Resumo Introdução: O panorama da saúde e nutrição da população mexicana se enquadra na conjunção de desnutrição infantil crónica, sobretudo no médio rural e indígena, e o incremento significativo do sobrepeso e obesidade. Esta informação vinda de enquetes gera resultados generalizados, sem considerar as particularidades do contexto biosociocultural em que vivem comunidades indígenas, co-determinante da condição nutricional destas. Objetivo: Estudar o estado nutricional de um grupo de escolares de cultura Otomí residentes em uma comunidade do México em situação de marginação, considerando o contexto biosociocultural em que vivem. Métodos: Estudo prospectivo transversal realizado em uma localidade do Estado do México. Amostra de conveniência constituída por 214 menores entre 6 e 12 anos de idade. Empregaram-se técnicas antropométricas internacionalmente aceitas para coletar a altura e o peso, e foi calculado o IMC. O estado de nutrição foi estimado com base no peso, a altura e o IMC para a idade e foram comparados com os referentes da OMS. Resultados: A prevalência da baixa altura para a idade e a desnutrição é menor, no entanto o sobrepeso/obesidade afeta a um terço dos meninos. Apenas para o IMC por grupos de idade e sexo houve diferenças em determinadas faixas etárias. As pontuações z dos três indicadores são semelhantes entre meninos e meninas. Discussão e Conclusões: Em comparação com os parâmetros nacionais e estaduais, os meninos estudados mostram menor prevalência de sobrepeso e obesidade associado ao seu contexto sociocultural.

Abstract Introduction: The health and nutrition outlook of the Mexican population may be framed in terms of chronic infant malnutrition, largely in the rural and indigenous sectors, and a significant increase in overweight and obesity. This general information is obtained from surveys without taking into account the biosociocultural context that is a codeterminant of the nutritional condition of many small indigenous communities. Objective: To study the nutritional status of Otomí school children living in a marginalized Mexican community from the perspective of the biosociocultural context in which they live. Methods: This is a prospective and transversal study carried out in a location of the state of México, México. The convenience sample was constituted by 214 children between 6 and 12 years old. Internationally accepted anthropometric techniques were used to collect data on the height and weight of these children. BMIs were calculated. The status of nutrition was estimated based on the expected weight, height, and BMI for each age. These data were compared with the corresponding WHO references. Results: The prevalence of low height and malnutrition related to the ages of these children was found to be low, but one in three of these children was found to be overweight or obese. There were some age groups differences regarding the BMI. The z scores of the three indicators are similar between boys and girls. Discussion and Conclusions: In comparison to the national and state parameters, the children studied showed a low prevalence of overweight and obesity associated with their sociocultural context.

Resumen Introducción: El panorama de la salud y nutrición de la población mexicana se enmarca en la conjunción de desnutrición crónica infantil, sobre todo en el medio rural e indígena, y el incremento significativo del sobrepeso y obesidad. Esta información proveniente de encuestas arroja resultados generalizados, sin considerar las particularidades del contexto biosociocultural en que viven comunidades indígenas, codeterminante de la condición nutricional de éstas. Objetivo: Estudiar el estatus nutricional de un grupo de escolares de cultura otomí residentes en una comunidad de México en situación de marginación, considerando el contexto biosociocultural en el que viven. Métodos: Estudio prospectivo transversal realizado en una localidad del Estado de México. Muestra por conveniencia constituida por 214 menores, entre 6 y 12 años de edad. Se emplearon técnicas antropométricas internacionalmente aceptadas para recabar la estatura y el peso, y se calculó el IMC. El estatus de nutrición se estimó con base en el peso, la estatura y el IMC para la edad y se compararon con los referentes de la OMS. Resultados: La prevalencia de estatura baja para la edad y la desnutrición es menor, no así el sobrepeso/obesidad que afecta a un tercio de los menores. Solo para el IMC por edad y sexo hubo diferencias en ciertos grupos de edad. Las puntuaciones z de los tres indicadores son semejantes entre niños y niñas. Discusión y Conclusiones: En comparación con los parámetros nacional y estatal, los menores estudiados muestran prevalencia menor de sobrepeso y obesidad asociado a su contexto sociocultural.

