Resumen La resucitación en control de daños busca combatir la descompensación metabólica del paciente severamente traumatizado mediante tres ejes: la hipotensión permisiva, la resucitación hemostática y la cirugía de control de daños. El objetivo de este artículo es hacer una revisión de la historia de la resucitación en control de daños y la cirugía de control de daños proponiendo un nuevo paradigma basado en los recientes avances de la tecnología endovascular. Un puente ha sido creado entre el manejo prehospitalario y el control del sangrado, descrito antes de la etapa I de la cirugía de control de daños, que es la inclusión y colocación de un REBOA. Esta es una herramienta adicional en el control de la hemorragia y de soporte en la resucitación hemodinámica de los pacientes con trauma severo de tipo cerrado y/o penetrante. Por lo que se propone un nuevo paradigma “El cuarto pilar”: Hipotensión permisiva, resucitación hemostática, cirugía de control de daños y REBOA.

Abstract Damage Control Resuscitation (DCR) seeks to combat metabolic decompensation of the severely injured trauma patient by battling on three major fronts: Permissive Hypotension, Hemostatic Resuscitation, and Damage Control Surgery (DCS). The aim of this article is to perform a review of the history of DCR/DCS and to propose a new paradigm that has emerged from the recent advancements in endovascular technology: The Resuscitative Balloon Occlusion of the Aorta (REBOA). Thanks to the advances in technology, a bridge has been created between Pre-hospital Management and the Control of Bleeding described in Stage I of DCS which is the inclusion and placement of a REBOA. We have been able to show that REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured blunt and/or penetrating trauma patient. That is why we propose a new paradigm “The Fourth Pillar”: Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA.

Resumen Introducción. La maniobra de reanimación mediante el denominado “balón de reanimación endovascular de aorta”(Resuscitative Endovascular Balloon Occlusion of the Aorta, REBOA), es un procedimiento para obtener el control proximal de la hemorragia. Nuestra hipótesis es que puede usarse como una maniobra emergente para el manejo del choque hemorrágico y como una intervención para prevenir la aparición de hemorragia masiva en los pacientes en riesgo. Materiales y métodos. Se recolectaron los datos de una cohorte prospectiva de pacientes entre el 2014 y 2018 en un centro de trauma de nivel I del suroccidente colombiano. Los datos se presentaron, de acuerdo con su distribución de normalidad, en medias y desviaciones estándar o medianas y rangos intercuartílicos. Resultados. Se incluyeron 70 pacientes, 27 considerados en riesgo de choque hemorrágico (mujeres embarazadas con placentación anormal) y 43 con choque hemorrágico (pacientes de trauma sometidos a cirugía y oclusión aórtica con balón). En el primer grupo, ningún paciente requirió transfusión masiva y no se reportaron muertes. En el último, hubo aumento significativo de la presión arterial sistémica después del procedimiento de 50,1 ± 22,5 a 107 mm Hg (rango: 87-129) y la mortalidad fue del 30,2 %. Conclusión. Esta muestra de pacientes sometidos a reanimación mediante oclusión aórtica con REBOA es la más grande reportada hasta ahora en Latinoamérica. Esta es una herramienta eficaz para el manejo de pacientes en choque hemorrágico o en riesgo de uno.

Abstract Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a procedure that involves placement of an endovascular balloon in the aorta to obtain proximal control of hemorrhage. We hypothesize that the REBOA can be used as an emergent maneuver for the management of patients with hemorrhagic shock and as a prophylactic intervention to prevent the appearance of massive hemorrhage in populations at risk. Methods: Data were collected from a prospective cohort of patients in the period between 2014 and 2018, at a level I trauma center in Southwestern Colombia. The data was presented according to their distribution of normality, in means and standard deviations or medians and interquartile ranges. Results: Seventy patients were included, 27 considered at risk of hemorrhagic shock (pregnant women with abnormal placentation) and 43 with hemorrhagic shock (trauma patients undergoing surgery and REBOA). In the first group, no patient required massive transfusion and no deaths were reported. In the latter, there was a significant increase in blood pressure [SBP pre-REBOA: 50.1 ± 22.5, post-REBOA SBP: 107 (87-129)] and mortality was 30.2%. Conclusion: Our experience in the use of REBOA is the largest reported in Latin America. This is an effective tool for the management of patients at or at risk of hemorrhagic shock.

