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BDSM sexual practices related to sadomasochism, domination and submission, represent a vast range of possibilities in terms of paraphernalia, associated emotions, uses and applications that are as diverse as the human beings who practice it. Taking this into account, we conducted a study to understand the practices related to BDSM, under the perspective of its own practitioners. For this, a qualitative methodology was used, with an emergent and projected type of design. We covered 8 in-depth interviews on men and women from Venezuela and the data was analyzed through the constant comparison method in order to generate grounded theory, this paper comes up as part of a larger study. Among the most outstanding findings were the importance of limits, some as irrefutable an others that are meant to break, and the importance of the physical and mental health conditions in the practice.

Anemia during pregnancy is a frequent finding and can increase morbidity and mortality in both mother and child. This paper aims to identify clinical, social and healthcare-related factors that affect the incidence of anemia in pregnant patients in a primary care prenatal clinic in Mara municipality. This is a descriptive field study that took place between November and December, 2013. Sixty-two patients were selected through non-probability sampling among four primary care clinics in the municipality of Mara. A high prevalence of anemia (76%) was found, with normal MCV (mean corpuscular volume), normal MCH (mean corpuscular hemoglobin), and normal MCHC (mean corpuscular hemoglobin concentration). In only 36% of cases serum iron levels fell below 50 ug/dl. Some clinical factors found to be related to anemia in pregnancy are multiparity (69.9%), infections before or during pregnancy (77.5%), low protein intake (91.8%), less than a year birth interval (63.3%), and gestational age (89.8%). The main socioeconomic factor related to anemia is poverty (89.8%). Prenatal checkup schedule needs to be adjusted in primary care clinics in the municipality of Mara taking into consideration clinical and socioeconomic factors in order to lower the prevalence of anemia during pregnancy in this population.

Roads directly or indirectly affect the structure, dynamics and function of ecosystems that they traverse. Most studies on the effect of roads on wildlife focus on the evaluation of mortality of vertebrates by vehicle collisions. Despite the extensive road network that exists in Venezuela, studies of wildlife mortality in them are scarce. In this paper, we analyzed the temporal and spatial pattern of vertebrate's collisions along the road Guanare-Guanarito, in Portuguesa state. We travelled 26 times between these towns (74 km) to localize dead vertebrates, at a speed of 50-60km/h. of those trips were conducted from March 13 to October 26, 2010, and 10 additional trips from December 7, 2009 to December 14, 2010; these ones, with the aim to include months and seasons that were insufficiently sampled during the first period. The elapsed time between trips varied from 14 to 37 days. The total distance traveled was 1 924 km. Dead animals found amounted 464 individuals, 66 of them were birds (25 identified species), 130 mammals (15 species) and 268 reptiles (18 species). The species with the highest number of individuals were the snake Leptodeira annulata (n=119), the oppossum Didelphis marsupialis (n=39) and the spectacled caiman Caiman crocodilus (n=33). Excluding domestic animals, the rate of road-killed vertebrates was 0.2282 indiv./km, a figure 28.3% higher than previous studies in the same road. Changes in the relative number of collisions for some species, respect to the numbers reported 20 years ago, were linked to the increase in traffic flow and changes in land use. Road segments with collision rates higher than expected by chance were identified. Collition by cars may be the principal cause of mortality for species like the tamandua (Tamandua tetradactyla) and the giant anteater (Myrmecophaga tridactyla), the last considered a vulnerable species. Some basic measures are proposed to reduce wildlife mortality on the road.

INTRODUCTION. Glycogen storage disease type II, or Pompe disease, is a lysosomal disease with an autosomal recessive pattern of inheritance. Late-onset Pompe disease is a progressive metabolic myopathy caused by decreased activity of the enzyme acid alpha-glucosidase (GAA), which gives rise to reduced degradation and later accumulation of glycogen in the lysosomes and cell cytoplasm. CASE REPORT. A 16-year-old Venezuelan male, diagnosed with late-onset glycogen storage disease type II, or Pompe disease, based on the patient's clinical picture and the biochemical findings. The patient presented unmistakable signs of muscular atrophy in the upper and lower limbs, as well as positive Gowers' sign. Levels of creatinkinase in serum were high. His functional respiratory capacity was diminished. The quantification of the enzymatic activity of acid alpha-glucosidase on filter paper did not show any significant decrease in activity. A molecular genetic analysis revealed the existence of two homozygotic mutations in the gene GAA, c.547-67C>G and c.547-39T>G, both on exon 2 of chromosome 17. According to the human genome database and the review that was undertaken, the changes detected in this patient represent new mutations in the acid alpha-glucosidase gene, GAA. This claim is in agreement with the clinical features and biochemical changes found in the patient. CONCLUSION. A molecular genetic study is mandatory in patients suspected of having this disease.

