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Background: To compare the effect of primary subcutaneous cellular tissue (SCT) closure on the incidence of seromas in midline laparotomy wounds. Methods: A cross-sectional study was designed. Patients undergoing midline laparotomy during the study period were included. Patient characteristics and closure techniques were recorded. A 30-day post-operative follow- up was included. Results: 83 patients underwent midline laparotomy abdominal surgery during the study period. 38.1% (n 16/42) of patients with only skin closure developed post-operative seromas versus 12.2% (n 5/41) of patients with skin and SCT closure, with an odds ratio of 0.22 (95% confidence interval [CI] 0.07-0.69, p = 0.009). Surgical site infection was 11.9% and 22%, respectively. Conclusions: SCT closure helps decrease post-operative seroma. Despite methodological limitations, this study lays the groundwork for future research with more rigorous methodologies that allow for longitudinal analysis and the confirmation of cause and effect.

Background: Hearing disabilities in pediatrics are a prevalent pathology with a high impact on quality of life. This study describes the internal ear morphometry of a Mexican pediatric population. The aim is to compare sensorineural hearing loss (SNHL) and control groups. Methods: An observational, cross-sectional, retrospective, and comparative study was conducted utilizing HRCT study images. Variables were measured with the Horos for Mac program. All variables were measured in 108 temporal bones (26 girls and 28 boys) and analyzed by groups, laterality, and sex. Results: The overall cochlear length mean was 35.62 ± 4.06 mm. Internal canal width significantly differed between the control and SNHL groups (p = 0.039). Conclusions: Our findings may be useful to determine control and SNHL pediatric population characteristics to facilitate preoperative management of cochlear implant surgery.

Aims: We address the following questions: 1) Which are the main vegetation types that currently occur in the Arid Chaco? 2) Do those vegetation types differ in terms of floristic composition, endemism, chorotypes and life forms? and 3) Is there any spatial association between the vegetation types and the environmental heterogeneity of the Arid Chaco? Study area: The southwestern extreme of the Gran Chaco, in Central-Western Argentina. Methods: The survey was based on a dataset comprising 654 relevés collected according to the Braun-Blanquet method. Data were classified by the hierarchical ISOmetric feature mapping and Partition Around Medoids (ISOPAM), and ordinated through isometric feature mapping (ISOMAP). Bioclimatic and edaphic variables were related to the ISOMAP ordination. Results: We recorded 439 vascular plant species, 62 endemic at the national level and 22 endemic species restricted to the study and surrounding environments in Central-Western Argentina. A total of nine vegetation types, belonging to four major clusters, were identified. The most prominent chorotypes included species distributed in the Chaco region and in the Arid Chaco/Monte phytogeographic units. The predominant life forms were micro- and nano-phanerophytes, followed by hemicryptophytes, chamaephytes and mesophanerophytes. Conclusions: Major results highlighted that xerophytic shrublands are the most common vegetation types in this area as a result of the historical and present use, while old growth forests were constrained to areas with low anthropogenic disturbance in the last decades or to protected areas. Most vegetation types (with the exception of halophytic environments) are poorly differentiated from a floristic point of view; however, they clearly differ in physiognomy. The floristic composition of the vegetation types described revealed numerous species in common with other sectors of the Chaco of northern Argentina, Bolivia and Paraguay. Although the number of species restricted to the Arid Chaco was quite low, the most relevant chorotype included species with Western and Eastern Chaco distribution, conferring a clear Chaquenian identity to this area and discriminating it from other phytogeographic units. Taxonomic reference: Catálogo de las Plantas Vasculares del Cono Sur (Zuloaga et al. 2008) and its online update (http://www.darwin.edu.ar). Abbreviations: ISOMAP = isometric feature mapping; ISOPAM = isometric partitioning around medoids.

Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic.Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey.Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI [1.023–1.241], p

Background/Objective: The objective of the study is to determine the morphological characteristics of residual alveolar bone for dental implants in a Hispanic population. Methods: A cross-sectional study was performed with 385 consecutive adult head-and neck computed tomography (CT) studies. The heights of alveolar bone in the maxilla and mandible, width, and bone density were measured. Groups were stratified for analysis according to the bone resorption. Results: A total of 508 alveolar spaces in the maxilla bone and 260 in the mandibular bone were included, with a mean age of 54.2 ± 14.8 years. Statistically significant differences between sexes were found in the width of the maxillary and mandibular second molar, the width in all regions of the mandible, and the height of the second molar. Statistically differences in the maxilla between Grades 3, 4, and 5 of residual ridge resorption in height, width, and density (p = 0.00), and in the mandibula between Grades 3, 4, and 5 of residual ridge resorption in width and density (p = 0.00). Conclusions: Enhancing pre-operative diagnostic accuracy is a cornerstone in ensuring the appropriateness of residual alveolar bone for dental implant placement, effectively mitigating the risks associated with inadequate bone quality. The rising adoption of CT as a complementary pre-operative diagnostic modality brings about a substantial leap in precision when compared to traditional panoramic radiography methods.

