Orbital inflammatory disease.

Orbital inflammatory disease (OID), commonly known as orbital pseudotumour, is an inflammatory disease of unknown cause. It has different forms of presentation and different degrees of severity. Its variable nature is the main cause for this disease to be misdiagnosed and misclassified. The prognosis of OID depends on the tissues affected and the histology. OID usually responds favourably to systemic steroid treatment. However, empiric steroids may mask other underlying diseases that respond well to this treatment as well, namely, IgG4-related disease or lymphoproliferative disorders. This fact has led to controversy among various authors as some recommend performing a biopsy in most of the cases, whereas others defend that this procedure should only be performed if the patient has not responded to empiric steroid treatment. Although steroids have been the mainstream treatment of OID, the side effects, relapse rates and lack of response in some cases have resulted in them being replaced by immunosuppressive and immunomodulator therapies that currently stand as a key steroid-sparing treatment option, in addition to radiotherapy and surgery. The aim of this review is to update the evidence on the diagnosis and treatment of OID.

Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism.

OBJECTIVE: The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). METHODS: A retrospective observational study was designed in 195 patients (mean age: 59.2 ±â€¯13.0 years; 77% woman) with PHPT (calcium: 11,3 ±â€¯1,1 mg/dl and PTH: 218 ±â€¯295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULT: 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ±â€¯98 vs. 244 ±â€¯334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ±â€¯0,4 vs. 1,7 ±â€¯0,9 cm; p = 0,001 and volume: 0,36 ±â€¯0,43 vs. 1,7 ±â€¯4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ±â€¯0,5 vs. 1,9 ±â€¯1,1 cm; p = 0,008 and volume: 0,30 ±â€¯0,20 vs. 1,2 ±â€¯1,1 cm3; p < 0,001), less heavy (567 ±â€¯282 vs. 1470 ±â€¯1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46-22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22-29,16). CONCLUSIONS: One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.

Extraction of an intraorbital foreign body with the help of an ocular external electromagnet: Instruments of the past still have a place in the present. / Extracción de cuerpo extraño orbitario con ayuda de electroimán ocular externo: instrumentos del pasado tienen cabida en el presente.

Intraorbital Foreign Bodies (IOFB) are objects, usually of metallic nature, located outside the orbit cavity, and can potentially cause serious damage to ocular and orbital structures. The case is presented of a patient with an anterior metallic IOFB that was extracted with the aid of a Livingston-Mansfield ocular external electromagnet. Despite being an instrument «of the past¼, we believe that the electromagnet can still be useful in certain circumstances.

Resultados en el tratamiento quirúrgico de hernia discal lumbar, reporte a siete años de seguimiento / Results in the surgical treatment of lumbar disc hernia, report of seven years follow up

Resumen: Introducción: La lumbalgia por hernia discal es provocada por el movimiento anormal intersomático, considerándose éste como factor etiológico de hernia discal, que en ocasiones es la indicación quirúrgica. Material y métodos: Con un diseño de estudio prospectivo, descriptivo, observacional y longitudinal en un período de Enero de 2000 a Diciembre de 2006. Muestra inicial de 195 pacientes, con 20 pacientes con criterios de inclusión a los siete años de seguimiento. Se tomaron en cuenta variables demográficas, dependientes e independientes. Se realizó análisis estadístico descriptivo comparando preoperatorio con la evolución a siete años. Resultados: Se englobaron los resultados en dos procedimientos: estabilización dinámica interespinosa y artroplastía, con 10 pacientes por cada procedimiento. Mediante la prueba de T y χ2 se observó significancia estadística al comparar los resultados de dolor y escala de Oswestry con parámetros de imagenología según Pfirrmann prequirúrgicos contra seguimiento final en los pacientes sometidos a estabilización dinámica. Para el grupo de artroplastía fue estadísticamente significativa la comparación de resultados de dolor con EVA (escala visual análoga) y función con escala de Oswestry, con una p < 0.05. Conclusión: Con este trabajo comprobamos que hubo significancia estadística al comparar los resultados clínicos de ambos procedimientos, observamos un porcentaje mínimo de complicaciones en los pacientes a quienes se les realizó estabilización dinámica en comparación con la artroplastía; por lo tanto, sugerimos realizar esta última sólo en casos en los que se reúnan adecuadamente todos los criterios para que los resultados clínicos y funcionales sean iguales a los esperados.