Homicides occur the world over, but they are not homogeneously distributed by geographical areas (continents, countries, regions), either over long or short periods of time, or in social groups, namely age, gender, social class or ethnicity. Why are there more homicides in some countries than in others? Why do killings increase in some countries, while they decrease in others? There are two fundamental schools of thought for social explanations of crime and violence: those attributing its origins to poverty and inequality and those blaming institutionalization or social norms. To discuss these theories, this paper analyzes and compares the changes in Colombia, Venezuela and Brazil in the first decade of the twenty-first century, where the homicide rate has decreased, increased and remained the same, respectively. Using the measurement of six variables (poverty, inequality, unemployment, national wealth, human development and the rule of law) and the technique of trajectory analysis, the results revealed that institutionalization is more to blame for the change than poverty and inequality. The text concludes that poverty and inequality affect crime and homicides, although not directly, but mediated by the institutions instead.

Objectives: To establish the frequency of imperforate anus (IA) in the population with Down syndrome (DS) and study the associated risk factors., Methods: An observational clinical study case control type was performed. The patients were evaluated at the Unit of Medical Genetics, University of the Andes, from February 2006 to February 2011. The patients with DS and IA were compared with 20 DS without IA. Antecedents of parents were obtained., Results: The frequency de IA in the population with DS was 4.79%. The presence of fever in the first trimester of gestation and the rural origin were associated as risk factors of AI in patients with DS [OR: 25.33 (IC 95% 2.07- 310.76; P = 0.009) and OR: 7.50 (IC 95% 1.09 - 51.52; P = 0.043), respectively]. The maternal age superior to 35 years presented a marginal significance (P = 0.048)., Conclusions: These papers emphasize the high frequency of IA in patients with DS and recommend to investigate the prenatal and environmental risk factors that can increase the presence of this anorectal anomaly in the population with DS, in order to consider them in the programs of prevention of congenital pathologies.

Klebsiella pneumoniae as a producer of extended spectrum beta-lactamase (ESBL) has played an important role as a cause of infection in the neonatal high risk unit (NHRU) of the Autonomous Hospital Institute of the Universidad de Los Andes (AHIULA). In this paper an outbreak caused by this bacterial specie that affected neonates hospitalized in this unit during February 2007 is described. Besides, the environment and the personnel were studied as possible sources of this organism. The strains of K. pneumonia isolated from the outbreak had the same resistance phenotype, produced ESBL type TEM and SHV and belonged to the same genotype as the isolated strains from the hands and the soapy solutions, possible sources of infection. This indicates that it was the same clone. The outbreak was resolved using two important measurements: reinforcing hand washing and with the opportune treatment of neonates with imipenem.

INVESTIGACION CLINICA was founded by the initiative of Américo Negrette, who became its first editor, and it has been published uninterruptedly since July 1960, with a quarterly frequency. The first issues consisted mainly of a collection of reviews of seminars held at the now called Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del Zulia, its publisher. Very soon, original research results from this institution were included in the novel journal. In the 60's, papers on results obtained during the outbreaks of Venezuelan Equine Encephalitis present in the area, were prominent. Originally, the journal published 3-4 papers, but due to the increased number of contributions, in 2001, its format changed from 1/16 to 1/8, and now each number includes 11 original articles. Currently, INVESTIGACION CLINICA publishes 44 papers a year, in Spanish or English on different biomedical topics, from contributors all around the world. Progressively it has been included in different renowned indexes, such as PubMed/MEDLINE, Science Citation Index Expanded, Excerpta Medica, Tropical Diseases Bulletin, Copernicus, Scopus, Periodica, and several others. Besides, it can be found in open access through www.Scielo.org.ve, www.freemedicaljournals.com and in our new Web page: https://sites. google.com/site/revistainvestigacionesclinicas/home. Most papers published in INVESTIGACION CLINICA have been cited in the regional or foreign literature accumulating more than 1200 citations by now. For this particular issue, to celebrate the 50th anniversary of INVESTIGACION CLINICA, we have invited some of our more recent referees or authors to contribute with Reviews in their respective areas of expertise.