Abstract Aims To describe the natural history of SARS‐CoV‐2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events. Methods and results Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS‐Cov‐2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS‐CoV‐2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty‐nine (22.9%) HCM patients were hospitalized for non‐ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS‐CoV‐2‐related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12–4.51], P = 0.0229}, baseline New York Heart Association class [OR per one‐unit increase 4.01 (95%CI: 1.75–9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16–26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20–49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community‐based SARS‐CoV‐2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98–2.91, P = 0.0600). Conclusions Over one‐fourth of HCM patients infected with SARS‐Cov‐2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality.

Objective: The correlate demographic variants and study techniques in a large intensive Mexican National Medical Residency Exam (ENARM) preparation course with performance. Methods: Data were obtained from the database of the intensive preparation course of the Universidad Autónoma de Nuevo León (UANL, a public university). The course was in-person, with an online platform for additional activities. Demographic data from the subjects enrolled were used and categorized in eight geographic regions. A sub-analysis was performed correlating the grade point average (GPA) to determine the influence of the probability of selection in the exam. Results: Of the total cohort, 942 attendees (51.4% men) were included for the analysis. The mean age was 26.9 ± 2.26, with a mean of 54.36 ± 29.48 h of platform time use. Of the total, 54.5% were selected for a residency program. Those who were selected used the platform for longer periods of time than those who were not selected (55.50 ± 28.63 vs. 52.98 ± 30.42 h, p = 0.097), although it was not statistically significant. Similarly, for the percentage of activities completed (67 ± 24% vs. 66 ± 25%, p = 0.463), differences by gender (54.1% men vs. 54.8% women, p = 0.540), and public versus private schools (56.3% vs. 50.7%, p = 0.052). However, there was significant difference between accredited schools (55.8% vs. 45.1%, p = 0.025), geographical location (p ≤ 0.001), and GPA (84.6 vs. 83.2, p = 0.002). Conclusions: Geographical location was the most important difference, which may be related to socioeconomic levels and resource availability. Graduating from an accredited school by the COMAEM and GPA are the important factors.

The use of human bodies for education and research purposes has existed for hundreds of years1. There is a long history of how bodies have been obtained2,3.

Al igual que otros dictadores europeos en la década de los veinte, el general Miguel Primo de Rivera tuvo que construirse un aura carismática para justificar su poder. En este artículo analizamos el intento de construir una figura carismática de Primo de Rivera a través de las instituciones propagandísticas dictatoriales, los medios de comunicación bajo control gubernamental, los viajes del dictador y las movilizaciones de masas dirigidas por la Unión Patriótica. Todos ellos fueron instrumentos fundamentales a la hora de elaborar una imagen oficial de Primo de Rivera como un líder providencial, salvador de la patria, que además era un militar viril, de actitud caballerosa, un buen católico y un considerado padre de familia. La creación de un líder carismático llevó emparejada una reelaboración del concepto de ‘masculinidad nacional’ que tenía como objetivo la restauración de un orden social y sexual que se consideraba seriamente amenazado en la década de los veinte.

Introducción y objetivos: Diferentes estudios etnobotánicos realizados en sistemas ganaderos de la Argentina han puesto de relieve la importancia de los conocimientos que los ganaderos criollos poseen sobre las plantas de su entorno. El trabajo se propuso documentar y analizar el conocimiento tradicional que los ganaderos poseen sobre las plantas utilizadas en la alimentación de emergencia de caprinos bajo manejo extensivo en el Chaco Árido de la provincia de Catamarca y analizar las prácticas asociadas al manejo de esos recursos forrajeros. M&M: Con el acompañamiento de 17 colaboradores claves, de ambos sexos que viven en 12 localidades distribuidas en los diferentes ambientes que integran el Chaco Árido, se realizaron entrevistas abiertas, semiestructuradas y caminatas guiadas con productores ganaderos nacidos en la zona dedicados a la cría extensiva de caprinos de raza criolla. Resultados: Se identificaron 28 especies de plantas vasculares utilizadas en cinco diferentes estrategias de alimentación de emergencia. Se aportan datos etnobotánicos sobre el nombre de las plantas, las partes utilizadas en la alimentación de los caprinos, el lugar y forma de recolección, modo de transporte y acondicionamiento, momento de utilización y categoría de animales alimentados. Se identifican múltiples y complejas necesidades que motivan a realizar este tipo de alimentación. Conclusiones: Se espera que el valioso conocimiento etnobotánico aportado por los campesinos cabriteros contribuya a perfeccionar las futuras estrategias de alimentación de emergencia del ganado caprino y la conservación de las forrajeras nativas utilizadas en estas prácticas.

