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Search Results: 1 - 10 of 377758 matches for " Pérez-Nú?ez "
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Tratamiento de los gliomas mediante virus oncolíticos: revisión de la literatura Oncolytic viral terapy of gliomas: review of the literature
I. Arrese,P. González,P. Miranda,A. Pérez-Nú?ez
Neurocirugía , 2005,
Abstract: Los gliomas son los tumores cerebrales primarios más frecuentes. Los tratamientos tradicionales se han basado en la cirugía, la radioterapia y la quimioterapia. Pese al avance en estas terapias, el pronóstico de estos tumores ha permanecido casi constante durante los últimos a os. Dada la ausencia de mejoría en el pronóstico, los últimos avances en técnicas de biología molecular han abierto un nuevo campo de investigación para el desarrollo de nuevos tratamientos, y dentro de ellos, se ha evaluado el uso de virus oncolíticos en diferentes ensayos. En esta revisión discutimos los avances ocurridos en el uso de terapias basadas en estos agentes anticancerosos. Gliomas are the most frequent primary tumors of the brain. The standard treatment includes surgery, radiotherapy and chemotherapy, but the outcomes of patients with these tumors have remained nearly unchanged for past years. Hopefully, recent advances in molecular biology are rising new clinical expectation for patients with brain tumors. Among the novel techniques in this new field of research a new field of research, the use of oncolytic viruses has been explored in different trials during last years. In the present review we analyze the advances in the understanding of the oncolytic viral therapy of gliomas.
Modelos de regresión para variables expresadas como una proporción continua
Salinas-Rodríguez,Aarón; Pérez-Nú?ez,Ricardo; ávila-Burgos,Leticia;
Salud Pública de México , 2006, DOI: 10.1590/S0036-36342006000500006
Abstract: objective: to describe some of the statistical alternatives available for studying continuous proportions and to compare them in order to show their advantages and disadvantages by means of their application in a practical example of the public health field. material and methods: from the national reproductive health survey performed in 2003, the proportion of individual coverage in the family planning program -proposed in one study carried out in the national institute of public health in cuernavaca, morelos, mexico (2005)- was modeled using the normal, gamma, beta and quasi-likelihood regression models. the akaike information criterion (aic) proposed by mcquarrie and tsai was used to define the best model. then, using a simulation (monte carlo/markov chains approach) a variable with a beta distribution was generated to evaluate the behavior of the 4 models while varying the sample size from 100 to 18 000 observations. results: results showed that the best statistical option for the analysis of continuous proportions was the beta regression model, since its assumptions are easily accomplished and because it had the lowest aic value. simulation evidenced that while the sample size increases the gamma, and even more so the quasi-likelihood, models come significantly close to the beta regression model. conclusions: the use of parametric beta regression is highly recommended to model continuous proportions and the normal model should be avoided. if the sample size is large enough, the use of quasi-likelihood model represents a good alternative.
Regresión espontánea de las malformaciones arteriovenosas cerebrales: presentación de un caso y revisión de la literatura Spontaneous regression of cerebral arteriovenous malformations: case report and review of the literature
B. Pascual,A. Lagares,P. Miranda,A. Pérez-Nú?ez
Neurocirugía , 2007,
Abstract: La regresión espontánea de las malformaciones arteriovenosas cerebrales (MAVs) es poco frecuente. Este hecho parece ser más común en aquellas MAVs de peque o tama o, cuyo modo de presentación clínica preferente es con hemorragia cerebral, con una única arteria aferente, y una sola vena de drenaje. No se conocen con exactitud cuáles son los factores responsables de la desaparición de las MAVs. La trombosis secundaria al sangrado es el factor más comúnmente asociado a este hecho. Otros posibles factores implicados son la gliosis secundaria a microsangrados repetidos o la oclusión de las arterias aferentes por peque os émbolos. Se presentan las características clínico radiológicas de un caso de regresión espontánea de MAV y se revisa la literatura al respecto Spontaneous regression of intracranial arteriovenous malformations (AVMs) is a rare phenomenon. Such an event is more likely to occur with small AVMs that present with intracranial hemorrhage, which are fed by a unique artey and drained through a single vein. The factors responsible for AVMs regression remain unclear. Thrombosis of the AVM secondary to intracranial hemorrhage ha been the most commonly associated factor. Other possible causes are the gliosis around the clot secondary to repeated frequent microbleedings or occlusion of the feeding arteries by small emboli. We report a new case of spontaneous regression of a AVM and review the literature related to this entity.
