Abstract: Objective: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. Materials and methods: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. Results: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. Conclusions: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

Resumen: Objetivo: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. Material y métodos: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. Resultados: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. Conclusiones: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Abstract: Teak is an important species in the forest markets, due to the value of the timber which, it has increased the interest to establish stands in Mexico. However, the influence of properties soil and nitrogen on plantations have been poorly evaluated. The aim of the study was to measure quality soil in 6-yrs-old commercial teak plantations in Nayarit, Mexico. 30 days before planting, were applied to fertilizers soils 50- 120 - 75 (NPP), 3 t ha-1 Ca hydroxide, 250 kg ha-1 of diammonium phosphate, 63 kg ha-1 of potassium chloride and 75 kg ha-1 Potassium sulfate to improve your fertility. After 6 yrs-old, the diameter, height, basal area and volume were measured in order to contrast the growth and productivity between stands. Soil samples, the texture, bulk density (BD), cation exchange capacity (CEC), pH, electrical conductivity (EC), organic matter (OM) and C:N ratio were determined to know the OM mineralization, as well as nitrogen in biomass. The ANOVA and Tukey test showed that soils with pH > 6 < 7, CEC > 30 cmol(+) kg-1, OM > 2.5 % and C:N ratio > 15 of 0 - 10 cm, were associated with the best stand productivity, as well as the highest nitrogen concentration in leaves. It is concluded that the success in the stand’s productivity with exotic species in Mexico, will depend essentially on the health of the soil.

Resumen: La teca es una especie importante en los mercados forestales, debido al valor de su madera, lo cual en México ha incrementado el interés de establecer plantaciones. Sin embargo, la influencia de las propiedades del suelo y nitrógeno bajo esas condiciones han sido poco evaluadas. El objetivo del presente estudio fue medir la calidad del suelo en plantaciones comerciales de teca en Nayarit, México. Antes de plantar (30 días), se aplicaron fertilizantes 50 - 120 - 75 (NPK), 3 t ha-1 de hidróxido de Ca, 250 kg ha-1 de fosfato diamónico, 63 kg ha-1 de cloruro de potasio y 75 kg ha-1 de sulfato de potasio. A la edad de 6 años, se midieron el diámetro, altura, área basal y se calculó el volumen, con el propósito de contrastar el crecimiento y productividad entre plantaciones. En muestras de suelo, se determinó la textura, densidad aparente (Da), capacidad de intercambio catiónico (CIC), pH, conductividad eléctrica (CE), materia orgánica (MO) y relación C/N para conocer la mineralización de la MO, así como el nitrógeno en la biomasa. El ANOVA y prueba de Tukey demostraron que los suelos con pH > 6 < 7, CIC > 30 cmol(+) kg-1, MO > 2.5 % y relación C/N > 15 de 0 - 10 cm, se asociaron a la plantación de mejor productividad, así como la mayor concentración de nitrógeno en hojas. Se concluye que en México, el éxito en la productividad de plantaciones con especies exóticas dependerá, esencialmente, de las propiedades del suelo.

