Safety and efficacy of topical interferon alpha 2B and mitomycin C for localized conjunctival intraepithelial neoplasia: long-term report of their pharmacological safety and efficacy.

PURPOSE: Ocular surface squamous neoplasia (OSSN) comprises a wide spectrum of squamous tumors, from which corneal/conjunctival intraepithelial neoplasia (CIN) is the most common one. The classic treatment is complete excision, but recurrence rates are high. Antineoplastic drugs such as mitomycin C (MMC) and interferon alpha 2b (IFNα2b) have been used as adjuvants or as primary treatment. To evaluate the efficacy and safety of topical IFNα2b and MMC in patients with CIN, a phase IIb double-blind clinical trial was performed. METHODS: Patients diagnosed with localized CIN were evaluated by slit lamp and impression cytology and were randomly given MMC 0.04% or INF2b (1 million IU/mL) 4 times daily until neoplasia resolution. Time of resolution and frequency of adverse effects were analyzed to determine the pharmacological efficacy and safety of both medications. RESULTS: Seventeen patients were included. Nine patients were treated with MMC and 8 with IFNα2b. All patients responded to treatment. The resolution time in days was 59.11 ± 24.02 in patients treated with MMC and 143.50 ± 47.181 in those treated with IFNα2b (p < 0.001). In the MMC group, one recurrence was reported (11%). There were no recurrences at 2 years of follow-up in the IFNα2b group. Regarding adverse effects, one or more mild adverse reaction occurred in 77% of patients managed with MMC and in 50% of patients managed with IFNα2b (p > 0.05). No serious adverse effects were reported. CONCLUSIONS: Topical chemotherapy with MMC and IFNα2b demonstrate pharmacological safety and efficacy. Therefore, these drugs could be considered as primary therapies for localized CIN .

Islet autoantibody types mark differential clinical characteristics at diagnosis of pediatric type 1 diabetes.

BACKGROUND: We aimed to study whether islet autoantibody type marks differential characteristics at the time of type 1 diabetes (T1D) diagnosis. METHODS: We studied 711 children with newly diagnosed autoimmune T1D. We compared demographic (sex, age, race/ethnicity), clinical (pubertal development, BMI percentile, diabetic ketoacidosis [DKA]) and laboratory (glucose, hemoglobin A1c [HbA1c], C-peptide, tissue transglutaminase antibodies [tTGA], thyroglobulin antibodies, and thyroid peroxidase antibodies [TPOA]) characteristics by presence/absence of autoantibodies to insulin (IAA), GAD65 (GADA), or IA-2/ICA512 (IA-2A). Islet autoantibody titers were evaluated among the children positive for the relevant autoantibody type. We used multivariable analysis to adjust for potential confounders. RESULTS: IAA+ was statistically associated with younger age (p < 0.0001) and lower HbA1c (p = 0.049) while Tanner stage, GADA status and number of positive islet autoantibodies were not significant in the multivariable model. GADA+ was associated with female sex (OR = 4.0, p = 0.002) and negatively with elevated tTGA titers (>50 U/mL) (OR = 0.21, p = 0.026) but not with age, IAA status, IA-2A status, islet autoantibody number, or thyroid autoimmunity. None of the associations with IA-2A positivity was statistically significant in the multivariable analysis. In multivariable models, IAA titer was significantly associated with younger age (p = 0.006), DKA (p = 0.017) and higher tTGA levels (p = 0.002); GADA titer with female sex (p = 0.028), racial minority (p = 0.046) and TPOA positivity (p = 0.021); and IA-2A titer with older age (p = 0.001) and not being African American (p = 0.024). CONCLUSIONS: Islet autoantibody type is associated with differential characteristics at diagnosis of pediatric T1D. Longitudinal and mechanistic studies are needed to evaluate T1D endotypes by autoantibody type.

Type 2 diabetes in prepubertal children.