Seagrass beds are considered important feeding places for a variety of fish species characterized with complex trophic interactions. In this paper we described the trophic network of a fish community inhabiting a seagrass bed in the Venezuelan Caribbean. In addition, a consumption index (CI) for each prey ingested is proposed using two variables: abundance and consumption frequency. Eight samplings (at four time intervals: 6:00, 12:00, 18:00 and 24:00 hours) were done in August 2005 and January 2006. Fifty one fish species in 29 families were captured; Haemulidae was the most abundant. Crustacea was the most important food resource of the 28 food items identified. The relative importance of trophic guilds, considering abundance and taxonomic species richness, was: benthophagous>herbivorous>piscivorous. The features of the trophic network were: 1) high proportion of short chains (two links), 2) high number of intermediate species, 3) high consumption of benthos, 4) low CI values and 5) few species with a high number of linkages. Temporal (hourly and monthly) differences were obtained in fish species number (total, intermediate and top), total linkages, connectivity and maximal chain lengths. The connectance did not show significant temporal variation and it was similar to other environments with different species richness. In contrast, the connectivity was lower than the one reported for environments with low species richness. As in other reports, the temporal variation of the trophic parameters and the community structure was different. The values of CI for the different preys were low except for harpacticoid copepods and crustacean larvaes. The cluster value of CI was high for benthos (>80 %) and, in general, low for plankton and nekton preys. The seagrass bed studied was an important feeding place where the configuration of trophic network changed in different temporal scales and reflected the dynamic of the feeding relationships this fish community.

Objectives: Hemoglobinopathies are the most common hereditary disorders in humans representing a public health problem in Venezuela. In this study the prevalence of hemoglobinopathies was evaluated in newborns from different areas of Venezuela, in cooperation with the neonatal screening system of the Study Unit of Inborn Errors of Metabolism (IDEA)., Materials and Methods: The heel blood samples of 101,301 newborns were analysed by high performance liquid chromatography (HPLC-CE) technique using Variant* Bio Rad System with the Sickle Cell Short program for the filter paper samples in and the Beta Tal Short program for the family studies., Results: We found a high prevalence of newborns heterozygous for hemoglobin S and C (Hb S and Hb C). It was observed that 1.96% (1989) of the newborns were carriers, with Hb FAS (67.92) being the most frequent phenotype, followed by Hb FAC (23.18%), Hb FAD (7.49%), Hb FSC (0.96%),) and Hb FSD (0.20%). All the neonatal positives cases were confirmed at 3 months of age., Conclusions: The frequencies of the variants found in this study confirms that the hemoglobin disorders are a public health problem in Venezuela, emphasizing the importance of instituting a national program of screening for hemoglobinopathies throughout the country, comprising not only an early treatment, but also an educational program and genetic counseling for the family group.

The purpose of this paper was to determine the relationship between fibrinogen concentration and cardiovascular ischaemic risk factors in a group of apparently healthy men from Maracaibo, Venezuela. Two hundred and forty six individuals, ages 31 to 65 years were evaluated by means of clinical and laboratory examination. In each person plasma fibrinogen concentration was measured by coagulometry, serum glucose and lipids by enzymatic methods and insulin by radioimmunoanalysis. 31.7% of subjects had fibrinogen values in the highest tertil of the whole group (> or = 311 mg/dL), they also showed significantly higher values of total cholesterol (p < 0.03) and LDL-C (p < 0.01). In addition, the individuals in this tertil showed a significant and positive correlation between the values of triglycerides with insulin (p < 0.02) and with HOMA-IR (p < 0.01). On the other hand, correlation analysis also showed a positive significant association between the fibrinogen levels and total cholesterol (p < 0.02), dependent of individuals with family history of ischaemic cardiovascular disease (total cholesterol: p < 0.02 and LDL-C: p < 0.003). In consideration of the high concentrations of fibrinogen found in 31.7% of apparently healthy men and their significant positive correlation with total cholesterol and LDL-C, on the group of men with a family history of ischaemic cardiovascular disease, it would be advisable to include the determination of fibrinogen in the cardiovascular evaluation of these particular subjects.

Knowledge of the morph-physiological conditions of young athletes, it of the utmost importance for planning better trainning programs and to identify those characteristics that lead to a better performance. This paper aims to classify a group of 114 male Venezuelan swimmers of the Miranda State contingent, aged between 7.00 and 18.99 years old, based on their anthropometric characteristics and skeletal maturity. For this purpose multivariate methods: Analysis of Principal Components (APC) and the Automatic Classification were employed. Anthropometric variables followed the International Society for the Advancement of Kinantropometry (ISAK) guidelines. Skeletal maturity and five indexes of body composition: brachial, crural, cormic and acromiale-iliac indexes, were additionally considered in the analysis. Three groups emerged very well defined and homogenous within and between groups. The first group identifies the younger swimmers with the smallest values in corporal dimensions. The second group comprises those swimmers characterized fundamentally by a greater development of the bicrestal diameter. In the third group, greater values of the anthropometrical variables were found, that shaped the typical profile of the swimmers, mainly characterized by a trapezoidal trunk. Most of the swimmers are advanced in skeletal age related to chronological age. This clustering of the swimmers permits a suitable way to identify the bio-morphological characteristics of the athletes.

