Gac Med Mex
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Acute lymphoblastic leukemia (ALL) is a clonal disease characterized by a proliferation of immature cells. In immunophenotypic, cytogenetic and molecular studies, it is a heterogeneous disease with diverse manifestations and prognoses. The treatment is complex and is associated with complications during its course. ⋯ The majority of patients, regardless of risk, reach complete remission. We found that the clinical and biological characteristics showed no significant differences related to the outcome. lmmunochemotherapy treatment may improve response.
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This article analyzes the Mexican regulation on palliative care and its relationship with the public debate on assisted death or suicide. This paper focuses on the rights that people with incurable diseases have, given the current contents of the General Health Statute and other applicable rules. Its main purpose is to activate the public debate on these matters.
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In this review, we assemble the fundamental concepts of the use of mechanical ventilation (MV) in children with acute respiratory failure (ARDS) and refractory hypoxemia. We also discusses topics of protective ventilation and recruitment potential, and specifically examine the options of ventilation and/or maneuvers designed to optimize the non-aerated lung tissue: alveolar recruitment maneuvers, positive end-expiratory pressure (PEEP) titulation, high frequency oscillatory ventilation (HFOV), airway pressure release ventilation (APRV), aimed at correcting the mismatch ventilation/perfusion (V/Q): use of prone position. The only pharmacological intervention analyzed is the use of neuromuscular blockers. ⋯ Use of recruitment maneuvers and PEEP downward titration can improve lung function in patients with ARDS and severe hypoxemia. We must keep in mind HFOV instauration as early as possible in response to failure of MV. The use of early and prolonged prone can improve gas exchange in hopes of a better control of what caused the use of MV.
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The relevance of basic sciences in medical education has been recognized for centuries, and the importance of exposing medical students to science was acknowledged and reinforced by the recommendations of Flexner in 1910. Since then, traditional medical education has been divided into preclinical and clinical subjects; within this scheme, the first terms of undergraduate medical education usually concentrate on basic sciences, while subsequent ones focus on clinical sciences and clinical training. ⋯ The removal of basic science subjects from the medical curriculum is paradoxical because nowadays the value of biomedical knowledge and the scientific reasoning to make medical decisions is more appreciated than ever. To maintain its relevance in medical education, basic sciences have to confront three challenges: a) increasing its presence in clinical education; b) developing nuclear programs; and c) renewing laboratory instruction.