Bienestar espiritual en pacientes de servicios de oncología y hemodiálisis de dos centros de referencia

RESUMEN Introducción: la espiritualidad es un concepto muy amplio para la humanidad, su consenso para los diversos grupos se encuentra en estudio permanente. La importancia de introducir su abordaje en la salud integral del paciente es cada vez más significativa en la práctica médica. Objetivos: validar la escala MLQ de Steger de bienestar espiritual en idioma guaraní y evaluar el bienestar espiritual en pacientes de los servicios de oncología y hemodiálisis de dos centros de referencia. Métodos: la población enfocada fueron los pacientes en tratamiento oncológico y en diálisis de los servicios de oncología del Hospital de Clínicas (San Lorenzo) y de hemodiálisis del Sanatorio Español-NefroServ (Asunción) durante los meses de mayo, junio y julio de 2021. Se utilizó como instrumento la escala MLQ de Steger. El cuestionario evalúa dos dimensiones del significado de la vida utilizando 10 elementos clasificados en una escala de siete puntos. Se respetaron los aspectos éticos de la investigación en humanos. Resultados: se realizaron 107 cuestionarios, siendo 54 mujeres y 53 varones, 64 fueron tomados en el servicio de hemodiálisis y 41 en el servicio de oncología, 42 fueron realizados en guaraní y 65 en español, según preferencia del encuestado. El promedio de edad de la muestra fue 54,6 ± 14 años. De los encuestados, 11,2% (12) tenían formación primaria incompleta, 25,2% (27) primaria completa, 14,01% (15) secundaria incompleta, 13,08% (14) secundaria, 25,2% (27) terciario y 11,2% (12) no respondieron a esta pregunta. En relación con la religión, 99 manifestaron profesar la religión católica (92,5%). Se utilizó la medición de confiabilidad alfa de Cronbach para medir el grado de fiabilidad de la escala realizada en idioma guaraní, arrojando un valor de 0,87 (alta confiabilidad). Conclusión: se ha logrado probar la validez del instrumento en el idioma guaraní para la comunidad paraguaya guaraní-parlante. Además, se han observado las tendencias en términos de medición del bienestar espiritual entre las muestras estudiadas y sus diferentes perfiles, lo que permite un abordaje más integral en el tratamiento, con las repercusiones que este bienestar pueda generar también en el aspecto físico, más allá de la medicina tradicional.

ABSTRACT Introduction: Spirituality is a very broad concept for humanity, its consensus for the various groups is under permanent study. The importance of introducing its approach in the comprehensive health of the patient is increasingly significant in medical practice. Objectives: To validate the Steger MLQ scale of spiritual well-being in the Guarani language and evaluate the spiritual well-being in patients of the oncology and hemodialysis services of two referral centers. Methods: The target population was patients undergoing cancer treatment and dialysis from the oncology services of the Hospital de Clínicas (San Lorenzo) and the hemodialysis services of the Sanatorio Español-NefroServ (Asunción) during the months of May, June and July 2021. The Steger MLQ scale was used as the instrument. This questionnaire assesses two dimensions of meaning in life using ten items rated on a seven-point scale. The ethical aspects of human research were respected. Results: One hundred seven questionnaires were completed, 54 women and 53 men, 64 were taken in the hemodialysis service and 41 in the oncology service, 42 were done in Guarani and 65 in Spanish, according to the respondent's preference. The average age of the sample was 54.6 ± 14 years. Of those surveyed, 11.2% (12) had incomplete primary education, 25.2% (27) completed primary, 14.01% (15) incomplete secondary, 13.08% (14) secondary, 25.2% (27) tertiary and 11.2% (12) did not answer this question. In relation to religion, 99 stated that they profess the Catholic religion (92.5%). Cronbach's alpha reliability test was used to measure the degree of reliability of the scale carried out in the Guarani language, yielding a value of 0.87 (high reliability). Conclusion: It was possible to test the validity of the instrument in the Guarani language for the Guarani-speaking Paraguayan community. In addition, trends have been observed in terms of measuring spiritual well-being in the samples studied and their different profiles, which allows a more comprehensive approach to treatment, with the repercussions that this well-being can also generate in the physical aspect, beyond traditional medicine.

