Implante de cemento óseo como alternativa para la reconstrucción de piso orbitario: reporte de caso

Antecedentes: El manejo de las fracturas orbitarias es uno de los retos del trauma facial. La gama de materiales para su reconstrucción es amplia y se mantiene en crecimiento constante, no así el consenso para su uso ni la literatura que lo sustenta. Objetivo: Presentar el uso y diseno˜ del implante óseo preformado como alternativa para la reconstrucción de las fracturas de piso de órbita en edad pediátrica. Caso clínico: Varón de 7 anos, ˜ quien sufre trauma contuso en hemicara derecha. Se integra diagnóstico clínico y tomográfico de fractura de piso de órbita derecha, de tipo estallamiento, pura, con atrapamiento de músculo recto inferior y ptosis palpebral derecha postraumática. Como tratamiento se realiza con éxito reconstrucción quirúrgica a los 7 días, con colocación de implante de cemento óseo preconstruido. A las 8 semanas posquirúrgicas, el paciente presenta ptosis leve residual, sin limitación a los movimientos ni diplopía. Conclusiones: El uso de cemento óseo se puede considerar adecuado para la reconstrucción de dichas fracturas, como una alternativa más dentro de los biomateriales que pueden ser utilizados por el oftalmólogo. Consideramos que nuestro optimismo por los resultados obtenidos en este reporte de caso nos obliga a aumentar el número de pacientes para recabar mayores evidencias y mayor seguimiento a largo plazo. ABSTRAC Background: The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. Objective: To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. Clinical case: A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. Conclusions: The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow u

Momento Económico (17-18)

En este número Temas de hoy, 2/ Encuentro sobre la Deuda Externa de America Latina y el Caribe, México, Alonso Aguilar, 3/ Fernando Carmona, 5/ Heberto Castillo. 6/ Gantón Garcia Cantú, 7/ Pablo Gómez, 8/ Sergio Méndez Arceo, 9/ Carlos Tello, 11/ Mario J. Zepeda Martinez, 12/ Argentina, Enrique Garcia Vázquez, 16/ Adolfo Pérez Esquivel, 20/ Brasil, Frei Betto, 22/ Ecuador, Blanca Chancoso, 24/ El Salvador, Guillermo Ungo, 25/ República Dominicana, Juan Bosch, 27/ Venezuela, Miguel Ángel Capriles, 28/ Organismos Económicos Latinoamericanos, Homero L. Hernández, 3

Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence

Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC. Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping. Results The population (N = 513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, − 0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, − 0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC

Ética profesional en educación superior : finalidades, estrategias y desafíos de la formación

Todo proyecto educativo que no responde a su época se expone a problemas de legitimidad y al duro escrutinio y sanción de los usuarios. Las instituciones de educación superior no son la excepción de esta premisa clásica, incluso más validada por eldinamismos, la versatilidad y ojo crítico en el mundo contemporáneo. La ética se ha convertido en el baremo principal para someter a juicio a las instituciones y a las personas que ahí actuan, como a las finalidades que se pretenden en sus acciones. En esta perspectiva, debe examinarse la función de las instituciones de educación superior.Este libro es el esfuerzo colectivo por acercarnos a esa problemática, en especial a las finalidades, estrategias y relaciones en juego para cumplir la tarea de la formación y sus nexos inevitables con la ética profesional

Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network.

AimThis report presents phenotypic and genetic data on the prevalence and characteristics of extended-spectrum β-lactamases (ESBLs) and representative carbapenemases-producing Gram-negative species in Mexico.Material and methodsA total of 52 centers participated, 43 hospital-based laboratories and 9 external laboratories. The distribution of antimicrobial resistance data for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, Acinetobacter baumannii complex, and Pseudomonas aeruginosa in selected clinical specimens from January 1 to March 31, 2020 was analyzed using the WHONET 5.6 platform. The following clinical isolates recovered from selected specimens were included: carbapenem-resistant Enterobacteriaceae, ESBL or carbapenem-resistant E. coli, and K. pneumoniae, carbapenem-resistant A. baumannii complex, and P. aeruginosa. Strains were genotyped to detect ESBL and/or carbapenemase-encoding genes.ResultsAmong blood isolates, A. baumannii complex showed more than 68% resistance for all antibiotics tested, and among Enterobacteria, E. cloacae complex showed higher resistance to carbapenems. A. baumannii complex showed a higher resistance pattern for respiratory specimens, with only amikacin having a resistance lower than 70%. Among K. pneumoniae isolates, blaTEM, blaSHV, and blaCTX were detected in 68.79%, 72.3%, and 91.9% of isolates, respectively. Among E. coli isolates, blaTEM, blaSHV, and blaCTX were detected in 20.8%, 4.53%, and 85.7% isolates, respectively. For both species, the most frequent genotype was blaCTX-M-15. Among Enterobacteriaceae, the most frequently detected carbapenemase-encoding gene was blaNDM-1 (81.5%), followed by blaOXA-232 (14.8%) and blaoxa-181(7.4%), in A. baumannii was blaOXA-24 (76%) and in P. aeruginosa, was blaIMP (25.3%), followed by blaGES and blaVIM (13.1% each).ConclusionOur study reports that NDM-1 is the most frequent carbapenemase-encoding gene in Mexico in Enterobacteriaceae with the circulation of the oxacillinase genes 181 and 232. KPC, in contrast to other countries in Latin America and the USA, is a rare occurrence. Additionally, a high circulation of ESBL blaCTX-M-15 exists in both E. coli and K. pneumoniae

Gender differences and management of stroke risk of nonvalvular atrial fibrillation in an upper middle-income country: Insights from the CARMEN-AF registry

Background: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. Objective: To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. Methods: A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014–2017). They were categorized according to Gender. Results: Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). Conclusions: CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC. Keywords: Atrial fibrillation, Gender, Thromboembolic risk, Antithrombotic therapy, Stroke, Mexic