[Indicators of rational prescription of medicines: feasibility of application in institutions in the AmericasIndicadores de prescrição racional de medicamentos: viabilidade de aplicação em instituições das Américas]. / Indicadores de prescripción racional de medicamentos: factibilidad de aplicación en instituciones de las Américas.

OBJECTIVE: Evaluate the feasibility of monitoring the quality of use of medicines in health institutions in countries of the Region of the Americas by means of rational prescription indicators. METHODOLOGY: A quantitative study of the use of medicines was conducted during the period 2016-2018. Rational prescription indicators were developed and selected in accordance with international reference values and the best available evidence for: 1) anti-inflammatory drugs: prescription of ibuprofen and/or naproxen as a percentage of all prescribed non-steroidal anti-inflammatory drugs; 2) oral antidiabetics: metformin as a percentage of all prescribed antidiabetics, and metformin and/or sulfonylureas as a percentage of all prescribed antidiabetics; 3) insulins: crystalline insulin and NPH as a percentage of total prescribed insulins; and 4) antihypertensive drugs: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs-II), and thiazide diuretics as a percentage of all prescribed antihypertensives. The defined daily dose (DDD) per 1 000 inhabitants was used as a measure of consumption per institution. RESULTS: Prescription of metformin as a percentage of all antidiabetics was lower than the value of the reference indicator (27.9%-67.6% vs. 88%), while the prescription of metformin and/or a sulfonylurea was comparable with that value (80.9%-97.5% vs. 88%). The values of NPH, crystalline, and NPH/crystalline insulin in relation to all prescribed insulins were variable with respect to the reference indicator (37.1%-100% vs. 75%). Prescription of ibuprofen and naproxen was below the value of the indicator (20%-50% vs. 80%). The percentage of ACE inhibitors, ARBs, and thiazides with respect to all antihypertensives ranged from 65.2%-77.2% to 65%, consistent with the value of the proposed indicator. CONCLUSIONS: The feasibility of applying the selected and constructed indicators of rational prescription was demonstrated. These indicators provide useful information for analyzing the quality of prescription in health institutions in countries in the Region and are a useful tool for periodically monitoring it.

OBJETIVO: Avaliar a viabilidade de monitorar a qualidade do uso de medicamentos em instituições de saúde em países da Região das Américas por meio de indicadores de prescrição racional. MÉTODOS: Foi realizado um estudo quantitativo do uso de medicamentos durante o período 2016-2018. Indicadores de prescrição racional foram desenvolvidos e selecionados de acordo com referências internacionais e as melhores evidências disponíveis para: 1) anti-inflamatórios: prescrições de ibuprofeno e/ou naproxeno como porcentagem da prescrição total de anti-inflamatórios não esteroidais; 2) antidiabéticos orais: prescrições de metformina como porcentagem de todos os antidiabéticos prescritos, metformina e/ou sulfonilureias como porcentagem de todos os antidiabéticos prescritos; 3) insulinas: insulina cristalina e NPH como porcentagem do total de insulinas prescritas; e 4) anti-hipertensivos: porcentagem de inibidores da enzima de conversão da angiotensina (IECA), antagonistas do receptor da angiotensina II (BRA) e diuréticos tiazídicos sobre o total de anti-hipertensivos prescritos. A dose diária definida (DDD) por 1 000 habitantes por dia (DHD) foi usada como medida de consumo por instituição. RESULTADOS: A prescrição de metformina em relação a todos os antidiabéticos foi inferior ao valor do indicador de referência (27,9%-67,6% x 88%), enquanto a prescrição de metformina e/ou uma sulfonilureia foi comparável ao valor de referência (80,9%-97,5% x 88%). As porcentagens de prescrição de insulina NPH, cristalina e NPH/cristalina em relação a todas as insulinas prescritas foram variáveis em relação ao valor de referência (37,1%-100% x 75%). A prescrição de ibuprofeno e naproxeno foi inferior ao valor de referência (20%-50% x 80%). A porcentagem de IECA, BRA e tiazídicos em relação a todos os anti-hipertensivos variou entre 65,2% e 77,2%, compatível com o valor do indicador proposto (65%). CONCLUSÕES: Demonstrou-se a viabilidade de aplicação dos indicadores de prescrição racional aqui selecionados e construídos, os quais fornecem informações úteis para analisar a qualidade da prescrição nas instituições de saúde dos países da Região e representam uma ferramenta útil para seu monitoramento periódico.

