Search

Cyriax es un masaje terapéutico que produce en zonas proximales a las inserciones tendinosas una inflamación controlada que restablece las propiedades del tejido conectivo lesionado, existe evidencia científica de sus efectos positivos en pacientes con tendinopatías causantes de dolor y limitación del movimiento. La tenosinovitis de Quervain es una tendinopatía frecuente que genera una estenosis de los tendones del abductor largo y extensor corto del pulgar, provocando el conjunto de síntomas antes descritos. Objetivo: Recopilar información actualizada sobre la eficacia del masaje de Cyriax en el aumento del rango de movimiento (ROM) en pacientes con Tenosinovitis de Quervain. Materiales y métodos: Se realiza una revisión bibliográfica de la literatura científica publicada entre 2009 y 2021 en las bases de datos: Medline, PubMed, Scielo, The Cochrane Library, Elsevier, Embase. Resultados: Se seleccionaron 15 artículos que comparan el Masaje de Cyriax con otras técnicas para demostrar su eficacia en el manejo del ROM, los resultados son positivos para el aumento del ROM y disminución del dolor. Conclusión: El masaje de Cyriax es eficiente para reducir el dolor y aumentar el ROM. Sin embargo, la heterogeneidad de los estudios, instrumentos de medida y/o diseño no permiten obtener conclusiones definitivas de la técnica como única vía de tratamiento.

Introduction Informed consent for any surgical intervention is necessary, as only well-informed patients can actively participate in the decision-making process about their care, and better understand the likely or potential outcomes of their treatment. No consensus exists on informed consent for suspension microlaryngoscopy (SML). Materials and methods Informed consent procedures in nine countries on five continents were studied. Results Several risks can be discerned: risks of SML as procedure, anesthesiologic risks of SML, specific risks of phonosurgery, risks of inadequate glottic exposure or unexpected findings, risks of not treating. SML has recognized potential complications, that can be divided in temporary (minor) complications, and lasting (major) complications. Conclusion SML is a safe procedure with low morbidity, and virtually no mortality. Eleven recommendations are provided.

Objective: To compare the effects of a neuromuscular exercise program (ENM) with respect to a municipal exercise program (EM) on the physical condition of older adults in the community. Methodology: Double blind, parallel group randomized clinical trial. Sample ma de up of 82 subjects, age X = 72 years (SD = +/- 5 years) belonging to the House for the Elderly in the city of Talca. Selection was non-probabilistic for convenience, group assignment by stratified randomization, and allocation concealment by sealed envelopes. Double blinding was for participants and assessors. Both groups exercised in parallel for 6 months, 3 times a week. The inter-group comparisons of physical condition were by means of one-way multivariate ANOVA. In all cases a p

Introduction: The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae. Materials and methods: This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers. Results: A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context. Conclusions: One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.

The introduction of fiber-guided lasers was a breakthrough in laryngology practice, opening the path for treating different pathologies with minimally invasive procedures, both in the operating room and in the office. The most recent technology in the area is the blue laser, which combines photoangiolytic and cutting properties, characteristics that make this equipment suitable for its use in upper aerodigestive tract surgery. However, there is not enough experience in this area. The authors present a case series of patients with different pharyngeal, laryngeal, and tracheal pathologies who were treated by means of transoral procedures using fiber-guided blue laser.The surgical records of patients with different upper aerodigestive tract pathologies who were treated with fiber-guided blue laser in the operating room, under general anesthesia with jet ventilation or supraglottic ventilation using suspension laryngotracheoscopy techniques between February 2018 and March 2022 were reviewed.A total of 80 surgical interventions in a group of 38 patients were performed. A wide variety of procedures was executed, either using the laser alone or in combination with other techniques to treat different pathologies of the aero-digestive tract safely and effectively, with adequate functional results.Following all necessary precautions, blue laser is a reliable tool to perform minimally invasive surgeries in the operating room using TOFLS techniques. It can be used alone or in combination with other devices to achieve the desired goals.