Abstract: The lack of a public policy based on scientific and traditional knowledge, oriented to the integral management of the territory is intrinsically expressed in the construction of risk, and therefore in the increase of the occurrence of disasters. Although in the last three decades there have been some advances in terms of civil protection in Mexico, it is necessary to conduct a critical review and evaluation of the National Civil Protection System and the existing institutional framework within the three orders of government, to determine role and functionality, as well as its effectiveness and relevance, in order to analyze its possible transformation into a System or National Coordination of Integrated Disaster Risk Management (IDRM). The implementation of such system should be based on five normative axes; efficiency and equity, integrality, transversality, co-responsibility and accountability. IDRM should be understood as a complex systematic process consisting of a series of decisions, actions and activities, as well as a transversal coordination between the different institutional and social actors, to understand and transform the needs and weaknesses expressed in the different aspects of vulnerability and exposure, in specific responses and collective solutions, whose main objective is the deconstruction of risk. Inevitably, IDRM requires a foundation directed towards the reduction of vulnerabilities as a strategic axis of diagnosis, laws, programs and co-management of government and society, where safeguarding human life is privileged, along with the improvement of the quality of life of the population and its integral development, within a framework of respect for human rights and, consequently, with a gender perspective. Based on the principles of the IDRM developed and agreed upon at the international level, this document contains a series of recommendations that were discussed by a group of academicians and put into consideration of the candidates for the Presidency of Mexico and those candidates of popular election at the Federal, State and Municipal level in June 2018, as well as to the President-elected Andrés Manuel López Obrador, and the next members of his cabinet, head of the cross-cutting areas related to disaster prevention. Within the sphere of IDRM, the same conception of the General Law of Civil Protection of 2012, poses significant challenges of coordination and institutional, administrative, regulatory and financial reforms, as well as a reconceptualization that could lead to its efficient implementation as a Public Policy. The latter must have a binding cross-sectoral character, in and between the different levels of government and be regulated under the axes of efficiency and equity, integrality, transversality, co-responsibility and accountability. For this, the reduction of institutional vulnerability is unavoidable. The transformation of the current National Civil Protection System into a National System for the IDRM, is raised through 55 considerations and requires the support of the Federal Government to establish new bases, learning from the most valuable elements of the generated experiences and focus on the production of welfare conditions of the population, considering as determining factors for the reduction of social vulnerability. It is a long-term research task, which must begin with the contributions of sciences and social, natural disciplines, as well as engineering and technology, in a sphere of rigorous assessment of its contemporary complexity, from an integral perspective, and therefore, of transdisciplinary work. Under this perspective, the territory is a fundamental factor in the processes of assessment of social vulnerability as it determines to a large extent the scope of the disaster risk reduction required by the National System for IDRM. As such, it is necessary and urgent recovering, disseminating and encouraging scientific research to generate theories, methods and models (quantitative and qualitative) of analysis, aimed at the comprehension of the territory, territoriality and habitability. It also should be directed towards strengthening territorial management, taking into account its different dimensions and scales, for the assessment of the real conditions of the population: experiences, resources, assets, capabilities, potentials and requirements in terms of social welfare, as an inescapable - and irreplaceable - device for the reduction and management of risks. Therefore, undoubtedly, IDRM must be understood in a transversal way to the public policy that affects the use of the territories from the local scale, and through the permanent coordination with other territorial levels: this is where the disasters have their origin and that is where the reduction of risk must first be rooted, which leads to the prevention of future disasters.

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Abstract: Objective: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. Materials and methods: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. Results: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. Conclusions: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

Resumen: Objetivo: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. Material y métodos: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. Resultados: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. Conclusiones: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Abstract Objective To compare drug use for cities along the US-Mexico border. Materials and methods Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected Mexican and of Mexican origin individuals on both sides of the border. Results Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (OR’s in the range of 4-11) were found in the US cities when compared to their across-the-border Mexican counterparts. Conclusions Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study.

Resumen Objetivo Comparar el consumo de drogas para las ciudades a lo largo de la frontera Estados Unidos-México. Material y métodos Los datos provienen del Estudio “US-Mexico study on alcohol and related conditions” (UMSARC, 2011- 2013), una encuesta de 4 796 personas mexicanas y de origen mexicano en ambos lados de la frontera. Resultados Las tasas más altas de cualquier consumo de drogas en el año pasado y los síntomas de trastornos por uso de drogas se encontraron sólo en la ciudad fronteriza de Laredo, en com paración con la ciudad no fronteriza de San Antonio. Tanto Nuevo Laredo como Reynosa/Matamoros mostraron mayo res tasas de consumo de drogas que la ciudad no fronteriza de Monterrey. Tasas mucho más altas (OR en el rango de 4-11) fueron encontradas en las ciudades de los Estados Unidos en comparación con sus contrapartes mexicanas fronterizas. Conclusiones El consumo de drogas en México es alto en la frontera. El uso de medicamentos recetados fuera de prescripción es una preocupación en las ciudades fronterizas del sur de Texas.

Abstract The persistence of the violence in México has allowed new ways of subjectivity through its internalization as a way to resist in a society where the words have lost their affectivity. The ascription to organized delinquency by the youth or the manifestation of violent behavior in different ambits has become more frequent. The silence and the fear also work as sources to legitimize this violence. The present paper presents some lines of thought about the testimonies of young people, who live in a context where the settlement of organized crime is accentuated. Their testimonies illustrate how they see their lives in a context that appears to present only two options: to assimilate or to be indifferent.