Adherence to antihypertensive drug treatment in Argentina: A multicenter study.

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.

Primary amoebic meningoencephalitis: a new case from Venezuela.

Primary amoebic meningoencephalitis (PAM) is not often seen. To date, less than 300 cases have been communicated to the medical literature since the disease was first discovered in 1965. Six of these reports originated in Venezuela. The authors describe a new spontaneous case of PAM in a 33-year-old previously healthy Western-Venezuelan man.

La Economia Colaborativa: propuesta de bases conceptuales para su estudio / The Sharing Economy: a proposal of conceptual basis for its study / A Economia Colaborativa: uma proposta de base conceptual para o seu estudo

RESUMEN En este documento se presentan las bases conceptuales para el estudio de la Economia Colaborativa. Se plantean las diferencias entre las modalidades de intercambio econômico emergentes a partir de la mediación tecnológica, tales como la economia de conciertos y la economia digital. Para esto, se realizó una búsqueda bibliográfica a partir de la metodologia de revision sistemática de literatura para ciencias sociales y económicas en Scopus, WoS y Redalyc en el periodo 2008-2019. Este ejercicio permitió ubicar a la economia colaborativa como una nueva institución económica que posee cuatro subsectores: consumo, producción, educación y finanzas. La economía colaborativa se distingue por las soluciones particulares, la forma de solucionar las necesidades de las personas y en la creación de comunidad. El documento concluye que a) es importante que la academia y los estados miren con detenimiento las diferencias entre las modalidades estudiadas y b) la economia colaborativa es un mecanismo para el cambio social.

ABSTRACT This paper presents the conceptual bases for the study of the Sharing Economy. The differences between the modalities of economic exchange emerging from technological mediation, such as the gig economy and the digital economy are presented. For this purpose, a literature search was conducted using the systematic literature review methodology for social sciences and economics in Scopus, WoS and Redalyc in the period 2008-2019. This exercise allowed us to locate the Sharing Economy as a new economic institution with four subsectors: consumption, production, education and finance. The Sharing Economy is distinguished by particular solutions, the way of solving people's needs and in the creation of community. The document concludes that a) it is important for academia and states to look carefully at the differences between the modalities studied and b) the collaborative economy is a mechanism for social change.

RESUMO Este documento apresenta a base conceitual para o estudo da Economia Colaborativa. As diferenças entre os modos emergentes de intercâmbio econômico através da mediação tecnológica, como a economia gig e a economia digital, são discutidas. Para este fim, foi realizada uma pesquisa bibliográfica utilizando a metodologia de revisão sistemática de literatura para ciências sociais e economia em Scopus, WoS e Redalyc no periodo 2008-2019. Este exercício nos permitiu identificar a economia colaborativa como uma nova instituição econômica com quatro sub-setores: consumo, produção, educação e finanças. A economia colaborativa se distingue por soluções particulares na forma como as necessidades das pessoas são resolvidas e na criação de comunidade. O documento conclui que a) é importante para o meio acadêmico e os estados examinar de perto as diferenças entre as modalidades estudadas e b) a economia colaborativa é um mecanismo de mudança social.

[Primary amebic meningoencephalitis: two new cases report from Venezuela]. / Meningoencefalitis amebiana primaria: comunicacion de dos nuevos casos Venezolanos.

Primary amebic menigoencephalitis (PAM) is rare. Two cases of PAM in Venezuelan patients are described. Case 1, a 10 year-old male with headache, fever, vomiting. The patient swam in a water reservoir before the onset of his disease. He died during his third hospital day. Case 2, a 23 year-old male with a history of headache, fever, vomiting, drowsiness, and behavioral disturbances. The patient died on his second hospital day. The diagnosis in both cases was PAM due to Naegleria fowleri. Central nervous system infection by free-living amebas should be considered in meningoencephalitides with bacterial-free cerebro-spinal fluid.