The use of shotgun metagenomic sequencing to understand ecological-level spread of microbes and their genes has provided new insights for the prevention, surveillance and control of microbial contaminants in the slaughterhouse environment. Here, microbial samples were collected from products and surrounding areas though a porcine slaughter process; shotgun metagenomic DNA-sequencing of these samples revealed a high community diversity within the porcine slaughterhouse and pork products, in zones originating from animal arrival through to the sale zones. Bacteria were more prevalent in the first zones, such as arrival- and anesthesia-zones, and DNA viruses were prevalent in the scorching-and-whip zone, animal products and sale zone. Data revealed the dominance of Firmicutes and Proteobacteria phyla followed by Actinobacteria, with a clear shift in the relative abundance of lactic acid bacteria (mainly Lactobacillus sp.) from early slaughtering steps to Proteobacteria and then to viruses suggesting site-specific community compositions occur in the slaughterhouse. Porcine-type-C oncovirus was the main virus found in slaughterhouse, which causes malignant diseases in animals and humans. As such, to guarantee food safety in a slaughterhouse, a better decipher of ecology and adaptation strategies of microbes becomes crucial. Analysis of functional genes further revealed high abundance of diverse genes associated with stress, especially in early zones (animal and environmental surfaces of arrival zone with 57,710 and 40,806 genes, respectively); SOS responsive genes represented the most prevalent, possibly associated with genomic changes responsible of biofilm formation, stringent response, heat shock, antimicrobial production and antibiotic response. The presence of several antibiotic resistance genes suggests horizontal gene transfer, thus increasing the likelihood for resistance selection in human pathogens. These findings are of great concern, with the suggestion to focus control measures and establish good disinfection strategies to avoid gene spread and microbial contaminants (bacteria and viruses) from the animal surface into the food chain and environment, which was achieved by applying HLE disinfectant after washing with detergent.

Resumen: Los pacientes con síndrome de Brugada pueden presentar arritmias ventriculares malignas y muerte súbita, por lo que frecuentemente tienen indicación de implante de cardiodesfibrilador. Ocasionalmente, estos pacientes pueden tener choques recurrentes difíciles de manejar en la práctica clínica. Estudios recientes han mostrado que la ablación por radiofrecuencia en los pacientes con síndrome de Brugada es posible y efectiva.A una mujer de 55 años con síndrome de Brugada afectada por una tormenta eléctrica, se le efectuó mapeo cardíaco electroanatómico tridimensional y ablación por radiofrecuencia. Durante el estudio electrofisiológico no se observaron arritmias espontáneas o inducidas. Un mapeo de voltaje cardíaco en ritmo sinusal, precedió al uso de ablación por radiofrecuencia para modificación del sustrato arritmogénico en endocardio y epicardio del tracto de salida del ventrículo derecho. El patrón de Brugada desapareció de su electrocardiograma en el período posablativo inmediato. En cuatro meses de seguimiento la paciente no ha tenido arritmias ventriculares ni evidencia electrocardiográfica de patrón de Brugada.La modificación del sustrato arritmogénico por medio de ablación por radiofrecuencia en pacientes con síndrome de Brugada y tormenta eléctrica, puede ser de utilidad en el manejo crítico. Summary: Patients with Brugada syndrome may have malignant ventricular arrhythmias and sudden cardiac death. Thus, these patients frequently have indication of implantable cardioverter defibrillator. Occasionally, these patients may experience recurrent appropriate cardioverter defibrillator shocks refractory to medical treatment. Recent reports indicate that radiofrequency ablation in Brugada syndrome is feasible, and effective.A 55-year-old woman with Brugada syndrome and an electrical storm, underwent three-dimensional electroanatomic mapping and radiofrequency ablation. During electrophysiological study there were no spontaneous or inducible arrhythmias. Voltage mapping of the right ventricle was created in sinus rhythm and both, endocardial and epicardial substrate modification of right ventricular outflow tract was performed. Brugada ECG pattern resolved post procedure. Follow up at 4 months revealed no recurrence of ventricular arrhythmias or Brugada electrocardiographic pattern.Radiofrequency mediated therapy for substrate modification in patients with Brugada syndrome and an electrical storm, may be useful in their critical care management. Resumo: Os pacientes com síndrome de Brugada podem apresentar arritmias ventriculares malignas e morte súbita, de modo que frequentemente têm indicação de implante de cardiodefibrilador. Ocasionalmente, esses pacientes podem ter choques recorrentes difíceis de lidar na prática clínica. Estudos recentes mostraram que a ablação por radiofrequência em pacientes com síndrome de Brugada é possível e eficaz.Uma mulher de 55 anos com síndrome de Brugada afetada por uma tempestade elétrica apresentava mapeamento cardíaco eletroanatômico tridimensional e ablação por radiofrequência. Durante o estudo eletrofisiológico não foram observadas arritmias espontâneas ou induzidas. O mapeamento da tensão cardíaca em ritmo sinusal antecedeu o uso da ablação por radiofrequência para modificação do substrato arritmogênico no endocárdio e no epicárdio da via de saída do ventrículo direito. O padrão de Brugada desapareceu de seu eletrocardiograma no período pós-ablativo imediato. Em 4 meses de acompanhamento, o paciente não apresentou arritmias ventriculares ou evidências eletrocardiográficas do padrão de Brugada.A modificação do substrato arritmogênico por meio da ablação por radiofrequência em pacientes com síndrome de Brugada e tempestade elétrica pode ser muito útil no manejo crítico.