Resumen Objetivo: Describir las variaciones en los soldados heridos en combate admitidos al departamento de emergencias durante el periodo de negociación del proceso de paz colombiano entre el 2011 y el 2016. Métodos: Estudio retrospectivo de todos los soldados heridos en combate que fueron manejados en un centro de trauma desde Enero del 2011 a Diciembre del 2016. Los pacientes se dividieron en dos grupos: aquellos que ingresaron al departamento de emergencias antes de la tregua del proceso de paz (Noviembre 2012) y aquellos que ingresaron durante la negociación. Los grupos se compararon con respecto a los periodos de tiempo. Resultados: Un total de 448 soldados heridos en combate fueron incluidos. Hubo una disminución gradual en el número de admisiones durante el periodo de negociación. Además, el número de soldados que sufrieron heridas por explosiones y fusiles disminuyó durante este periodo. En el 2012 se registraron 150 soldados heridos en combate. Este número disminuyó a 84, 63, 32 y 6 en los años 2013, 2014, 2015 y 2016 respectivamente. La proporción de pacientes con un ISS ≥9 y la proporción de admitidos a la unidad de cuidado intensivo fueron significativamente mayores en el periodo antes de la negociación. Desde Agosto a Diciembre/2016 no se registraron admisiones. Conclusión: Este estudio describe una disminución gradual en el número de soldados heridos en combate admitidos al departamento de emergencia en un periodo de 6 años. Este fenómeno pudo deberse al periodo de negociación del proceso de paz.

Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties’ admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

Background: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. Aim: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. Material and Methods: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. Results: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. Conclusions: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.

La infección esofágica por virus del herpes es una entidad rara que se ha reportado con mayor frecuencia en pacientes inmunocomprometidos. Esta infección afecta principalmente a pacientes con virus de la inmunodeficiencia humana (VIH) y a pacientes que reciben terapia inmunosupresora o quimioterapia. La severidad de los síntomas está relacionada con el grado de afectación esofágica, siendo la odinofagia la presentación clínica más frecuente. Por otro lado, el hallazgo endoscópico más común es la presencia de úlceras múltiples bien circunscritas que se presentan típicamente en el tercio distal del esófago. El tratamiento estándar descrito es el aciclovir oral por 1 a 2 semanas.

Esophageal herpes viral infections are rare condition that have been reported most frequently in immunocompromised patients. This infection primarily affects patients with human immunodeficiency virus (HIV) and patients receiving immunosuppressants or chemotherapy. The severity of symptoms is related to the degree of esophageal involvement. Odynophagia is the most common clinical presentation while the most common endoscopic finding is multiple well-circumscribed ulcers. These typically occur in the distal third of the esophagus. Standard treatment is oral acyclovir for one to two weeks