Abstract Background Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify height positions of the BCT and report their prevalence in a Mexican population. Methods Patients: A retrospective, descriptive, observational, and cross-sectional was performed using computed tomography angiography (CTA) of adult (> 18 years of age) patients, without gender distinction, of Mexican origin. Measuring techniques were standardized using the suprasternal notch to analyze linear and maximum heights, linear and curved lengths, and the vertebral origin and bifurcation levels of the BCT. Results A total of 270 CTA were obtained (66.7% men and 33.3% women). A high position of BCT was present in 64.81% (n 175/270). The mean linear medial height was 0.58 ± 1.91 cm, the maximum height of the free edge was 3.85 ± 2.04 cm, side length of the midline at the maximum height of the free edge was 1.46 ± 2.59, linear length 3.72 ± 0.70, and a curve length 3.99 ± 0.79. The BCT origin was most predominant at the T3 (57.9%) and T4 (27.0%) vertebral levels, with the bifurcation at T2 (57.9%) and T1 (36.2%). Conclusions There is a high prevalence of high position BCT in our population. Patients should be assessed before any procedures in the area, due to the potential risk of complications.

Abstract Background Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it’s fidelity impact. Methods Using four suturing models (SM) (pigskin, sponge, commercial pad, and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM. Results Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p

Background: The coronavirus pandemic is an international public health emergency without precedence in modern history. It represents a challenge to the academic and psychological stability of students due to the changes it can cause in daily life. This study aimed to evaluate the prevalence and level of burnout in medical students caused by the academic and psychological instability that the pandemic represents. Methods: A cross-sectional prospective study was designed using the Maslach Burnout Inventory-Student Survey (MBI-SS). This evaluated the emotional exhaustion due to study demands, cynicism, and negative self-academic efficacy. This study was based in the school of medicine of the Universidad Autonoma de Nuevo Leon (UANL), in Monterrey, Mexico during the Spring semester 2020. Results: A total of 154 (93 women and 61 men) first-year medical students participated (response rate 36.4%). Burnout was identified in 14.9% (n=23), and high emotional exhaustion in 53.9% (n=83). Burnout was almost 4 times more likely to develop in men than in women (aOR = 4.8; 95% Confidence Interval=1.7-13.3) when considering age as a covariable in the multivariable model. Conclusion: Further epidemiological studies of burnout syndrome in medical students are needed, and schools should consider promoting mental health and making programs available for their students to help overcome the emotional and social challenges during the pandemic.

Introduction: A high riding jugular bulb is the most common anatomical variation of the petrous section of the temporal bone. The objective of our study was to determine the prevalence of dehiscence and high riding jugular bulb (HRJB) in a Mexican population. Material and methods: This is an observational retrospective, cross-sectional, and descriptive study. The presence of High Riding Jugular Bulb was analyzed, taking as reference the basal turn of the cochlea in axial sections and then reformatted in coronal sections to observe the presence or absence of dehiscence. Patients between 0 to 95 years of age were included and classified by age groups for analysis. Infants included patients ≤ 2 years old, children from 3 to 12, teenagers from 13 to 18, and adults included patients >18 years of age. Results: A total of 229 CT (458 ears) were included. The prevalence of HRJB was 38.4%, higher in women (44.6%), and present bilaterally in 7.9% of patients. It is the highest prevalence reported in the literature. Dehiscence was present in 1.3% of the population. Conclusion: High Riding Jugular Bulb and its dehiscence are important anatomical variations associated with several symptoms like unexplained headache and tinnitus. Due to unawareness of these variations in surgery, the lesion to a vessel could be fatal. It is otorhinolaryngologists be aware of the high prevalence for patient safety.