When a person loses the sense of sight, in general, it is suggested to use a white cane to perform daily activities. However, using a white cane limits the movement of a person. In addition, guide dogs can be served in this impairment. However, the acquisition and maintenance of a guide dog is extremely high for people in development countries. In this regard, this paper presents a proof-of-concept of a low-cost robotic system able to guide a visual impaired, as a guide dog. The robot is specially designed for climbing stairs at indoors, and it uses convolutional neural networks (CNN) for both object detection and hand gesture recognition for special instructions from the user. Experimental results showed that our prototype robot can climb stairs with 86.7% of efficiency in concrete stair surfaces. Also, the visual representation by CNN performed more than 98% accuracy.

Caring for the elderly and sick people is one of the biggest concerns of families. Those who experience the responsibility and the enormous work involved in this care recognizes that all kind of help it's welcomed. The objetive of this paper is to present Nurse-bot as a mechatronics system for taking care of the elderly and sick people. In particular, we refer this device not only as a tool, but with the time and development a true support to the people. It is like-a nurse made robot that monitors vital signs and keeps the information, so that the attending physician has up-to-date parameters before the consultation that allows a better follow-up of the results of the prescribed treatment made by a specialist. A proof-of-concept and the first prototype is presented in this work. Experimental results shows insights that this robot can help people.

We aimed to better understand resistome and virulome patterns on animal and process-area surfaces through a pig slaughterhouse to track possible contamination within the food production chain. Culture-dependent methods revealed high levels of microbial contamination, corresponding to mesophilic and pathogenic bacteria on both the animal and process-area surfaces mainly in the anesthesia (AA and AS) zone followed by "scorching and whip" (FA and FS) zone and also in the end products. To evaluate the potential risk of antibiotic resistance and virulence determinants, shotgun metagenomic DNA-sequencing of isolates from selected areas/products uncovered a high diversity and richness of antibiotic resistance genes (ARGs): 55-62 genes in the anesthesia area (AA and AS) and 35-40 in "animal-arrival zone" (MA and MS). The "scorching and whip" (FA and FS) area, however, exhibited lowered abundance of ARGs (1-6), indicating that the scalding and depilating process (an intermediate zone between "anesthesia" and "scorching and whip") significantly decreased bacterial load by 1-3 log10 but also diminished the resistome. The high prevalence of antibiotic-inactivating enzyme genes in the "animal-arrival zone" (60-65%) and "anesthesia" area (56%) were mainly represented by those for aminoglycoside (46-51%) and lincosamide (14-19%) resistance, which did not reflect selective pressures by antibiotics most commonly used in pig therapy-tetracyclines and beta-lactams. Contrary to ARGs, greater number of virulence resistance genes were detected after evisceration in some products such as kidney, which reflected the poor hygienic practices. More than 19 general virulence features-mainly adherence, secretion system, chemotaxis and motility, invasion and motility were detected in some products. However, immune evasion determinants were detected in almost all samples analyzed from the beginning of the process, with highest amounts found from the anesthesia area. We conclude that there are two main sources of contamination in a pig slaughterhouse: the microorganisms carried on the animals' hide, and those from the evisceration step. As such, focussing control measures, e.g., enhanced disinfection procedures, on these contamination-source areas may reduce risks to food safety and consumer health, since the antibiotic and virulence determinants may spread to end products and the environment; further, ARG and virulence traits can exacerbate pathogen treatments.

Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally "healthy" from "severely morbid" patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.