Abstract: INTRODUCTION: As a consequence of population isolation by the presence of geomorphological barriers, dolphins from northern South America are subdivided into three species: I. geoffrensis (Amazon and Orinoco Rivers), I. boliviensis (Madeira River in Bolivia), and the recently described I. araguaiaensis inhabiting the hydrologic complex of the Araguaia -Tocantins Rivers in the northeastern Brazilian Amazon. The importance of pink dolphins at the ecosystems they inhabit is supported by: 1) its position as top predators in the food chain; 2) bioindicators for ecosystem health; 3) its cultural and mythological meaning for the local ethnic groups, such as Sikuanis from the Orinoco, and Ticuna for the Amazon; and 4) their economic value, mainly as a touristic attraction. The conservation status of Orinoquian populations of river dolphins (i. g. humboldtiana), has not been fully established. However, we know their populations are threatened by a series of human activities on both aquatic and terrestrial environments, affecting their occurrence across the basin. This research is part of an inter-institutional effort conducted between the Corporación para el Desarrollo Sostenible del Área de Manejo Especial de la Macarena (CORMACARENA) and Fundación Omacha, to monitor pink dolphin populations inhabiting the rivers: Meta, Manacacías, Yucao, and Cusiana, in order to identify conservation tensors affecting the species in the study area. METHODS: We conducted a multitemporal study to determine anthropogenic threats affecting dolphin populations during two hydrologic periods along 317.2 km-1 across the middle Meta River basin. We calculated the degradation index for streams of continental waters and density of the river dolphins, developed by Gómez-Salazar et al. (2012). Water quality, habitat transformation, species exploitation, and the increment in number of human settlements were identified as the main conservation tensors in the analyzed area. RESULTS: We obtained a high value in the index of degradation, with a potential increment in value through time. River confluences were identified as priority areas for the conservation of the species. The development of infrastructure projects on the main streams was identified as a future threat on freshwater ecosystems in the basin. Differences in hydrologic periods were identified as an important variable, not only affecting the ecological dynamic of the species, but also determining the anthropogenic tensors through time. Water quality, habitat modification, and species exploitation were particularly intense at low water level periods, while boat traffic, and fishing activities are more frequent at periods of high water levels in the region. DISCUSSION AND CONCLUSIONS: For the Meta River, water quality and species exploitation appear to be the major tensors for dolphins and they may explain the low densities recorded for the area in comparison with densities reported for the Amazon basin. Even though, we consider this analysis is not definite and more samplings are necessary to confirm this hypothesis. Finally, river confluences were identified as conservation hot spots for dolphin populations. We point out on the importance of river dolphins as umbrella species, ideal to develop conservation strategies in the region.

Resumen: INTRODUCCIÓN: El proceso de especiación del género Inia (familia Iniidae) fue resultado del aislamiento entre cuencas por procesos geomorfológicos, lo que dio lugar a tres especies: 1) I geoffrensis, en los ríos Amazonas y Orinoco; 2) I boliviensis, en la cuenca alta de río Madeira en Bolivia (la recientemente descrita), y 3) I araguaiaensis, en el complejo hidrográfico formado por los ríos Araguaia-Tocantins, en la amazonia brasilera. La importancia de los delfines rosados en los ecosistemas acuáticos dulceacuícolas donde habitan se sustenta, por: 1) Son los depredadores tope en las redes tróficas; 2) bioindicadores de la salud de los ecosistemas; 3) su significancia cultural y mitológica en etnias como los Sikuanis del Orinoco y los Ticuna del Amazonas; 4) Su valor económico, principalmente como atractivo turístico. El estatus de conservación de las poblaciones del delfín de río (I. g. humboldtiana), es poco conocido. Sin embargo, sus poblaciones se encuentran amenazadas por actividades humanas realizadas en los ambientes acuáticos y terrestres, afectando su distribución a lo largo de la cuenca. Esta investigación participa de un esfuerzo interinstitucional de la Corporación para el Desarrollo Sostenible del Área de Manejo Especial de la Macarena (CORMACARENA) y de la Fundación Omacha. El objetivo fue evaluar, monitorear y generar estrategias para la conservación de las poblaciones del delfín rosado en la cuenca media del río Meta y en sus tributarios Manacacías, Yucao y Cusiana. MATERIALES Y MÉTODOS: Se llevó a cabo un estudio multitemporal a fin de establecer las amenazas de origen antrópico y la densidad de la especie durante dos periodos hidrológicos a lo largo de 317.2 km-1 lineales en la cuenca media del río Meta y sus tributarios. Para estudiar los cursos de agua muestreados, se calculó el índice de degradación en corrientes de aguas continentales desarrollado por Gómez-Salazar et al. (2012). La alteración en la calidad del agua; modificación del hábitat; la explotación de especies, y el incremento en los asentamientos humanos fueron identificados como tensores para la conservación de la especie en el area de estudio. RESULTADOS: Se registró valores altos para el índice de degradación, con potencial incremento a futuro. Las confluencias son identificadas como áreas prioritarias para la conservación de la especie. El desarrollo de proyectos infraestructura fueron identificados a lo largo del tiempo como la principal amenaza a la conservación de los ecosistemas acuáticos asociados a esta cuenca. Los diferentes periodos hidrológicos fueron identificados como una variable importante, afectando la dinámica de las especies y determinando la intensidad de los tensores antrópicos durante los periodos hidrológicos evaluados. Calidad del agua, modificación de hábitat, y explotación de especies se presentaron durante el periodo de aguas bajas; tráfico de embarcaciones y actividades de pesca son más frecuente durante el periodo de aguas altas para la region. DISCUSIÓN Y CONCLUSIONES: Para el río Meta, la calidad del agua y la explotación de especies fueron los mayores tensores para los delfines presentando bajas densidades para el área de estudio en comparación con las densidades reportadas para la cuenca del Amazonas. Se considera que este análisis no es definitivo y más estudios son necesarios para confirmar esta hipótesis. Finalmente, las confluencias de los ríos fueron identificadas como (puntos calientes: hot spots) para la conservación de los delfines. Los delfines constituyen una valiosa herramienta al ser empleados como especies sombrilla, ideal para el desarrollo de estrategias de conservación en la región.

CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7%), grau III (73,3%) associado a prolapso mucoso e intussuscepção (52%). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3%) pacientes, sutura grampeada incompleta em 2 (2,6%) e dor retal persistente em 3 (4,0%). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3%) e 2 dias em 34,7%. Ocorreu redução na linha de sutura em 7 (9,3%), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6%). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

Este artículo presenta uno de los productos de la investigación aplicada "Gestión ambiental de la amalgama dental en el departamento de Antioquia", realizado entre febrero del 2005 y febrero del 2007 por los siguientes grupos de investigación de la Universidad de Antioquia: Ciencia y Tecnología Biomédica (CTB), Materiales Preciosos (MAPRE) y Grupo de Investigaciones Pirometalúrgicas y de Materiales (GIPIMME), así como de la empresa privada New Stetic S. A. OBJETIVO: describir las condiciones locativas y ambientales en 30 grandes entidades odontológicas del departamento de Antioquia, definidas en el proyecto como aquellas con cinco o más sillas o unidades odontológicas en un mismo sitio de trabajo y que corresponden aproximadamente a 85% de la población de referencia. Por ello, los resultados pueden considerarse como derivados de un censo. La descripción se realiza desde una perspectiva asociada al riesgo de contaminación con mercurio del personal laboralmente expuesto. MATERIALES Y METODOS: se diseño y aplicó un instrumento de observación en cada entidad sobre características del piso y paredes, ventilación, temperatura, lugar de almacenaje de mercurio, elementos para el manejo de residuos de la amalgama (escupidera y colector) y actividades diferentes a la prestación de servicios odontológicos. Cada entidad fue visitada por un ingeniero investigador y un estudiante avanzado de ingeniería en una fecha acordada, previamente capacitados para la recolección de la información. RESULTADOS: no todas las entidades grandes prestan los servicios en instalaciones adecuadas ni hacen un buen manejo de las variables ambientales, de tal manera que se hace imperativo emprender acciones integrales inmediatas que disminuyan el peligro de contaminación con mercurio.

This article is a product from the project "Environmental Management of Dental Amalgam in the State of Antioquia" which was carried out by the following research groups belonging to the University of Antioquia: Science and Biomedical Technology, Precious Materials, and Pirometallurgical and Materials Researches, as well as the private company New Stetic S. A., between February 2005 and February 2007. OBJECTIVE: to describe the environmental conditions in 30 big dental offices of the State of Antioquia, Colombia. Those dental offices having more than five dental chairs in the same work place were defined as "big" for the purpose of this project. Due to the fact that these dental offices represents 85% of the population of reference, the results described in this article can be consequently considered as is they were derived from a census. The description is made bearing in mind the people who are exposed to the risk of mercury contamination due to their occupation. MATERIALS AND METHODS: an observation tool was designed in order to be applied in each dental office. It contained aspects as floor and wall characteristics, ventilation, room temperature, storing place for mercury, elements for handling amalgam scraps, and those activities which deviate from the regular dental service in the same site. Each dental office was visited by a research engineer and an advanced engineering student on a previously defined date. The researchers were trained in advance to collect the information. RESULTS: it was found that some big dental offices have inadequate conditions in their premises for offering their services, and do not have a good handling of the environmental conditions. That’s why immediate actions are mandatory to minimize the risk of mercury contamination.