Abstract: Introduction: Low back pain by herniated disc is caused by abnormal intersomatic movement, considering this as an etiological factor of disc herniation and the surgical indication. Material and methods: A prospective, descriptive, observational, longitudinal study design, in a period from January 2000 to December 2006. Initial sample of 195 patients, with inclusion criteria in 20 patients at seven years follow up. Demographic, dependent and independent variables were taken into account. Descriptive statistical analysis was conducted comparing preoperative with evolution to seven years. Results: Two groups were compared: dynamic interspinous stabilization and lumbar arthroplasty, with 10 patients for each procedure. Using T and χ2 test, statistical significance was observed when comparing the results of pain and Oswestry scale with parameters of imaging according to Pfirrmann pre surgical against final follow-up in patients undergoing dynamic stabilization. And for Arthroplasty was statistically meaningful comparison of results of pain with VAS (visual analogue scale) and function with Oswestry scale, with a p < 0.05. Conclusion: With this work we can see that there was statistical significance to compare clinical outcomes of both procedures, observing a minimum percentage of complications in patients who underwent dynamic stabilization compared with arthroplasty; therefore we suggest to perform the latter only in cases in all criteria, to meet adequately to be equal to the anticipated clinical and functional outcomes.

Photophobia and neuropathic pain in Sudecks syndrome. / Fotofobia y dolor neuropático en el síndrome de Sudeck.

The case is presented of a 14 year-old patient diagnosed with Sudeck's syndrome secondary to uneventful foot trauma. The patient complained of decreased visual acuity along with photophobia and intense ocular pain not correlated with the exploratory findings. Sudeck's syndrome is an idiopathic neuropathic inflammatory disease characterised by disproportionate pain, unrelated to a previous traumatic event, which can evolve to severe and generalised pain. A new explanation has recently described this as "neuropathic eye pain" for those patients with severe eye pain that do not correlate with clinical signs. In the case presented here, the pain became widespread and led to photophobia and very intense ocular neuropathic pain. It is believed that this was the cause of the visual decrease presented by this patient. It is proposed that the Sudeck syndrome should become part of the differential diagnosis of neuropathic eye pain.

[Results in the surgical treatment of lumbar disc hernia, report of seven years follow up]. / Resultados en el tratamiento quirúrgico de hernia discal lumbar, reporte a siete años de seguimiento.

INTRODUCTION: Low back pain by herniated disc is caused by abnormal intersomatic movement, considering this as an etiological factor of disc herniation and the surgical indication. MATERIAL AND METHODS: A prospective, descriptive, observational, longitudinal study design, in a period from January 2000 to December 2006. Initial sample of 195 patients, with inclusion criteria in 20 patients at seven years follow up. Demographic, dependent and independent variables were taken into account. Descriptive statistical analysis was conducted comparing preoperative with evolution to seven years. RESULTS: Two groups were compared: dynamic interspinous stabilization and lumbar arthroplasty, with 10 patients for each procedure. Using T and 2 test, statistical significance was observed when comparing the results of pain and Oswestry scale with parameters of imaging according to Pfirrmann pre surgical against final follow-up in patients undergoing dynamic stabilization. And for Arthroplasty was statistically meaningful comparison of results of pain with VAS (visual analogue scale) and function with Oswestry scale, with a p 0.05. CONCLUSION: With this work we can see that there was statistical significance to compare clinical outcomes of both procedures, observing a minimum percentage of complications in patients who underwent dynamic stabilization compared with arthroplasty; therefore we suggest to perform the latter only in cases in all criteria, to meet adequately to be equal to the anticipated clinical and functional outcomes.

