere beneficia a saúde e favorece a iniciação esportiva. No entanto, existe controversia sobre essa possível melhoria e em que medida podem ser induzidas pelo treinamento físico em pré-púberes. O objetivo foi realizar uma revisão sistemática para identificar as mudanças na capacidade aeróbica por conta do efeito do treinamento físico em pré-púberes. Foram revisadas seis bases de dados eletrônicas, de acordo com o cumprimento da declaração PRISMA. Somente 11 artigos preencheram os critérios estabelecidos de inclusão. A melhora da capacidade aeróbica foi encontrada em 73% dos estudos; e somente em três estudos não foram observadas alterações devido aos detalhes metodológicos. No entanto, é necessário unificar os programas de treinamento, bem como o desenho dos estudos para estabelecer o treinamento da capacidade aeróbica em pré-púberes

Data on genotype frequency for SNPs associated to age of smoking onset and successful smoking cessation treatment.

This article contains data on the allele and genotype frequency for single nucleotide polymorphisms (SNPs) in candidate genes CHRNA5 (rs16969968, rs17408276, rs680244) CHRNA3 (rs6495307, rs12914385) NRXN1 (rs10865246, rs1882296, rs985919) and HTR2A (rs6311, rs6313) previously evaluated as genetic risk variants for cigarette smoking at an early age and relapse to smoking cessation treatment Pérez-Rubio et al., 2018. These SNPs were selected due to previous associations in other populations, including Mexican Mestizos. Smokers were classified according to the age at onset, cigarettes per day, nicotine dependence, COPD status and therapy received.

Genetic variants as risk factors for cigarette smoking at an early age and relapse to smoking cessation treatment: A pilot study.

OBJECTIVES: Tobacco smoking is a complex and multifactorial disease involving both environmental and genetic factors. In the Mexican mestizo population, single-nucleotide polymorphisms (SNPs) associated with cigarette smoking and a greater degree of nicotine addiction have been identified; however, no possible roles have been explored in regard to the age of onset of smoking or in the success of quitting. METHODS: In this study, 151 Mexican mestizo, who smoke cigarettes, were included. They were grouped according to the age at which they started smoking: those who started smoking before 18 years of age (early smokers, ES) and those who started smoking ≥18 years of age (late smokers, LS). In addition, relapse in smoking was evaluated at the first month after the end of treatment. Genetic association was evaluated characterizing 10 SNPs in 4 genes (CHRNA5, CHRNA3, NRXN1, and HTR2A). RESULTS: According to the dominant model of genetic inheritance, rs6313 (CT+TT) of the HTR2A gene was associated (p = 0.0201) with cigarette consumption at early ages (OR = 2.68, CI = 1.18-6.07). When the risk of relapse was analyzed one month after the end of treatment, regardless of the age of onset, the T allele (rs6313) of HTR2A appeared to be a risk factor for relapse (OR = 2.92, 95% CI = 1.06-8.11); the T allele was found more frequently in those who relapsed (50.0%) compared with people who maintained abstinence (25.4%) (p = 0.0332). CONCLUSIONS: Our findings suggest that in Mexican mestizos who smoke cigarettes, the presence of the T allele in rs6313 of the HTR2A gene increases the risk for the early onset of cigarette smoking as well as the risk for relapsing one month after completing smoking cessation treatment.

The VNTR 48 bp Polymorphism in the DRD4 Gene Is Associated with Higher Tobacco Smoking in Male Mexican Mestizo Smokers with and without COPD.

Cigarette smoking is influenced by nicotine's effects on dopaminergic activity, which appear to be moderated by genetic variation, particularly a variable number tandem repeat (VNTR, 48 bp) polymorphism in the third exon of the dopamine receptor gene (DRD4). Smokers with the VNTR ≥7 repeats (long, L allele) report markedly increased participation in some smoking behaviors; hence, our aim was to evaluate the association of the L allele in Mexican Mestizo smokers with and without COPD. The DRD4 VNTR 48 bp was genotyped in 492 Mexican Mestizo smokers: 164 COPD patients (≥20 cigarettes per day, cpd), 164 heavy smokers without COPD (HS, ≥20 cpd) and 164 light smokers without COPD (LS, 1-10 cpd). In the dominant model analysis (SL + LL vs. SS), men in the COPD and HS groups showed a statistical difference compared to LS (p = 0.01, OR = 2.06, CI 95% 1.17-3.64 and p = 0.05, OR = 1.88, CI 95% 1.03-3.45, respectively). In addition, by clustering smokers >20 cpd (COPD + HS) and comparing with the LS group, we found an association with increased risk of higher tobacco smoking p = 0.01, OR = 1.99, CI 95% 1.18-3.34. In conclusion, the long allele (L) in the VNTR of the DRD4 gene is associated with the risk of presenting higher tobacco smoking in male Mexican Mestizo smokers.