OBJECTIVE: Puberty-induced insulin resistance is considered critical in the pathogenesis of type 2 diabetes (T2D) in youth. The development of T2D before puberty suggests distinct risk factors and pathophysiology but, because of its rarity, this has not been well studied. We aimed to describe the clinical characteristics of children with T2D diagnosed before the onset of puberty. RESEARCH DESIGN AND METHODS: We retrospectively studied all children with autoantibody-negative T2D and available pubertal development assessment seen at our center between July 2016 and July 2019, and compared characteristics of those at Tanner stage I (prepubertal, n = 35) versus those at Tanner II-V of pubertal development (n = 341). RESULTS: At T2D diagnosis, prepubertal children compared with those at Tanner II-V had higher body mass index z-score (p = 0.003) and higher C-peptide (p = 0.003) (while glucose levels were not significantly different), with differences retaining significance after adjustment for glucose, race/ethnicity and sex. Dyslipidemia occurred in 100% of prepubertal children versus 89.7% of those diagnosed later (p = 0.036). Of the prepubertal children diagnosed under age 10 (n = 13), 69.2% were female, 100% racial/ethnic minority, 100% had obesity with history of dyslipidemia and none with diabetic ketoacidosis. CONCLUSIONS: T2D, although rarely, can develop before puberty. Children with T2D diagnosed in the prepubertal period have more severe obesity, greater insulin resistance, and more frequent dyslipidemia than older youth. These findings suggest that children with prepubertal T2D are at increased risk for associated morbidity compared with older youth and underscore the significance of interventions to prevent and treat obesity in early childhood.

Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps.

PURPOSE: Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D. METHODS: We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis. RESULTS: At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, p<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model p<0.0001). CONCLUSION: There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.

Emotional support for parents with premature children admitted to a neonatal intensive care unit: a qualitative phenomenological study.

BACKGROUND AND OBJECTIVES: Parents who have a premature child in neonatal intensive care units (NICUs) are in a stressful situation. The aim of this paper is to analyze the emotional support received by parents with premature children admitted to NICUs. METHODS: A phenomenological qualitative study with an explanatory and interpretative approach was employed. RESULTS: The findings are: 1) The experience and emotions of a premature delivery; showing sadness, guilt and despair, stress, anxiety, and uncertainty over the future of their child. 2) The emotional support received by the father/mother of the partner; discussion of how their partner is cared for, as well as the care given to the premature child and other children in the family; the stress that this causes them on not being able visit all at once. 3) The emotional support offered by the health professionals (doctors, nurses, etc.); parents indicate that they have received very strong support from the nurses, but also that they were not always asked about their feelings when in the NICU. 4) The informal emotional support of relatives and parents in the NICU. After talking with other support mothers, the mothers then felt less guilty. CONCLUSION: As regards premature birth, the mothers showed feelings of sadness and guilt, asked themselves where they had failed and what they had done wrong.

[Clinical and metastatic characteristics in retinoblastoma]. / Características clínicas y metastásicas en retinoblastoma.

BACKGROUND: retinoblastoma is an intraocular malignancy of the childhood. Tumor invasion and metastases are the cause of mortality. The objective was to determine the clinical characteristics, the appearance and site of metastases in patients with retinoblastoma. METHODS: descriptive, observational, retrospective and cross-sectional study was carried out. We reviewed 86 patients with retinoblastoma. RESULTS: the average age was 24.5 months. There were 51.2 % women. 75.6 % had unilateral presentation and 24.4 % bilateral; two of these were trilateral The clinical manifestation were leukokoria, strabismus and glaucoma. We found metastatic disease in 18 patients (20 %), being the central nervous system (CNS) and bones frequently affected. The metastases odds ratio was 3.50 associated to choroidal invasion; 6.25 for patients with invasion to optical nerve with edge with tumor; 3.75 for which they had choroidal invasion and optic nerve with free edge and 5.62 for patients with choroidal invasion and optic nerve with surgical edge with tumor. CONCLUSIONS: choroidal invasion and surgical edge with tumor showed a greater relative risk for development of metastatic disease. The sites commonly affected were the CNS and bones.

Metabolic Profiling of Dietary Polyphenols and Methylxanthines in Normal and Malignant Mammary Tissues from Breast Cancer Patients.