Inflammation plays an important role in the development of cardiovascular diseases (CVDs), suggesting that the immune system is a target of therapeutic interventions used for treating CVDs. This study evaluated mechanisms underlying inflammatory response and cardiomyocyte hypertrophy associated with bacterial lipopolysaccharide (LPS)- or heat shock protein 60 (HSP60)-induced Toll-like receptor (TLR) stimulation and the effect of a small interfering RNA (siRNA) against Ca2+/calmodulin-dependent kinase II delta B (CaMKIIδB) on these outcomes. Our results showed that treatment with HSP60 or LPS (TLR agonists) induced cardiomyocyte hypertrophy and complement system C3 and factor B gene expression. In vitro silencing of CaMKIIδB prevented complement gene transcription and cardiomyocyte hypertrophy associated with TLR 2/4 activation but did not prevent the increase in interleukin-6 and tumor necrosis factor-alfa gene expression in primary cultured cardiomyocytes. Moreover, CaMKIIδB silencing attenuated nuclear factor-kappa B expression. These findings supported the hypothesis that CaMKIIδB acts as a link between inflammation and cardiac hypertrophy. Furthermore, the present study is the first to show that extracellular HSP60 activated complement gene expression through CaMKIIδB. Our results indicated that a stress stimulus induced by LPS or HSP60 treatment promoted cardiomyocyte hypertrophy and initiated an inflammatory response through the complement system. However, CaMKIIδB silencing prevented the cardiomyocyte hypertrophy independent of inflammatory response induced by LPS or HSP60 treatment.

RESUMO São relatados quatro casos de encarceramento de forame epiploico (EFE), entre os casos: três machos e uma fêmea; dois da raça Quarto de Milha, um SRD e um Brasileiro de Hipismo; idade média de 11 anos; altura média de cernelha de 160,5cm; massa corporal média de 465kg. Todos os animais possuíam o hábito de aerofagia. A presença de refluxo enterogástrico e intestino delgado distendido à palpação transretal foi variável na dependência do segmento intestinal aprisionado. À laparotomia exploratória constataram-se: dois casos de aprisionamento jejunoileal; um de jejuno; e o outro de íleo. Todos os animais apresentaram EFE da esquerda para a direita, representando o sentido horário. Apenas o animal que apresentava o íleo aprisionado sobreviveu; os demais foram submetidos à eutanásia no período transoperatório devido à extensa isquemia intestinal e às lesões vasculares decorrentes da manobra de redução. A aerofagia é o fator de risco que apresenta maior correlação positiva com o EFE, fato corroborado pelos casos apresentados. Apesar de ser descrito um bom prognóstico para o EFE na literatura, foi obtido um desfecho ruim entre os casos atendidos, e salienta-se que a extensão da lesão e o sangramento da veia porta no transoperatório contribuíram para esse resultado.

ABSTRACT Four cases of epiploic foramen entrapment (EFE) are reported. Among the cases, three males and one female, two Quarter Horses, one mixed breed and one Brazilian Equestrian, aged between 3 to 20 years, mean 11 years. The average height was 160.5cm and 465kg. All horses had a previous record of crib-biting habit. The presence of enterogastric reflux and small intestine distended loops in transrectal palpation was variable in dependence of the trapped segment. In surgical exploration were identified two cases of jejunum and ileum entrapped, one of the ileum and one of jejunum. All animals showed EFE from left to right. The horse that had trapped the ileum has survived. The others were euthanized due to the extent of injury or rupture of large vessels during surgical reduction. Although there are many notes of possible risk factors for EFE occurrence, cribbing is the risk factor that has the highest positive correlation with EFE. This appointment was confirmed by the cases presented. Despite being described a good prognosis for the EFE, a bad outcome was achieved among the cases, and stresses that the extent of the injury and bleeding from the portal vein contributed to this outcome.