Revistas de acceso abierto y voracidad editorial en cuidados paliativos / Open access journals and predatory publishing in palliative care

OBJETIVO: Las revistas de acceso abierto han aumentado en los últimos años en todos los ámbitos de la medicina. Una corrupción de este acceso abierto es lo que se ha llamado voracidad editorial (predatory publishing). Pretendemos conocer qué revistas del ámbito de cuidados paliativos están disponibles en acceso abierto y saber si pueden tener perfil de voracidad editorial. MÉTODO: Búsqueda de revistas sobre cuidados paliativos en acceso abierto en buscadores online, registros de revistas y correos electrónicos recibidos de estas publicaciones. Variables registradas: nombre, editorial y página web de la revista, perfil del pago, inclusión en lista de Beall, registro e indexación, correos electrónicos solicitando trabajos, posibilidad de optar a revisor o comité editorial. RESULTADOS: Se encontraron 32 revistas del ámbito de cuidados paliativos con opción total o parcial de acceso abierto; tres de ellas no se encontraban activas. La mediana de coste por publicación de un trabajo original fue de 1.389€. Se encontraron tres perfiles de publicación: nueve revistas de editoriales reconocidas, indexadas e incluso con factor de impacto que admiten la posibilidad de publicar con acceso abierto; siete revistas de editoriales de perfil académico (open access scholarly), algunas indexadas y con factor de impacto, que solo publican con acceso abierto, y 16 revistas sospechosas de voracidad editorial. Encontramos asociación entre la presencia en la lista de Beall y algunos criterios de sospecha de voracidad editorial: ausencia de factor de impacto (p = 0,004) o de indexación en PubMed (p = 0,001); ausencia de registro en OASPA (p = 0,001); envío de correos electrónicos solicitando trabajos (p = 0,05); opción de pago único por periodo de tiempo (p = 0,02), y flexibilidad en el pago según tipo de artículo (p = 0,02). CONCLUSIONES: En el ámbito de los cuidados paliativos hay publicaciones de acceso abierto, algunas de ellas sospechosas de ser voracidad editorial

OBJECTIVE: Open access journals have increased in recent years in all areas of medicine. Predatory publishing is corrupting this open access. The objective of this study is to find out the medical journals that are available in open access in the field of Palliative Care and establish whether they could have a predatory publishing profile. Method: Online search with Google and Bing, and a search in open access journal registries, and e-mails from open access Palliative Care journals. Registered variables: name, editorial and website of the journal, payment profile, inclusion in Beall's list register and indexation, e-mails requesting articles, and possibility to become reviewer or editorial committee. RESULTS: We found 32 journals in the field of Palliative Care with full or partial open access option; three of them were not active. The median original publication fee was 1389€. Globally, three types of journal could be distinguished: 9 journals of recognized publishers, indexed and even with impact factor, that allow the possibility of publishing with open access; 7 open access scholarly journals, some indexed and with impact factor, that only publish open access, and 16 suspected predatory journals. We found an association between the presence of the journal on Beall's list and some suspicion criteria for predatory publishing such as: absence of impact factor (P=.004) or PubMed indexation (P=.001); no OASPA registration (P=.001); e-mails requesting works (P=.05); option of payment per time period (P=.02); and flexibility in payment according to type of article (P=.02). CONCLUSIONS: In the field of Palliative Care there open access publications, however some of them are suspected predatory publishing

TNF promoter polymorphisms are associated with genetic susceptibility in COPD secondary to tobacco smoking and biomass burning.

Background: Smoking and smoke from biomass burning (BB) are the main environmental risk factors for COPD. Clinical differences have been described between COPD related to smoking and related to wood smoke, but no studies have shown genetic differences between patients exposed to these two risk factors. Methods: To investigate a possible association of tumor necrosis factor (TNF) promoter polymorphisms, we conducted a case-control study. A total of 1,322 subjects were included in four groups: patients with a diagnosis of COPD secondary to smoking (COPD-S, n=384), patients with COPD secondary to biomass burning (COPD-BB, n=168), smokers without COPD (SWOC, n=674), and biomass burning-exposed subjects (BBES n=96). Additionally, a group of 950 Mexican mestizos (MMs) was included as a population control. Three single nucleotide polymorphisms (SNPs) were selected in the TNF gene (rs1800629, rs361525, and rs1800750) and one SNP in the lymphotoxin alpha gene (rs909253). Results: Statistically significant differences were found with genotype GA of the rs1800629: COPD-S vs SWOC, (p<0.001, odds ratio [OR] =2.55, 95% CI=1.53-4.27); COPD-S vs COPD-BB (p,0.01). When performing the comparison of the less severe (G1: I + II) and the more severe (G2: III + IV) levels, differences were identified in G1 (p<0.05, OR=1.94, 95% CI=1.04-3.63) and G2 (p<0.001, OR=3.68, 95% CI=1.94-3.07) compared with SWOC. Regarding genotype GA of rs361525, it has been associated when comparing COPD-BB vs BBES (p=0.0079, OR=5.99, 95% CI=1.38-53.98). Conclusion: The heterozygous genotype GA of polymorphisms rs1800629 and rs361525 in the TNF promoter are associated with the risk of COPD.