SCOPE: Dietary polyphenols may protect against breast cancer. However, it is unknown whether polyphenols reach human malignant breast tumors in molecular forms and(or) at concentrations likely to act against cancer. METHODS AND RESULTS: Ninteen breast cancer patients consumed three capsules daily from biopsy-confirmed diagnosis to surgery (6 ± 2 days). The capsules contained pomegranate, orange, lemon, olive, cocoa, and grapeseed extracts plus resveratrol, providing 37 different phenolics (473.7 mg), theobromine and caffeine (19.7 mg). A total of 101 metabolites are identified in urine, 69 in plasma, 39 in normal (NT), and 33 in malignant (MT) tissues by UPLC-ESI-QTOF-MS. Eight control patients did not consume extracts. Phenolic-derived metabolites in MT and NT are mainly glucuronidated and(or) sulfated. Some representative metabolites detected in MT (median and range, pmol g-1 ) are urolithin-A-3-O-glucuronide (26.2; 3.2-66.5), 2,5-dihydroxybenzoic acid (40.2; 27.7-52.2), resveratrol-3-O-sulfate (86.4; 7.8-224.4), dihydroresveratrol-3-O-glucuronide (109.9; 10.3-229.4), and theobromine (715.0; 153.9-3,216). Metabolites, as detected in breast tissues, do not exert antiproliferative or estrogenic/antiestrogenic activities in MCF-7 breast cancer cells. CONCLUSION: This is the first study that describes the metabolic profiling of dietary phenolics and methylxanthines in MT and NT comprehensively. Although phase-II conjugation might hamper a direct anticancer activity, long-term tumor-senescent chemoprevention cannot be discarded.

Association of single-nucleotide polymorphisms in non-coding regions of the TLR4 gene with primary open angle glaucoma in a Mexican population.

BACKGROUND: Toll-like receptor 4 (TLR4) non-coding polymorphisms are associated to primary open angle glaucoma (POAG), normal tension glaucoma, and pseudoexfoliation glaucoma. This study was performed to determine whether non-coding single nucleotide polymorphisms (SNPs) in the TLR4 gene contribute to POAG in a Mexican population. MATERIAL AND METHODS: A total of 187 unrelated Mexican patients with POAG and 109 control subjects were included. Allelic, genotypic, and haplotypic diversity was assessed for the non-coding polymorphisms rs11536889, rs1927911, rs12377632, and rs2149356 of the TLR4 gene. Genotyping of target SNPs was performed by 5' exonuclease allelic discrimination assays. RESULTS: Strong linkage disequilibrium was observed among the SNPs (D' > 0.818), which were located in one haplotype block. The rs11536889 polymorphism was not associated to POAG in any case. The frequency of the minor allele of rs2149356 was significantly higher in the glaucoma group, conferring an increased risk of POAG (p = 0.0018, OR = 1.803, 95% CI 1.2556-2.5890) whereas minor allele of rs12377632 was significantly lower, attributing a protective effect (p = 0.0001, OR = 0.6662, 95% CI 0.4753-0.9339). Subjects with genotypes carrying the minor allele of rs1927911 and rs2149356 shown an increased risk for POAG (p = 0.03, OR = 1.78, 95% CI 1.10-2.87, and p < 0.0004, OR =2.62, 95%CI 1.61-4.27 respectively). Finally, we found significant risk haplotypes. The GTT haplotype (constituted by rs1927911, rs12377632, and rs2149356) reached the higher OR (p = 0.0026, OR = 4.70, 95% CI 1.73-12.77). CONCLUSIONS: We have identified intronic TLR4 SNPs as genetic susceptibility alleles for POAG in a Mexican population. Our findings support the association of the TLR4 gene with POAG.

Diagnosis and management of posterior reversible encephalopathy syndrome in systemic lupus erythematosus. Case report / Diagnóstico y manejo de síndrome de encefalopatía posterior reversible asociado a lupus eritematoso sistémico. Reporte de caso clínico

ABSTRACT Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological disorder that may include encephalopathy, seizures, headache, and visual disturbances. It is associated with conditions that induce endothelial damage, causing vasogenic cerebral edema that can be observed in magnetic resonance scans. It occurs in <1% of patients with systemic lupus erythematosus (SLE). It is usually resolved with timely treatment, but delays may lead to neurological sequelae or death. A case of PRES is presented in a patient with SLE with severe activity, a hypertensive emergency, and lupus glomerulonephritis debuting with epileptic status. The outcome was satisfactory with anticonvulsants, as well as treatment for her cerebral edema and hypertension, along with control of other causal factors.