There are three marine shrimp species in the Venezuelan internal market, two of them are native species, from fisheries, Farfantapenaeus brasiliensis and Litopenaeus schmitti, and one is an exotic species and farmed, L. vannamei. The objectives of this paper were to determine the possible variation of lipid content and fatty acid composition of these species, even under different culture conditions (e.g. feed used). The lipid content in all the species are higher (5 to 10 times) that the data from previous papers deal with marine shrimps, ranged from 4.8 to 10.9%, suggesting that its impact in the human health should be reviewed. At the same time, there were detected differences between the lipid content and fatty acids composition of the species. Wild L. schmitti had the highest lipid content (10.9%), following by wild F. brasiliensis (9.0%), cultured L. schmitti (4.8% to 7.1%) and cultured L. vannamei (5.1% to 6.2%). On the other hand, L. schmitti fed on commercial feed had the highest proportion of EPA and/or DHA, following by L. vannamei fed on the experimental feed, wild L. schmitti and fed with the experimental feed and wild F. brasiliensis.

The diatom flora of Unare and Píritu Lagoons, Venezuela, comprises freshwater, estuarine and marine organisms. In this paper, 15 species of diatoms belonging to the subclass Bacillariophyceae D.G. Mann are described. Water samples from Unare and Píritu lagoons (Venezuela) were collected from November 1988 to July 1989. Samples were fixed with neutral formaldehyde (10%) and were examined under phase contrast microscopy. Species under study were Dictyoneis marginata (Lewis) Cleve, Cymbella affinis (Kützing) Cleve, Cymbella sp., Achnanthes brevipes var. intermedia (Kützing) Cleve, Lyrella irroratoides (Hustedt) Mann, Navicula carinifera (Grunow) Peragallo, Navicula liber (W. Smith) Peragallo, Navicula vacillans (Schmidt) Peragallo, Navicula sp, Amphora crassa var. campechiana Grunow, Amphora decussata Grunow, Caloneis powelli (Lewis) Cholnoky, Tryblionella acuta (Cleve) Mann in Round et al., Tryblionella apiculata Gregory, Surirella febigerii Lewis.

The marine phytoplankton of Venezuela has been studied on a regular basis since the mid 20th century. However, a species checklist that can be used as a framework for taxonomic studies is lacking. In this paper, an index of the marine microflora of Venezuela is presented for the first time. The index includes only those diatoms (89 centric and 186 pennate species), dinoflagellates (eight naked and 154 thecate species) and coccolithophores (24 species) for which formal diagnosis and illustrations (drawings and/or photographs) have been reported in the scientific literature (journals and/or first degree or master's theses). It is ordered alphabetically according to class, order, family, and species. It includes the author (s) of the taxa.

This paper describes the process of modifying and validating a hunger index developed in the United States by Wehler et al (1992). It is part of a research whose main objective is to develop and validate a simple method that measures both quantitative (food sufficiency) and qualitative (female self-perception) dimensions of household food insecurity. In a pilot study, the original instrument was modified from a 2 point 8 item to a 4 point 12 item scale. Precision measured with Alpha Chronbach's coefficient was high (0.871) suggesting consistency in the scale's items. The instrument was applied to a sample of 238 poor and very poor households in a peri-urban barrio of Caracas. To determine overall internal validity of the scale the relationship between possible economic, social and behavioral determinants and food security level measured with the scale, was analyzed. Construct validity of the scale was established with factor and principal components analysis. Finally, with multiple regression analysis evidence is presented for overall validity of the scale. Four determinants: predictors of food sufficiency score, monthly income per capita, social class, and number of children in the household predict in the expected direction self-perceived food security level (R2 = 0.343). Results suggest that this instrument, together with an abbreviated measure of food sufficiency, based on strategic foods may be a valid, precise, and simple method for identifying and monitoring households that suffer from some degree of food insecurity in poor urban communities.

Schistosoma mansoni partially develops its life cycle into snails of the Family Planorbid. Biomphalaria glabrata represents an important host-intermediate. This paper reports experimental infection with miracidia vs. snail in sympatric and parapatric combination. The infection assay to sympatric combination were: BH snail (Belo Horizonte, Brasil) vs. a common geographic origin parasite, and Barbula, Carabobo State, Venezuela vs. SM Venezuela parasitic. The parapatric combination were: BH snail vs. SM; Barbula vs. BH; Caripe Monagas State, Venezuela vs. SM and Caripe vs. SM. During the study period was observed not miracid penetration. The infection percentage ranged from 88.89% in Barbula vs. SM combination to 0.00% in the Caripe vs. BH and BH vs. SM combination. We concluded which different existence of susceptibility from evaluated combination.