Ensayo del cometa como bioindicador de inestabilidad genómica en pacientes diabéticos hemodializados / Comet assay as a bioindicator of genomic instability in hemodialysis diabetic patients

Introducción: Procesos como la mutagénesis, la carcinogénesis y la teratogénesis son producto de la interacción de agentes de origen endógeno como exógeno que interactúan con la molécula de ADN en forma crónica produciendo rupturas en la doble hélice, y en cromosomas completos resultando en la inestabilidad genómica. El estrés oxidativo al que se encuentran sometidas las células al formarse las especies reactivas de oxígeno (ROS) y también las especies reactivas de nitrógeno (RNS), que pueden provenir de radicales producidos a consecuencia de la diabetes o en estados iniciales de la enfermedad renal crónica o como respuesta a procesos inflamatorios en estados avanzados de estas patologías, actúan como agentes genotóxicos endógenos.Objetivos: Esta investigación tuvo como objetivo determinar el daño basal en la molécula de ADN de pacientes diabéticos hemodializados, a través del ensayo del Cometa, como un bioindicador de inestabilidad genómica., durante seis meses de tratamiento. Materiales y métodos: Se planteó un estudio longitudinal prospectivo de cohorte para comparar los diferentes niveles de daño antes y durante los primeros seis del tratamiento de hemodiálisis. Se evaluó con el test del cometa o electroforesis de células individuales, el daño basal en muestras de sangre venosa de pacientes diagnosticados con Diabetes de tipo II como control negativo y en pacientes diabéticos con enfermedad renal crónica antes de iniciar el tratamiento de diálisis y luego durante el tratamiento. Se utilizó el test de t- Student para muestras independientes y emparejadas. Resultados: Se observó un aumento significativo de daño basal y oxidativo en el material genético de pacientes diabéticos con enfermedad renal crónica, comparados con los controles negativos (p< 0.005) y se observó, además, que el daño celular aumenta con el tratamiento de hemodiálisis (p<0.005). Conclusión: Los resultados obtenidos en esta investigación permiten concluir que el estrés oxidativo tiene un efecto genotóxico y que el nivel de daño genético es un buen bioindicador del avance de la enfermedad renal crónica y que la hemodiálisis induce a un aumento de daño a nivel del material genético, aumentando el riesgo de carcinogénesis.

Introduction: Processes such as mutagenesis, carcinogenesis and teratogenesis are the product of the interaction of agents of endogenous and exogenous origin that interact with the DNA molecule in a chronic way producing ruptures in the double helix, and in complete chromosomes resulting in genomic instability. The oxidative stress to which the cells are subjected when reactive oxygen species (ROS) and reactive nitrogen species (RNS) are formed, which may come from radicals produced as a result of diabetes or in initial stages of chronic kidney disease or in response to inflammatory processes in advanced stages of these pathologies, act as endogenous genotoxic agents. Objectives: This research aimed to determine the basal damage in the DNA molecule of hemodialyzed diabetic patients, through the Comet assay, as a bioindicator of genomic instability, during six months of treatment. Materials and methods: For this research, a prospective longitudinal cohort study was proposed to compare the different levels of genetic damage before and during the first six of hemodialysis treatment. Baseline damage was evaluated with the comet test or single cell electrophoresis, in venous blood samples from patients diagnosed with Type II Diabetes as a negative control and in diabetic patients with chronic kidney disease before starting dialysis treatment and then during treatment. Results: A significant increase in basal and oxidative damage was observed in the genetic material of diabetic patients with chronic kidney disease, compared to negative controls (p< 0.005) and it was also observed that cell damage increases with hemodialysis treatment (p<0.005). The t-Student test was used for independent and paired samples. Conclusion: The results obtained in this research allow us to conclude that oxidative stress has a genotoxic effect and that the level of genetic damage is a good bioindicator of the progression of chronic kidney disease and that hemodialysis induces an increase in damage at the level of the genetic material, increasing the risk of carcinogenesis.

Surgery and Radiosurgery in Autism: A Retrospective Study in 10 Patients.

INTRODUCTION: A subgroup of patients with autism spectrum disorder (ASD) show self or heteroaggression, dyscontrol episodes, and others are of obsessive-compulsive disorder (OCD) profile; some of them are resistant to medical and behavioural treatment. We describe the long-term outcome in a group of these patients, treated with radiofrequency brain lesions or combined stereotactic surgery and Gamma Knife (GK) radiosurgery. METHODS: We reviewed the medical records of 10 ASD patients with pathological aggressiveness and OCD, who had undergone radiofrequency lesions and/or radiosurgery with GK in our institution. RESULTS: The 10 patients had a significant reduction of their symptoms (PCQ 39.9 and 33, OAS 11.8 and 5, CYBOCS-ASD 30.4 and 20), preoperatively and in the last follow-up, respectively; p < 0.005 (in all cases), although all but 2 needed more than 1 treatment to maintain this improvement. CONCLUSIONS: We observed a marked improvement in behaviour, quality of life, and relationship with the environment in all our 10 patients after the lesioning treatments, without long-lasting side effects.