RESUMEN El síndrome de encefalopatía posterior reversible (PRES) es un trastorno clínico-radiológico caracterizado por encefalopatía, convulsiones, cefalea y alteraciones visuales. Se asocia a entidades que ocasionan daño endotelial, causando edema cerebral vasogénico evidente en resonancia magnética. En pacientes con lupus eritematoso sistémico (LES) se presenta en < 1%. Con tratamiento oportuno usualmente resuelve; caso contrario puede producir secuelas neurológicas o muerte. Se reporta el caso de PRES en una paciente con LES con actividad severa, emergencia hipertensiva y glomerulonefritis lúpica que comienza con estatus epiléptico. Evolucionó satisfactoriamente con tratamiento anticonvulsivante, antiedema cerebral, antihipertensivo y control de los demás factores causales.

Temblor Mentoniano: Reporte De Un Caso Aislado / Chin Tremor: Report Of An Isolated Case

Resumen El temblor mentoniano o genioespasmo es un desorden del movimiento de carácter involuntario, rítmico, hereditario autosómico dominante, exacerbado por situaciones de estrés o emocionales. Registrado por primera vez en 1894, en Italia. Se reporta una niña de 4 años de edad con temblor mentoniano desde el año de edad, sin precedente de herencia, con respuesta exitosa al uso de Toxina Botulínica.

Abstract The chin tremor or geniospasm is an involuntary, rhythmic, autosomal dominant hereditary movement disorder, triggered by stress or emotional situations. Registered for the first time in 1894, in Italy. We report a 4-year-old girl with mental tremor from one year of age, with no previous inheritance, with a successful response to the use of Botulinum Toxin.

Synthesis of 2-monoacylglycerols and structured triacylglycerols rich in polyunsaturated fatty acids by enzyme catalyzed reactions.

This paper studies the synthesis of structured triacylglycerols (STAGs) by a four-step process: (i) obtaining 2-monoacylglycerols (2-MAGs) by alcoholysis of cod liver oil with several alcohols, catalyzed by lipases Novozym 435, from Candida antartica and DF, from Rhizopus oryzae, (ii) purification of 2-MAGs, (iii) formation of STAGs by esterification of 2-MAGs with caprylic acid catalyzed by lipase DF, from R. oryzae, and (iv) purification of these STAGs. For the alcoholysis of cod liver oil, absolute ethanol, ethanol 96% (v/v) and 1-butanol were compared; the conditions with ethanol 96% were then optimized and 2-MAG yields of around 54-57% were attained using Novozym 435. In these 2-MAGs, DHA accounted for 24-31% of total fatty acids. In the operational conditions this lipase maintained a stable level of activity over at least 11 uses. These results were compared with those obtained with lipase DF, which deactivated after only three uses. The alcoholysis of cod liver oil and ethanol 96% catalyzed by Novozym 435 was scaled up by multiplying the reactant amounts 100-fold and maintaining the intensity of treatment constant (IOT=3g lipase h/g oil). In these conditions, the 2-MAG yield attained was about 67%; these 2-MAGs contained 36.6% DHA. The synthesized 2-MAGs were separated and purified from the alcoholysis reaction products by solvent extraction using solvents of low toxicity (ethanol and hexane); 2-MAG recovery yield and purity of the target product were approximately 96.4% and 83.9%, respectively. These 2-MAGs were transformed to STAGs using the optimal conditions obtained in a previous work. After synthesis and purification, 93% pure STAGs were obtained, containing 38% DHA at sn-2 position and 60% caprylic acid (CA) at sn-1,3 positions (of total fatty acids at these positions), i.e. the major TAG is the STAG with the structure CA-DHA-CA.

