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Introducción: La proteína relacionada con la parthormona (PTHrP), un factor abundante en el tejido óseo, es un importante modulador de la formación ósea. Se ha demostrado que la PTHrP (107-111), conocida como osteostatina, cargada en el material cerámico mesoporoso SBA-15, ejerce acciones osteogénicas in vitro. Objetivo: Comprobar si dicho material y una versión funcionalizada del mismo (C8-SBA-15) promueven la reparación ósea en un modelo de defecto cavitario en el fémur del conejo. Material y métodos: Para ello se han llevado a cabo estudios histológicos e inmunohistoquímicos y de microtomografía computerizada (µCT). Resultados: Tras la implantación de los biomateriales no se observaron niveles significativos de inflamación ni resorción ósea (4 y 8 semanas). A las 8 semanas las biocerámicas no cargadas con la osteostatina se encontraban separadas de la médula ósea por una cápsula fibrosa, que disminuía de forma significativa en presencia del péptido. Se observó (por µCT) un aumento de la neo-formación ósea a diferentes distancias de los biomateriales, principalmente en los cargados con la osteostatina. Además, estos resultados fueron confirmados por inmunohistoquímica de marcadores osteoblásticos. Conclusión: Nuestros hallazgos sugieren que estas biocerámicas cargadas con la osteostatina son una buena estrategia para acelerar la regeneración ósea.

Background: Population aging has a direct impact on the increasing demand of health services and on medical care costs. The objective was to carry out a cost analysis of health care costs in older adults in a regional general hospital of the Instituto Mexicano del Seguro Social., Methods: A calculation of the costs was done based on a retrospective collection of health care data. Unit prices were used to estimate costs. These were reported in 2016 Mexican pesos. A cost analysis was carried out by means of a regression model. Explanatory variables were sex, age and comorbidity level, the latter measured by using the Charlson index., Results: The average cost of all the 509 patients was 34 769 Mexican pesos (SD = 2869 pesos). Age variable explains the costs; however, sex and comorbidity variables were not significant. Cost predictions with the statistical model show differences mainly by age. In the case of females, the model predicts greater costs compared with those of males. Costs for older adults of 85 years or more were greater than those for the group of younger people (75-84)., Conclusion: The hospitalization costs estimated are high and they differ according to the age group. We suggest to make further research in order to know the factors associated with high hospital costs for this age group.

Endemic populations of Hechtia perotensis have been described in Puebla and Veracruz, Mexico. Good quality seed collections can be used in conservation, research and ecological restoration. To evaluate seed quality of wild and endemic species, some compounds are used as effective promoters of germination, such as potassium nitrate (KNO3) and gibberellic acid (AG3), because they increase seed germination capacity and reduce latency. The triphenyl tetrazolium chloride (tetrazolium) test correlates seed viability because it is based on the activity of dehydrogenases in live tissues that catalyze mitochondrial respiration. The objective of this study was to obtain information on size and weight of capsules and seeds and seed germination and viability of H. perotensis, collected in Veracruz in the year 2012 and 2015. The hypotheses were 1) that seed germination and viability are independent of the year of collection, 2) that there is a tetrazolium concentration that can identify seed viability better than others, and 3) that pretreatment with KNO3 or AG3 improves seed germination. Seed germination was assessed using a completely randomized design with three treatments (control and the germination promoters 0.2 % KNO3 and 500 mg/L AG3), four treatments for the viability test (control, 0.2, 0.5 and 1.0 % of tetrazolium) and six replicates for each treatment. A total of one hundred seeds for germination experiments, and 25 seeds for the viability test were used. The results between and within years were analyzed with ANOVA and multiple comparison with the Tukey test. The proportion of non-germinated seeds was quantified along with the number of normal and abnormal seedlings, seeds with viable embryo, seeds without embryo, and seeds with low or no viability. On average, for the 2012 collected sample, 36 % had viable embryos, 7 % had low viability, 24 % were not viable and 33 % had no embryo. This result was significantly different from the 2015 sample, for which 87 % of seed showed viable embryos, 10 % had low viability, 0 % was not viable and 3 % had no embryo. Seed germination was also significantly different between years (22 and 92 %) Pregerminative treatments did not improve germination. Seed germination and viability of H. perotensis significantly varied between years of seed collection.