The Role of Science in Advising the Decision Making Process: A Pathway for Building Effective Climate Change Mitigation Policies in Mexico at the Local Level.

This study examines a pathway for building urban climate change mitigation policies by presenting a multi-dimensional and transdisciplinary approach in which technical, economic, environmental, social, and political dimensions interact. Now, more than ever, the gap between science and policymaking needs to be bridged; this will enable judicious choices to be made in regarding energy and climate change mitigation strategies, leading to positive social impacts, in particular for the populations at-risk at the local level. Through a case study in Juarez, Chihuahua, Mexico, we propose a multidimensional and transdisciplinary approach with the role of scientist as policy advisers to improve the role of science in decision-making on mitigation policies at the local level in Mexico.

Indicadores de prescripción racional de medicamentos: factibilidad de aplicación en instituciones de las Américas

[RESUMEN]. Objetivo. Evaluar la factibilidad de monitorear la calidad de la utilización de medicamentos en instituciones sanitarias de países de la Región de las Américas mediante indicadores de prescripción racional. Métodos. Se realizó un estudio cuantitativo de utilización de medicamentos durante el período 2016-2018. Se desarrollaron y seleccionaron indicadores de prescripción racional de acuerdo a referencias internacionales y a la mejor evidencia disponible para: 1) antiinflamatorios: porcentaje de prescripción de ibuprofeno y/o naproxeno sobre prescripción total de antinflamatorios no esteroideos; 2) antidiabéticos orales: metformina como porcentaje de todos los antidiabéticos prescritos, metformina y/o sulfonilureas como porcentaje de todos los antidiabéticos prescritos; 3) insulinas: insulina cristalina y NPH como porcentaje del total de insulinas prescritas y 4) medicamentos antihipertensivos: porcentaje de inhibidores de la enzima convertidora de la angiotensina (IECA), antagonistas de los receptores de la angiotensina II (ARA-II) y diuréticos tiazídicos sobre el total de antihipertensivos prescritos. Se empleó la dosis diaria definida (DDD) por 1 000 habitantes y día (DHD) como medida del consumo por institución. Resultados. La prescripción de metformina con relación a todos los antidiabéticos fue menor al valor del indicador de referencia (27,9%-67,6% vs. 88%), mientras que la prescripción de metformina y/o una sulfonilurea fue comparable con dicho valor (80,9%-97,5% vs. 88%). Los valores de insulina NPH, cristalina y NPH/ cristalina con relación a las insulinas prescritas fueron variables frente al valor del indicador de referencia (37,1%-100% vs. 75%). La prescripción de ibuprofeno y naproxeno estuvo por debajo del valor del indicador (20%-50% vs. 80%). El porcentaje de IECA, ARA-II y tiazidas respecto a todos los antihipertensivos osciló entre 65,2%-77,2% vs 65%, acorde al valor del indicador propuesto. Conclusiones. Se demostró la factibilidad de aplicar los indicadores de prescripción racional seleccionados y construidos, que proporcionan información útil para analizar la calidad de la prescripción en las instituciones sanitarias de países de la Región y representan una herramienta útil para su monitoreo periódico.