Hemodiálisis incremental. ¿Una propuesta terapéutica? / Incremental hemodialysis. A therapeutic proposal?

La función renal (FR) es medida por varios métodos. La más utilizada es el aclaramiento de creatinina (ClCr), que reflejaría, el filtrado glomerular (FG). Para su medición se recurre a la recolección de orina durante 24 horas o a la utilización de fórmulas, siendo la más utilizada, la ecuación CKD-EPI (Chronic kidney disease Epidemiology Collaboration). La disfunción renal se clasifica en 5 estadios. El estadio 5 (cuando el ClCr es igual o inferior a 15 ml/min), es cuando los pacientes están prontos a recibir tratamiento sustitutivo renal (TSR). La hemodiálisis (HD), es una técnica muy utilizada como TSR y normalmente es llevada a cabo 3 veces a la semana, por 4 horas cada una. Un paciente de 59 años, quién debido a la distancia entre su domicilio y el Centro de diálisis decide (consentimiento firmado), someterse a solo 2 sesiones de HD por semana. Al inicio del tratamiento, el paciente presentaba todos los datos clínicos y bioquímicos de la Enfermedad renal Crónica Avanzada, estadio 5 y un volumen diurético (VD) ≥ 1 litro/día. En caso de empeoramiento clínico y/o bioquímico, las sesiones de HD serían 3 veces por semana. Al año, los parámetros clínicos, bioquímicos y la función renal residual (FRR), permanecen óptimos. Si FRR (medido por el aclaramiento de urea (Kru) y el VD), declina serán necesarias 3 sesiones de HD, semanales. El mantenimiento de la FRR, está relacionado con la mortalidad y la HD incremental, al preservar mejor la FRR, mejora la sobrevida del paciente.

Several methods are useful to measure renal function (RF). In clinical practice, the creatinina cleareance (CrCl), is widely used, which approximately reflects the glomerular filtration rate (GFR). The 24 hs urine volume collection is required to measure CrCl, however, thanks different formulas we can have a precise CrCl value. The CKD-EPI (chronic kidney disease epidemiology collaboration), is the equation frequently used. According to glomerular filtration rate (GFR), the renal function has been classified in 5 stages. At advances stages (stage 5), (CrCl: 15 ml/min), the patient is faced to receive renal replacement therapy (RRT). Hemodialysis (HD) method is often used. It is carry out 3 times per week (4 hours each). A 59 years old male, due to the distance between the Capital City and his home, decided to receive HD only two times per week (signed consent). At the beginning of the treatment the patient presents all the clinical and biochemical data corresponding to Chronic Renal Failure stage 5. His diuretic volume (DV), ≥ 1 lt/day. In the case of RF deterioration reflected clinical and/or biochemically, the HD session would be 3 times a week. At year, presents adequate residual renal function (RRF) and clinics, biochemical parameters as well. If the RRF (measured by urea clareance (Kru) and the DV) decline, 3 sessions per week will be necessary. The RRF maintenance is related to mortality, therefore, its preservation thanks incremental HD, improve the patient survival.

[Blood lead levels and markers of renal dysfunction among mechanical workshop workers]. / Plomo y nefropatía: Biomarcadores urinarios en la detección de daño renal precoz.

UNLABELLED: The role of lead (Pb) as an environmental cause of nephropathy is difficult to ascertain due to the difficulty to determine clinically its exposure. AIM: To assess lead levels and renal function in a group of males working in mechanical workshops. MATERIAL AND METHODS: Blood and urine samples were obtained from 100 mechanical workshop workers aged 38 ± 16 years and 95 non-exposed office clerks aged 37 ± 17 years. Blood lead and creatinine levels were determined. In exposed workers, urinary excretion of intestinal alkaline phosphatases (IAP) and N-acetyl-glucosaminidase (NAG) were measured as early markers of renal failure. RESULTS: Blood lead levels were 66.4 ± 43 and 33.6 ± 18 µg/L among mechanical workshop workers and non-exposed controls, respectively, p < 0.01. The figures for serum creatinine were 0.9 ± 0.1 and 0.9 ± 0.1 respectively, p = NS. Among exposed workers urinary excretion of IAP was 0.47 ± 0.6 U/L and of NAG, 0.92 ± 1.1 U/L. There was a positive correlation between blood lead levels and NAG excretion (r = 0.284) and IAP excretion (r = 0.346). CONCLUSIONS: Exposed workers had higher blood lead levels and there was a weak positive association between these levels and the urinary excretion of NAG and IAP.