Alteración en la circulación de líquido cefalorraquídeo relacionada a neoplasia de alto grado (xantoastrocitoma) / Altered cerebrospinal fluid circulation related high-grade neoplasia (xanthoastrocytoma)

Introducción: La alteración en la circulación de líquido cefalorraquídeo es conocida como fístulas de líquido cefalorraquí- deo (LCR). En el Instituto Nacional de Neurología y Neurocirugía se presentó un incremento notable en 2011, reportándose 18 casos; para 2012 se incrementaron a 42 casos en el Servicio de Neurocirugía, de los cuales 22 son hombres y 20 mujeres. Esta complicación sucede como inconveniente de procesos neuroquirúrgicos hipofisiarios, de fosa posterior o de etiología múltipleξ ; se manifiesta en el paciente con la presencia de salida de líquido cefalorraquídeo por nariz (rinolicuorrea), oído (otolicuorrea) y en la herida quirúrgica; los pacientes refieren síntomas como: cefalea, vértigo, mareo, náuseas y fiebre; al ver esto, acuden a urgencias. Objetivo: Describir el estudio de caso de un paciente con neoplasia de alto grado (xantoastrocitoma) con presencia de fístula de líquido cefalorraquídeo más neuroinfección. Metodología: Para la descripción sistemática se recurrió al proceso enfermero en sus diferentes etapas. Procedimiento: Para la valoración se recurrió a la historia clínica y exploración neurológica; el cuadro clínico fue de gran apoyo para la realización de diagnósticos de enfermería utilizando el formato: problema, etiología y signos y síntomas (PES); se presentó un plan de cuidados en el que se ejecutan las intervenciones y se evalúan de acuerdo con las necesidades del enfermo. Éste presenta complicaciones por neuroinfección más fístula de líquido cefalorraquídeo (FLC). Conclusiones: El conocimiento en el tratamiento de las fístulas de líquido cefalorraquídeo facilita la recuperación y evita complicaciones; aunque hay casos en que, a pesar de implementar las medidas para el tratamiento, el proceso es devastador.

Introduction: The altered cerebrospinal fluid circulation related known as cerebrospinal fluid fistulas (CSF) in the National Institute of Neurology and Neurosurgery presented a significant increase in 2011 reported 18 cases; in 2012, 42 cases in the neurosurgical service, of which 22 are men and 20 women. This complication occurs after neurosurgery complicating pituitary, posterior fossa or multiple etiologies; the patient manifests the presence of cerebrospinal fluid output by nose (rhinoliquorrhea) and heard (otolicuorrea), patients report symptoms like headache, dizziness, lightheadedness, nausea and fever, to see this come to the emergency. Target: Describe a case study in a patient with high-grade neoplasia (xanthoastrocytoma) neurosecondary infection presence of cerebrospinal fluid fistula. Methodology: For the case study nursing process is used at different stages. Procedure: The evaluation was based on the clinical history, the neurological examination and the clinical manifestations were conducted formatted nursing diagnosis: problem, etiology and signs and symptoms (PES) presents a care plan in which interventions are implemented and evaluated according to the needs of the patient presented further complications neuro FLC infection. Conclusions: Knowledge in the treatment of fistulae, facilitating recovery and avoids complications that although cases despite the measures to implement the process treatment is devastating.

Injection of botulinum toxin A for the treatment of dysfunction of the upper esophageal sphincter.