La tuberculosis laríngea primaria es una enfermedad rara con una amplia gama de manifestaciones clínicas. Se reporta el caso de un médico otorrinolaringólogo con diabetes de tipo II y con diagnóstico de tuberculosis laríngea primaria. El diagnóstico de cáncer de cuerda vocal se había considerado en otra institución, y al ingreso el paciente sólo presentaba disfonía de seis meses de evolución. En el estudio histopatológico se encontraron granulomas, células gigantes multinucleadas, fibrosis y necrosis, y en la tinción de Ziehl-Neelsen, bacilos ácido-alcohol resistentes. El cultivo del tejido de cuerda vocal para micobacterias y la PCR-IS6110 fueron positivos. La cepa de Mycobacterium tuberculosis demostró sensibilidad a todos los medicamentos de primera línea. Se inició tratamiento según la estrategia DOTS (Directly Observed Treatment, Short-course). Se discute la presentación clínica, los diagnósticos diferenciales, el abordaje diagnóstico y los factores de riesgo asociados y se hace una breve revisión de la literatura.

El presente documento sostiene que los actuales criterios de medición de productividad en la actividad de la ciencia y la tecnología no son los más adecuados. Sin embargo, es un hecho que estos mismos criterios, con todo lo criticable que puedan ser, se están aplicando para hacer estimaciones diversas sobre la calidad de la producción científica, tanto a nivel individual como a nivel colectivo, por ello no es adecuado abstraerse de tocar este tema. La evidencia obtenida permite sustentar la afirmación de que sí es posible encontrar tamaños óptimos eficientes de centros de investigación. Los resultados indican que no existe un único tamaño óptimo, sino varios tamaños óptimos en función del entorno en que se inscribe la actividad de ciencia y tecnología desarrollada en una institución. Esto permite concluir que el reto es encontrar -colectivamente- una manera de incidir, dentro del actual marco de estimación, para mejorar el aprecio por la actividad de los investigadores y promover mejores políticas y criterios de evaluación.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO2 laser transoral microsurgery or CO2 TOLMS or CO2 laser transoral surgery only (with a handpiece) would be defined as CO2 TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO2 wave-guide with a handpiece would be a CO2 TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant.

This paper presents an open shop scheduling problem based on a real mechanical workshop made of m machines that process n jobs. It deals with different resource constraints related to the tools allocation and the multi-skills staff assignment. Resource skills and their availability are required to execute one process task. In this work, we expose a multi-objective problem where the idea is to minimize three objectives simultaneously. The first one considers the minimization of the total flow time of jobs in the production system, then the workload balancing concerning both, humans and machines is addressed. We propose and compare two multi-objective methods: NSGA-II and NSGA-III. Computational experiments are designed according to the literature, we expose the small and large sized instances to present the general performance of these algorithms using the hyper-volume metric to compare them.

Resumen.Este artí­culo hace un análisis sobre el programa educativo denominado Escuelas Multigrado, operado por la Secretaria de Educación Pública en coordinación con los gobiernos de los estados que presentan más rezagos educativos, manifestados a consecuencia de las lejaní­as de las poblaciones en relación a las ciudades estatales o municipios poblacionales con escases de niños para la construcción de escuelas y oferta educativa completa.En respuesta a estas demandas se crearon las escuelas multigrado en donde un docente trabaja con niños de diferentes edades dentro de un aula, por lo que se ve en la necesidad de desarrollar diferentes métodos de enseñanza para cada niño en particular, también influye el contexto en el que el niño se desarrolla, incluidos aspectos lingüí­sticos, culturales y sociales. En el artí­culo se desarrollan cada una de las competencias que deben manejar los maestros al darles seguimiento a partir del momento en que las escuelas multigrado son establecidas en el estado de Hidalgo, lo que ejemplifica los aspectos que muestran para generar alternativas. El presente análisis concluyó en agosto del 2013.Palabras claves: escuelas multigrado, marginación y métodos de aprendizaje.Abstract.This paper makes an analysis of the educational program called multi-grade schools operated by the Department of Education in coordination with the Governments of the States with more educational backwardness manifested as a result of the remoteness of populations in relations with state cities or municipalities scarcity of population with children, building schools and comprehensive educational offering. In response to these demands multigrade schools where a teacher works with children of different ages in a classroom and seeing in need to develop different teaching methods for each individual child, also influences the context is created in which the child develops, including linguistic, cultural and social aspects. The article develop each of the skills that teachers must manage, giving tracking from multigrade schools are established in these areas and aspects knowing that display, and generating alternatives.Keywords: multi-grade schools, Marginalization and learning methods.

