Territorio, lugares y salud : redimensionar lo espacial en salud pública

RESUMEN: El propósito de este escrito es avanzar en la lectura del proceso de salud-enfermedad en clave territorial. La teorización sobre el vínculo salud y ambiente debe extenderse desde las tipologías médicas, y su énfasis en la distribución del riesgos ambientales (físico, biológico, químico), hacia el reconocimiento de la producción social y subjetiva de los territorios. Para avanzar en esta teorización la salud pública debe enriquecerse con la integración de nociones propias de las ciencias sociales como la apropiación del espacio, territorio-territorialidades y lugares. Además, ha de orientarse desde una mirada escalar hacia los microterritorios, pues es en el escenario de los territorios locales y en los lugares cotidianos de la vida, donde se concretan los modos de vivir, de enfermar y de construir salud

Vocabulario de la sociedad civil, la ruralidad y los movimientos sociales en América Latina

El Vocabulario de la Sociedad Civil, la Ruralidad y los Movimientos Sociales en América Latina tiene como objetivo desarrollar vocablos relacionados con temas de gran trascendencia para la vida colectiva de la población Latinoamericana; pretende introducir a estudiantes, personas del ámbito académico y activistas en la comprensión de estas categorías de análisis. A través de la mirada de 70 especialistas que participaron en este vocabulario, es posible comprender muchos de los términos que se utilizan dentro de la investigación social y áreas relacionadas con las ciencias políticas, ambientales y rurales, a partir de una mayor explicación y detalle. Es por ello que se inserta este trabajo desde una mirada colectiva y amplia de los conceptos que se exponen. En este libro podrá encontrar las ideas de varios autores y autoras de distintas universidades, con una visión multi, inter y transdisciplinaria. El esfuerzo que se realizó para conjuntar varios términos y analizar su compleja red de interpretaciones, permitirá que este manuscrito pueda ser consultado por estudiantes, personas del ámbito científico-académico, y ciudadanía; porque contiene el estado del arte, la historia del paulatino avance de múltiples conceptos y su vigencia en el contexto actual

Práctica actual de la ureteronefroscopia flexible con láser en América Latina para el tratamiento de la litiasis renal

"Introducción: Actualmente se ha incrementado la ureteronefroscopia flexible para el tratamiento de cálculos renales, existiendo gran variación en la técnica quirúrgica e indicaciones a través de todo el mundo. Objetivos: Conocer la práctica actual, variaciones en la técnica, uso e indicaciones de la ureteronefroscopia flexible para tratamiento de cálculos renales en Latinoamérica. Métodos: Enviamos un cuestionario anónimo de 30 preguntas sobre ureteronefroscopia flexible para el tratamiento de cálculos renales, vía correo electrónico y enlace Web a urólogos de Latinoamérica de enero de 2015 a julio de 2015. Recolectamos las respuestas a través del sistema Survey Monkey. Resultados: Participaron 283 urólogos de 15 países latinoamericanos (tasa de respuesta del 10,8%); 254 contestaron completamente el cuestionario; 52,8% son urólogos de México y 11% de Argentina, 11,8% realizan > 100 casos por ano, ˜ 15,2% consideran la ureteronefroscopia como tratamiento de elección para cálculos > 2 cm y 19,6% realiza ureteronefroscopia en etapas solo para cálculos > 2,5 cm. El 78,4% utiliza fluoroscopia, el 69,1% utiliza camisa ureteral en todos sus casos, el 55,8% deja el catéter doble J al final de la cirugía, el 37,3% considera estado libre de lito con 0 fragmentos y el 41,2% utiliza radiografía simple para evaluar el estado libre de cálculos. Conclusiones: La mayoría de urólogos participantes considera la ureteronefroscopia flexible como el tratamiento de primera elección para cálculos 100 ureteronefroscopias por ano. ˜ Más de la mitad utiliza fluoroscopia y camisa de acceso ureteralrutinariamente, el método más frecuente para la evaluación del estado libre de cálculos es la radiografía simple de abdomen. © 2015 AEU. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.""Introduction The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. Objectives To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. Methods We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. Results A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed > 100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones > 2 cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring > 2.5 cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. Conclusions Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones 100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography. © 2015 AEU.

Pieloplastía retroperitoneoscópica. Experiencia en el Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México