Genetic polymorphisms in CYP2A6 are associated with a risk of cigarette smoking and predispose to smoking at younger ages.

Nicotine is the main component of cigarettes that causes addiction, which is considered a complex disease, and genetic factors have been proposed to be involved in the development of addiction. The CYP2A6 gene encodes the main enzyme responsible for nicotine metabolism. Depending on the study population, different genetic variants of CYP2A6 associated with cigarette smoking have been described. Therefore, we evaluated the possible association between SNPs in CYP2A6 with cigarette smoking and nicotine addiction-related variables in Mexican mestizo smokers. We performed a genetic association study comparing light smokers (LS, n=349), heavy smokers (HS, n=351) and never-smokers (NS, n=394). SNPs rs1137115, rs4105144, rs1801272 and rs28399433 were genotyped in the CYP2A6 gene. We found that the A allele of rs1137115 (OR=1.41) in exon 1 of CYP2A6 and the T allele of rs4105144 (OR=1.32) in the 5' UTR of the gene are associated with the risk of cigarette smoking (p<0.05); rs1137115 affects the level of alternative splicing, resulting in a CYP2A6 isoform with low enzymatic activity, whereas rs4105144 is likely to be in a binding site for the transcription factor for glucocorticoids receptor (GR) and regulates the expression of CYP2A6. In addition, having a greater number of risk alleles (rs1137115 (A), rs4105144 (T) and rs28399433 (G)) is associated with a younger age at onset. The present study shows that in Mexican mestizos, the analyzed SNPs confer greater risk in terms of consumption and age of onset.

Redes integradas de servicios de salud: gestión de tres programas sanitarios en red. Resultados y alcances en la red sudeste, área programática Hospital El Cruce, región sanitaria VI, provincia de Buenos Aires / Integrated networks of health services: management of three network health programs. Results and scope in the southeast network, Hospital El Cruce programmatic area, health region VI, province of Buenos Aires

OBJETIVO Se abordará el análisis de las capacidades técnico-asistenciales y de gestión para el desarrollo de tres Programas sanitarios estratégicos en la red de servicios de salud de la Subregión Sudeste, Área programática del Hospital El Cruce, Región Sanitaria VI, Provincia de Buenos Aires. Se seleccionaron tres Programas, que por su relevancia sanitaria en términos de impacto en salud y por los procesos de interacción entre servicios que implican, ponen de manifiesto el grado de consolidación de la red, alcances y obstáculos a revertir. Estos Programas son; Programa de Cardiopatías Congénitas, Programa de Procuración y Trasplante y Programa Cirugías de Corta Estancia. Los dos primeros representan Programas de alta complejidad y el tercero corresponde a intervenciones de baja complejidad asistencial. METODOLOGÍA El diseño metodológico será cuantitativo y cualitativo, incluyendo variables de estructura, procesos y resultados de los Programas en el contexto de la red. Por su temporalidad y procesos aplicados para la recolección de datos se trata de un estudio transversal retroprospectivo, que triangula información secundaria con fuentes primaria aplicando entrevista a actores claves. RESULTADOS El estudio contribuirá a la identificación de barreras y oportunidades para la consolidación de redes, particularmente referidas a la accesibilidad y cobertura efectiva de los Programas estudiados; posibilitará sistematizar capacidades técnico asistenciales y de gestión que aporten base a la planificación de procesos de atención en red y de recursos asistenciales; y aportará evidencias para el desarrollo de herramientas de medición de brechas asistenciales y de cobertura en los Programas seleccionados y en la red en general

¿Conspiración del silencio o confabulación en la negación? / Conspiracy of silence or collusion in denial?