Consenso Paraguayo de Hipertensión Arterial 2015

Este consenso fue ideado por el Director del Programa Nacional de Prevención Cardiovascular del M.S P. y B.S. (Paraguay) a raíz de que se necesitaba un documento actualizado que sirva como guía a los profesionales de la salud de todos los niveles de atención incluyendo a las diferentes especialidades, que tratan la hipertensión arterial y sus complicaciones agudas y crónicas. A través del convenio entre el Programa Nacional de Prevención Cardiovascular y la Sociedad Paraguaya de Cardiología de realizar actualizaciones de las Guías o documentos para difusión de manejo de patologías cardiovasculares y factores de riesgo asociados, se ha decidido elaborar y lanzar este material, que será utilizado como guía oficial en todo el territorio nacional. Con mesas de trabajo de varios días y la colaboración de representantes de sociedades científicas afines y asesores internacionales se ha logrado esta guía. Se presentan recomendaciones para facilitar el manejo de los pacientes con hipertensión arterial y sus complicaciones, con el propósito de disminuir la morbimortalidad cardiovascular. Han sido elaboradas según las evidencias científicas y conocimiento de expertos, con un enfoque práctico y sencillo. Todos los participantes aprobaron las decisiones finales. Los autores reconocen que la publicación y difusión de directrices serán siempre una guía práctica y que permitirá a los médicos ampliar los conocimientos con las recomendaciones propuestas, detectar precozmente el daño de órganos blancos y mejorar la calidad de vida de los pacientes hipertensos.

This consensus was conceived by the Director of the National Program of Cardiovascular Prevention of the M.S P. y B.S. (Ministry of Public Health and Social Welfare, Paraguay) because an updated document was necessary as a guide for health professional of all care levels including different specialties that treat arterial hypertension and its acute and chronic complications. Through this consensus between the National Program of Cardiovascular Prevention and the Paraguayan Cardiology Society of updating Guides or documents for the dissemination of the management of cardiovascular pathologies and associated risk factors it was decided to elaborate and launch this material that will be used as an official guide in the national territory. This guide was achieved after working tables held during several days and the collaboration of representatives of related scientific societies and international advisers. Recommendations for facilitating the management of patients with arterial hypertension and its complications are presented in order to reduce the cardiovascular morbidity and mortality. They have been elaborated according to scientific evidence and knowledge of experts with a practical and simple approach. All the participants approved the final decisions. The authors recognize that the publications and dissemination of guidelines will always be a practical guide that will allow physicians to increase their knowledge with the proposed recommendation in order to early detect the damage of target organs and improve the quality of life of the hypertensive patients.

Geographic variations in the PARADIGM-HF heart failure trial.

AIMS: The globalization of clinical trials has highlighted geographic variations in patient characteristics, event rates, and treatment effects. We investigated these further in PARADIGM-HF, the largest and most globally representative trial in heart failure (HF) to date. METHODS AND RESULTS: We looked at five regions: North America (NA) 602 (8%), Western Europe (WE) 1680 (20%), Central/Eastern Europe/Russia (CEER) 2762 (33%), Latin America (LA) 1433 (17%), and Asia-Pacific (AP) 1487 (18%). Notable differences included: WE patients (mean age 68 years) and NA (65 years) were older than AP (58 years) and LA (63 years) and had more coronary disease; NA and CEER patients had the worst signs, symptoms, and functional status. North American patients were the most likely to have a defibrillating-device (54 vs. 2% AP) and least likely prescribed a mineralocorticoid receptor antagonist (36 vs. 65% LA). Other evidence-based therapies were used most frequently in NA and WE. Rates of the primary composite outcome of cardiovascular (CV) death or HF hospitalization (per 100 patient-years) varied among regions: NA 13.6 (95% CI 11.7-15.7) WE 9.6 (8.6-10.6), CEER 12.3 (11.4-13.2), LA 11.2 (10.0-12.5), and AP 12.5 (11.3-13.8). After adjustment for prognostic variables, relative to NA, the risk of CV death was higher in LA and AP and the risk of HF hospitalization lower in WE. The benefit of sacubitril/valsartan was consistent across regions. CONCLUSION: There were many regional differences in PARADIGM-HF, including in age, symptoms, comorbidity, background therapy, and event-rates, although these did not modify the benefit of sacubitril/valsartan. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.