OBJECTIVE: The objective was to evaluate changes in swallow safety and dietary status after the transcutaneous injection of botulinum toxin A into the upper esophageal sphincter in a series of outpatients with dysphagia. STUDY DESIGN: This was an experimental, prospective, nonrandomized study. METHODS: Patients who were at risk for aspiration and who had an unsuccessful trial of swallowing therapy were admitted to the study. All patients showed significant pooling of fluids in the postcricoid region. All patients were treated in the office; none had previous esophageal dilatation. The upper border of the cricoid cartilage was identified using standard electromyogram procedures and 100 U of botulinum toxin (Botox A) were injected. Outcomes were assessed using the penetration-aspiration scale, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status. RESULTS: Thirteen patients underwent an instrumental evaluation of swallowing function at approximately 6 months after treatment to corroborate the self-reported changes in swallowing. Of the 13 patients, 12 showed an overall improvement in their ability to take an oral diet safely as evidenced by the penetration-aspiration scale. Of the 12 patients who were on a non-oral or nearly non-oral diet, 9 resumed a normal oral diet. The remaining 3 were on an oral diet supplemented by percutaneous endoscopic gastrostomy feeding. One patient remained on a non-oral diet. CONCLUSIONS: Injection of Botox A in the office with no additional treatments resulted in a long-term increase in swallow safety, a reduction of penetration and/or aspiration, and a reduced need for non-oral feeding. Injection of Botox A in the office should be considered when there is failure of the cricopharyngeus muscle to relax after the swallow, significant pooling in the cricopharyngeal region, and a risk for penetration and aspiration.

Bioseguridad e higiene en la formación del odontólogo

La Bioseguridad ocupa un lugar central en la formación de grado ya que la Odontología es considerada una profesión de alto riesgo. Los docentes deben ser protagonistas gestionando y participando en la formación de los estudiantes en ésta área del conocimiento. El objetivo de este trabajo fue conocer los contenidos de Bioseguridad que y como se enseña Bioseguridad, en la carrera de Odontología de la Universidad Nacional de Córdoba, Argentina. Para ello se analizaron los programas de todas las asignaturas (n=62) de la carrera y se realizaron entrevistas a profesores de 55 cátedras para conocer qué contenidos de los explicitados se abordan con los alumnos y de qué manera se realiza. Al analizar los programas de las asignaturas (básicas, preclínicas y clínicas) se observó que los contenidos de Bioseguridad están insertos en el 63% de los programas. De la entrevista a los profesores surge que el 60% de las cátedras entrevistadas expresó que les corresponde la enseñanza de Bioseguridad; el 48% de las cátedras expreso que la enseñanza de estos contenidos es sistematizada a lo largo del curso y a que pesar de no figurar en los programas los abordan en las clases teóricas (13%), en los trabajos prácticos (31%) y/o en otras actividades (4%). La Bioseguridad no es un contenido transversal en el plan de estudios, lo que indicaría una falla en la articulación vertical y horizontal entre las cátedras que manifiestan enseñar Bioseguridad.

Biosecurity occupies a main place in degree formation since The Dental Medicine is considered to be a profession of high risk. The teachers must be protagonists managing and informing the student `s training in this one area of the knowledge. The aim of this work was to know Biosecurity 's contents teaches and how they are teaches, in the career of dentist of the Universidad Nacional de Córdoba, Argentina. We analyzed the programs of all the subjects (n=62) of the career and we realized interviews to teachers of 55 chairs to know what contents presented in programs are approached by the pupils and in what way it was realized. On having analyzed the programs of the subjects (basic, preclínics and clinics chairs) it was observed that Biosecurity 's contents are inserted in 63 % of programs. From the interview to the teachers 60 % of the interviewed chairs expressed that Biosecurity's education corresponds to them; 48 % of them expressed that the education of these contents is systematized along the course and in despite of not appearing in the programs they approach them in the theoretical classes (13 %), in the practical works (31 %) and / or in other activities (4 %). Biosecurity is not a transverse content in the study plan, which would indicate failings in the vertical and horizontal joint among chairs that demonstrate to teach Biosecurity.

Conocimiento sobre riesgos y profilaxis preventiva en estudiantes de odontología / Knowledges about risk and preventive prophylaxis in students of odontology

En la práctica odontológica hay exposición a riesgos biológicos. En este trabajo indagamos: qué conocimientos sobre dichos riesgos tienen los alumnos, pues representan una problemática de morbi-mortalidad a nivel mundial, nacional y local; y si saben cómo prevenirlos y cómo proceder ante un accidente. Se encuestaron 192 estudiantes del último año de la Facultad de Odontología (UNC). El 95% afirmó conocer los riesgos vinculados con enfermedades infectocontagiosas, pero en general no conocen cuáles son. Con respecto a la profilaxis de disposición, las respuestas fueron incorrectas. El 94 % afirmó conocer los procedimientos ante un accidente de trabajo, pero hubo respuestas imprecisas y desconocimiento sobre los protocolos a seguir. De este estudio inferimos que la mayoría de los alumnos no percibe la vinculación entre riesgo- enfermedad, no conoce totalmente los protocolos relacionados a exposición con material biológico e inmunización , ni la conducta a seguir ante accidentes de trabajo en la práctica clínica.