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Tratamiento de la incontinencia urinaria de esfuerzo con cinta libre de tensión sistema obturador TVTO / Effort urinary incontinence: Treatment with obturator system tension free vaginal tape TVTO

Resumen Objetivo: En busca de mejorar el tratamiento de la incontinencia urinaria de esfuerzo (IUE), se dan a conocer ventajas y beneficios con la técnica cinta libre tensión obturador (tension-free vaginal tape obturador, TVTO, por sus siglas en inglés). Material y métodos: Estudio prospectivo observacional y descriptivo. Se revisaron expedientes clínicos de pacientes con UIE tratadas con TVTO de diciembre de 2004 a diciembre de 2008 (N = 108) en quienes se usó una cinta de polipropileno no absorbible TVTO, Gynecare Jhonson & Jhonson. Datos a investigar: edad, gestaciones, diagnóstico, índice de masa corporal, anestesia, sangrado operatorio, tiempo quirúrgico, complicaciones, estancia hospitalaria, valoración de continencia. Se utilizaron porcentajes, promedios y medidas de tendencia central. Resultados: Se estudiaron 108 pacientes de 39 a 74 años (edad promedio: 48 años). Gestaciones promedio, 3. Se diagnosticaron 52 (48.1%) con IUE, 33 (30.5%) con IUE y cistocele, 23 (21.2%) con IUE recidivante, 46 (42.5%) con peso normal, 39 (36.1%) con sobrepeso, 23 (21.2%) con obesidad. En el 100% se aplicó bloqueo peridural. Tiempo quirúrgico promedio de 24 min. Sangrado operatorio promedio de 30 ml. Complicaciones: retención urinaria, 1 (0.9%); equimosis en muslo, 1 (0.9%); perforación de uretra, 1 (0.9%); estancia hospitalaria, 1 día. Seguimiento a 7 y 30 días, continencia urinaria, 100%; 3 meses, continencia del 100%; a los 6 y 12 meses, 99.07% de continencia urinaria. Actualmente la continencia es de 99.07%. Conclusión. La técnica TVTO reduce morbilidad, tiempo quirúrgico, estancia hospitalaria, incapacidad, y permite que la paciente se reicorpore más rápido a sus actividades y mejore su calidad de vida, en comparación con el estándar de oro para tratamiento de IUE. En manos expertas el tiempo quirúrgico es de 12 min.

Abstract Objective: Seeking a better treatment for Effort Urinary Incontinence (EUI). Announce the advantages and disadvantages of this technique. Material and methods: descriptive, observational prospective study. The clinical records of patients treated with TVTO for EUI with were reviewed. From December 2004 to December 2008 (N=108). Nonabsorbable polypropylene TVTO, Gynecare Jhonson & Jhonson, was used. The following data were assessed: age, number of pregnancies, diagnosis, body mass index, anesthesia, surgical bleeding, surgical time, complications, hospital stay, assessing continence; using percentages, averages, and measures of central tendency. Results: We studied 108 patients from 39 to 74 years of age, average 48 years-old. Average number of pregnancies: 3. 52 diagnosed with EUI (48.1%), EUI and cystoce-le 33 (30.5%), recurrent EUI 23 (21.2%), 46 with normal body weight (42.5%), overweight 39 (36.1%), obesity 23 (21.2%). Epidural anesthesia was applied to the 100% of patients. Average surgical time 24 minutes; average surgical bleeding 30 ml. Complications: urinary retention 1 (0.9%), thigh ecchymosis 1 (0.9%), urethral perforation 1 (0.9%); hospital stay 1 day. Follow-up at 7 and 30 days, urinary continence 100%, 3-month continence 100%; 6-and 12-month continence 99.07%. Currently, continence is 99.07%. Conclusion: TVTO technique reduces morbidity, surgical time, hospital stay, disability, promoting a faster return of the patient to normal activities, improving quality of life, compared with the gold standard treatment for EUI. In expert's hands, the surgical time is 12 minutes.

[The morbidity and mortality in vaginal hysterectomy performed with bipolar electrosurgery]. / Morbilidad y mortalidad en histerectomía vaginal por electrocirugía bipolar con biclamp.

OBJECTIVE: to know the morbidity and mortality in vaginal hysterectomy (VH) carried out with bipolar electrosurgery (BiClamp). METHODS: a multicentric study with 380 patients who underwent to VH for benign illness, with and without prolapse, with and without abdominal previous surgeries using Biclamp was carried out. RESULTS: twenty five patients (6.57 %) presented complications. The most frequent were related to the urinal system and infection, when VH was carried out. Bladder injury in five cases (1.31 %), vesicular-vagina fistula in two cases (0.52 %). Vaginal vault abscesses in seven cases (1.84 %). A second surgery due to intra abdominal bleeding in four cases (1.05 %) was carried out. Vaginal vault bleeding was present in two cases (0.52 %); other complications were: hematoma in vaginal vault, thrombophlebitis, sepsis and death with one case (0.26 %) for each one. The injuries were repaired by a gynecologist and the fistulae by an urologist. The bleeding was inmediately remedied and the infection was treated with cephalosporin. CONCLUSIONS: the morbidity and the operative mortality were in the range reported in the literature. This technique is quicker, less invasive, with a prompt patient recovery.