Introduction: Insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations., Aim: To evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment)., Methodology: An experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010). Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment. A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose. Sleep quality was evaluated at 18-24 months (Epworth test)., Results: A total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46 years (SD: 14.3). Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P=.88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P<.0001), with a statistically significant reduction being observed in the IG. More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P<.0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose. In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P<.0001)., Conclusions: The integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Background: Allergic rhinitis and asthma are the more frequent allergic diseases. Dermatophagoides pteronyssinus is one of the more clinically relevant causes of allergic diseases., Objective: To standardize the biological potency Allergenic Bioequivalent Units (BAU) of Dermatophagoides pteronyssinus allergen extracts of three national laboratories., Methods: This experimental, prospective, transversal, quantitative study included patients allergic to house dust mites. According to the FDA protocol, allergenic extracts of Dermatophagoides pteronyssinus from three Mexican manufacturers, were injected intradermally in threefold dilutions, until get an midpoint orthogonal diameters 50 mm erythema sum. Statistical analysis was done using logistic regression, one-way analysis of variance and Bonferroni test., Results: We included 20 adult patients, 11 women and 9 men, aged between 16 and 45 years. Four patients had allergic asthma and rhinitis and 16 only had allergic rhinitis. There were no systemic anaphylactic reactions. Correlation coefficients of linear regression of the dose/response were to Allerstand r=0.55, Allergomex r=0.54 and Allerquim r=0.57(p=0.001). Dilutions calculated for 100,000 BAU/ml for each extract were Allerstand 1:26295, Allergomex 1:26341 and Allerquim 1:73993. The protein concentration (mcg/mL) was: Allergomex: 63, Allerquim 65, Allerstand 154., Conclusions: It was established the biological potency for each tested extract. We have found significant differences in the biological equivalence among the extracts from the three manufacturers. The procedure showed an adequate safety profile.

Background: Hypersensitivity reactions to insulin are infrequent, yet of clinical importance. The mechanisms of hypersensitivity involved can be of three types: I, III and IV., Objective: To describe the pathophysiology of hypersensitivity to insulin, its clinical features and diagnostic and therapeutic approach, that help identify the cases of allergy to insulin and begin a treatment, or if necessary, to refer patients to a specialists or appropriate medical attention., Methods: An electronic search of papers related to insulin hypersensitivity was performed in PubMed and the articles selected were those considered the most relevant for this review., Results: Thirty eight papers about pathophysiology, mechanisms of injury and the different types of insulin involved in hypersensitivity reactions were included. Likewise, information for the diagnosis of insulin hypersensitivity and some options of treatment for first contact physicians or the referral of patients to specialists in endocrinology and allergy were included., Conclusions: Insulin hypersensitivity has a low prevalence and diverse clinical manifestations. The different types of insulin suitable allow the majority of cases of hypersensitivity to continue the treatment in a efficient and flexible manner.

Uterine fibroids are a significant source of morbidity for women of reproductive age, and can result in substantial symptoms affecting their quality of life. Definitive treatment has traditionally been a myomectomy, but increasingly women are not prepared to undergo such an invasive procedure for a benign and usually self-limiting condition. Focused ultrasound ablation is one of the least invasive treatment options outside medical therapy and does not require an anesthetic.Magnetic resonance guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging guidance for therapy and thermal feedback provided by magnetic resonance imaging. This paper provides an overview of the MRgFUS technique, including a brief description of the treatment system, guidelines for selection of patients and follow-up, and a comparison with other treatment techniques.

Background: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute., Aim: To report our experience with Adult Still's disease., Material and Methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago., Results: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed leukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and leflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode., Conclusions: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.