[ABSTRACT]. Objective. Evaluate the feasibility of monitoring the quality of use of medicines in health institutions in countries of the Region of the Americas by means of rational prescription indicators. Methodology. A quantitative study of the use of medicines was conducted during the period 2016-2018. Rational prescription indicators were developed and selected in accordance with international reference values and the best available evidence for: 1) anti-inflammatory drugs: prescription of ibuprofen and/or naproxen as a percentage of all prescribed non-steroidal anti-inflammatory drugs; 2) oral antidiabetics: metformin as a percentage of all prescribed antidiabetics, and metformin and/or sulfonylureas as a percentage of all prescribed antidiabetics; 3) insulins: crystalline insulin and NPH as a percentage of total prescribed insulins; and 4) antihypertensive drugs: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs-II), and thiazide diuretics as a percentage of all prescribed antihypertensives. The defined daily dose (DDD) per 1 000 inhabitants was used as a measure of consumption per institution. Results. Prescription of metformin as a percentage of all antidiabetics was lower than the value of the reference indicator (27.9%-67.6% vs. 88%), while the prescription of metformin and/or a sulfonylurea was comparable with that value (80.9%-97.5% vs. 88%). The values of NPH, crystalline, and NPH/crystalline insulin in relation to all prescribed insulins were variable with respect to the reference indicator (37.1%-100% vs. 75%). Prescription of ibuprofen and naproxen was below the value of the indicator (20%-50% vs. 80%). The percentage of ACE inhibitors, ARBs, and thiazides with respect to all antihypertensives ranged from 65.2%-77.2% to 65%, consistent with the value of the proposed indicator. Conclusions. The feasibility of applying the selected and constructed indicators of rational prescription was demonstrated. These indicators provide useful information for analyzing the quality of prescription in health institutions in countries in the Region and are a useful tool for periodically monitoring it.

[RESUMO]. Objetivo. Avaliar a viabilidade de monitorar a qualidade do uso de medicamentos em instituições de saúde em países da Região das Américas por meio de indicadores de prescrição racional. Métodos. Foi realizado um estudo quantitativo do uso de medicamentos durante o período 2016-2018. Indicadores de prescrição racional foram desenvolvidos e selecionados de acordo com referências internacionais e as melhores evidências disponíveis para: 1) anti-inflamatórios: prescrições de ibuprofeno e/ou naproxeno como porcentagem da prescrição total de anti-inflamatórios não esteroidais; 2) antidiabéticos orais: prescrições de metformina como porcentagem de todos os antidiabéticos prescritos, metformina e/ou sulfonilureias como porcentagem de todos os antidiabéticos prescritos; 3) insulinas: insulina cristalina e NPH como porcentagem do total de insulinas prescritas; e 4) anti-hipertensivos: porcentagem de inibidores da enzima de conversão da angiotensina (IECA), antagonistas do receptor da angiotensina II (BRA) e diuréticos tiazídicos sobre o total de anti-hipertensivos prescritos. A dose diária definida (DDD) por 1 000 habitantes por dia (DHD) foi usada como medida de consumo por instituição. Resultados. A prescrição de metformina em relação a todos os antidiabéticos foi inferior ao valor do indicador de referência (27,9%-67,6% x 88%), enquanto a prescrição de metformina e/ou uma sulfonilureia foi comparável ao valor de referência (80,9%-97,5% x 88%). As porcentagens de prescrição de insulina NPH, cristalina e NPH/cristalina em relação a todas as insulinas prescritas foram variáveis em relação ao valor de referência (37,1%-100% x 75%). A prescrição de ibuprofeno e naproxeno foi inferior ao valor de referência (20%-50% x 80%). A porcentagem de IECA, BRA e tiazídicos em relação a todos os anti-hipertensivos variou entre 65,2% e 77,2%, compatível com o valor do indicador proposto (65%). Conclusões. Demonstrou-se a viabilidade de aplicação dos indicadores de prescrição racional aqui selecionados e construídos, os quais fornecem informações úteis para analisar a qualidade da prescrição nas instituições de saúde dos países da Região e representam uma ferramenta útil para seu monitoramento periódico.

Comparison of the efficacy of carbamazepine, haloperidol and valproic acid in the treatment of children with Sydenham's chorea: clinical follow-up of 18 patients.

In order to compare and contrast the efficacy of haloperidol, carbamazepine, and valproic acid in the treatment of Sydenham's chorea a prospective study including 18 cases of this disorder was undertaken. Age of patients ranged from 7 to 15 years. Ten children were female and 8 were male. All but one had generalized, either symmetric or asymmetric chorea. The patients were divided in three equal groups, and were given a standardized dose of each of the drugs built-up over a week. Following therapy, the six children receiving valproic acid showed remarkable improvement, without side effects. Five patients receiving carbamazepine showed improvement without side effects. Only three of the patients that received haloperidol improved. In the 4 cases that did not show clinical improvement after one week of treatment, therapy with valproic acid led to disappearance of the symptoms in a lapse that ranged from 4 to 7 days. Recurrence related to discontinuation of treatment was observed in two patients. In view of the present results we recommend valproic acid as the first choice drug to treat Sydenham chorea.