RESUMO: O objetivo desse estudo foi avaliar os efeitos do Extrato Aquoso de Amendoim (EAA) no peso, bioquímica sérica e na histologia hepática de ratos Wistar submetidos a dietas normo e hiperlipídicas. A pesquisa foi realizada utilizando 40 ratos Wistar machos, divididos em quatro grupos (n=10): GA (dieta hiperlipídica), GB (dieta hiperlipídica +EAA), GC (dieta normolipídica) e GD (dieta normolipídica +EAA). Após 8 semanas, os animais foram eutanasiados e foram coletadas amostras sanguíneas para a avaliação de dados bioquímicos (Colesterol total e suas frações, triglicerídeos, uréia, creatinina, AST, ALT e glicemia) e fragmentos do fígado para análise histológica. Os animais do grupo GB tiveram um ganho de peso inferior quando comparados ao GA (XGB= versus XGA= p<0,05), já os grupos GC e GD não obtiveram diferenças estatísticas. Os animais que receberam o EAA tiveram uma redução nos níveis de colesterol (XGB= versus XGA= p<0,05 e XGD= versus XGA= p<0,01), dos triglicerídeos (XGB= versus XGA e XGD= versus XGA= p<0,001) e mais discretamente dos níveis de ALT. A glicemia, uréia e creatina permaneceram dentro dos valores de referência. As amostras hepáticas analisadas, dos ratos dos diferentes grupos, não apresentaram alterações histopatológicas. Conclui-se que O EAA apresentou efeitos preventivos sobre o ganho ponderal e dislipidemia.

ABSTRACT: The aim of this study was to evaluate the effect of Aqueous Extract from Peanut (EAA) in weight, serum biochemistry and liver histology of Wistar rats with normal hearing and a high fat diet. The survey was conducted using 40 male Wistar rats divided into four groups (n=0): GA (high fat diet), GB (fat diet+EAA), GC (normolipídica diet), and GD (normolipídica diet+EAA). After 8 weeks, the rats were euthanized and blood samples were collected to evaluate biochemical data (total cholesterol and its fractions, triglycerides, urea, creatinine, AST, ALT and glucose) and liver fragments for histological analysis. The animals of the GB group had a lower weight gain when compared with GA (XGB versus XGA= p<0.05), but CG and GD did not obtain statistical differences. The rats that received EAA had a reduction in cholesterol levels (XGB= versus XGA= p<0.05 vs. XGA and XGD= p<0.01), triglycerides (=XGB versus XGA and =XGD versus XGA= p<0,001) and more discreetly ALT levels. Blood glucose, urea and creatine remained within the reference values. Liver samples analyzed, the rats of different groups showed no histopathological changes. In conclusion, the EAA had preventive effects on weight gain and dyslipidemia.

A anastomose de Martin-Gruber como factor de confusão no diagnóstico clínico de síndrome do canal cárpico é uma entidade para a qual o clínico normalmente não está alerta. A sua associação com a presença de sinostose rádio-cubital proximal congénita ainda não se encontra descrita na literatura indexada, possivelmente pela raridade de ambas as patologias. Apresentamos um caso de uma doente com um quadro clínico de síndrome do canal cárpico bilateral, associado a anastomose de Martin-Gruber e a sinostose rádio-cubital proximal congénita bilaterais, que se apresentou como um desafio diagnóstico e terapêutico.

Martin-Gruber anastomosis is a confounding factor in the clinical diagnosis of carpal tunnel syndrome to which clinicians are not usually alert. Its association with congenital proximal radio-ulnar synostosis is not yet described in the indexed literature, possibly due to the rarity of both conditions. We present a case of a patient with a clinical picture of bilateral carpal tunnel syndrome, associated with Martin-Gruber anastomosis and proximal bilateral radioulnar synostosis, who presented a diagnostic and therapeutic challenge.

RESUMO:Objetivou-se com este trabalho avaliar a produção de massa e o teor de flavonoides de plantas de marcela cultivadas com fósforo e cama de frango e colhidas em duas épocas. Estudou-se a combinação de doses de P2O5 (0, 100, 200 e 300 kg ha-1) na forma de superfosfato triplo, com e sem cama de frango (10 t ha-1), arranjados como fatorial 4x2, no delineamento blocos casualizados, com quatro repetições. Foram feitas duas colheitas das plantas, consideradas como parcelas subdivididas no tempo. A propagação foi indireta, com semeio em bandejas e transplante ao campo. As plantas foram colhidas aos 195 e 223 dias após o transplantio - DAT. A altura máxima das plantas foi de 1,14 m com uso da cama de frango e de 0,97 m sem cama, aos 195 dias após o transplantio. A produção máxima de massa fresca de parte aérea das plantas foi de 30,31 t ha-1 na colheita aos 223 DAT, enquanto a de massa seca foi de 11,38 t ha-1, ambas com o uso de 300 kg ha-1 de P2O5.A massa fresca de inflorescências foi maior (4,08 t ha-1) com adição de cama de frango ao solo e menor (3,49 t ha-1) sem cama de frango; em resposta às doses de fósforo, cresceram linearmente, sendo a máxima de 4,65 t ha-1 com uso de 300 kg ha-1 de P2O5, independente da época de colheita. A massa seca de inflorescências foi máxima de 2,38 t ha-1 com o uso de 300 kg ha-1 P2O5 na colheita aos 223 DAT. A maior produção de massa seca e o maior teor de flavonoides das inflorescências foram obtidos com o cultivo das plantas de marcela em solo com cama de frango (10 t ha-1) e com P2O5 (300 kg ha-1) na colheita aos 223 dias após o transplantio.