INTRODUCCIÓN: La lumbalgia por hernia discal es provocada por el movimiento anormal intersomático, considerándose éste como factor etiológico de hernia discal, que en ocasiones es la indicación quirúrgica. MATERIAL Y MÉTODOS: Con un diseño de estudio prospectivo, descriptivo, observacional y longitudinal en un período de Enero de 2000 a Diciembre de 2006. Muestra inicial de 195 pacientes, con 20 pacientes con criterios de inclusión a los siete años de seguimiento. Se tomaron en cuenta variables demográficas, dependientes e independientes. Se realizó análisis estadístico descriptivo comparando preoperatorio con la evolución a siete años. RESULTADOS: Se englobaron los resultados en dos procedimientos: estabilización dinámica interespinosa y artroplastía, con 10 pacientes por cada procedimiento. Mediante la prueba de T y 2 se observó significancia estadística al comparar los resultados de dolor y escala de Oswestry con parámetros de imagenología según Pfirrmann prequirúrgicos contra seguimiento final en los pacientes sometidos a estabilización dinámica. Para el grupo de artroplastía fue estadísticamente significativa la comparación de resultados de dolor con EVA (escala visual análoga) y función con escala de Oswestry, con una p 0.05. CONCLUSIÓN: Con este trabajo comprobamos que hubo significancia estadística al comparar los resultados clínicos de ambos procedimientos, observamos un porcentaje mínimo de complicaciones en los pacientes a quienes se les realizó estabilización dinámica en comparación con la artroplastía; por lo tanto, sugerimos realizar esta última sólo en casos en los que se reúnan adecuadamente todos los criterios para que los resultados clínicos y funcionales sean iguales a los esperados.

Multifocal Best's disease: The importance of genetic tests. / Enfermedad de Best multifocal: la importancia de los test genéticos.

OBJECTIVES AND METHODS: Our objective is to describe a multifocal vitelliform presentation of Best's disease. The lesions in this disease may vary in size and shape, some may be a disc diameter in size, and often have some irregularity in their contour. The case is described of a 21-year-old male patient referred to our ophthalmology department due to a progressive loss of vision. His poor visual acuity was confirmed, and a complete examination was performed, in which macular flecks were observed, with yellow pigment arranged in oval distribution near their periphery. Due to the suspicion of Best's multifocal disease, genetic tests were performed. Multifocal vitelliform disease with the same features as those in Best's disease occurs most frequently in patients with a normal electro-oculogram (EOG), and a normal family history. CONCLUSION: Best's multifocal disease must be suspected in case of multiple vitelliruptive lesions close to the posterior pole. Genetic testing is essential for its diagnosis.

Prevalencia de disfunción eréctil en estudiantes de medicina / Erectile dysfunction prevalence in medical students

INTRODUCCIÓN: La prevalencia de disfunción eréctil (DE) en hombres jóvenes, según estudios internacionales es entre un 8 por ciento -30 por ciento. En Chile no se cuenta con datos sobre prevalencia de DE en población joven. El objetivo de este estudio es evaluar la prevalencia de DE en estudiantes de medicina. MATERIALES Y MÉTODOS: Estudio observacional transversal, para determinar la prevalencia de DE, se aplicó el cuestionario International Index of Erectile Function simplificado (IIEF-5), en estudiantes de Medicina de la Universidad Mayor, Santiago. Cursando desde primer a séptimo año, durante 2017, en voluntarios entre 18 - 30 años de edad. RESULTADOS: Del total de 158 encuestados, 11 % tiene Disfunción Severa, 20 % Disfunción Moderada, 7 por ciento Disfunción Leve - Moderada y 7 por ciento Disfunción Leve. Obteniéndose una tasa de prevalencia de 45 por ciento . La mayor prevalencia se presentó en el tercer año de carrera con un 63,6 % , la menor prevalencia se obtuvo en quinto año con un 27 por ciento . CONCLUSIÓN: La prevalencia de DE alcanzó el 45 por ciento . Superior a lo descrito en los estudios que abordan el tema. Es posible que estos resultados sean a causa de la población estudiada, ya que está documentado que los estudiantes de medicina sufren de ansiedad y depresión mayor a la que tiene la población general de la misma edad. Al ser una patología con una prevalencia creciente dentro de la población joven, es importante para los médicos mejorar los mecanismos de pesquisa de esta enfermedad.AU