Mecanismos para la asignación de los recursos financieros a partir de la descentralización en el estado de Jalisco
Pérez-Nú?ez,Ricardo; Arredondo-López,Armando; Pelcastre,Blanca;
Salud Pública de México , 2006, DOI: 10.1590/S0036-36342006000200006
Abstract: objective: to analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of jalisco (ssj, per its abbreviation in spanish), within the context of decentralization. material and methods: through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the ssj in financial resource allocation was documented. from september to november 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. results: from the point of view of decision-makers, autonomy of the ssj has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. in this sense, the implications attributable to labor situations that are still centralized are evident. some innovative systems for financial resource allocation have been established in the ssj for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. adjustments were also made for degree of marginalization and population lag, under the equity criterion. conclusions: general work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. although decentralization has granted more autonomy to the ssj, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.
Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte II: Hemorragia infratentorial Surgical treatment for spontaneous intracerebral haemorrhage: Part II: Infratentorial haematomas
A. Pérez-Nú?ez,R. Alday,J.J. Rivas,A. Lagares
Neurocirugía , 2008,
Abstract: El tratamiento quirúrgico juega un papel fundamental en el manejo de algunos pacientes con hematomas de cerebelo, y sin embargo, no existe una guía de tratamiento universalmente aceptada que permita seleccionar a este subgrupo de pacientes. El objetivo del presente trabajo fue revisar la base sobre la que se fundamentan las indicaciones del tratamiento quirúrgico en esta patología. En ausencia de ensayos clínicos que afronten este problema, las series clínicas muestran que los criterios más consistentes para la decisión terapéutica son el nivel de consciencia, el tama o del hematoma, la presencia de hidrocefalia y los datos radiológicos de compresión de los espacios continentes de LCR en la fosa posterior. El parámetro mejor estudiado como reflejo de este último aspecto posiblemente sea la deformidad del IV ventrículo. La literatura sugiere que los hematomas de 4 o más cm de diámetro, o que causan una oclusión completa del IV ventrículo o de la cisterna prepontina deben ser intervenidos independientemente del nivel de consciencia, al presentar una compresión significativa del tronco del encéfalo (TDE). Por el contrario, es probable que hematomas de menos de 3 cm y que no deforman el IV ventrículo, no causen una compresión importante en la fosa posterior, y puedan ser manejados de forma conservadora o mediante el drenaje de la hidrocefalia si fuera preciso. Para hematomas de tama o intermedio la decisión terapéutica está menos clara, pudiendo optarse por observación estricta en los pacientes con GCS 14-15 o con drenaje ventricular externo (DVE) aislado en aquellos con GCS<14 que presenten hidrocefalia. En presencia de un bajo nivel de consciencia a pesar del tratamiento de la hidrocefalia, o en ausencia de ésta, se debería realizar una evacuación del hematoma. Finalmente, no parece indicado el tratamiento de pacientes con GCS 3 y ausencia de reflejos de tronco, o aquéllos en los que por su edad avanzada o mala calidad de vida previa presenten un pronóstico funcional malo. Se ha encontrado además que los pacientes en coma y con signos radiológicos de grave compresión del TDE las posibilidades de una buena recuperación son muy escasas. A pesar de todo el tratamiento ha de ser individualizado en cada caso, ya que no existe la evidencia suficiente que permita elaborar una guía de aplicación estricta. Surgery plays a mayor role in the management of some patients with cerebellar haematomas, although a universally accepted treatment guideline is lacking. The aim of this study was to review the existing evidence supporting surgical evacuation of the haematoma in
Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte I: Hemorragia supratentorial Surgical treatment for spontaneous intracerebral haemorrhage: Part I: Supratentorial haematomas
A. Pérez-Nú?ez,A. Lagares,B. Pascual,J.J. Rivas
Neurocirugía , 2008,
Abstract: La hemorragia intracerebral espontánea (HIE) constituye uno de los procesos ictales de mayor gravedad. A pesar de esto y de una elevada incidencia, su tratamiento médico no va mucho más allá de un papel de soporte vital y control médico de la hipertensión intracraneal, y las indicaciones del tratamiento quirúrgico están pobremente basadas en evidencia científica. El objetivo del presente trabajo fue revisar las bases de la indicación quirúrgica en la HIE supratentorial. Encontramos 10 ensayos clínicos y 5 meta-análisis en lengua inglesa que analizaban la utilidad del tratamiento quirúrgico en esta patología. Aunque globalmente estos estudios no mostraron un beneficio significativo del tratamiento quirúrgico en el conjunto de pacientes con HIE supratentorial, existe un subgrupo de pacientes en los que parece que dicho tratamiento podría ser beneficioso. En la hemorragia intracerebral espontánea supratentorial las recomendaciones actuales indican que los pacientes jóvenes, con hematomas lobares cuyo volumen causa un deterioro del nivel de consciencia, deben ser intervenidos. En pacientes con hematomas putaminales que reúnen las mismas condiciones de edad y deterioro neurológico la cirugía podría mejorar la evolución, al menos en términos de supervivencia. Un grave deterioro neurológico con GCS<5, la localización talámica y la presencia de una