International audience; The continuous evolution of manufacturing environments leads to a more efficient production process that controls an increasing number of parameters. Production resources usually represent an important constraint in a manufacturing activity, specially talking about the management of human resources and their skills. In order to study the impact of this subject, this paper considers an open shop scheduling problem based on a mechanical production workshop to minimise the total flow time including a multi-skill resource constraint. Then, we count with a number of workers that have a versatility to carry out different tasks, and according to their assignment a schedule is generated. In that way, we have formulated the problem as a linear as and a non-linear mathematical model which applies the classic scheduling constraints, adding some different resources constraints related to personnel staff competences and their availability to execute one task. In addition, we introduce a genetic algorithm and an ant colony optimisation (ACO) method to solve large size problems. Finally, the best method (ACO) has been used to solve a real industrial case that is presented at the end.

The article ‘Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society,’ written by Marc Remacle, Christoph Arens, Mostafa Badr Eldin, Guillermo Campos, Carlos Chiesa Estomba, Pavel Dulguerov, Ivana Fiz, Anastasios Hantzakos, Jerome Keghian, Francesco Mora, Nayla Matar, Giorgio Peretti, Cesare Piazza, Gregory N. Postma, Vyas Prasad, Elisabeth Sjogren, Frederik G. Dikkers, was originally published Online First without open access. After publication in volume 274 issue 10, page 3723–3727 the authors decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Este artículo muestra como un segmento de mercado como el de los investigadores en México - caracterizado por su alto nivel de educación- también se rige ciegamente por estructuras institucionales que finalmente reproducen inequidades similares a las que se encontrarían en cualquier otro segmento de trabajadores con menor nivel de educación; aunque, evidentemente la intensidad de las desigualdades es menor y en ocasiones aparecen metamorfoseadas. Este segmento está en una dinámica de crecimiento que avanza en sentido contrario a lo que ocurre en el actual contexto de destrucción masiva del empleo. Las desigualdades manifiestas están orientadas hacia las investigadoras y los jóvenes investigadores. A pesar de que en este mercado se mantienen condiciones laborales excepcionales respecto a otros segmentos, éstas son extraordinariamente frágiles. El principal obstáculo al crecimiento absoluto y racional de la actividad de investigación en México -dejando de lado la persistentemente baja inversión en I+D del gobierno mexicano- es la concentración de la investigación en el D.F. y en tres instituciones: la UNAM, La UAM y el Politécnico Nacional (IPN). Se concluye con la necesidad de pasar a una segunda fase de institucionalización de la investigación en México.

Recent research has shown that the psychological skills assessed by the Intercultural Adjustment Potential Scale (ICAPS) can predict adjustment, above and beyond what is already accounted for by personality. The purpose of this study was to examine if the skills tapped by the ICAPS can predict adjustment above and beyond that accounted for by both personality and general intelligence, and whether intelligence can predict adjustment above and beyond skills and personality. International students completed a battery of instruments including the ICAPS, a personality measure, and several adjustment indices. In a separate session they also completed a measure of general intelligence. The results indicated that the ICAPS did predict adjustment independently of both personality and intelligence, but that intelligence did not.

Objectives:Determine whether long-term survival of fat implanted into the vocal folds is possible.Methods:Nine patients of those treated between 1992 and 2005 by means of bilateral fat injection into the vocal folds responded the call to assess long term results. Initial diagnosis was unilateral vocal fold palsy (6) and superficial sulcus (3). The graft was obtained by means of dissection of fat from the abdominal wall, and injected with an 18 G needle into the body of the vocal folds until 50% over correction was achieved. In palsy cases a higher fat volume was required on the paralyzed side. All patients underwent laryngostroboscopic examination preoperatively and postoperatively, along with postoperative magnetic resonance imaging (MRI) of the larynx, 4 to 14 years after surgery. As far as MRI is concerned, spine echo and fat-suppressed sequences in axial coronal and sagittal planes were obtained, looking for high intensity areas in T1-weighted images at the level of the vocal folds.Results:Laryngostro...

Objectives:Sulcus vocalis and scars of the vocal folds reduce pliability of the cover impairing vibration. Severity of dysphonia is directly related to magnitude of structural damage. The purpose of surgical treatment is to restore anatomy in order to re-establish function. The aim of the study was to evaluate the effectiveness of microsurgical liberation of scars and placement of fibrin glue implants into the subepithelial space of the vocal folds to improve pliability.Methods:Fifteen patients (age range, 13-69 years) with diagnosis of sulcus and/or scars were classified into 3 groups, according to severity of structural damage: Group 1: Unilateral, localized lesions with minimal subepithelial compromise. Group 2: Sulcus and/or scars with subepithelial fibrosis. Group 3: Severe scarring. Microsurgical liberation of scar tissue and placing of fibrin glue implants were performed. Fibrin glue components are mixed until solidified. An implant is tailored and it is placed into the subepithelial space. All pat...