The role of parasites in acute appendicitis of pediatric patients.

There is little evidence regarding the relationship between parasites and acute appendicitis. In order to determine such a relationship, if any, 830 appendectomy specimens were studied. Age, sex, pathological findings and the presence and type of parasites and the type of parasite were analyzed. Parasites were present in 62 cases (7.46%). Ascaris lumbricoides and Trichuris trichiura were the most frequently encountered parasites. These were observed, alone or in combination, in 45 cases (72.5%). Appendix perforation, peritonitis, necrosis and flegmonous appearance, were more frequent in the cases of acute appendicitis without parasitic infestation (p < 0.05). There were no differences between the cases with or without parasitic infestation (p > 0.05) In cases of peritonitis. The low incidence of parasites among the appendectomy specimens and the failure to demonstrate its relationship with all events derived of appendicitis, do not support the hypothesis that parasites are a major cause of appendicitis in pediatric patients.

Delitos contra la libertad sexual / Crimes against sexual freedom

Los delitos contra la libertad e indemnidad sexual son hechos producidos a diario en nuestro país y son expresión de una sociedad decadente en valores; son, a la vez, fenómenos de alarma social, debido a que los medios de comunicación los enfocan como un elemento de la problemática social. La violencia sexual es un problema de salud pública en nuestro país y muchos otros. Existen múltiples definiciones para los términos: violencia, violación, abuso o delito contra la libertad sexual, todos referidos a este acto, en el que básicamente se afecta la voluntad y libertad sexual de la víctima. Finalmente, al constituirse estos actos en delitos, también deben tener sanciones propias del mismo, todas dependientes de procesos jurídico-penales...

Crimes against sexual freedom and indemnity are events occurring daily in our country and that are a reality, are both phenomena of social alarm, because the media's focus as an element of social problems. Sexual violence is a public health problem in our country and many others. There are multiple definitions of the terms: violence, rape, abuse or crime against sexual freedom, all referred to this act, which basically will and sexual freedom of the victim is affected. Finally when these acts constitute offenses, they should also have own sanctions thereof, all dependent criminal legal process...

Lesiones por violencia familiar en el reconocimiento médico legal (RML) / Injuries Violence family doctor Legal Recognition (RML)

Determinar las lesiones por violencia familiar y sus características. Material y Métodos: Se realizó un estudio descriptivo prospectivo de enero a diciembre del 2013. Resultados: En el año 2013, se realizaron 1754 RML, de las cuales 423 correspondieron a lesiones por violencia familiar; el 30,97% (131/423) correspondió a peritadas entre 36 a 49 años. Los hallazgos encontrados fueron: 93,14%(394/423) fueron adultos. Respecto al agente causante. El 39,48%(167/423) es producido por uña humana, en agredidos varones, y en mujeres, el 21,04%(89/423) el agente contuso (puñete, patada, etc. fue el agente causante, los casados y convivientes tienen mayor frecuencia de lesiones por violencia familiar, el 45,63% (193/423) de las mujeres peritadas era casada, y en el sexo masculino el 23,40% (99/423) eran casados; respecto a la región anatómica lesionada, el 8,75%(37/423) de varones presentó lesiones en cabeza y cuello, entre otros hallazgos. Conclusión: Las lesiones por violencia familiar son frecuentes en el sexo masculino como en el sexo femenino, las mujeres presentan lesiones por agente contuso debido a la fuerza que la caracterizaba a los agresores que vendrían a ser varones en la mayoría de casos. Los varones presentan lesiones por uña humana...