ABSTRACT:The aim of this experiment was to evaluate the biomass yield and flavonoid contents of Achyrocline satureioides grown under different levels of phosphate fertilizer in association with broiler litter, during two successive harvests. Four levels of P2O5 (0, 100, 200 and 300 kg ha-1), as triple superphosphate, and two levels of broiler litter (0 and 10 t ha-1) were arranged as a 4x2 factorial design in randomized blocks with four replications. Two harvests of plants, considered as split-plot, were made. Seeds were sown in polystyrene trays then transplanted to the experimental field and harvested at 195 and 223 days after transplanting (DAT). The maximum heights of the plants were 1.14 m under the addition of broiler litter and 0.97 m without it, at 195 days after transplanting. The highest yields of total fresh weight (30.31 ton ha-1) and dry weight (11.38 ton ha-1) were obtained at 223 DAT, both with the concentration of 300 kg ha-1 P2O5. The fresh weight of the inflorescences was greater under the addition of broiler litter (4.08 ton ha-1) than without it (3.49 ton ha-1). The plants grew linearly in response to the use of phosphate, and the maximum yield was 4.65 ton ha-1 under the concentration of 300 kg ha-1P2O5, regardless of the harvest season. The dry weight of the inflorescences reached maximum yield (2.38 ton ha-1) at 223 DAT, in response to the use of 300 kg ha-1P2O5. The highest yield of dry weight and the highest contents of flavonoids from the inflorescences were obtained when A. satureioides was grown under the concentration of P2O5 (300 kg ha-1) with the addition of broiler litter (10 ton ha-1) and harvested at 223 DAT.

Background: The anterior sacral meningocele is a rare form of spinal dysraphism located in the presacral extraperitoneal space. It is generally asymptomatic and appears as a small pelvic mass. Case description: We present a case of a 10 year-old male that developes a bacteria meningitis because of a pararectal abscess that is connected with an anterior sacral meningocele. We successfully treated it using a posterior approach. Conclusion: The aim of the surgery is to repair the dural defect and to obliterate the communication between the thecal sac and the herniation defect. The posterior approach is the simplest and most effective surgical technique because the lower risk of neurological injury than the anterior approach.

Introducción: El meningocele sacro anterior es una rara forma de disrafismo espinal, localizado en el espacio presacro extraperitoneal. Generalmente es asintomático y suele presentarse como una pequeña masa pélvica. Caso clínico: Presentamos el caso de un niño de 10 años de edad que desarrolla una meningitis bacteriana consecuencia de un absceso pararectal que se comunica con una cavidad meningocélica sacra anterior. Recibe tratamiento quirúrgico realizándose con éxito un abordaje posterior. Conclusión: La finalidad de la cirugía es reparar el defecto dural y obliterar la comunicación existente entre el saco tecal y el defecto herniario. El abordaje posterior es la técnica quirúrgica más efectiva puesto que tiene menor riesgo de daño neurológico que el abordaje anterior.

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología.

Introduction: The increase of prevalent haemodialysis patients is a challenge for surgery units. Vascular access related complications are the main cause of hospital admissions in many dialysis units. Outpatient surgery could decrease waiting lists, cost and complications associated to vascular access. Material and methods: We have performed a prospective study of the vascular access related surgery in a ten year period. Outpatient surgery was included with the rest of the activity in a general surgery unit and was performed by not exclusive dedicated surgeons. Results: Since 1998 to December 2009 we performed 2,413 surgical interventions for creating and repairing arteriovenous fistula in 1,229 patients, including elective and emergency surgery (74.8% and 25.2% respectively). Outpatient procedures were performed in 82% of cases (89% in elective and 60% in emergency surgery). There were unexpected admissions secondary to surgical complications in 6% of patients. There was no postoperative mortality. The rate of admissions was 0.09 events and 0.2 days per patient/year. Conclusions: Outpatient surgery is possible in a high percentage of patients to perform or to repair an arteriovenous fistula, including emergency surgery. Vascular access surgery can be included in ordinary activity of a surgical unit. Outpatient vascular access surgery decreases unnecessary hospital admissions, reduces costs and nosocomial complications.

