Infartos cerebrales de repetición y anemia drepanocítica en un niño: revisión de la literatura médica / Repeated brain infarctions and sickle cell anemia in a child: medical literature review

Una de las complicaciones neurológicas más devastadoras de la anemia drepanocítica son los ictus, tanto isquémicos como hemorrágicos. El 11 por ciento de los pacientes con hemoglobina SS (HbSS) tienen un ictus antes de los 20 años de edad. Se presenta el caso de un niño de 14 años, congolés, gravemente desnutrido, con anemia drepanocítica y antecedentes de ictus isquémicos de repetición, que fue atendido en la Clínica Internacional Cira García. La resonancia magnética evidenció signos de infartos antiguos a diferentes niveles en ambos hemisferios y zonas de encefalomalacia. Este paciente muestra la evolución natural de las complicaciones cerebrovasculares de la anemia de células falciformes(AU)

Among the most devastating neurologic complications from sickle-cell anemia are the ischemic and hemorrhagic ictus. The 11 percent of patients with SS hemoglobin (HbSS) has ictus before the twenties. This is the case of a child from the Congo aged 14 severely undernourished presenting with sickle-cell anemia and backgrounds of repeated ischemic ictus, seen in the Cira García International Clinic. Magnetic resonance showed signs of an old infarction at different levels of both hemispheres and encephalomalacia zones. This patient shows the natural course of the cerebrovascular complications of sickle-cell anemia(AU)

Infartos cerebrales de repetición y anemia drepanocítica en un niño: revisión de la literatura médica / Repeated brain infarctions and sickle cell anemia in a child: medical literature review

Una de las complicaciones neurológicas más devastadoras de la anemia drepanocítica son los ictus, tanto isquémicos como hemorrágicos. El 11 por ciento de los pacientes con hemoglobina SS (HbSS) tienen un ictus antes de los 20 años de edad. Se presenta el caso de un niño de 14 años, congolés, gravemente desnutrido, con anemia drepanocítica y antecedentes de ictus isquémicos de repetición, que fue atendido en la Clínica Internacional Cira García. La resonancia magnética evidenció signos de infartos antiguos a diferentes niveles en ambos hemisferios y zonas de encefalomalacia. Este paciente muestra la evolución natural de las complicaciones cerebrovasculares de la anemia de células falciformes

Among the most devastating neurologic complications from sickle-cell anemia are the ischemic and hemorrhagic ictus. The 11 percent of patients with SS hemoglobin (HbSS) has ictus before the twenties. This is the case of a child from the Congo aged 14 severely undernourished presenting with sickle-cell anemia and backgrounds of repeated ischemic ictus, seen in the Cira García International Clinic. Magnetic resonance showed signs of an old infarction at different levels of both hemispheres and encephalomalacia zones. This patient shows the natural course of the cerebrovascular complications of sickle-cell anemia

[Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments]. / Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. MATERIAL AND METHODS: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tract infection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal Access for the camera port and two abdominal work ports of 10 and 3 mm. RESULTS: Total operation room time was 120 min in the first case and 40 min. in the second with an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery CONCLUSION: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to perform a pure technique without the use of abdominal incisions.

[Rainfall and acute febrile syndrome in a dengue-endemic area]. / Pluviosidad como Predictor de Consulta por Síndrome Febril Agudo en un Area Endémica de Dengue.

OBJECTIVE: Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. METHODS: 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 % of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. RESULTS: June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 %CI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 %CI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 %CI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). CONCLUSIONS: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.

Pluviosidad como predictor de consulta por síndrome febril agudo en un área endémica de dengue / Rainfall and acute febrile syndrome in a dengue-endemic area

Objetivo Describir los patrones de consulta por SFA asociado al dengue y evaluar su asociación con la pluviosidad. Métodos En dos clínicas, durante un periodo de 7 meses (de marzo a septiembre) se identificaron 318 casos de SFA indiferenciado que se incluyeron en un seguimiento clínico sistemático. El 31 por ciento (81/281) fueron IgM positivos para dengue. Se evaluó la pluviosidad (litros/metro cuadrado por día) previa como variable explicatoria del patrón de consultas. Resultados Los meses con más casos de SFA fueron junio, julio y septiembre. Los casos de dengue sólo fueron significativamente más frecuentes en julio. Al evaluar los patrones de pluviosidad de las semanas anteriores, la consulta por SFA estuvo asociada con la pluviosidad promedio registrada 5 semanas antes y esta asociación fue independiente de la institución y del mes (Razón de tasas de incidencia ajustada: RTI=1,04; IC95 por ciento 1-1,08; p=0,045). Por otra parte, un promedio de la pluviosidad de 5 semanas consecutivas fue un predictor independiente de consulta por dengue, 4 semanas después (RTI=1,6; IC95 por ciento 1,15-2,22; p=0.006). Se evidenció una relación lineal entre la pluviosidad y las consultas por dengue: pluviosidad (promedio de 5 semanas) x 0,72 (IC95 por ciento 0,60-0,84; p<0,001)=casos por cada 100 000 habitantes en una semana (4 semanas después). Conclusiones La pluviosidad podría predecir el patrón de consulta por dengue en una región endémica.

Objective Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. Methods 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 percent of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. Results June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 percentCI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 percentCI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 percentCI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). Conclusions: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.