To determine the injuries from domestic violence and their characteristics. Material and Methods: A prospective descriptive study from January to December 2013. Results: In 2013, 1754 FE were performed, of which 423 were for injuries from domestic violence; 30.97% (131/423) corresponded to patients between 36-49 years. The findings were: 93.14% (394/423) were adults. Regarding the causative agent, 39.48% (167/423) were produced by human nail in assaulted men and women, 21.04% (89/423) blunt agent (hitting, kicking, etc) was the causative agent, the married and cohabiting couples have increased frequency of domestic violence, 45.63% (193/423) of women patients were married, and in males 23.40% (99/423) were married; concerning the injured anatomical region, 8.75% (37/423) of men had lesions in the head and neck and in females 8.98% (38/423). Conclusion: domesticviolence injuries are common in males as in females, women have injuries by blunt agents due to the force of male offenders in most cases. Men have human nail injuries...

Meningoencefalitis amebiana primaria: comunicacion de dos nuevos casos Venezolanos / Primary amebic meningoencephalitis: two new cases report from Venezuela

La meningoencefalitis amebiana primaria (MAP) es infrecuente. Describimos dos nuevos casos de MAP en pacientes Venezolanos. Caso 1, Varón de 10 años, con fiebre, cefalea, vómitos y debilidad generalizada, y antecedente de inmersión en un estanque de agua días antes del inicio de sus síntomas, falleciendo 72 horas después del ingreso. Caso 2, Varón de 23 años con historia de cefalea, fiebre, vómitos, somnolencia y cambios de conducta. El paciente falleció 40 horas después. El estudio neuropatológico en ambos casos reveló MAP por Naegleria fowleri. La encefalitis por amebas anfizoicas debe sospecharse en casos de meningoencefalitis asépticas.

Primary amebic menigoencephalitis (PAM) is rare. Two cases of PAM in Venezuelan patients are described. Case 1, a 10 year-old male with headache, fever, vomiting. The patient swam in a water reservoir before the onset of his disease. He died during his third hospital day. Case 2, a 23 year-old male with a history of headache, fever, vomiting, drowsiness, and behavioral disturbances. The patient died on his second hospital day. The diagnosis in both cases was PAM due to Naegleria fowleri. Central nervous system infection by free-living amebas should be considered in meningoencephalitides with bacterial-free cerebro-spinal fluid.

The role of parasites in acute appendicitis of pediatric patients

Abstract. There is little evidence regarding the relationship between parasites and acute appendicitis. In order to determine such a relationship, if any, 830 appendectomy specimens were studied. Age, sex, pathological findings and the presence and type of parasites and the type of parasite were analyzed. Parasites were present in 62 cases (7.46%). Ascaris lumbricoides and Trichuris trichiura were the most frequently encountered parasites. These were observed, alone or in combination, in 45 cases (72.5%). Appendix perforation, peritonitis, necrosis and flegmonous appearance, were more frequent in the cases of acute appendicitis without parasitic infestation (p < 0.05). There were no differences between the cases with or without parasitic infestation (p > 0.05) In cases of peritonitis. The low incidence of parasites among the appendectomy specimens and the failure to demonstrate its relationship with all events derived of appendicitis, do not support the hypothesis that parasites are a major cause of appendicitis in pediatric patients.

Resumen. Existe poca evidencia con respecto a la relación entre parásitos y apendicitis aguda. Con el objeto de clarificar dudas, se estudiaron 830 muestras de especimenes apendiculares. Se analizaron la edad, el sexo, los hallazgos histopatológicos, la presencia o no de parásitos y el tipo de parásito presente. Se observaron parásitos en 62 casos (7,46%). Ascaris lumbricoides y Trichuris trichiura fueron los parásitos mas frecuentemente visualizados, solos o en combinación en 45 casos (72,5%). La perforación apendicular, la peritonitis, la necrosis apendicular y las características flegmonosas del apéndice, fueron observados con mayor frecuencia en los casos sin infestación parasitaria (p < 0,05). En los casos de peritonitis, no se observó diferencia significativa entre los casos con o sin infestación parasitaria. La baja frecuencia de la presencia parasitaria en las biopsias estudiadas y la imposibilidad de demostrar una relación entre los parásitos y todas las manifestaciones histopatológicas de la apendicitis aguda, impiden afirmar que los parásitos constituyen una causa importante en la etiopatogénia de la apendicitis aguda en pacientes pediátricos.