Introducción: El aumento de pacientes que precisan tratamiento renal sustitutivo, sobre todo en el grupo de pacientes sometidos a hemodiálisis, supone un reto en incremento de actividad y de ocupación de recursos para los servicios de cirugía. Las complicaciones relacionadas con los accesos vasculares son la causa fundamental de ingresos en muchas unidades de diálisis. La cirugía sin ingreso puede disminuir la ocupación de camas hospitalarias, reduce la lista de espera y las complicaciones relacionadas con un ingreso innecesario. Material y métodos: Hemos realizado un estudio prospectivo de las intervenciones realizadas en el período 1998-2009 para la creación o la reparación de fístulas arteriovenosas (FAV) para hemodiálisis, con el objetivo de conocer el nivel de ambulatorización, resultados, complicaciones y su posible impacto en la tasa de ingresos de los pacientes en hemodiálisis. La actividad fue realizada dentro del funcionamiento global del servicio de cirugía general sin unidad específica de cirugía mayor ambulatoria (CMA). Las intervenciones las realizaron varios cirujanos del servicio interesados en el tema, pero sin dedicación exclusiva a éste (su actividad es la de cualquier cirujano general) y sin guardias específicas. La cirugía ambulatoria se organizó dentro de la actividad ordinaria del servicio de cirugía general sin una unidad específica, ni cirujanos especialmente dedicados a la misma. Resultados: Desde la apertura de nuestro hospital en 1998 hasta diciembre de 2009 hemos realizado un total de 2.413 intervenciones en 1.229 pacientes (primeros accesos y reparaciones de los mismos). La cirugía programada supuso el 74,8% de las intervenciones; el 25,2% restante fueron intervenciones urgentes. El porcentaje global cirugía ambulatoria fue del 82% (89% en cirugía programada y 60% en cirugía urgente). Se produjeron un 6% de ingresos imprevistos. No hubo mortalidad postoperatoria. El número de ingresos fue de 0,09 episodios por paciente año con una estancia media de 0,2 días por paciente y año. Conclusiones: La mayoría de las intervenciones relacionadas con las FAV, incluso la cirugía urgente, se pueden realizar en régimen ambulatorio dentro de la actividad habitual de un servicio de cirugía. Se evitan así costes asociados con la ocupación de camas hospitalarias y se disminuyen las complicaciones relacionadas con el ingreso.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

La radionecrosis y el edema cerebral son complicaciones asociadas a la radiocirugía. Presentamos los casos de tres pacientes tratadas con radiocirugía mediante acelerador lineal, de un meningioma de polo frontal izquierdo, peñasco y parasagital parietooccipital, respectivamente, que desarrollaron, entre dos y ocho meses más tarde, lesiones de tipo radionecrótico con extenso edema peritumoral que resultaron resistentes al tratamiento con esteroides y que se han resuelto con la administración de 40 sesiones de oxígeno hiperbárico. Son pocos los casos publicados hasta ahora en la literatura con tan excelentes resultados, por lo que consideramos un hecho a tener muy en cuenta ante las posibles complicaciones de este tipo que puedan presentarse en el transcurso de la práctica radioquirúrgica antes de recurrir a la cirugía.

Design, construction, and testing of the thermal performance of a flat solar collector for domestic water heating are described. The absorbing plate is built from readily available materials: two sheets of galvanized steel, one of the channelled type, the other one flat, which are joined by electric welding. The absorber is connected to a 198-L thermotank, insulated with polyurethane foam. In terms of receiving surface, the prototype tested here has an area of 1.35 m², about 20% smaller than comparable copper-tube-based collectors offered in the market. Temperature measurements conducted over a 30-day period gave values which were a few degrees lower than the theoretically calculated water temperatures. Momentary thermal efficiency values between 35% and 77% were observed. The water temperature achieved in the tank at the end of the day aver ages 65°C in winter weather conditions in the central Mexican highland. This design of solar water heater is well suited to Mexican conditions, as it makes use of the high local intensity of the solar radiation, and as the channel shape of the ducts minimizes bursting during the rare occurrences of freezing temperatures in the region; it also has the advantage of being manufacturable at low cost from simple materials.