The influence of temperature, humidity and rainfall on field population trend of stable fly, Stomoxys calcitrans, over three consecutive years in two dairy farms located in semiarid climate in Aguascalientes State, in Mexico, were determined. The dairies were visited weekly between April 1999 to March 2002, on each occasion 10% of the dairy cows were selected making direct counts of stable flies observed front the legs. The occurrence of stable fly adults from weekly counts was divided in four population phases: population increasing phase I (first peak), fluctuation phase, population increasing phase II (second peak) and population decreasing phase, for each year of study. Pearson's correlation analysis was developed (P < 0.01) between weekly average fly number per cow and mean temperature, mean relative humidity and rainfall recorded from one to four weeks before count in each population phases. The population increasing phase I, was observed in spring-summer period, in where relative humidity had significant correlation indices (r = 0.6 to 0.8), the first peak occurred in September, June and August, of each year studied, respectively. The population-decreasing phase was observed between last weeks of summer and in the fall, showed high correlation indices with temperature (r = 0.9). No significant correlations were founded with the rainfall over the study.

El trabajo tuvo como objetivo determinar la influencia de la temperatura, humedad y la precipitación pluvial en la curva poblacional de campo de la mosca del establo, Stomoxys calcitrans, en un periodo de tres años en dos establos lecheros localizados en un clima semiárido en el estado de Aguascalientes, México. Los establos se visitaron semanalmente entre abril de 1999 y marzo del 2002, en cada ocasión se seleccionó al 10% de las vacas en lactancia realizando un conteo directo de moscas del establo que se observaran en el frente de las piernas. La ocurrencia de la mosca del establo en los conteos semanales fue dividido en cuatro fases: incremento poblacional fase I (primer pico), fase de fluctuación, incremento poblacional fase II (segundo pico) y fase de decremento poblacional, para cada año de estudio; se realizó un análisis de correlación de Pearson (P < 0,01) entre el promedio semanal de moscas por vaca y la temperatura promedio, humedad relativa promedio y precipitación pluvial registradas de una a cuatro semanas antes del conteo, en cada una de las fases poblacionales. En el incremento poblacional fase I (primavera-verano), la humedad relativa fue el único factor climático con índices de correlación significativos (r = 0,6 a 0,8), el primer pico ocurrió en septiembre, junio y agosto, respectivamente para cada año estudiado. La fase de decremento poblacional se observó en las últimas semanas del verano y en el otoño, detectando altos índices de correlación con la temperatura (r = 0,9). No se encontró ningún coeficiente significativo con la precipitación pluvial en el estudio.

An epidemiological study was carried out in the northern Mexican state, Nayarit. Fourteen patients with possible cutaneous leishmaniasis skin lesions gave positive Montenegro skin tests. Biopsies were taken from the skin ulcer and analyzed by polymerase chain reaction (PCR) with specific primers for the Leishmania mexicana complex; however all biopsies were not amplified. PCR carried out with specific primers for the L. braziliensis complex resulted in the amplification of all patient DNA. DNA from 12 out of 14 biopsies gave positive amplification with primers species specific for L. (Viannia) braziliensis and hybridized with a species specific L. (V.) braziliensis probe. These results demonstrate the presence in Nayarit of at least two members of the L. braziliensis complex. Most of the cutaneous lesions were caused by L. (V.) braziliensis and two by another species belonging to the L. braziliensis complex. As far as we are aware, this is the first report of L. (V.) braziliensis in Nayarit. The main risk factor associated with the contraction of this disease in Nayarit is attributed to working on coffee plantations.