Medicina tradicional entre los indígenas de Izalco, Sonsonate, El Salvador / Traditional medicine among the indigenous people of Izalco, Sonsonate, El Salvador

La medicina tradicional forma parte importante de la vida diaria del ser humano, ya que ha sido imposible prescindir de su uso aunque sea de manera consciente o inconsciente. Desde los inicios de la evolución del ser humano, fue necesario ir descubriendo a base de prueba y error cuales eran los beneficios que los recursos naturales les proporcionaban. De esta manera, surgieron personas interesadas en la especialización y manejo de las propiedades de la medicina tradicional, sirviendo a sus comunidades en el momento de una enfermedad. Estos son conocidos como sacerdotes, chamanes, brujos, curanderos, espiritistas, dependiendo del lugar en el mundo. Estos sujetos han sido respetados, admirados y temidos en la historia de la humanidad, por el mismo hecho de creer que así como contribuyen al bienestar de los enfermos, igualmente pueden hacer daño físico, psicológico y espiritual. Con el paso del tiempo fueron surgiendo avances que han permitido el desarrollo de la medicina científica. Sin embargo, existen en el mundo personas que prefieren la medicina natural como un medio de prevención y curación de las enfermedades. En esta investigación, se desarrollan temáticas específicas con relación a la medicina natural y a los personajes practicantes de la misma. Haciendo un recorrido histórico desde el origen de la medicina natural, enfatizando en la medicina indígena mesoamericana, en sus costumbres y creencias; describiendo la fusión entre la medicina de Mesoamérica y Europa. Así como las enfermedades y desarrollo de la medicina tradicional en El Salvador e Izalco. Además de las relaciones humano ambientales vistas desde de la perspectiva de los profesionales en el estudio de la medicina tradicional. Se crea una vista panorámica de Izalco, lugar elegido para realizar la investigación, destacando su cultura que envuelve sus tradiciones religiosas, las cuales están estrechamente relacionadas con la medicina natural en la comunidad indígena y como punto principal las costumbres y creencias que actualmente se conservan respecto a la medicina tradicional antigua. Se refleja parte de los conocimientos que los curanderos, espiritistas y parteras poseen. El tipo de personas que utilizan los servicios; la prevención de las enfermedades y la regulación jurídica son puntos tomados en cuenta por los curanderos, ya que de ello depende su prestigio. La identificación y el registro de los recursos naturales que más utilizan como parte de la curación de enfermedades da a conocer lo que vienen conservando desde tiempos antiguos dentro del sincretismo cultural que se vivió y que ahora es tomado como propio.

Epílepsia refractaría: hallazgos clínicos, electroencefalográficos e imágenes de resonancia magnética y de medicina núclear / Refractory epilepsy: clinical finds electroencefalographic and imaging of resonance and nuclear medicine

La epílepsia es un trastorno neurológico frecuente. La localización del foco epileptógeno en pacientes refractarios al tratamiento es importante para ofrecerles solución quirúrgica de su enfermedad. Valorar la relación entre las alteraciones encontradas en electroencefalografía y en las imágenes de medicina núclear y resonancia magnética núclear en pacientes epilépticos refractaríos al tratamiento vistos en el Servicio de Neurología del Hospital Militar "Dr. Carlos Arvelo". Es un estudio descriptivo, prospectivo, transversal. A cada paciente se le realizaron EEG basal, IRM cerebral y SPECT intercrítica. Adicionalmente, se realizó SPECT basal y/o PET inter-ictal a los que presentaron alteraciones perfusionales importantes en la SPECT basal. Todos los estudios SPECT (100 por ciento) presentaron una o varías áreas de hipoperfusión, coincidiéndo unívocamente con el foco clínico eléctrico (FCE) en 7 casos (buena relación), coincidiéndo al menos una de las áreas alteradas en la perfusión con el FCE en 6 casos (aceptable), y sin relación entre ambos en 6 casos (mala). No hubo dependencia entre la buena, aceptable o mala relación FCE-medicina núclear y la edad de los pacientes, el tiempo de evolución de la epílepsia, el número de crisis al mes, el tipo de crisis, o antecedentes de lesión difusa del sistema nervioso central, pero si con el número de fármacos utilizados para el control del paciente. Los estudios de medicina núclear deberían introducir en los algoritmos diagnósticos de la epílepsia refractaria al tratamiento.