Plomo y nefropatía: biomarcadores urinarios en la detección de daño renal precoz / Blood lead levels and markers of renal dysfunction among mechanical workshop workers

The role of lead (Pb) as an environmental cause of nephropathy is difficult to ascertain due to the difficulty to determine clinically its exposure. Aim: To assess lead levels and renal function in a group of males working in mechanical workshops. Material and Methods: Blood and urine samples were obtained from 100 mechanical workshop workers aged 38 ± 16 years and 95 non-exposed office clerks aged 37 ± 17 years. Blood lead and creatinine levels were determined. In exposed workers, urinary excretion of intestinal alkaline phosphatases (IAP) and N-acetyl-glucosaminidase (NAG) were measured as early markers of renal failure. Results: Blood lead levels were 66.4 ± 43 and 33.6 ± 18 µg/L among mechanical workshop workers and non-exposed controls, respectively, p < 0.01. The figures for serum creatinine were 0.9 ± 0.1 and 0.9 ± 0.1 respectively, p = NS. Among exposed workers urinary excretion of IAP was 0.47 ± 0.6 U/L and of NAG, 0.92 ± 1.1 U/L. There was a positive correlation between blood lead levels and NAG excretion (r = 0.284) and IAP excretion (r = 0.346). Conclusions: Exposed workers had higher blood lead levels and there was a weak positive association between these levels and the urinary excretion of NAG and IAP.

A putative placebo analysis of the effects of LCZ696 on clinical outcomes in heart failure.

AIMS: Although active-controlled trials with renin­angiotensin inhibitors are ethically mandated in heart failure with reduced ejection fraction, clinicians and regulators often want to know how the experimental therapy would perform compared with placebo. The angiotensin receptor-neprilysin inhibitor LCZ696 was compared with enalapril in PARADIGM-HF. We made indirect comparisons of the effects of LCZ696 with putative placebos. METHODS AND RESULTS: We used the treatment-arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) as the reference trial for comparison of an ACE inhibitor to placebo and the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity-Alternative trial (CHARM-Alternative) as the reference trial for comparison of an ARB to placebo. The hazard ratio of LCZ696 vs. a putative placebo was estimated through the product of the hazard ratio of LCZ696 vs. enalapril (active-control) and that of the historical active-control (enalapril or candesartan) vs. placebo. For the primary composite outcome of cardiovascular death or heart failure hospitalization in PARADIGM-HF, the relative risk reduction with LCZ696 vs. a putative placebo from SOLVD-T was 43% (95%CI 34­50%; P < 0.0001) with similarly large effects on cardiovascular death (34%, 21­44%; P < 0.0001) and heart failure hospitalization (49%, 39­58%; P < 0.0001). For all-cause mortality, the reduction compared with a putative placebo was 28% (95%CI 15­39%; P < 0.0001). Putative placebo analyses based on CHARM-Alternative gave relative risk reductions of 39% (95%CI 27­48%; P < 0.0001) for the composite outcome of cardiovascular death or heart failure hospitalization, 32% (95%CI 16­45%; P < 0.0001) for cardiovascular death, 46% (33­56%; P < 0.0001) for heart failure hospitalization, and 26% (95%CI 11­39%; P < 0.0001) for all-cause mortality. CONCLUSION: These indirect comparisons of LCZ696 with a putative placebo show that the strategy of combined angiotensin receptor blockade and neprilysin inhibition led to striking reductions in cardiovascular and all-cause mortality, as well as heart failure hospitalization. These benefits were obtained even though LCZ696 was added to comprehensive background beta-blocker and mineralocorticoid receptor antagonist therapy.

Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure.

BACKGROUND: Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. METHODS AND RESULTS: We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensin-converting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-B-type natriuretic peptide and troponin) versus enalapril. CONCLUSIONS: Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.