INTRODUCTION: The prevalence of erectile dysfunction (ED) in young men, according to international studies is between 8 pertcent -30 pertcent . In Chile, there is no data on the prevalence of ED in young population. The aim of this study is to assess the prevalence of ED in medical students. MATERIALS AND METHODS: Cross-sectional observational study. To determine the prevalence of ED, the simplified International Index of Erectile Function (IIEF-5) questionnaire was applied to medical students of the Universidad Mayor, Santiago. From first to seventh year, during 2017, with volunteers between 18 - 30 years of age. RESULTS: Of the total of 158 respondents, 11 percent have Severe Dysfunction, 20 pertcent Moderate Dysfunction, 7 pertcent Mild Dysfunction - Moderate and 7 pertcent Mild Dysfunction. Obtaining aprevalence rate of 45 pertcent. The highest prevalence was presented in the third year of career with 63.6 pertcent , the lowest prevalence was obtained in the fifth year with 27 pertcent CONCLUSIONS: The prevalence of ED reached 45 pertcent. Superior to that described in the studies that address the issue. It is possible that these results are due to the population studied, since it is documented that medical students suffer from anxiety and depression greater than that of the general population of the same age. Being a pathology with a growing prevalence within the young population, it is important for doctors to improve the mechanisms of research of this disease.AU

Middle Miocene closure of the Central American Seaway.

Uranium-lead geochronology in detrital zircons and provenance analyses in eight boreholes and two surface stratigraphic sections in the northern Andes provide insight into the time of closure of the Central American Seaway. The timing of this closure has been correlated with Plio-Pleistocene global oceanographic, atmospheric, and biotic events. We found that a uniquely Panamanian Eocene detrital zircon fingerprint is pronounced in middle Miocene fluvial and shallow marine strata cropping out in the northern Andes but is absent in underlying lower Miocene and Oligocene strata. We contend that this fingerprint demonstrates a fluvial connection, and therefore the absence of an intervening seaway, between the Panama arc and South America in middle Miocene times; the Central American Seaway had vanished by that time.

An acute injection of corticosterone increases thyrotrophin-releasing hormone expression in the paraventricular nucleus of the hypothalamus but interferes with the rapid hypothalamus pituitary thyroid axis response to cold in male rats.

The activity of the hypothalamic-pituitary-thyroid (HPT) axis is rapidly adjusted by energy balance alterations. Glucocorticoids can interfere with this activity, although the timing of this interaction is unknown. In vitro studies indicate that, albeit incubation with either glucocorticoid receptor (GR) agonists or protein kinase A (PKA) activators enhances pro-thyrotrophin-releasing hormone (pro-TRH) transcription, co-incubation with both stimuli reduces this enhancement. In the present study, we used primary cultures of hypothalamic cells to test whether the order of these stimuli alters the cross-talk. We observed that a simultaneous or 1-h prior (but not later) activation of GR is necessary to inhibit the stimulatory effect of PKA activation on pro-TRH expression. We tested these in vitro results in the context of a physiological stimulus on the HPT axis in adult male rats. Cold exposure for 1 h enhanced pro-TRH mRNA expression in neurones of the hypophysiotrophic and rostral subdivisions of the paraventricular nucleus (PVN) of the hypothalamus, thyrotrophin (TSH) serum levels and deiodinase 2 (D2) activity in brown adipose tissue (BAT). An i.p. injection of corticosterone stimulated pro-TRH expression in the PVN of rats kept at ambient temperature, more pronouncedly in hypophysiotrophic neurones that no longer responded to cold exposure. In corticosterone-pretreated rats, the cold-induced increase in pro-TRH expression was detected only in the rostral PVN. Corticosterone blunted the increase in serum TSH levels and D2 activity in BAT produced by cold in vehicle-injected animals. Thus, increased serum corticosterone levels rapidly restrain cold stress-induced activation of TRH hypophysiotrophic neurones, which may contribute to changing energy expenditure. Interestingly, TRH neurones of the rostral PVN responded to both corticosterone and cold exposure with an amplified expression of pro-TRH mRNA, suggesting that these neurones integrate stress and temperature distinctly from the hypophysiotrophic neurones.