Epilepsia sintomática en pacientes del Hospital Eugenio Espejo frecuencia y causas

La prevalencia de epilepsia en países desarrollados es de 2,7 - 8/1000 habitantes, con 23 - 39 por ciento de epilepsia sintomática en la población general y del 15 - 20 por ciento de epilepsia sintomática en menores de 20 años (1,2,3,4,5). Para países en desarrollo, en los que se incluye el Ecuador, es de 17 - 22/1000 habitantes, con reportes del 29,5 al 49 por ciento de epilepsia sintomática en la población general, y; de 29,5 - 32 por ciento de epilepsia sintomática en menores de 20 años. (6,3,7,8). Siendo la epilepsia una causa importante de consulta en el servicio de neurología clínica del Hospital Eugenio Espejo; 10,9 por ciento de 2.846 pacientes atendidos durante el año de 1994; realizamos este estudio para conocer la frecuencia de epilepsia sintomática en pacientes menores de veinte años en el Servicio de Neurología Clínica del Hospital Eugenio Espejo, la que consideramos es mayor que en las series publicadas en países industrializados. De enero a septiembre de 1994, se estudiarnos a cuarenta y dos (42) pacientes, correspondientes a todos los pacientes con diagnóstico clínico de epilepsia que acudieron al servicio de neurología clínica del Hospital Eugenio Espejo; a los 42 pacientes se les realizó; tomografía axial computarizada (TAC) simple y contrastada para determinar la presencia de causa orgánica ya sea: enfermedad cerebro-vascular (hematomas o infartos), neoplasias (primarias o metastásicas), procesos infecciosos, secuelas de trauma craneo-encefálico , atrofias, calcificaciones, lesiones granulomatosas, lesiones quísticas parasitarias; las mismas que puedan tener relación causa-efecto con las crisis convulsivas. En los casos en los que la tomografía axial no aclaró el diagnóstico se realizó imagen por resonancia magnética (IRM) cerebral simple y contrastada. (truncada).

NORMATIVIDAD SOBRE PUEBLOS INDÍGENAS EN AISLAMIENTO, CONTACTO RECIENTE Y CONTACTO INICIAL, EN LA REGION ANDINA / REGULATIONS ON INDIGENOUS PEOPLES IN ISOLATION, RECENT CONTACT AND INITIAL CONTACT, IN THE ANDEAN REGION

El presente documento, elaborado por encargo del Organismo Andino de Salud y el Convenio Hipólito Unanue, es una lista armonizada de normas, reglamentos y otros instrumentos, correspondientes a diferentes sectores del Estado, referidos a pueblos indígenas en aislamiento, contacto reciente y contacto inicial, de la región Andina. Se elabora con el objetivo de presentar "el estado del arte" con respecto a los instrumentos legales, técnicos y operativos existentes para la protección de los pueblos mencionados. Dada la necesidad de contextualizar la situación legal general de estos pueblos, se incorpora un listado de normas generales del ámbito nacional como del internacional. Además, se presentan Declaraciones y Resoluciones suscritas en reuniones internacionales de análisis y concertación, que congregaron a los actores de la problemática de estos pueblos, como organizaciones indígenas, gobiernos y organismos internacionales de defensa de los derechos fundamentales. Estos documentos son: la "Declaración de Belem" (2005), el "Llamamiento de Santa Cruz" (2006), la "Declaración de Quito" (2007) y la "Declaración de Asunción" (2008)