This paper is a limited-scope experimental study to evaluate the effectiveness of the Dental Health Educational Programs implemented in Venezuelan schools by the Dentistry Division of the Ministry of Health and Social Welfare. Two hundred and ninety-six six-to-twelve year olds were randomly selected from two schools, one private, the other public, located in the Municipality of Maracaibo, State of Zulia, Venezuela. The children assigned to each school were randomly distributed among the experimental and control groups. A general hypothesis was set up, stating that reinforcement and motivation generate changes in the gingival health of the children under study, but with different results for each, depending on their psycho-social characteristics. Two approaches were used: instruction/supervision and instruction/supervision/reinforcement/stimulation. These two approaches were then measured against a "psycho-social profile" which is based on material conditions and the developmental stages of the children. Instructions were given to the experimental group on how to brush their teeth. They were supervised, reinforced and stimulated for a period of six months, with a post-test assessment. The control group was only given instructions on how to brush their teeth and supervised. A scale based on Massler's classification was used to determine the developmental stages. Standardized indices were used to evaluate the dependent variable: Plaque Index and Gingival Index. The results showed that: the material living conditions and developmental stage of the child are elements that influence the assimilation of pre-established behavior, the basis of preventive programs.

When an ecosystem is disturbed, it reverts to an early successional state, characterized by changes in community structure and function, that can be anticipated as response to stress. The purpose of this paper was to check the effect of a disturbance caused by application of chemical compound (Copper Sulfate, to 100 micrograms L-1 granular of 92%) on the phytoplankton community in a pond located in Guaicaipuro, Edo. Miranda (Venezuela), and compare the diversity and composition of the community before and after the chemical application. An additional purpose was, to test the Odum's hypothesis about the community response to chemical stress. The chemical compound was apply in different random points to assure homogeneous distribution in the water body. Only one application of the chemical was used 6 hours after the first sample was taken. Dissolved oxygen in surface and depth were measured. In order to estimate the diversity and composition of phytoplankton community, samples were taken in 5 random points of the pond, until a 2 liter sample was completed in an intermediary basis, during 30 days in the beginning of rainy season, between june and july of 1994. Oxygen showed a maximum value at surface of 9.3 mg O2/L and minimal value at depth (2.3 mg O2/L). Species richness varied between 4 and 18. Phytoplankton community varied between 7.1 x 10(4) and 7.8 x 10(6) cel/L, and diversity index between 0.12 and 1.39. Oxygen, species richness and phytoplankton minimal values were noticed at the fifth day after chemical application. Before chemical application, phytoplankton community was dominated by filamentous microalgae, especially Chlorophyta. After the fifth day, this group decreased in abundance and species number. On the seventh day small-size Cyanobacteria became dominant, particularly Chroococcoid forms. The community reverted to an early stage of ecological succession. Since the ninth day, community showed the following abundance sequence: Chrysophyta, Pyrrophyta, Bacillariophyta, and Euglenophyta, with an increased species richness. At the end of the study period, filamentous Chlorophyta species appeared. These results support Odum's hypothesis.

The Prenatal Diagnosis Program of the Medical Genetic Unit of University of Zulia has the following objectives: Identification of Genetic Risk Factors (GRF) in those couples who attend to the Prenatal Genetic Clinic, application of different prenatal diagnostic procedures (PDP), and providing adequate genetic counseling. The goal of this paper is to show preliminary results obtained between January 1993 and December 1996. Three hundred and twenty one pregnant women were analyzed by determining the GRF and taking into account the genetic clinical history. The GRF analyzed were: Advanced maternal age (AMA), congenital malformation history (CMH), previous child with chromosomic anomalies (PCCA), defects of neural tube history (DNTH), congenital heart disease history (CHDH), any parent carrier of chromosomic anomaly (PCA), habitual abortion (HA), abnormal fetal echography (AFE), altered maternal serum levels of alpha-feto-protein (AMSAFP) and OTHERS: exposure to teratogenic agents, history of Mendelian diseases, maternal systemic diseases and anxiety in the mother or in her partner. The PDP was designed according to the GRF, which included fetal echography (FE), fetal echocardiography (FEc), amniocentesis (AMN), chordocentesis (CCT) and AMSAFP. Results showed that 58.4% of the expectant mothers asked for counseling during the 2nd trimester, 70% of the total showed only one GRF, and AMA was the most frequent GRF found (40.3%), followed by PCCA, AFE, CHDH, HA, DNTH, PCA, and OTHERS in that order. The specific PDP applied to the identified GRF allowed a health evaluation of the fetus. The GRF identification gave the opportunity of establishing a Prenatal Diagnostic Program producing a response to the couple's needs and showed the utility of an integral and multidisciplinary management directed to any expecting mother in order to identify any high GRF.