Resumen La persistencia de la violencia en México ha incidido en la conformación de nuevas subjetividades a partir de su interiorización como una forma de resistir dentro de una sociedad en la que la palabra ha perdido su efectividad simbólica. La adscripción de jóvenes al crimen organizado y la manifestación de conductas violentas, en cualquier ámbito, es cada vez más frecuente. El silencio y el miedo operan como fuentes de legitimación de la misma. El presente trabajo muestra algunas líneas de reflexión en torno a testimonios de jóvenes que habitan en contextos de violencia ligados al narcotráfico. Dichos testimonios ilustran cómo estos perciben su vida en un contexto donde las únicas opciones aparentes son la asimilación o la indiferencia.

Abstract Objective To compare drug use for cities along the US-Mexico border. Materials and methods Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected Mexican and of Mexican origin individuals on both sides of the border. Results Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (OR’s in the range of 4-11) were found in the US cities when compared to their across-the-border Mexican counterparts. Conclusions Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study.

Resumen Objetivo Comparar el consumo de drogas para las ciudades a lo largo de la frontera Estados Unidos-México. Material y métodos Los datos provienen del Estudio “US-Mexico study on alcohol and related conditions” (UMSARC, 2011- 2013), una encuesta de 4 796 personas mexicanas y de origen mexicano en ambos lados de la frontera. Resultados Las tasas más altas de cualquier consumo de drogas en el año pasado y los síntomas de trastornos por uso de drogas se encontraron sólo en la ciudad fronteriza de Laredo, en com paración con la ciudad no fronteriza de San Antonio. Tanto Nuevo Laredo como Reynosa/Matamoros mostraron mayo res tasas de consumo de drogas que la ciudad no fronteriza de Monterrey. Tasas mucho más altas (OR en el rango de 4-11) fueron encontradas en las ciudades de los Estados Unidos en comparación con sus contrapartes mexicanas fronterizas. Conclusiones El consumo de drogas en México es alto en la frontera. El uso de medicamentos recetados fuera de prescripción es una preocupación en las ciudades fronterizas del sur de Texas.

Resumen Introducción y Objetivo El tratamiento de las neoplasias mamarias así como de ciertos padecimientos benignos requieren, en muchos casos, una mastectomía unilateral o bilateral con resección de la piel, glándula mamaria y complejo pezón-areola. La reconstrucción mamaria es una parte importante del tratamiento multidisciplinario para lograr la reintegración de las mujeres a una vida normal. El objetivo de nuestro estudio fue reportar los resultados de los diferentes tipos de reconstrucción mamaria en pacientes con cáncer de mama, así como otros padecimientos benignos, en un hospital de alta especialidad del Occidente de México. Material y Método Serie de casos en la que incluimos pacientes sometidas a reconstrucción mamaria entre el 1 enero de 2006 y el 31 de diciembre de 2012 con diferentes procedimientos, evaluando el tipo de cirugía inicial, tipo de reconstrucción, procedimientos complementarios y morbilidad. El seguimiento de las pacientes fue de 24 meses. Resultados Recogimos 170 pacientes con un promedio de edad de 46.12 ± 8.2 años. Las técnicas más utilizadas fueron: reconstrucción con implante expansor tipo Becker (48.8%), expansor tisular (11.2%), colgajo miocutáneo de recto abdominal transverso (8.8%), implantes definitivos (8.8%) y reconstrucción con dorsal ancho más implante o expansor (8.8%). Se presentaron complicaciones en 20 pacientes (11.8%). Conclusiones Nuestros resultados son satisfactorios ya que la morbilidad temprana y tardía son aceptables, pero, perfectibles. Con el advenimiento de extensas campañas de detección oportuna esperamos aumentar los procedimientos conservadores por cirugía temprana y los procedimientos oncoplásticos durante la mastectomía sin necesidad de esperar periodos prolon-gados para la reconstrucción.