Se describe el diseño, construcción y pruebas del desempeño térmico de un colector solar plano para calentamiento de agua para uso doméstico. La placa absorbedora se construyó de materiales fácilmente asequibles: dos placas de acero galvanizado, una del tipo acanalado y la otra plana, unidas mediante soldadura de arco eléctrico. La placa absorbedora está conectada a un termotanque con capacidad de 198 L, aislado con espuma de poliuretano. La superficie receptora de es te prototipo es de 1.35 m², aproximadamente 20% más pequeña comparado con los colectores, basados en tubos de cobre, ofertados en el mercado. Mediciones de temperatura por un periodo de 30 días, arrojaron valores menores por algunos grados que las temperaturas de agua teóricamente calculadas. Se observaron valores momentáneos de eficiencia térmica entre 35% y 77%. La temperatura del agua lograda al final del día promediaba en 65°C en condiciones de invierno, en el altiplano central mexicano. Este diseño de calentador solar de agua está bien adaptado a las condiciones mexicanas, por aprovechar la alta intensidad local de la radiación solar, y porque la forma acanalada de los ductos minimiza rupturas durante las escasas ocurrencias de temperaturas de congelamiento en esta región; además es fácilmente manufacturable, a bajo costo, partiendo de materiales simples.

Children are the population group who most need photo protection. They are very sensitive to the negative consequences of an excessive sun exposure, and they aren’t aware of the risk. Children have much more open air activity than adults, and the exposure to ultraviolet radiation and sun burns in childhood are a risk factor of the utmost importance in the development of skin cancer in adulthood. It is therefore of vital relevance to protect the child from the deleterious effects of ultraviolet radiation. The photo protection measures include sun avoidance, protection with cloths, caps and solar glasses, and the use of photo protection ointments. Sun education campaigns should be implemented in hospitals, schools and communication media, and with dermatologists, pediatricians, teachers and political referents altogether.

Los niños son el grupo poblacional en el que más debe extremarse la fotoprotección. Son muy sensibles a los efectos negativos derivados de una exposición solar excesiva, y no son conscientes de este riesgo. Los niños desarrollan una actividad al aire libre mucho más importante que los adultos, y la exposición a la radiación ultravioleta y las quemaduras durante la infancia son un factor de riesgo fundamental para el desarrollo de cáncer cutáneo en la edad adulta. Es por tanto de vital importancia proteger al niño de los efectos nocivos de la radiación ultravioleta. Las medidas de fotoprotección incluyen las conductas de evitación solar, la protección con ropa, gorros y gafas solares, y el uso de cremas fotoprotectoras. Las campañas de educación solar deben desarrollarse en los hospitales, en los colegios, y en los medios de comunicación, de forma conjunta entre dermatólogos, pediatras, profesores y responsables gubernamentales.

Objective: Analysis of the inter-observer variability of biomicroscopy used for the diagnosis of Diabetic Retinopathy. Methods: This was a descriptive study. Parallel observer-blind evaluations of the degree of retinopathy in type 2 diabetic patients, as defined on biomicroscopic photographs, were performed by two ophthalmologists. The sample size required for the Kappa index among ophthalmologists with a disagreement ratio of 15%, precision ratio of 5% and confidence level of 95% is n=196 («n» being the number of eyes). The only variable measured was the degree of Diabetic Retinopathy, according to the modified Early Treatment Diabetic Research Study (ETDRS) classification. Results: The average age of the 217 patients photographed was of 65.42 years (SE= 9.91). In 191 instances there was total agreement between the 2 ophthalmologists. In 24 instances the discrepancy was only of one degree of the classification of the ETDRS, and in 2 the discrepancy was of two degrees. In no case was it greater than this. (Quadratic weighed Kappa = 0.876, IC95%: 0.655-0.952 and linear weighed Kappa = 0.804, IC95%: 0.729-0.878). Conclusions: The Weighed Kappa index demonstrated a «very good» agreement of the degree of diabetic retinopathy. The discrepancies were slight, were of no clinical importance, and would not have affected treatment decisions. The results indicate that this examination, performed by a single ophthalmologist, can be utilised as a reference standard in Diabetic Retinopathy diagnosis.