Estado nutricional y riesgo de malnutrición en pacientes hospitalizados del Hospital Universitario Departamental de Nariño / Nutritional status and risk of malnutrition in hospitalized patients at Hospital Departamental Universitario de Nariño

Objetivo. Estimar el estado nutricional y el riesgo de malnutrición de pacientes hospitalizados en Pasto, Colombia. Metodología. Un estudio transversal fue llevado a cabo en el Hospital Universitario Departamental de Nariño. La muestra comprendió 400 pacientes voluntarios que fueron incorporados prospectivamente. El estado nutricional fue evaluado con el Índice de Masa Corporal (IMC) siguiendo los criterios de la Organización Mundial de la Salud (OMS) (bajo peso, normal, sobrepeso y obesidad). El riesgo de desnutrición fue detectado de acuerdo al Malnutrition Universal Screening Tool (MUST) que incluyeron el IMC, pérdida de peso y enfermedad aguda. Resultados. La prevalencia de desnutrición según el IMC fue de 24,5 %. La malnutrición varió según la edad (≥65 años), régimen de seguridad social, estado civil, hijos y educación. La puntuación del MUST mostró que 55 % de los pacientes estaban en riesgo de malnutrición. Variables como la edad (≥65 años), etnia, residencia, origen, nivel socioeconómico, régimen de seguridad social, hijos, educación y servicios hospitalarios se relacionaron con el riesgo de malnutrición. Conclusiones. El presente estudio sugiere que estos pacientes hospitalizados tenían un alto porcentaje de malnutrición. Individuos de edad igual o superior a 65 años fueron los más afectados teniendo tanto bajo peso como riesgo de malnutrición. Por lo tanto, hay una necesidad de incluir una evaluación nutricional con el fin de prevenir las consecuencias de malnutrición en personas mayores.

Objective. To estimate the nutritional status and risk of malnutrition of hospitalized patients in Pasto, Colombia. Methodology. A cross-sectional study was conducted at Hospital Universitario Departamental de Nariño. The sample comprised 400 voluntary patients that were recruited prospectively. Nutritional status was assessed with Body Mass Index (BMI) following the World Health Organization (WHO) criteria (underweight, normal, overweight and obesity). The risk of malnutrition was screened through the Malnutrition Universal Screening Tool (MUST) that included BMI, weight loss and acute disease. Results. The prevalence of malnutrition according to BMI was 24.5%. Malnutrition differed by age (≥65 years), social security system, civil status, offspring and education. The MUST score showed that 55% of the patients were at risk of malnutrition. Variables such as age (≥65 years), ethnicity, residency, origin, socioeconomic status, social security system, offspring, education and hospital departments were related to the risk of malnutrition. Conclusions. The present study suggests that these hospitalized patients had a high rate of malnutrition. Individuals equal and older than 65 years were the most affected having both underweight and risk of malnutrition. Therefore, there is a need to include nutritional assessment in order to prevent consequences of malnutrition in older individuals.

Assessment of factors associated with pre-diabetes in HCV infection including direct and dynamic measurements of insulin action.