Microtia is a congenital malformation characterized by total or partial absence of the whole auricle or any of its components, varying from a small auricle to the total absence (anotia). There may be associated atresia of the external auditory meatus. The frequency varies in different parts of the world between 0.4 and 5.5/10,000 newborns. In this paper we report the clinical and epidemiological characterization of this congenital malformation in a sample of 97.759 neonates born at the Ruíz y Páez Hospital in Ciudad Bolivar, Venezuela, between April 1978 and December 1994. A total of 38 patients with microtia were identified. The global frequency was 3.8 per 10,000/newborns. In 47.4% of the patients microtia was an isolated malformation and in 52.6% was associated to other malformations. Sixty three percent of the affected were males. The unilateral form was present in 81.5% of the cases, more frequently on the right side. The annual frequency of the defect was stable over the studied years. The clinical classification of the cases with associated malformations allowed us to establish that 18.4% of the cases correspond to developmental fields defects, associated to preauricular dimples and/or tags, 7.8% were cases of the facio-auriculo-vertebral spectrum and in 15.7% the microtia was part of a monogenic or chromosomal syndrome. In 10.5% it was not possible to define any etiological or pathogenic mechanism. The frequency obtained in this study for microtia shows intermediate values when compared with others reports from Latin America.

Human milk is considered the ideal food for the infant and it has been extensively used to estimate its nutrient requirements. The objective of this paper was to determine the effect of lactation time on the macronutrient an mineral content of milks obtained from Venezuelan women and also to compare this with the established nutrient requirements of the infant. For this purpose 83 milk samples from 45 low income mothers were analyzed at the colostrum (48 h to 54 d) and mature states of lactation (1.3 and 6 months). The results showed that colostrum had a higher protein and a lower fat content than mature milks whereas its content of energy and carbohydrate was similar to mature milk. The iron and calcium content of the milk remained unchanged during the whole study whereas Zn and Cu decreased and increased with lactation time respectively. In contrast, phosphorous and magnesium increased up to 3rd month of lactation and remained constant there after. The macronutrient content of 850 ml of the analyzed milk almost completely fulfilled the daily infant requirements established in the US (RDA) and Canada (RNI). The mineral content of this volume of milk however was insufficient to cover the infants requirements particularly those established in the US. The most notorious deficiency in these milks was in Fe since they could fulfill only 11% the infants RDA for this mineral. The infant mineral requirements established in Canada are substantially lower than those defined in the US and therefore the analyzed milks could totally fulfill the Canadian infant daily requirements of Mg, Fe and Ca and more than 70% and 80% of the requirements of Zn and P. In general, the results of this study showed that the nutrient content of the analyzed milks agree well with those reported in the literature for women from different parts of the world including developed and underdeveloped areas. At the same time they pointed out the differences in the definition of the infant nutrient requirements set by different countries and also emphasize the fact that human milk, which by definition is the natural source of nutrients for the human infant apparently is incapable of fulfilling its daily requirements.

The production of articles resulting from biomedical, clinical, and public health studies that originated in Argentina, Brazil, Chile, Cuba, Mexico, and Venezuela from 1973 through 1992 was analyzed to discover trends in health research in Latin America. From the database of the Institute for Scientific Information (ISI), 41,238 articles with first authors who resided in those countries were extracted. These articles were analyzed by subject area, type of study, country, number of authors and institutions that participated in the investigation, and citations received by each article. Also analyzed were 95 articles in epidemiology selected from a pool of 570 published by authors from the six countries in 11 public health journals that enjoy international prestige. The results showed that the number of published works increased by 117% between the first and last five-year periods within the study period. Clinical research was distributed the most evenly among the countries, and public health research was the most concentrated (60.7% originated in Brazil). The numbers of biomedical and public health research articles showed relatively more growth than those reporting on clinical research throughout the period. A relative decrease was found in articles by only one author, which suggests a greater frequency of team efforts, and an increase was seen in articles with authors tied to two or more national or foreign institutions, which indicates greater cooperation between institutions and countries. The average number of citations received by each article was 3, which was less than half the number received by the articles in the ISI database (7.78). Regarding the subset of 95 articles in epidemiology, the great majority (96%) dealt with infectious diseases or maternal and child health, while in the international literature 78% of such articles were about chronic diseases. This group of articles gave evidence of more cooperation with international institutions and had a citation index of 4.36 per article. It is concluded that, despite the inherent limitations, this type of study reveals some general trends in the development of research in the six Latin American countries with the greatest scientific production and makes it possible to formulate hypotheses on the factors that influence these trends. Taken with the paper caution, the results of studies like this one can be of great value in defining health science and technology policies.

In Venezuela, the law protects mangroves specifically. This paper is a retrospective review of the existing regulations on mangrove to find out: how has it been protected?; which have been the results of different approaches followed to do so?; which could be the problems for its protection in the near future? The result from the analysis indicates that regulations should not protect a specific mangrove species. The focal point on the regulation should be the protection of mangrove, as well as the vital relationships between this landscape unit and the existing others. Therefore, decisions of mangrove should be proposed as part of a plan for the basin where it belongs. Intervention on mangrove must be based on expert judgement, due to high uncertainty about the success of corrective or mitigative actions.