To explore the existing literature on the effect of Interprofessional Education (IPE) on the work environment of health professionals. The research question was systematized according to the PCC (Population, Concept, and Context) format. A scoping review was performed. A search of multiple bibliographic databases identified 407 papers, of which 21 met the inclusion criteria. The populations of the 21 studies reviewed were composed of professionals in the fields of medicine, nursing, psychology, occupational therapy, physiotherapy, and social work, among others. The study contexts were both academic and nonacademic hospitals, mental health institutions, and community settings, and the topics examined were organizational climate, organizational culture, organizational attachment and job satisfaction. The findings from the reviewed studies showed positive effects of IPE interventions on organizational climate and culture, but the results on job satisfaction and organizational attachment were mixed (i.e., positive and no effects following IPE interventions). Research on IPE is worth more attention as IPE could be an effective alternative for the fulfillment of the Quadruple Aim and achieving the third of the United Nations Sustainable Development Goals, aimed at improving health and well-being. It seems critical for IPE to be positioned as a trend in global health, aiming at boosting human health resources as one of its building blocks and calling the attention of health decision-makers.

The superior semicircular canal dehiscence (SSCD) syndrome is a condition in which the lack of bone overlying the superior semicircular canal is associated with auditory and vestibular signs and symptoms. It was first described in 1998 by Minor et al., using computerized tomography (CT). It has been the diagnosis of patients that suffer from vertigo, hearing loss, chronic disequilibrium, nystagmus, tinnitus, autophony, and/or oscillopsia in the absence of other otological affections. The etiology remains unknown, but it has been concluded that it can be congenital, acquired, or a mixed syndrome, as are many other bone dehiscences. SSCD can be symptomatic or asymptomatic, and its motives are still unknown. The representative manifestation is known as Tullio’s phenomenon or Hennebert’s sign. The diagnosis is based on the clinical history and radiological evidence. CT is the most used study in combination with audiological and vestibular test findings. Repair through the transmastoid approach and the middle fossa approach has been used and has had the best symptomatology resolution. The latter procedure is considered the most effective, although comparative outcomes are still deficient.

Introduction: The Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) and Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS), with the EULAR-OMERACT-2005 MR-Atlas, demonstrate characteristics and lesion degrees (synovitis, erosions, bone marrow edema [BME]) in rheumatoid arthritis (R.A.) clinical diagnosis for follow-up and treatment response. Our study’s objective was to use RAMRIS in patients from three R.A. phases to detect lesions according to their tissue characterization (fluid levels in tissue) using different magnetic resonance imaging (MRI) sequences. Methods: Sixty contrast-enhanced MRIs from R.A. patients (clinical suspect arthralgia [CSA] – 38%, early R.A. [ERA] – 37%, and established [R.A.] – 25%) were evaluated according to the American College of Rheumatology (ACR-EULAR)-2010 criteria. R.A. lesions evaluation was performed with RAMRIS/Atlas/scoring; our analysis added the presence of lesions in the thumb and wrist (tenosynovitis, synovitis, erosions, and BME), proposing an “extended RAMRIS.” Results: Overall, 83% (50/60) women, mean 42 ± 13.5 (19-70) years-of-age, from 1731 evaluated sites, 964 lesions were identified. Synovitis 46% (445/964) was most frequently found in the carpal bones 72% (321/445). Extended RAMRIS demonstrated tenosynovitis and erosions in 1st carpometacarpal, 1st metacarpophalangeal, and hand-wrist tenosynovitis. Gadolinium contrast showed synovial and erosions enhancement indicating active lesions, most predominantly in ERA. Conclusions: Extended RAMRIS score was not statistically different (p = 0.43) from RAMRIS-2005. However, it considers all hand-wrist bone joint sites and tendon lesions needed for assessing a more accurate degree of disease development. A proposed extended RAMRIS should be considered.