Although hepatitis C (HCV) is associated with diabetes, few studies have examined pre-diabetes in this population. We aimed to evaluate factors associated with pre-diabetes in HCV-infected patients, including direct measurement of insulin action. Ninety-seven non-cirrhotic, non-diabetic and HCV-infected patients underwent clinical evaluation and oral glucose tolerance testing (OGTT). Insulin sensitivity was measured directly by steady-state plasma glucose (SSPG) concentration during insulin suppression test. Early phase and total insulin secretion were determined using OGTT. Rates of pre-diabetes were as follows: 21% impaired fasting glucose (IFG), 7% impaired glucose tolerance (IGT) and 9% combined IFG/IGT. Twelve percent of Caucasians, 50% of African Americans and 70% of Latinos had pre-diabetes (P = 0.002). Patient characteristics among the glucose metabolism categories were similar except those with combined IFG/IGT had a higher body mass index (BMI) vs normal glucose tolerance (NGT) (30 vs 26 kg/m(2), P = 0.007) and lower LDL vs NGT and IGT (74, 104 and 112 mg/dL, respectively, P ≤ 0.01). On multivariable analysis, non-Caucasian race (OR 23.1, P = 0.003), BMI (OR 3.4, P = 0.02) and greater liver inflammation (OR 7.9, P = 0.03) predicted IFG, whereas non-Caucasian race (OR 14.8, P = 0.01) and SSPG (OR 1.1 per 10 units, P = 0.01) predicted IGT. Early and total insulin secretion adjusted for the degree of insulin resistance was decreased in pre-diabetes compared with NGT (P = 0.01 and P = 0.02, respectively). Pre-diabetes is highly prevalent among HCV-infected patients, and in some instances, coincides with host responses to the virus. In most cases, however, factors that are associated with pre-diabetes in HCV-infected patients are similar to those observed in the non-HCV population.

Hypoxic preconditioning induces an AT2-R/VEGFR-2(Flk-1) interaction in the neonatal brain microvasculature for neuroprotection.

The angiotensin II receptor subtype 2 (AT2-R) has been proposed to mediate protective vascular actions after brain injury. In this study we investigated the participation of this peptide in the tolerance to cellular damage induced by preconditioning in a rat model of neonatal hypoxia-ischemia (HI). We found that injured animals present a decreased number of microvessels in the ipsilateral (IPLT) side of the brain while in the contralateral (CNLT) side the microvessel number is increased. On the contrary, in the preconditioned animals the microvessels maintained the same number as in control animals. However these vessels show a remarkable increase of the fluorescent signal when they are labeled with antiFlk-1 (VEGFR2), while the Flt-1 (VEGFR1) signal faded in both the injured and the preconditioned animals. The pharmacological blockade of the AT2-R by the drug PD123319 (1.69 mM in the lateral ventricle) diminished the resilience of the microvasculature to HI injury provided by preconditioning and also the Flk-1 increase that occurred in these animals. In conclusion these results suggest an interaction of the AT2-R with VEGFR2 in the neonatal brain microvasculature that produces protective effects which are associated with injury tolerance.

Identification of enteropathogenic and enterohaemorrhagic Escherichia coli strains by immunoserological detection of intimin.

AIMS: To evaluate the sensitivity and specificity of polyclonal and monoclonal antibodies (Mabs) against intimin in the detection of enteropathogenic and enterohaemorrhagic Escherichia coli isolates using immunoblotting. METHODS AND RESULTS: Polyclonal and Mabs against the intimin-conserved region were raised, and their reactivities were compared in enteropathogenic E. coli (EPEC) and enterohaemorrhagic E. coli (EHEC) isolates using immunoblotting analysis. In comparison with rat antiserum, rabbit anti-intimin IgG-enriched fraction had a stronger recognition pattern to a wide spectrum of intimin types in different EPEC and EHEC serotypes. On the other hand, murine monoclonal IgG2b specific to intimin, with dissociation constant of 1.3x10(-8) mol l(-1), failed in the detection of some of these isolates. CONCLUSION: All employed antibodies showed 100% specificity, not reacting with any of the eae-negative isolates. The sensitivity range was according to the employed antisera, and 97% for rabbit anti-intimin IgG-enriched fraction, followed by 92% and 78% sensitivity with rat antisera and Mab. SIGNIFICANCE AND IMPACT OF THE STUDY: The rabbit anti-intimin IgG-enriched fraction in immunoblotting analysis is a useful tool for EPEC and EHEC diagnoses.