Hallervorden Spatz syndrome (HSS), described in 1.922, is a rare progressive disorder recessively inherited involving the basal ganglia. It is manifested clinically by mental deterioration, rigidity, choreoathetosis and spasticity evident during the first two decades of life. Increased concentration of iron in the globus pallidus and substantia nigra has been demonstrated convincingly. the objective of this paper is to describe two venezuelan children with this syndrome. Patient 1 is a 14-year-old boy with progressive impairment of language, mental deterioration and slowing of voluntary movements started at the age of 8 years. Patient 2 is a young girl first examined at 8 years of age because of psychomotor development delay, progressive impairment of gait, rigidity of the limbs, progressive dystonia and mental deterioration. Multiple test were performed, including metabolic studies, CT scan and magnetic resonance imaging in the brain. These two cases may lead us to think that besides the Huntington Disease, the HSS is also an entity to be taken into consideration in a young patient with movement disorder, mental deterioration and progressive course.

The number of cadaveric kidneys available for transplantation has become insufficient around the world. Despite concerted efforts, we have been unsuccessful in greatly improve the supply of organ donors, and consequently the number of end stage renal failure patients awaiting for kidney transplantation continues to increase. The primary objective of this paper is to quantify the need and supply of kidneys for transplant in Venezuela. An overview of the current level of kidney transplant activity in Venezuela is presented, observing that the activity with cadaveric donors had been predominant since 1983, although not to an optimal level. The annual activity in kidney transplant between 1989-1991 remained stable in 6 transplants/million people, but went sharply down to 4.6 in 1992. An estimate of the current need is around 10 donors/million people. This is in contrast with an effective donation rate of only 2.01 and 1.92 donors/million achieved in 1990 and 1991 respectively. The most frequent cause for no donation was the lack of familiar consent. Based on an analysis of the factors involved in the shortage of donor supply in Venezuela, we present some recommendations to increase the availability of cadaveric organ donors in the country. These measures include an improvement of education and legal regulation in the field of organ donation and transplantation, and following the Spanish model, the creation of a program of hospital transplant coordinators that can detect and evaluate potential organ donors as well as coordinate the logistical aspects of transplantation.

The paper presents a synthesis of the history of malaria: the ancient origins of disease, the parasites which produce it, and its vectors. Emphasis is given to its existence in Venezuela, the struggle against its endemic character during the decades of the XXth century and its almost total eradication from malarial areas during the fifties. Reference is also made to current research of an anti-malarial vaccine and its application in a rural area of this country.

The purpose of this paper is to report on the pioneering research of ten Venezuelan physicians who played an important role in the development of physical anthropology, paleopathology and, to a certain extent, of forensic anthropology in the country. A brief historical overview of the progress of this science in Venezuela, in the context of its evolution in other parts of the world, is also presented.

Development of therapeutic endoscopy has permitted the treatment of early gastric cancer (EGC) in its different macroscopic forms. In this paper we present 9 cases of EGC treated endoscopically in our Institution. We describe the criteria we follow to perform this procedure. The patients selected were of advanced age and high surgical risk. Seven cases were macroscopically Type I and two were Type IIa. According to localization six were proximal tumors (body and fundus) and three were located in the antrum. Six of the nine patients are alive after resection, one more than 6 years and 3 more than 3 years. Three patients died of ailments no related to cancer.

A congenital malformations surveillance program in effect at the Ruiz y Páez Hospital in Ciudad Bolívar since April 1978, has allowed us to detect 25 patients with osteochondrodysplasias (OCD) in a total of 70,152 newborns, up to August 1990, for a prevalence of one case of OCD every 2,806 newborns. The clinical entities found were: Achondroplasia, Thanatophoric Dysplasia, Osteogenesis Imperfecta II-A, Camptomelic Dysplasia, Kniest Dysplasia, Conradi-Hunnerman syndrome, Parenti-Fracaro type Achondrogenesis and Jeune Asphyxiating Thoracic Dysplasia. The results presented in this paper indicate that this type of diseases represent a relatively important group of nosological entities adding up to more than 200 new annual cases in the country. This relatively high frequency, the different inheritance mechanisms involved, the variable complications and the high morbidity and mortality rate of these diseases, make the patients affected, a problematic group not receiving, in general, adequate medical attention regarding diagnosis, genetic counselling and treatment.

The subject of this paper is the importance of preventive and social medicine in medical education; it presents a study based on an examination of the function of these subjects with particular reference to the Luís Razetti School of Medicine. The authors assert that, in the present state of medical education, the new physician is unprepared to deal with the country's real needs. The purposes of the medical school are to turn out personnel who can mesh effectively into the operations of health systems, to do research and identify health problems of the community, to participate in the framing of health policies, and to train teaching staff who are socially aware and thus in tune with the country's health policies. Despite much discussion and study of the subject, little has been done in practice. The authors state their views and assert that the universities must draw up the curricula for their medical schools with an eye to the needs of the countries and with emphasis on preventive and social medicine.