This historical article reviews the most important milestones in the evolution of human and patient's rights. The latter have derived from human rights and have followed a similar historical evolution, but in markedly different times. This has lead to the persistence of monarchic type, paternalistic clinical relationship forms in republican societies. The acceptance of informed consent and patient's rights has been a democratization of clinical relationships. On the other hand the right to body health management is a real cultural revolution. The democratization of clinical relationship is in agreement with our technical, pluralist and secularized times.

A 49 year old "mapuche" male patient was operated on and tuberculosis of the gallbladder was found. Later on, he developed evidence of meningeal and pulmonary involvement and elevated pancreatic enzyme levels. In spite of appropriate anti-tuberculosis therapy, the patient died. Autopsy revealed multiorgan involvement with pancreatic tuberculosis and areas of steatonecrosis. Immune deficiency related to the previous cholecystectomy may have facilitated the severe dissemination of the disease observed in this patient.

To understand the ethics of our present time (macrocosmos), the patient-physician relationship (microcosmos complex) and its changes through history are analyzed. The patient-physician relationship is no longer between two individuals, it is plural and technified. An individualistic forms of ethic cannot answer the questions that arise from contemporary society. The power (political) of medical science has placed us at the threshold of a qualitative change, new that the human genome can be known and the very nature of the species can be modified. Man's destiny will depend on the way (ethic) he uses his knowledge. An ecological ethic could be the answer.

Portal hypertension is a common pathology in childhood and one of its most common causes is cavernomatosis of the portal vein. This obstruction causes hemodynamic changes which lead to splenomegaly and collateral circulation. Esophageal varices are one of the most important sequelae, which endanger the patient's life because of a bleeding tendency. Ecosonography helps to detect the thickening of the lesser omentum vis a vis the aortic diameter, caused by the collateral circulation. We studied 15 children presenting with portal hypertension resulting from portal vein cavernomatosis; we performed an upper GI endoscopy and abdominal ecosonography. The endoscopy revealed grade II esophageal varices in 20% of cases, the remaining 80% had grade III and grade IV. Ecosonography revealed an increased lesser omentum/aorta ratio in children with portal hypertension, compared to controls (p < 0.001). Our results suggest that the lesser omentum/aorta ratio has diagnostic value in pediatric portal hypertension.

Rectal polyps are relatively frequent in infancy and constitute one of the main causes of hematoquezia during this time of life. They are usually treated with multiple drugs before the correct diagnosis is made. We report our experiences with the use of rectoscopy and colonoscopy for the diagnosis and treatment of 214 patients with rectosigmoid polyps, including other sites in the colon, studied between 1982-1988. The highest incidence was between 3 and 6 years of age (63.8%), and the most frequent location in 253 rectosigmoid polyps (91%) and histologically (99.7%) were juvenile polyps. Endoscopic polypectomy proved to be a valuable method, easy to perform and with few complications to treat colon polyps, thus eliminating the surgical interventions.

Ascariasis is one of the most frequent intestinal parasitosis of man, specially in tropical regions where it affects mostly children. The adult worm can migrate through the ampulla of vater and penetrate the bile ducts producing different degrees of obstruction and infection. Ultrasonography is a rapid and simple non invasive procedure very effective for the visualization of the worm in the biliary tree. We present the clinical and ultrasonographic characteristic of biliary ascariasis in five children diagnosed by ultrasonography in our institution during the last nine years.

We present here our experience in colonoscopy performed in 93 children between 1984-1988 at hospital J. M. de los Ríos de Caracas. Mean age was 5.44 y/o and the range was 2-13 y/o. Rectal bleeding in 91.36% of the cases was the most common indication of the procedure. Rectal and sigmoid polyps were found in 24.73%. Vascular malformations in 16.13%, studies informs as normal 13.98% and ulcerative colitis in 10.75% No complications were observed so we can suggest colonoscopy as the first tool in diagnosis and treatment of the colonic pathology in children of any age.