ResumenIntroducciónLa pieloplastía laparoscópica es un procedimiento que cada día se hace más popular;alcanza éxitos que van de 89 % a 100 % y tiene menor morbilidad cuando se compara con la cirugía abierta.ObjetivoPresentar nuestra experiencia en este procedimiento con abordaje retroperitoneal. La técnica realizada fue la descrita por Rasswiler J.ResultadosSe realizaron 14 pieloplastías con abordaje retroperitoneal. Diez pacientes se sometieron a técnica de pieloplastía desmembrada, y los 4 restantes a técnica de Fenger. No se presentó algún incidente transoperatorio que haya motivado conversión a cirugía abierta. No se presentaron complicaciones transoperatorias y se tuvo un rango de sangrado de 50 a 250mL. Se tuvo un tiempo quirúrgico promedio de 182 minutos. Con un seguimiento de 31 meses, se presentó falla al tratamiento en 2 casosConclusionesEl abordaje laparoscópico se ha convertido en la técnica quirúrgica de elección para la corrección de la estenosis de la unión ureteropiélica, debido a que ofrece un éxito similar a la cirugía abierta pero con las ventajas de una menor morbilidad, tiempo de recuperación más corto y resultados estéticos favorables.AbstractBackgroundLaparoscopic pyeloplasty is an increasingly popular procedure, achieving success rates of 89 % to 100 %. It has a lower morbidity rate when compared with open surgery.AimsThe aim of this article was to present our experience with this procedure using a retroperitoneal approach. The technique was that described by J. Rasswiler.ResultsFourteen pyeloplasties with retroperitoneal approach were performed. Ten patients underwent the dismembered pyeloplasty technique and the Fenger technique was used in the remaining 4 patients. No intraoperative incident meriting conversion to open surgery occurred. There were no intraoperative complications and the range of blood loss was from 50 to 250mL. Mean surgery duration was 182 minutes. Treatment failure in 2 cases presented at the thirtyfirst month follow-up.ConclusionsThe laparoscopic approach has become the surgical technique of choice for correcting ureteropelvic junction stricture because it offers a similar success rate to that of open surgery, but with the advantages of less morbidity, a shorter recovery period, and favorable esthetic results

Implantation of a heterologous dermo-epidermal skin substitute in a patient with deep dermal burn that enhances biomechanical and functional recovery: Case report

In Mexico, burns are considered a public health problem; approximately 93% of all burned patients are treated at public hospitals. For patients undergoing extensive burns, prompt skin coverage avoids potential complications, is life-saving, and is the key for acceptable functional and aesthetic results. Many efforts have been undertaken to find new strategies for the treatment of burns. The aim of this study was to create a human Dermo-Epidermal Skin Substitute (hDE-SS) by combining heterologous keratinocytes and fibroblasts cultured onto Radio-sterilized Human Amnion (RHA), suitable for the treatment of patients with deep dermal burns. The manufacture of hDE-SS was carried out under sterile conditions in a Class 100 Cleanroom located inside the Laboratory of Biotechnology at the National Center of Research and Attention for Burn Patients (CENIAQ, its acronym in spanish). The heterologous cells were obtained from skin remnants collected from elective aesthetic surgeries. RHA used as a scaffold was obtained from placental tissue irradiated with 25 kGy of gamma radiation. Viable constructs were obtained, revealing a positive immunophenotype for fibroblast surface antigen (1B10) and negative for human alpha smooth muscle actin protein (α-sma). Keratinocytes were positive for CK5 and CK10 to a lesser extent. hDE-SS was implanted in one patient with a deep dermal burn who fulfilled the inclusion criteria for this study. The implanted patient was followed up through days 7, 14, 21, 35, and 92 post-implantation using photographic monitoring and measurement of the following: viscoelasticity (R6); net elasticity (R5); maximal extension (R0), and hydration, melanin, and erythema with a Cutometer®. The employment of hDE-SS in a deep dermal burn showed clinical re-epithelization within a 7-day period favored by cellular migration, due to the presence of fibroblasts and keratinocytes. Also, the functional and mechanical quality of the skin was measured with the Cutometer®, demonstrating that it is optimal and similar to controls of healthy skin and an autograft, justifying the usage of hDE-SS. Keywords: Heterologous keratinocytes, Heterologous fibroblasts, Human dermo-epidermal skin substitute, Human amnion, Deep dermal burn, Suction method, Biomechanics, Cutomete

Low Serum Tryptophan Levels as an Indicator of Global Cognitive Performance in Nondemented Women over 50 Years of Age

Aging is a physiological decline process. The number of older adults is growing around the world; therefore, the incidence of cognitive impairment, dementia, and other diseases related to aging increases. The main cellular factors that converge in the aging process are mitochondrial dysfunction, antioxidant impairment, inflammation, and immune response decline, among others. In this context, these cellular changes have an influence on the kynurenine pathway (KP), the main route of tryptophan (Trp) catabolism. KP metabolites have been involved in the aging process and neurodegenerative diseases. Although there are changes in the metabolite levels with age, at this time, there is no study that has evaluated cognitive decline as a consequence of Trp catabolism fluctuation in aging. The aim of this study was to evaluate the relation between the changes in Trp catabolism and cognitive impairment associated with age through KP metabolites level alterations in women over 50 years of age. Seventy-seven nondemented women over 50 years old were examined with a standardized cognitive screening evaluation in Spanish language (Neuropsi), Beck anxiety inventory (BAI), and the geriatric depression scale (GDS). Also, serum levels of Trp, kynurenine (Kyn), kynurenic acid (KYNA), and 3-hydroykynurenine (3-HK) and the glutathione ratio (GSH/GSSG) were measured. Results showed a negative correlation between age and Trp levels and a positive correlation between age and KYNA/Trp and 3-HK/Trp ratios. The level of cognitive impairment showed a significant positive association with age and with kynurenine pathway activation and a significant negative correlation with Trp levels. The GSH/GSSG ratio correlated positively with Trp levels and negatively with Kyn/Trp and 3-HK/Trp ratios. The depression score correlated negatively with Trp and positively with the 3-HK/Trp ratio. We concluded that KP activation increases with age and it is strongly associated with the level of cognition performance in nondemented women over 50 years of age