Resumen El proposito de este trabajo es encaminar a los estudiantes hacia la utilizacion y comprension de una de las tecnicas de investigacion mas utilizadas, pero a su vez una de las mas complejas; la observacion. La observacion por si misma representa una de las formas mas sistematizadas y logicas para el registro visual y verificable de lo que se pretende conocer, consiste en utilizar los sentidos ya sea para describir, analizar, o explicar desde una perspectiva cientifica, valida y confiable algun hecho, objeto o fenomeno desde una forma participante, no participante, estructurada o no estructurada; de esta forma se plantea la necesidad de que el observador cuente con habilidades y destrezas que le permitan desarrollar este proceso con calidad. Palabras clave : Tecnica, investigacion social, validez, objetividad, sistematica. Abstract The purpose of this paper is to connect students to the use and understanding of one of the most widely used research techniques, but also one of the most complex and the observation. The observation itself is one of the most systematic and logical for the visualand verifiable record what we want to know is to use either way to describe, analyze, or explain from a scientific perspective, a valid and reliable Indeed, object or phenomenon from a participant is not participating, structured or unstructured, in this way raises theneed for the observer count skills that allow them to develop this process with quality. Keywords: Technical, social research, validity, objectivity, systematic.

Resumen La administracion es una ciencia social encargada de estudiar, dirigir y disenar las acciones organizacionales dentro de empresas, instituciones y organismos publicos, privados y Estales; y el cambio climatico es un problema con caracteristicas unicas, ya que su naturaleza global e impactos involucran interacciones complejas; por lo tanto, lo primero que debemos hacer como administradores es tener conciencia de que tan grave es el problema, y asumir a plenitud la fragilidad que nos asecha, como individuos parte de la humanidad; de esta manera el compromiso como se advierte resulta insoslayable para la Administracion. Pa labras clave: Administracion, rol, etica, responsabilidad social, cambio climatico. Summary The administration is a social science entrusted to study, directing and designing the organizational actions inside companies, institutions and public, private organisms and State; and the climate change is a problem with the only characteristics, since his global nature and impacts involve complex interactions; therefore, the first thing that we must do as administrators is to have conscience of which so serious it is the problem, and to assume to fullness the fragility that us, as individuals it departs from the humanity; hereby the commitment as he becomes aware turns out to be unavoidable for the Administration. K ey words: Ad ministration, role, ethics, social responsibility, climate change.

Resumen Hidalgo es uno de los estados concentradores y representantes de la pobreza extrema del pais; donde algunas de sus regiones pueden ser comparadas con naciones donde la pobreza rompe las barreras de lo humano como en el caso del continente africano. Hidalgo es uno de los estados con mayor signo de atraso economico y social a nivel nacional, estos son factores que se han agudizado en los ultimos quince anos; profundizandose en las ultimas fechas a consecuencia de la inestabilidad estructural y sociopolitica que ha venido sufrido la economia del pais. Ante estas necesidades, se asume que el reto y el compromiso con la educacion del estado de Hidalgo es ofertar cursos y grados academicos como alternativas de actualizacion profesional y de formacion de expertos en diversas areas de las ciencias por medio de la elevacion de la calidad del sistema educativo, considerando sus necesidades y caracteristicas particulares. Palabras Clave: Hidalgo, desarrollo, educacion. Abstract Hidalgo is one of the representative Mexican States of extreme poverty in the country; where some of its regions can be compared with nations where poverty breaks the barriers of humane as in the case of the African continent. Hidalgo is one of the states with higher reference of national economic and social falling behind, these are facts that have strengthen in the last fifteen years; deepening in the last times in consequence of the structural and socio political instability that the economy of the country has been suffering. In view of the necessities, it is assumed that the challenge and commitment with education in the State of Hidalgo is to offer courses and academic degrees as alternatives to professional updating and experts formation en diverse science areas by means of the education system quality improving, considering its necessities and particular characteristics. K ey words: Hidalgo, development, education.