Background and Objective Treatment of mammary neoplasms as well as certain benign conditions require, in many cases, a unilateral or bilateral mastectomy with resection of the skin, the mammary gland and the nipple-areola complex. Breast reconstruction is an important part of the multidisciplinary treatment to achieve the reintegration of women into a normal life. The aim of our study was to report the results of the different types of breast reconstruction in patients with breast cancer as well as other benign conditions in a highly specialized hospital in Western Mexico. Methods Case series of patients undergoing breast reconstruction from 1 January 2006 to 31 December 2012 were included with different procedures evaluating the type of initial surgery, type of reconstruction, complementary procedures and morbidity. The follow-up of the patients was 24 months. Results One hundred and seventy patients were included. The average age was 46.12 ± 8.2 years. The most used techniques were: reconstruction with expander Becker type implant (48.8%), tissue expander (11.2%), transverse rectus abdominus mucocutaneous flap (8.8%), definitive implants (8.8%) and wide dorsal reconstruction plus implant or expander (8.8%). Complications occurred in 20 patients (11.8%). Conclusions Our results are satisfactory, since early and late morbidity are acceptable, but, perfectible. With the advent of extensive early detection campaigns, we hope to increase conservative procedures for early and oncoplastic procedures during mastectomy, without the need to wait for long periods for reconstruction.

Abstract This paper studies how the Mexican financial system has changed. We use Markov chains to analyze the transitions the Mexican financial sector has experienced in the period 2007-2014. The main result shows that, although the number of financial institutions increased considerably, a new financial institution is highly likely to adopt the structure of an unregulated multi-purpose financial entity (Sofom ENR). The growing tendency to incorporate as Sofom ENRs, under an unregulated framework, may entail certain risks for the Mexican population. This in turn suggests that the authorities should consider measures relating to Sofom ENRs, such as: increasing restrictions on founding such entities, pressuring them to change to regulated entities, or adapting the regulatory framework to make them more competitive and reliable.

Resumen Este artículo estudia cómo ha cambiado el sistema financiero mexicano. Para ello se emplean Cadenas de Markov con el objeto de analizar las transiciones ocurridas en el periodo 2007-2014. El resultado principal muestra que, si bien, el número de instituciones financieras se incrementó considerablemente, existe una alta probabilidad de que una institución entrante se constituya como Sofom ENR. La creciente tendencia de incorporación de Sofom ENR, en un marco no regulado, podría implicar algunos riesgos para la población mexicana. Lo que sugiere que se deben contemplar algunas medidas relacionadas a las Sofom ENR como pueden ser: incrementar las restricciones para incorporar estas entidades, fomentar su cambio a figuras reguladas o, ajustar su marco regulatorio para convertirlas en entidades más competitivas y confiables.

Resumen Objetivo: La fibromialgia (FM) es un síndrome de dolor crónico generalizado, asociado a alteraciones emocionales y comportamentales. El objetivo de este estudio fue identificar los síntomas afectivo-conductuales y las estrategias cognitivas de afrontamiento en la percepción de dolor de pacientes con FM. Material y métodos: Se realizó un estudio de corte transversal, con análisis de casos y controles, con una muestra de dos grupos de mujeres, en la ciudad de Barranquilla (Colombia): 34 con diagnóstico de FM y 30 controles, a quienes se les realizó evaluación de síntomas psicológicos y de percepción de dolor. Resultados: Los pacientes con FM presentan significativamente mayores síntomas afectivo-conductuales (ansiedad, depresión, insomnio, somatización y disfunción social) que los sujetos controles (p<0.001), así como una tendencia a utilizar la retirada social como estrategia de afrontamiento (p<0.005). De acuerdo con el análisis factorial, la percepción de dolor y los síntomas afectivo-conductuales en pacientes con FM se agruparon en un mismo factor, lo cual demostró interdependencia de las variables. Conclusiones: Los síntomas afectivo-conductuales se asocian a la percepción de dolor y se relacionan con la utilización de estrategias pasivas y centradas en la emoción como mecanismo para afrontar la experiencia de dolor.

Abstract Objective: Fibromyalgia (FM) is a syndrome of chronic widespread pain associated with emotional and behavioral disorders. The purpose of the study was to identify the affective -behavioral symptoms and cognitive coping strategies involved in the perception of pain in patients with FM. Material and methods: A cross-sectional study was performed, with analysis of cases and controls, with a sample of two groups of women, in the city of Barranquilla (Colombia). Affective - behavioral symptoms and cognitive coping strategies were assessed in 34 patients with FM and 30 controls matched by age and educational level. Results: Our findings indicate greater affective and behavioral symptoms in patients with FM (anxiety, depression, insomnia, somatization and social dysfunction) (p<0.001) and a tendency to use social withdrawal as a coping strategy (p<0.005). According to factor analysis, pain perception and affective-behavioral symptoms were grouped in a single factor, demonstrating interdependence between variables. Conclusions: The affective-behavioral symptoms are associated with perception of pain and are relate to the use of passive strategies, and focused on emotion as a mechanism to confront the experience of pain.

