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Abordase la relación dialéctica entre el Estado y la sociedad em aras de proteger y garantizar un acceso igualitario a la salud pública, teniendo en vista la necesidad de dicho acceso como derecho humano fundamental, como asimismo la extrema necesidad de que el sistema público de salud sea sustentable. Para ello, se parte de un concepto básico de salud, recorrendo un camino constructivo conceptual.

Guided bone regeneration can play an important role in orthopedic applications. This work presents the synthesis and characterization of composite scaffolds based on polysaccharides loaded with microparticles of titanium or tantalum as novel materials proposed for composite systems with promising characteristics for guided bone regeneration. Ti/Ta composite scaffolds were synthesized using chitosan and gellan gum as organic substrates and crosslinked with oxidized dextran resulting in stable inorganic-organic composites. Physico-chemical characterization revealed a uniform distribution of metal nanoparticles within the scaffolds that showed a release of metals lower than 5 %. In vitro biological assays demonstrated that Ta composites exhibit a 2 times higher ALP activity than Ti and a higher capacity to support the full differentiation of human mesenchymal stem cells into osteoblasts. These results highlight their potential for bone regeneration applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important., (Copyright: © 2019 Permanyer.)

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important., (Copyright: © 2018 Permanyer.)

Patients with Gaucher type 1 (GD1) throughout Argentina were enrolled in the Argentine bone project to evaluate bone disease and its determinants. We focused on presence and predictors of bone lesions (BL) and their relationship to therapeutic goals (TG) with timing and dose of enzyme replacement therapy (ERT). A total of 124 patients on ERT were enrolled in a multi-center study. All six TG were achieved by 82% of patients: 70.1% for bone pain and 91.1% for bone crisis. However, despite the fact that bone TGs were achieved, residual bone disease was present in 108 patients on ERT (87%) at time 0. 16% of patients showed new irreversible BL (bone infarcts and avascular osteonecrosis) despite ERT, suggesting that they appeared during ERT or were not detected at the moment of diagnosis. We observed 5 prognostic factors that predicted a higher probability of being free of bone disease: optimal ERT compliance; early diagnosis; timely initiation of therapy; ERT initiation dose ≥45 UI/kg/EOW; and the absence of history of splenectomy. Skeletal involvement was classified into 4 major phenotypic groups according to BL: group 1 (12.9%) without BL; group 2 (28.2%) with reversible BL; group 3 (41.9%) with reversible BL and irreversible chronic BL; and group 4 (16.9%) with acute irreversible BL. Our study identifies prognostic factors for achieving best therapeutic outcomes, introduces new risk stratification for patients and suggests the need for a redefinition of bone TG. Am. J. Hematol. 91:E448-E453, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Acute pancreatitis is an inflammatory disease of the pancreas, characterized by abdominal pain and high level of pancreatic enzymes. Pancreatitis is the most common disease of pancreas in children and adults. For the diagnosis we need 2 of 3 characteristics: abdominal pain characteristic of acute pancreatitis, amylase and/or lipase 3 times higher than the normal upper limit and characteristic findings in images. The etiologies are multiple: trauma, metabolic disease and infections: mixovirus, HIV, measles, coxsackie, hepatitis B, C, cytomegalovirus, varicella, herpes simplex. Three cases of PA associated with H1N1 Influenza virus were reported, only one in a child with uncomplicated features.

Insulinoma is a rare pancreatic neuroendocrine tumor that is usually described as benign, sporadic, and very small (<2 cm). However, there have been rare case reports of insulinoma presenting as a giant tumor. We describe 3 cases of giant insulinomas, all of which developed liver metastases. The patients were aged 38, 63, and 67 years. Clinically, all patients presented with Whipple's triad associated with a large mass located in the pancreatic tail. The tumors ranged in size from 10 to 15 cm. On microscopic examination, the tumors were well differentiated with amyloid deposition ranging between 20% and 30%. Immunohistochemically, all 3 tumors showed strong diffuse expression of chromogranin and synaptophysin, whereas they were only focally positive for insulin. One patient developed liver recurrence 3 years after resection of the primary tumor yet remained asymptomatic without treatment. Another patient with liver recurrence underwent right hepatectomy and has been free of disease for 2 years. The third patient died of metastatic disease 13 years after initial surgery. Giant insulinomas are characterized by focal expression of insulin and high rates of liver metastases. Long-term follow-up is mandatory in these patients, as recurrence is expected after primary surgery.

Background: Solid pseudo papillary tumor of the pancreas is considered a neoplasm of low malignant potential. The radicality of surgical approach is controversial., Patients and Methods: We describe and analyze retrospectively the clinical, radiological, laboratory, operative report and pathology results of seven patients who were diagnosed and operated by solid pseudo papillary tumor of the pancreas in the period 2003 to 2010, in our institution., Results: Six patients were female and one male. The median age was 35 years (range: 15-49). The most common symptom was abdominal pain (100%). Jaundice in one patient (14.3%). The radiological appearance mixed solid-cystic was the most common. We performed four Whipple procedures (57.1%), 2 distal pancreatectomy with splenectomy (28.6%), one by laparoscopy and the other by local resection. Morbidity presented in four patients. There was no postoperative mortality or reoperation. Five tumors were located in the pancreatic head (71.4%) and two in the tail (28.6%). The median tumor size was 93 mm (range: 20-150). Two (28.6%) were R1 resections. Four tumors showed malignant behavior (57.1%): splenic capsule and infiltration of metachronous liver metastases (1), infiltration of superior mesenteric artery (1), lymphatic metastasis (1) and synchronous liver metastases, and lymphovascular invasion duodenal infiltration (1). There was no mortality from the disease during the average follow-up of 26 months (range 6-70 months)., Conclusion: Solid pseudo papillary tumor is a neoplasm with high malignant potential in our experience. We recommend an aggressive surgical approach with radical resection including lymphadenectomy.

Background: The etiology of pneumonia is important to indicate antibiotics. A clinical prediction score (RP) has been designed, although the radiological interpretation is not easy., Objective: To design a simple prediction score (PRs) to identify etiology in children with pneumonia, including radiological patterns, clinical and laboratory features., Methods: Cross sectional study. We prospectively included children under 5 years hospitalized for pneumonia with microbiological evidence (2007-2008). According to the RP, were allocated 3 points when the temperature value was ≥ 39 º C, 2 when the patient age was ≥ 9 months, 2 when the number of neutrophils was 8000/mm3 and 1 when the immature neutrophils number was ≥ 5%. Radiography was evaluated as one point when consolidation was diagnosed and 0 point when pleural effusion or other infiltrations were present. RPS range was from 0 to 9 points. We determined the best cutoff for predicting bacterial pneumonia (ROC) and was calculated based on the same sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative (NPV) and positive likelihood ratio ( RVP) and negative (NLR)., Results: 196 patients (viral: 82%, bacteria: 18%), 8.7 ± 10 months. We identified a score ≥ 3 (auROCc = 0.87 95% CI 0.81 to 0.94) as the best point to predict bacterial pneumonia (S: 88.6%, E: 68.9%, PPV: 38.3 %, NPV: 96.5% RVP: 2.85; RPN: 0.17)., Conclusion: The PRs showed an acceptable performance, but less sensitive than the original score to predict bacterial pneumonia. Although this tool may be easily applied, it should be validated in future studies.