The purpose of this paper is to evaluate the frequency and some of the clinical and epidemiological characteristics of asymptomatic gastric ulcer, found in persons who attend the Center for Control of Gastrointestinal Cancer of San Cristóbal, Venezuela, as part of a gastric cancer mass screening program. 350 patients with active peptic ulcer were found, 176 duodenal and 174 gastric, diagnosed by means of endoscopy. Of the patients with gastric ulcers, 67 (38.5%) had no symptoms. This group of asymptomatic patients were analyzed regarding age, sex, place of residence, type of work and also the location of the ulcer and the histology. We conclude that this entity is frequent in our region that it is associated with agricultural workers and house wives. It is necessary to continue a prospective periodical evaluation of these patients in order to understand the natural history of the entity.

In order to establish a preliminary information about the penetration of delta infection in our population, 40 HBsAg positive sera were tested for antidelta. 20 were asymptomatic patients and 20 were symptomatics. In the group of asymptomatic patients 3 belong to a high risk population: 1 homosexual, 1 dialysis patient, 1 nurse of dialysis unit. None of the patients of this group were positive for antidelta. In the group of symptomatics one was positive for antidelta. It's represents a seroprevalence of 5%. This patient was an indian who lives in the city but was born in Perijá where severe epidemics have been reported. These results support that the infection seems to be restricted to this indigenous group but the spread must be considered because the patient was living in the city. In addition, the use of antidelta as the unique serologic marker should undervalue the real prevalence of infection in the cases of acute hepatitis, which represent the majority of symptomatics patients. In consequence the paper of delta agent must be considered in the genesis of hepatitis in our population as well as its further epidemiologic course.

"This paper presents six indirect techniques for estimating the degree of death coverage as applied to vital statistics information in Venezuela between 1960 and 1982, collected by two public institutions, namely, the 'Oficina Central de Estadistica e Informatica' (OCEI) and the Ministry of Health and Social Assistance (MSAS).... The results show remarkable improvements in the death registry coverage for both institutions, that amount to 97 or 98 per cent at the beginning of the 80's. Nevertheless, great differences can be observed between them regarding both structure and volume of deaths by sex and age." Among the problems discussed are the impact of immigration and errors in age reporting. (SUMMARY IN ENG), (excerpt)

This paper discusses an integrated project in Venezuela, planned and designed to ascertain the best procedures required for production of large quantities of shellfish, including: selection and maintenance of pollution-free growing areas; the best harvesting methods; and the safest and most economical marketing procedures. The major problems involved in producing safe, wholesome and nutritious shellfish are primarily those of sanitation and adequate preservation of the foods until they finally reach the consumer. Therefore, it is essential that these products be produced and handled in a sanitary manner on a continuous basis. There are numerous codes of recommended handling practices for shellfish, most developed only after many technical conferences were organized to evaluate all of the available scientific evidence. Therefore, for producing safe shellfish in Venezuela, this publication recommends the adoption of these sanitary and handling practices, designed and tested by the faculty and staff personnel of Universidad Simón Bolívar.

The model for evaluation of the curriculum of a medical course presented in this paper was designed and used in the academic evaluation done in the School of Medicine of Lisandro Alvarado West-Central University, in Venezuela. The model includes an evaluation of program structures, the formulation of objectives, consistency among objectives, subject matter and exercises and between the institution's activities and objectives, the balance between theoretical and practical instruction, and the vertical transfer of the curriculum. Matrices were designed for all the variables used in the evaluation, and permitted the identification of relevant and irrelevant subject matter and of shortcomings in the curriculum that were hindrances to learning.

A strain of Aspergillus sp. is described and proposed as a new species under the name "Aspergillus insulicola sp. nov." Montemayor & Santiago, 1973. This strain was isolated from soil samples taken in "Aves Island" during a scientific expedition.--Aves Island, situated at 15 degrees, 40 feet, 42 inches N and 63 degrees, 36 feet, 47 inches W, about 665 Km of the coast of Venezuela, has very special ecological conditions. Due to its smallness: 550 m long and 40 to 120 m across and to its low profile only 3 m over sea level, it is swept by the sea during the periodical storms and hurricanes in the area. It has thus a very interesting fauna and flora. We took a series of soil samples to study its mycological flora. Forty samples were inoculated by dilution method. In this first paper a species is described and proposed as a new species because of its macroscopic and microscopic characteristics, as well as by its biological properties, under the name "Aspergillus insulicola sp. nov.". In its study we have tried to follow as closely as possible the methods recommended by Kennet B. Raper & Dorothy Fenell, world authorities on the genera Aspergillus and Penicillium. The strain is being kept in USB under the number T1, and has been sent to ATCC & CBSC to be incorporated in their collections.