Resumen: Objetivo: Describir la ocurrencia de eventos potencialmente traumáticos (EPT) en estudiantes de preparatoria, medir la sintomatología postraumática subumbral en quienes aún sufren repercusiones de un EPT y asociar la sintomatología con variables sociodemográficas y características del EPT. Material y métodos: Estudio transversal analítico realizado en un muestra por conveniencia de 1000 estudiantes de tres preparatorias del Estado de México. Se aplicó la Escala para Estrés Postraumático en Universitarios Mexicanos. Se evaluó la presencia de síntomas y su frecuencia; la asociación con variables explicativas se realizó con modelos de regresión logística y cuantílica, respectivamente. Resultados: 80% reportó un EPT. De éstos, 79% aún sufría repercusiones actuales y casi la mitad de ellos presentó sintomatología. El sexo, número de eventos y características del EPT (cambios percibidos y gravedad) se encontraron asociados. Conclusiones: Los resultados sugieren intervenir tempranamente para disminuir el riesgo de desarrollar un trastorno.

Abstract: Objective: Describe the occurrence of potentially traumatic events (PTE) in high-school students, measure subthreshold post-traumatic symptomatology in those who still experience PTE repercussions and associate the symptomatology with sociodemographic and PTE characteristics. Materials and methods: Analytic transversal study carried out in a convenience sample of one thousand students from three high schools in the State of Mexico. The Scale for Post Traumatic Stress in University Students was applied. The presence of symptoms, their frequency and their association with explanatory variables was assessed by means of logistic and quantile logistic regression models, respectively. Results: 80% reported PTE. Of this, 79% still experienced current repercussions and almost a half presented symptomatology. Gender, number of events, and PTE characteristics (perceived and grave symptoms) were associated. Conclusions: Results suggest to intervene early to reduce the risk of developing a disorder.

Abstract: Objective: Describe the occurrence of potentially traumatic events (PTE) in high-school students, measure subthreshold post-traumatic symptomatology in those who still experience PTE repercussions and associate the symptomatology with sociodemographic and PTE characteristics. Materials and methods: Analytic transversal study carried out in a convenience sample of one thousand students from three high schools in the State of Mexico. The Scale for Post Traumatic Stress in University Students was applied. The presence of symptoms, their frequency and their association with explanatory variables was assessed by means of logistic and quantile logistic regression models, respectively. Results: 80% reported PTE. Of this, 79% still experienced current repercussions and almost a half presented symptomatology. Gender, number of events, and PTE characteristics (perceived and grave symptoms) were associated. Conclusions: Results suggest to intervene early to reduce the risk of developing a disorder.

Resumen: Objetivo: Describir la ocurrencia de eventos potencialmente traumáticos (EPT) en estudiantes de preparatoria, medir la sintomatología postraumática subumbral en quienes aún sufren repercusiones de un EPT y asociar la sintomatología con variables sociodemográficas y características del EPT. Material y métodos: Estudio transversal analítico realizado en un muestra por conveniencia de 1000 estudiantes de tres preparatorias del Estado de México. Se aplicó la Escala para Estrés Postraumático en Universitarios Mexicanos. Se evaluó la presencia de síntomas y su frecuencia; la asociación con variables explicativas se realizó con modelos de regresión logística y cuantílica, respectivamente. Resultados: 80% reportó un EPT. De éstos, 79% aún sufría repercusiones actuales y casi la mitad de ellos presentó sintomatología. El sexo, número de eventos y características del EPT (cambios percibidos y gravedad) se encontraron asociados. Conclusiones: Los resultados sugieren intervenir tempranamente para disminuir el riesgo de desarrollar un trastorno.

Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 μg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh ≤ 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with ≤ 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

La insuficiencia suprarrenal relativa (ISR) es frecuente en pacientes cirróticos con sepsis grave, asociándose a un pobre pronóstico. Se desconoce su importancia en condiciones de enfermedad estable. El objetivo del trabajo ha sido evaluar la prevalencia de la ISR en una serie de pacientes cirróticos estables y su relación con el deterioro de la función hepática. Se determinó el impacto de la ISR en la supervivencia y se correlacionaron los niveles entre el cortisol basal en plasma y saliva en sujetos controles y cirróticos. Fueron incluidos 47 pacientes ambulatorios y 16 controles. La funcionalidad del eje hipotalámico-pituitario-suprarrenal se valoró mediante la prueba de estimulación con 250 μg de ACTH sintética EV, definiendo la ISR como delta cortisol < 9 μg/dl. Respecto al grado de deterioro de la función hepática, 22 tenían un Child-Pugh ≤ 8 y 25 pacientes = 9. La prevalencia de ISR fue de un 22%, siendo significativamente más elevada en aquellos con mayor deterioro de la función hepática (8/32 vs. 3/13, p < 0.05). Se observó correlación entre el cortisol salival y el plasmático basal (r = 0.6, p < 0.0004). Por último, la supervivencia fue más elevada en los pacientes sin ISR al año (97%) y a los tres años (91%) que aquellos que desarrollaron esta complicación (79 % y 51%, p < 0.05, respectivamente). En resumen, la prevalencia de ISR es elevada en los pacientes con cirrosis estable y se relaciona con un deterioro de la función hepática y una mayor mortalidad.

Objetivo: comparar la supervivencia de pacientes con resincronizador cardíaco con o sin desfibrilador con la de pacientes con cardiodesfibrilador. Materiales y métodos: cohorte retrospectiva cuyo desenlace primario fue la mortalidad de origen cardíaco; la exposición fueron las terapias electrofisiológicas y la información se obtuvo de las historias clínicas y de otros registros médicos. Resultados: se estudiaron 70 pacientes de edad avanzada con dispositivos funcionales. El 82 % recibieron tratamiento farmacológico optimizado. No se encontró asociación significativa entre la probabilidad de supervivencia y la terapia de resincronización cardíaca con o sin cardiodesfibrilador versus la terapia con cardiodesfibrilador (log rank test p = 0,54), pero sí un mayor tiempo de supervivencia en los primeros (ANOVA p = 0,0012). La tasa de peligro fue 0,017 para el día 371 y del 0,15 para el día 2169. Durante el período de observación se presentaron 14 muertes, tres de ellas atribuibles a etiología no cardíaca. Conclusión: se observó que la terapia con resincronizador cardíaco se asoció de forma significativa con un mayor tiempo supervivencia.

Objective: To evaluate survival in patients with cardiac resynchronization with or without cardioverterdefibrillator versus patients with implantable cardioverter- defibrillator alone. Materials and methods: Retrospective cohort, the primary end point was death from cardiac causes, the exposure was electrophysiological therapies, and the information sources were medical files and other records. Results: 70 elderly patients with functional devices; 82 % of them received optimized medical therapy. No significant association was found between survival of patients with cardiac resynchronization therapy with or without defibrillator and cardioverter-defibrillator therapy alone (log rank test, p = 0.54), but the former had a longer survival time (ANOVA p = 0.0012). The hazard ratio was 0.017 for day 371 and 0.15 for day 2169. Fourteen deaths occurred during the observation period, three of them from non-cardiac causes. Conclusion: Cardiac resynchronization therapy was associated with significantly longer survival time.

Objetivo: comparar a sobrevivência de pacientes com ressincronizador cardíaco com ou sem desfibrilador em pacientes com desfibriladores. Materiais e métodos: coorte retrospectivo de cujo principal resultado primário foi a mortalidade de origem cardíaca; a exposição foram as terapias e eletrofisiológicos e a informação foi obtida a partir da história clínica e outros registros médicos. Resultados: Foram estudados 70 pacientes idosos com dispositivos funcionais. 82 % receberam tratamento farmacológico otimizado. Não foi encontrado associação significativa entre a probabilidade de sobrevivência e terapia de ressincronização cardíaca com ou sem cardiodesfibrilador versus a terapia cardiodesfibrilador (log rank test, p = 0,54 ), mas há um maior tempo de sobrevivência no primeiro (ANOVA, p = 0,0012 ). A taxa de risco foi 0,017 para o dia 371 e 0,15 para o dia 2169. Durante o período de observação, apresentaram 14 mortes, três deles atribuíveis a etiologia não cardíaca. Conclusão: constatou-se que a terapia com ressincronizador cardíaco foi significativamente associado com um maior tempo de sobrevivência.