situación basal o edad que impidan una adecuada recuperación funcional, son criterios considerados tradicionalmente contraindicación del tratamiento quirúrgico. Dada la ausencia de evidencia científica sólida en la que sustentar estas recomendaciones, la decisión terapéutica debe realizarse de manera individualizada y prestando atención al soporte socio-familiar del paciente, que jugará un papel importante en la evolución del mismo a medio/largo plazo. Spontaneous intracerebral haematoma (SICH) represents one the most severe subtypes of ictus. However, and despite a high incidence, medical treatment is almost limited to life support and to control intracranial hypertension and indications of surgical treatment are poorly defined. The aim of this paper was to review the evidence supporting surgical evacuation of SICH. Ten clinical trials and five meta-analyses studying the results of surgical treatment on this pathology were found on English literature. These studies considered all together, failed to show a significant benefit of surgical evacuation in patients with SICH considered as a whole. However, a subgroup of these patients has been considered to potentially present a better outcome after surgical treatment. C
Tratamiento de los gliomas mediante virus oncolíticos: revisión de la literatura
Arrese,I.; González,P.; Miranda,P.; Pérez-Nú?ez,A.; Pascual,B.; Lobato,R.D.;
Neurocirugía , 2005, DOI: 10.4321/S1130-14732005000200007
Abstract: gliomas are the most frequent primary tumors of the brain. the standard treatment includes surgery, radiotherapy and chemotherapy, but the outcomes of patients with these tumors have remained nearly unchanged for past years. hopefully, recent advances in molecular biology are rising new clinical expectation for patients with brain tumors. among the novel techniques in this new field of research a new field of research, the use of oncolytic viruses has been explored in different trials during last years. in the present review we analyze the advances in the understanding of the oncolytic viral therapy of gliomas.
Regresión espontánea de las malformaciones arteriovenosas cerebrales: presentación de un caso y revisión de la literatura
Pascual,B.; Lagares,A.; Miranda,P.; Pérez-Nú?ez,A.; Arrese,I.; Lobato,R.D.; Campollo,J.;
Neurocirugía , 2007, DOI: 10.4321/S1130-14732007000400006
Abstract: spontaneous regression of intracranial arteriovenous malformations (avms) is a rare phenomenon. such an event is more likely to occur with small avms that present with intracranial hemorrhage, which are fed by a unique artey and drained through a single vein. the factors responsible for avms regression remain unclear. thrombosis of the avm secondary to intracranial hemorrhage ha been the most commonly associated factor. other possible causes are the gliosis around the clot secondary to repeated frequent microbleedings or occlusion of the feeding arteries by small emboli. we report a new case of spontaneous regression of a avm and review the literature related to this entity.
Análisis del gasto en salud reproductiva en México, 2003
Cahuana-Hurtado,Lucero; ávila-Burgos,Leticia; Pérez-Nú?ez,Ricardo; Uribe-Zú?iga,Patricia;
Revista Panamericana de Salud Pública , 2006, DOI: 10.1590/S1020-49892006001000001
Abstract: objectives: to estimate reproductive health expenditures in mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic indicators in different states, using health accounts methods. methods: we estimated reproductive health expenditures between january and december 2003, at the national and state level. we used health accounts methods adjusted for the particular characteristics of mexico on the basis of information from public and private sources. expenditures were calculated for the four main reproductive health programs (maternal-perinatal health, family planning, cervical and uterine cancer, and breast cancer) according to different funding entities, goods and services providers, and functions of health care, in both the public and private sector. we estimated public expenditures by state per beneficiary, and analyzed how these costs were related with pubic health care expenditures and annual per capita gross domestic product (gdp) for each state. results: the reproductive health expenditures in mexico during the year 2003 were us$ 2.912 6 billion, a figure that represented 0.5% of the national gdp in 2003 and slightly more than 8% of the total health care expenditures. costs were higher for public entities (53.5%) than for private entities (46.5%). the maternal-perinatal health program accounted for the highest costs, mainly from deliveries and complications; direct payments from households accounted for nearly 50% of the total figure. costs for family planning were accrued mainly in the public sector, and represented 5.9% of the total expenditure. of the total spending on reproductive health, 7.9% was devoted to cervical and uterine cancer and breast cancer programs. mean public expenditures on reproductive health per beneficiary were us$ 680.03, and differences between states were associated wit
Early Impact of a National Multi-Faceted Road Safety Intervention Program in Mexico: Results of a Time-Series Analysis
Aruna Chandran, Ricardo Pérez-Nú?ez, Abdulgafoor M. Bachani, Martha Híjar, Aarón Salinas-Rodríguez, Adnan A. Hyder
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087482
Abstract: Background In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León. Methods An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999–2011 with dummy variables representing each intervention phase. Results In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city. Conclusion These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.
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