Comparison of the efficacy of carbamazepine, haloperidol and valproic acid in the treatment of children with Sydenham' s chorea: clinical follow-up of 18 patients

In order to compare and contrast the efficacy of haloperidol, carbamazepine, and valproic acid in the treatment of Sydenham s chorea a prospective study including 18 cases of this disorder was undertaken. Age of patients ranged from 7 to 15 years. Ten children were female and 8 were male. All but one had generalized, either symmetric or asymmetric chorea. The patients were divided in three equal groups, and were given a standardized dose of each of the drugs built-up over a week. Following therapy, the six children receiving valproic acid showed remarkable improvement, without side effects. Five patients receiving carbamazepine showed improvement without side effects. Only three of the patients that received haloperidol improved. In the 4 cases that did not show clinical improvement after one week of treatment, therapy with valproic acid led to disappearance of the symptoms in a lapse that ranged from 4 to 7 days. Recurrence related to discontinuation of treatment was observed in two patients. In view of the present results we recommend valproic acid as the first choice drug to treat Sydenham chorea

Decreto de 5 de junho de 2012

Institui o Comitê de Gestão Integrada das Ações de Atenção à Saúde e de Segurança Alimentar para a População Indígena

The neuropathology of experimental chronic manganese poisoning in rats: a preliminary report

Ratas machos adultas Spraque-Dawley fueron intoxicadas con manganeso a través del agua de bebida. Los animales recibieron 0.1, 1.0 y 5.0 mg Mn/ml, en forma de MnCl2 durante ocho (8) meses. Este modelo experimental de intoxicación crónica por manganeso, comparte rasgos neuropatológicos con la enfermedad humana, tales como alteraciones corticales y estriatales. Nuestros resultados sugieren que el manganeso administrado por vía oral, a dosis bajas, puede inducir alteraciones, como se evidenció a través de los estudios por microscopía de luz

Leiomiosarcoma de la vulva / Leiomyosarcoma of the vulva

Los leiomiosarcoma de la vulva constituyen una rara entidad nosológica. Se presentó el caso de una paciente de 19 años de edad con un leiomiosarcoma de la vulva, que fue tratada mediante vulvectomía radical y disección inguinal bilateral. Como tratamiento coadyuvante se indicó radioterapia y quimioterapia con el esquema de CYVADIC

Peso del encéfalo normal del venezolano adulto según sexo y edad / Normal brain weight in venezuelan adults related to sex and age

Se revisa el peso de los encéfalos de sujetos con edades comprendidas entre 19 y 100 años, obtenidos de 3967 necropsias suscesivas realizadas durante un período de diez años en el Hospital General del Sur de Maracaibo. El análisis del peso de 1104 cerebros adultos normales arroja un promedio de 1215 g para sujetos sel sexo masculino y de 1122 g para el sexo femenino. Se obseva que el peso encefálico disminuye a medida que se incrementa la edad de los sujetos, disminución que es más acentuada después de los 65 años en los hombres y de 75 años en las mujeres

Leiomiosarcoma de la vulva / Leiomyosarcoma of the vulva

Los leiomiosarcoma de la vulva constituyen una rara entidad nosológica. Se presentó el caso de una paciente de 19 años de edad con un leiomiosarcoma de la vulva, que fue tratada mediante vulvectomía radical y disección inguinal bilateral. Como tratamiento coadyuvante se indicó radioterapia y quimioterapia con el esquema de CYVADIC

Tumor de células granulares de la vulva / Granular cell tumor of the vulva

El tumor de células granulares es una rara entidad nosológica, de causa desconocida y de histiogénesis incierta. Se presenta el caso de un tumor de células granulares de la vulva, con discusión del cuadro clínico, características clínicas histopatológicas y las teorías de la histiogénesis del tumor