Resumen La palabra crisis se ha convertido en un vocablo constante en el lenguaje y en la vida cotidiana del hombre; es un concepto clave para el analisis y la fundamentacion ideologica o teorica, interpretada en sentidos positivos o negativos. Cuando un sistema general entra en crisis todos los componentes sufren alteraciones en mayor o menor grado; en el caso de la crisis economica que vive el mundo actual se tiene que esta tuvo su origen en los Estados Unidos de Norteamerica en el 2008 llevado a los analistas financieros a focalizarla como una de las crisis mas complejas vividas despues de la de 1929; la enfermedad es grave y sus efectos, dejaran secuelas y aprendizajes futuros. Palabras Clave: crisis, violencia, economia, politicas sociales. Abstract The word crisis has become a constant term in the language and daily life of mankind; it is a key concept for the analysis and ideological or theoretical foundation, understood in positive or negative senses. When a general system falls into crisis all the components suffer alterations in a higher or lower degree; in the case of the economic crisis that the world lives nowadays, it is understood that this one had its origin The United States of America in 2008 taken to the financial analysts to focus it as one of the most complex crisis lived after the one of 1929; the illness is serious and its effects, will leave consequences and future learning. K ey words: crisis, violence, economy, social politics.

Primary laryngeal tuberculosis is a rare disease with a wide variety of clinical manifestations. We report the case of an ear-nose and throat diabetic physician with primary laryngeal tuberculosis. The diagnosis of laryngeal cancer had been considered before in another institution, and at the patient's admission, he only presented dysphonia with a six-month evolution. The vocal cord histological examination showed granulomas, giant cells, fibrosis and necrosis, and the Ziehl-Neelsen staining showed acid-alcohol resistant bacilli. The culture from vocal cord tissue was positive for mycobacteria, and IS 6110 -PCR was positive too. The Mycobacterium tuberculosis strain was sensitive to first line drugs. Treatment using directly observed therapy short-course (DOTS) was initiated. Clinical presentation, differential diagnosis, diagnostic workup, associated risk factors and a brief literature revision are discussed in this article.

Este artículo muestra como un segmento de mercado como el de los investigadores en México - caracterizado por su alto nivel de educación- también se rige ciegamente por estructuras institucionales que finalmente reproducen inequidades similares a las que se encontrarían en cualquier otro segmento de trabajadores con menor nivel de educación; aunque, evidentemente la intensidad de las desigualdades es menor y en ocasiones aparecen metamorfoseadas. Este segmento está en una dinámica de crecimiento que avanza en sentido contrario a lo que ocurre en el actual contexto de destrucción masiva del empleo. Las desigualdades manifiestas están orientadas hacia las investigadoras y los jóvenes investigadores. A pesar de que en este mercado se mantienen condiciones laborales excepcionales respecto a otros segmentos, éstas son extraordinariamente frágiles. El principal obstáculo al crecimiento absoluto y racional de la actividad de investigación en México -dejando de lado la persistentemente baja inversión en I+D del gobierno mexicano- es la concentración de la investigación en el D.F. y en tres instituciones: la UNAM, La UAM y el Politécnico Nacional (IPN). Se concluye con la necesidad de pasar a una segunda fase de institucionalización de la investigación en México. This article shows how the labor market of researchers in Mexico - characterized by a high level of education - is also ruled by blind institutional structures that, finally, reproduce inequities in a similar way to those which we would encounter in any other workers' segment with a lesser level of education. Though, evidently, the intensity of inequities is smaller and in some occasions they turn out to be transfigured. This segment has a growth dynamic that advances in the opposite direction to what happens in the current context of the massive destruction of employment. Inequities are orientated towards female and young researchers and, although we can find exceptional working conditions with regard to other segments, these conditions are extraordinarily fragile. The main obstacle to the absolute and rational growth of the activity of research in Mexico - leaving the persistently low investment in R+D of the Mexican government - is the concentration of the research in the F.D. and in three institutions: the UNAM, The UAM and the Politechnical Institute (IPN). We conclude with the need to go on to the second phase of institutionalization of research in Mexico.

This article argues that the limited progress in outreach within Mexico’s higher education institutions (HEIs) is due to the lack of a clear and socially-shared meaning of what this activity is. We propose a typology based on the actions undertaken in the HEIs. This emphasizes the concept oriented by an economistic point of view. It also raises the possibility of recognizing outreach as a basic function in addition to those usually recognized in the HEIs.