Salud y enfermedad en Ayacucho: la medicina tradicional en el escenario del siglo XXI / Health and disease in Ayacucho: traditional medicine in the 21st century scenario

La investigación titulada Salud y enfermedad en Ayacucho: La medicina tradicional en el escenario del siglo XXI es una evaluación aproximativa del proceso de la medicina tradicional en la ciudad de Ayacucho, espacio de la sierra sur-central del Perú que, culturalmente, formó parte del antiguo mundo andino. Históricamente, Ayacucho fue el escenario de acontecimientos que marcaron algunos procesos sociales, culturales y políticos del país. La ciudad fue fundada poco después de la invasión española; por ello, la irrupción de la cultura foránea modificó procesualmente las cosmovisiones de las culturas del antiguo Perú. Así pues, el decurso convergente de nuevos paradigmas y el rico bagaje ancestral de conocimientos y formas diversas de entender el mundo sellan el trasfondo de lo que ocurrió y ocurre con la variedad de percepciones sobre estas dicotomías: salud- enfermedad y enfermar-morir. La medicina tradicional, desde la perspectiva de los usuarios y operadores de este sistema de salud, crea y recrea permanentemente la utilización de procedimientos rituales, símbolos, recursos naturales y elementos de la farmacopea moderna con el propósito de restablecer la salud de los ciudadanos afectados principalmente por los síndromes culturales o males de filiación cultural. La existencia de muchos médicos andinos o hampiq significa el "florecimiento" de diversos sistemas de salud de origen ancestral en una realidad globalizada donde predomina el sistema médico oficial, el cual no resuelve totalmente los males de salud que afectan a la actual población ayacuchana. El enfoque antropológico de esta problemática pretende abrir nuevos caminos de investigación para rescatar y ampliar estos conocimientos, y legitimar la vigencia de "lo nuestro" en una sociedad que hoy cambia vertiginosamente.

Leishmaniosis visceral: hallazgos ecográficos en un canino / Visceral leishmaniosis: sonographic findings in a dog

La leishmaniosis visceral es una zoonosis que se distribuye en forma creciente en nuestra región. En un muestreo de 156 caninos realizado en la Ciudad de Corrientes entre febrero y abril del 2011 hubo una prevalencia del 10%. Las alteraciones observadas en hígado, bazo, linfonódulos y otros órganos abdominales se dan por una respuesta del organismo a la entrada del parásito. En los riñones las lesiones se manifiestan por depósito de inmunocomplejos a nivel de la membrana basal del glomérulo. En el caso presentado el ultrasonido reveló: hepatomegalia, bazo de tamaño normal con dilatación del calibre de la vena esplénica, páncreas con signos sugerentes de inflamación y linfonódulos abdominales aumentados de tamaño, riñones con alteración de la relación entre corteza-médula y pelvis renal dilatada. La ecografía permite identificar alteraciones en los órganos que no son detectadas en el examen físico. La investigación de signos ecográficos presentes en estos pacientes favorecería el diagnóstico de esta enfermedad.

Desenvolvimento de um dispositivo eletrodistrator osteogênico / Development of a vertical alveolar osteogenic eletrodistrator

A técnica de distração osteogênica vem sendo aplicada com sucesso para o crescimento alveolar vertical. Este trabalho tem por objetivo o desenvolvimento de um eletrodistrator osteogênico alveolar vertical (EDO) passível de interagir sinergicamente com os tecidos biológicos, visando a neoformação óssea para a reabilitação com implantes. Para o desenvolvimento de EDO foi necessário a adquirir dados eletricos e mecânicos...

The osteogenic distraction technique has been applied successfully for vertical alveolar growth. Therefore, the objective of this work is the development of a vertical alveolar osteogenic eletrodistrator (EDO) that is able to interact synergically with biological tissue, aiming at the ossecus...

Desenvolvimento de um dispositivo eletro distrator osteogênico alveolar vertical / Development of a vertical alveolar osteogenic eletrodistrator

A técnica de distração osteogênica vem sendo aplicada com sucesso para o crescimento alveolar vertical. Este trabalho tem por objetivo o desenvolvimento de um eletrodistrator osteogênico alveolar vertical (EDO) passível de interagir sinergicamente com os tecidos biológicos, visando a neoformação óssea para a reabilitação com implantes. Para o desenvolvimento do EDO foi necessário a adquirir dados eletricos e mecânicos que foram obtidos através de dois protótipos. O EDO composto de um sistema mecânico e um circuito eletrônico de controle de corrente (CEC), foi colocado no rebordo alveolar de 4 cães, sem raça definida. O lado direto da mandíbula foi...