Objetivo: Análisis de la variabilidad interobservador de la biomicroscopía utilizada para el diagnóstico de retinopatía diabética. Métodos: Diseño: Observacional descriptivo. Valoración en paralelo, de forma ciega para los observadores, del grado de retinopatía diabética mediante biomicroscopía en pacientes diabéticos tipo 2. Muestra: Para la evaluación del índice Kappa, con una estimación de una proporción de desacuerdo del 15%, (precisión del 5% intervalo de confianza del 95%) muestra n=196, (siendo «n» el número de ojos). Variables a medir: grado de retinopatía diabética, según la clasificación del ETDRS modificada. Resultados: La edad media de los pacientes fotografiados fue de 65,42 años (DE= 9,91). De las 217 biomicroscopías realizadas, en 191 se encontró concordancia total. En 24 la discordancia fue tan sólo en un grado de la clasificación del ETDRS y en 2 la discordancia fue en dos grados. En ningún caso fue mayor. Kappa ponderado cuadrático = 0,876, IC95%: 0,655-0,952 y Kappa ponderado lineal = 0,804, IC95%: 0,729-0,878. Conclusiones: El índice Kappa ponderado demuestra un grado de acuerdo «muy bueno». Las discrepancias producidas además de escasas no tienen trascendencia clínica, ya que no afectan a la decisión de tratamiento. La biomicroscopía leída por un solo oftalmólogo es un instrumento fiable como patrón de referencia para el diagnóstico de la retinopatía diabética.

Background: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. Patients and method: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0-F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. Results: The APRI score < 0.5 or > 1.5 and IF < 4.2 or > 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). Conclusions: Our study showed that these models don't avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients.

Introducción: Los índices APRI y de Forns (IF), son modelos no invasivos a partir de datos rutinarios de laboratorio para la predicción de fibrosis hepática en pacientes con hepatitis crónica C. El propósito de nuestro estudio es confirmar el valor de estos modelos para predecir fibrosis significativa en estos pacientes y si pueden disminuir la necesidad de la biopsia hepática en coinfectados y no coinfectados por el VIH. Pacientes y métodos: Incluimos 60 pacientes con hepatitis crónica y datos histológicos, 33 coinfectados por VIH. El 73% tenía fibrosis leve (F0-F1), el 23% grave (F3-F4) y el 18,3% cirrosis histológica. Calculamos y comparamos los índices APRI e IF con el grado de fibrosis hepática. Resultados: Los valores de APRI < 0,5 o > 1,5 e IF < 4,2 o > 6,9, indicativos de fibrosis leve o severa, sólo han podido aplicarse en el 53% y 49% de los casos respectivamente. Ningún parámetro bioquímico, ni el APRI o el IF se asociaron con el grado de fibrosis en los pacientes no coinfectados con el VIH. Sólo observamos asociaciones en los pacientes VIH(+): la fibrosis severa (F3-4) con un mayor nivel de gammaglobulinas [24,5% vs. 30% (p < 0,05)] y de GGT [77 (46,5) vs. 32 (48,5) (p < 0,05)], y una menor tasa de protrombina [72 vs. 91% (p < 0,05)] y de plaquetas 10(9) [129 (40) vs. 170 (78) (p < 0,05)]; se observó un mayor porcentaje de APRI < 0,5 (41,6%) con fibrosis leve (F0-1) frente al observado (0) en la grave (F3-4) (p < 0,05); la especificidad (E) del APRI < 0,5 para establecer fibrosis leve o inexistente fue del 100%, pero la sensibilidad (S) era excesivamente baja (41%), con un valor predictivo positivo (VPP) de 100%, pero un valor predictivo negativo (VPN) muy bajo (36,3%). Conclusiones: Nuestro estudio mostró que estos modelos no evitan la necesidad de biopsias hepáticas. Más de la mitad de los pacientes no pueden ser clasificados apropiadamente y la S y VPN son muy bajos. La combinación de estos índices con los niveles de gammaglobulinas, Gamma-GT, GOT, GPT, plaquetas y tiempo de protrombina, sólo han podido servir de orientación sobre el grado de fibrosis o inflamación hepáticas, y de forma limitada a los pacientes coinfectados con el VIH.