Background: Focal segmental glomerulosclerosis (FSGS) causes end stage renal disease (ESRD) in significant proportion of patients worldwide. Primary FSGS carries poor prognosis and management of FSGS patients, refractory to standard treatments or resistant to steroids, remains a major challenge. Lipoprotein apheresis is a therapeutic approach for drug resistant primary FSGS and post-renal transplant primary FSGS recurrence.Objectives: To examine the safety and probable benefit at 1, 3, 6, 12, and 24-months following completion of apheresis treatment using Liposorber® LA-15 system in patients with nephrotic syndrome (NS), due to refractory primary FSGS or primary FSGS associated NS, in post renal transplant children.Material and Methods: Prospective, multicenter, single-arm intervention study using Liposorber® LA-15 system. Patients ≤21 years old with drug resistant or drug intolerant NS secondary to primary FSGS with glomerular filtration rate (GFR) ≥60 ml/min/1.73 m2 or post renal transplant patients ≤21 years old with primary FSGS associated NS were included in the study. Each patient had 12 dextran-sulfate plasma adsorption lipoprotein apheresis sessions over a period of 9 weeks. All patients were followed up at 1, 3, 6, 12, and 24-months following completion of treatment.Results: Of 17 patients enrolled, six were excluded from the outcome analysis (protocol deviations). Of the remaining 11 patients, all but one have completed apheresis treatments. Three patients were lost to follow-up immediately after completion of apheresis and excluded from outcome analysis. At one-month follow-up, 1 of 7 patients (14.3%) attained partial remission of NS while 2 of 4 subjects (50%) and 2 of 3 subjects (66.7%) had partial/complete remission at 3- and 6-months follow-up, respectively. One of two patients followed up for 12 months had complete remission and one patient had partial remission of NS after 24 months. Improved or stable eGFR was noted in all patients over the follow-up period.Conclusion: The results of our multicenter study showed improvement in the response rates to steroid or immunosuppressive therapy and induced complete or partial remission of proteinuria in some of the patients with drug resistant primary FSGS. The main limitation of our study is the small number of subjects and high dropout rate.

Research benefits professors and students, mentors and mentees, however, many Universities lack formal programs, especially in basic sciences such as anatomy. Faculty, many times, lack the time, resources, and a well-structured program. Mentoring and collaborative work, have played an important role in creating an effective environment that inspires its members into scientific production, enhances research skills, while gaining experience. The authors presented a student anatomy research group (Grupo de Investigación en Anatomía [GIA]) model that integrates faculty from basic and clinical fields through a collaborative mentoring and tightly organized structure that increases training, experience, and scientific output. The transformation stages described shows the progress, reporting the fundamental elements for integration of the model, with results presented at 16 years of experience of the group in the Anatomy department. Results evidence a steady increase in student/professor involvement, scientific publishing, presentations in meetings (national/international), and cites.

En este trabajo se estudia la dinámica de transición en la interacción entre vid (Vitisvinifera L.) y cultivo de cobertura. A partir de datos obtenidos en un ensayo de campo ser postuló un modelo estadístico para investigar dicha interacción biológica y se pudo determinar que el sistema vid-cultivo de cobertura cambió de una interacción biológica del tipo comensalismo a otra de amensalismo, siendo la vid la que no se ve afectada. Sobre la base de esta información, se formuló un modelo biomatemático para describir esta interacción, se estimaron los parámetros del mismo y se analizó la estabilidad de los puntos de equilibrio. Se evidencia en el presente estudio que el cultivo de cobertura no afecta el crecimiento de la vid, durante el período considerado en el ensayo.

The article explores the transformations of Spanish and Catalan national identities and the growth of the pro-independence movement in Catalonia following the 2008 global recession. It argues that the Great Recession provided a new historical context of hot nationalism in which Catalanist narratives of loss and resistance began to ring true to large sectors of Catalan society, whereas the Spanish constitutionalist narratives seemed increasingly outdated. The article also shows the limits of the process of mass nationalization by both the Catalan and the Spanish governments and the eventual 'crystallization' of an identity and political divide between pro and anti-independence supporters which split Catalan society down the middle and led to a sort of national identity deadlock.

This article analyses how the official idea of Spain was communicated by the Army to the whole country during the dictatorship of Primo de Rivera. The Primo Rivera regime created a series of military institutions, the most prominent of which were the Delegados gubernativos and the Servicio Nacional de la Educación Física Ciudadana y Premilitar, with the aim of spreading its Spanish nationalist doctrine and of «educating» the masses in patriotic values. From studying how these institutions functioned, it can be inferred that the efforts of the Primo Rivera regime achieved the opposite of what they intended, producing a «negative nationalisation», in which growing popular opposition to the agents of the State who were spreading the official idea of the nation ran parallel to a rejection of the idea of Spain being defended by these agents.

Les tres esferes. Cap a un model de la nacionalització a Espanya

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In this paper, we discuss bremsstrahlung induced by neutrino scattering. This process should exist since neutrinos are expected to couple to photons via magnetic dipole and transition moments. These moments are loop-induced and tiny in the Standard Model with neutrino masses but could be significantly enhanced in extended theories. As concrete example, we study the scattering of the two largest neutrino fluxes on earth, solar neutrinos and Cosmic Neutrino Background (CNB). It is tempting to consider this as a potential signature for CNB searches but it turns out that the signal is extremely small and unlikely to be observed. [ABSTRACT FROM AUTHOR]