The osteogenic distraction technique has been applied successfully for vertical alveolar growth. Therefore, the objective of this work is the development of a vertical alveolar osteogenic eletrodistrator (EDO) that is able to interact synergically with biological tissue, aiming at the osseous neoformation for the rehabilitation with implants. For the EDO development, it was necessary to the obtain electric and mechanical data through two prototypes. The EDO, composed of a mechanical system and electronic current control (CEC), was placed in the alveolar bone of 4 dogs without definite race. The right side of the jaw was considered an experimental side, where an EDO was placed and a current of 20 ìA was...

Kidney disease in Paraguay.

Paraguay is a landlocked country located in South America with a total population of 5,884,491. Most of the population (95%) is mestizo, a mixture of Spanish and American/Indian races. The total number of indigenous people in the country has increased from 38,703 in 1981 to 85,674 in 2002. The gross domestic product per capita was US $932.00 annually per person in the year 2002. Between 1992 and 1997, there were 380 patients on chronic dialysis in Paraguay and 75 patients received renal transplants, mostly living-related. The prevalence of renal replacement therapy was 87 patients per million, and the incidence of renal disease continues to rise. Seventy percent of cases of ESRD are of unknown etiology and 15% have diabetes-related renal disease. Only citizens covered by the employee's national health insurance have complete coverage for dialysis and transplantation. The remainder of the population has to apply to public hospitals when the need for hemodialysis arises. At such hospitals, they can receive hemodialysis coverage from the National Institute of Nephrology or from other medical foundations to obtain entrance to these programs. They must otherwise use their own resources to pay for treatment. Seventy percent of patients on chronic dialysis turn to public hospitals for treatment. Hospital hemodialysis is the method most widely used. Home dialysis is rarely performed and there are very few programs for ambulatory peritoneal dialysis. Thus, a large number of patients are not able to enter chronic dialysis programs. In a recent survey of 4655 ill children registered, the distribution of main renal disease was acute glomerulonephritis in 42 cases (9 per 1000), nephrotic syndrome in 40 cases (8.5 per 1000), systemic lupus erythematosis in 28 cases (6 per 1000), and hematuria alone in 11 cases (2.3 per 1000). In ambulatory pediatric practice, urinary tract infection is the leading reason for seeking medical advice. Two thirds of such cases are associated with urinary tract anomalies. Children with ESRD are able to enter hemodialysis programs, but there are not sufficient resources to transplant them. Over 60% of the children with ESRD are hospitalized with terminal renal failure; malformations of the urinary tract are the usual cause. One study of 9880 adults aged 18 to 74 years reported that 39.1% of the women and 26.8% of the men examined were found to have hypertension. Almost half who were found to have raised blood pressure in this study were not previously known to have hypertension. In another cross-sectional study of the urban and suburban mestizo population of Asuncion among patients between 20 and 74 years of age, the overall prevalence of diabetes mellitus was 6.5%, impaired glucose tolerance 13.5%, hypertension 17%, and obesity 31.6%. Extrapolating from this data, we can assume that 178,000 patients with hypertension in Paraguay need medical treatment. To face the problem of growing numbers of patients with end-stage renal failure, it is necessary to carry out basic epidemiologic research to detect and quantify cases early in the course of disease, and thus propose treatments designed to slow the progress of the disease. Without this type of data, it would be difficult to establish an efficient action plan for improving the development of the treatment of renal disease. Thus, we are recommending the establishment of early detection and treatment campaigns for chronic renal disease, especially in individuals at risk. It is also desirable to promote renal transplantation using related live donors. We need to cooperate with government authorities to increase the insurance coverage of patients on chronic dialysis and find the most practical ways to establish long-term dialysis programs. A major question that is hard to answer in practice is whether there should be universal insurance for dialysis and transplantation for all who need it from the outset, as opposed to implementation in successive stages, which gives priority to only a minority of the population; which could be better adapted to our financial possibilities.

Hipertrofía ventricular izquierda en pacientes en hemodiálisis crónica / Left ventricular hypertrophy in patients with chronic hemodialisis

Hemos realizado un estudio transversal, descriptivo con componente analítico en 30 pacientes en hemodiálisis crónica, en ambos sexos, mayores de 18 años, que se dializan 4 horas, 3 veces por semana, con baño de acetato, con la intención de determinar la incidencia y las causas de hipertrofia ventricular izquierda. Se realizó una ecocardiografía Doppler y dosaje de hemoglobina, albúmina y medición de PA. Se consideró hipertrofia ventricular izquierda cuando la masa del ventrículo izquierdo era mayor a 125 g/m2 en varones y a 110 g/m2 en mujeres. Hipertensión arterial _ 140/90. La hemoglobina fue de 7,8±1,8 g/dl, albúmina de 3,9±0,5g por ciento, PA de 132,7±20,7 / 80,2±9,7; siendo hipertensos el 33 por ciento (154,3±10,6 / 88,1±6,2) y normotensos el 67 por ciento (121,3±14,6 / 70,1±8,7). En la ecocardiografía se constató hipertrofia ventricular izquierda con una masa de 203,4±53,9 g/m2, encontrándose correlación entre la hipertrofia y la hemoglobina (r= -0,40); la hipertrofia y la presión arterial sistólica (r= 0,45); la hipertrofia y la presión arterial diastólica (r= 0,54); no habiendo correlación con el nivel de albúmina o el tiempo en diálisis. En la ecocardiografía; el espesor del tabique interventricular 12,1±1,9 mm en mujeres y 13,4±1,7 mm en varones (p< 0,05); el espesor de la pared posterior del VI 11,3±1,3 mm en mujeres y 12,5±0,9 mm en varones (p <0,05). Todos los pacientes en hemodiálisis presentaron hipertrofia ventricular izquierda, sin embargo el 67 por ciento eran normotensos. La etiología de la hipertrofia ventricular en los pacientes en hemodiálisis crónica es multifactorial, relacionada en nuestro estudio con la anemia y los niveles de presión arterial, principalmente la diastólica.Taquicardia auricular focal y extrasístoles auriculares frecuentes: Aspectos electrofisiológicos, implicancia clínica y ablación percutánea exitosa con catéter por radiofrecuencia

Factores de riesgo cardiovascular en sujetos con insuficiencia renal crónica / Cardiovascular risk factors in subjects with chronic renal failure

La enfermedad cardiovascular es la causa más frecuente de mortalidad en personas con insuficiencia renal crónica. Muchos factores de riesgo conducen a cardiopatía isquémica en este grupo de pacientes. Entre estos factores se cuentan a tradicionales como: hipertensión arterial, el hábito de fumar, la hipercolesterolemia, la inactividad física, etc, que de hecho afectan a la población con función renal normal y no tradicionales como: proceso inflamatorio crónico y la desnutrición, los cuales pueden llevar a coronariopatías. Los factores de riesgo conocidos tales como la hiperhomocisteinemia, la hipertensión arterial, la hipercolesterolemia, presentan una situación bifásica. A niveles bajos de presión arterial, niveles bajos de homocisteína y niveles de colesterol, presentan riesgo incrementado de desarrollar eventos cardiovasculares. En la IRC, la reacción inflamatoria con protína c-reactiva elevada,, desnutrición y la aterosclerosis consiguiente y la calcificación arterial que presentan debido al desequilibrio fosfo-cálcico propio de los enfermos renales, tornan a estos pacientes al tratamiento convencional. Resultados promisorios se han verificado con la angioplastia con ballon y puesta de stent, pero estudios involucrando un número mayor de individuos son necesarios para tener conclusiones definitivas

Fundación de la Sociedad Boliviana de historia de la medicina / Foundation of the Bolivian Society of history of medicine

El propósito es hacer conocer, la génesis, fundación y presentación del Estatuto y Reglamento Interno de la Sociedad Boliviana de Historia de la Medicina.

Correlación entre horas de lectura y miopia / Correlation between hours of reading and myopia

La intensión de esta investigación es relacionar las horas de lectura con la miopia. Se realizo un estudio observacional descriptivo, de corte transversal, con un componente analitico, donde se comparó estudiantes de medicina de la Universidad Nacional de Asunción y transeúntes del centro de Asunción, para el mismo se reclutaron 100 estudiantes de primer curso, 100 estudiantes de sexto curso y 100 transeúntes, siendo el número de hombres y mujeres igual. Se vió una frecuencia de 51 por ciento de personas con miopia en los estudiantes de medicina, contrastando con un 29 por ciento de los mismos en los transeúntes (p=0,00013); un 45, 8 por ciento de los miopes y un 34,3 por ciento de los no miopes lee mas de 12 horas por semana, donde se ve que las horas de lecturas es significativamente mayor en los miopes (p=0,02)