Fallo ovárico, una problemática para las mujeres en edad reproductiva y su relación genética / Ovarian failure, a problem for women in reproductive age and its genetic relationship

La insuficiencia ovárica primaria es una condición en la que las mujeres menores de 40años experimentan oligomenorrea o amenorrea durante 4meses o más; esta pérdida temprana de la función ovárica puede estar relacionada con una serie de etiologías, incluidos trastornos genéticos, autoinmunes, infecciones o causas iatrogénicas; no obstante, del 74 al 90% son idiopáticas. A pesar de ser una alteración poco prevalente, es de gran importancia clínica, ya que afecta en múltiples aspectos de la vida a todas las mujeres. En la actualidad se están desarrollando diferentes estudios con el fin de encontrar nuevos blancos moleculares para establecer nuevas terapias para el tratamiento de esta patología.(AU)

Primary ovarian failure is a condition in which women under 40 experience oligomenorrhea or amenorrhea for 4months or longer; this early ovarian function loss may be related to a series of etiologies, including genetic disorders, autoimmune diseases, infections or iatrogenic causes; however 74%-90% are idiopathic. Despite being a less prevalent disorder, it is of great clinical importance since it affects all women in multiple aspects of life. At present, different studies are being developed in order to find new molecular targets to establish new therapies for the treatment of this pathology.(AU)

MicroARN: la biología molecular como herramienta de predicción en preeclampsia / MicroRNAs: molecular biology as a tool for preeclampsia prediction

La preeclampsia es una patología con una importante incidencia a nivel mundial que se encuentra asociada directamente con el 15% de las muertes maternas. Esta se caracteriza usualmente por la presencia de hipertensión y proteinuria, que se manifiestan desde la mitad de la gestación. Los microARN son moléculas de ARN monocatenario que actúan principalmente degradando el ARN mensajero transcrito o inhibiendo la traducción de microARN. Los microARN placentarios ejercen un papel en el crecimiento y función de la placenta, se considera factible su uso potencial como biomarcadores de diagnóstico debido a la capacidad de entrar en la circulación materna y ser detectables en el plasma materno.

Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.

[Vascular injury associated with knee dislocation]. / La lesión vascular asociada a la luxación de rodilla.

INTRODUCTION: Knee dislocation is a rare injury but considered serious clinically since it can be accompanied by vascular and neurological injuries that if they do not have a timely diagnosis and treatment can lead to the loss of the limb. Regarding vascular injury, the optimal diagnostic method for the identification of this type of lesion is of the utmost importance. OBJECTIVE: To present the literature review on the epidemiology, classification and diagnostic approach of knee dislocation with or without associated vascular injury. METHODS: Report of the literature found in databases and analyses based on clinical experience and synthesis of these documents. CONCLUSION: Vascular injury is not an uncommon finding in the context of knee dislocation, with a high risk of complications and even amputation if an early diagnosis is not made, the authors recommend angio-CT to confirm the suspected diagnosis and not delay treatment.

INTRODUCCIÓN: La luxación de rodilla es una lesión poco común, pero considerada grave clínicamente, ya que puede acompañarse de lesiones vasculares y neurológicas que si no tienen un diagnóstico y tratamiento oportuno pueden llegar a la pérdida de la extremidad. Respecto a la lesión vascular es de suma importancia el método diagnóstico óptimo para la identificación de este tipo de lesiones. OBJETIVO: Presentar la revisión bibliográfica sobre la epidemiología, clasificación y aproximación diagnóstica de la luxación de rodilla con o sin lesión vascular asociada. MÉTODOS: Reporte de la literatura encontrada en bases de datos y análisis basados en experiencia clínica y síntesis de estos documentos. CONCLUSIÓN: La lesión vascular no es un hallazgo infrecuente en el contexto de una luxación de rodilla, tiene un riesgo elevado de complicaciones e incluso de amputación si no se realiza un diagnóstico temprano, los autores recomiendan la angio-TAC para confirmar la sospecha diagnóstica y no retrasar el tratamiento.

Transfusiones al final de la vida. Revisión de algunas consideraciones importantes / Transfusions at the end of life. Review of some important considerations

La trasfusión de hemoderivados se utiliza con más frecuencia en pacientes con neoplasias hematológicas que en pacientes con tumores sólidos, y de forma variable en el caso de pacientes terminales con otro tipo de patologías. La anemia y trombocitopenia son frecuentes en este grupo diverso de pacientes, que reciben tratamientos hasta el final de la vida, siendo la transfusión de componentes sanguíneos, como los glóbulos rojos o las plaquetas, una intervención necesaria para el alivio de síntomas y mejoras en el estado clínico. Sin embargo, en pacientes con enfermedad terminal, los síntomas son de origen multifactorial y los valores hematológicos no necesariamente se convierte en un criterio para transfundir. No obstante, la evidencia científica que apoya que las transfusiones mejoren significativamente los síntomas de los pacientes paliativos aún no es concluyente.A pesar de que la literatura define algunas indicaciones para transfundir las dificultades, empiezan en el contexto de la selección del tipo de transfusión, la cantidad de las mismas y el fin de vida. En la literatura científica se encuentran diferentes comunicaciones que relacionan las últimas unidades de hemoderivados administrados, previo a la muerte del paciente; sin embargo, poco se encuentra con relación a criterios uniformes que apoyen la decisión al final de la vida y la relación riesgo beneficio no es clara.Las trasfusiones sanguíneas, además de ser procedimientos comunes en la práctica clínica, son terapias que generan riesgos y costes considerables para el sistema, por lo que la búsqueda de opciones alternas se hace imperativo a la hora de evitar terapias innecesarias.(AU)

Transfusion of blood products is used more frequently in patients with hematological malignancies than in patients with solid tumors, and variably in the case of terminally ill patients with other types of pathologies. Anemia and thrombocytopenia are frequent in this diverse group of patients, who receive treatments until the end of life, the transfusion of blood components, such as red blood cells or platelets, being a necessary intervention for the relief of symptoms and improvements in condition. clinical. However, in terminally ill patients, symptoms are multifactorial in origin and hematological values do not necessarily become a criterion for transfusing, however, the scientific evidence supporting that transfusions significantly improve the symptoms of palliative patients has not yet is conclusive.Although the literature defines some indications for transfusing difficulties, they begin in the context of the selection of the type of transfusion, the amount of the transfusion, and the end of life. In the scientific literature there are different reports that list the last units of blood products administered, prior to the death of the patient; however, little is found in relation to uniform criteria that support the decision at the end of life and the risk benefit ratio is not clear.Blood transfusions, in addition to being common procedures in clinical practice, are therapies that generate considerable risks and costs for the system, so the search for alternative options becomes imperative when it comes to avoiding unnecessary therapies.Patients with end-of-life transfusion needs generally have a history of known chronic disease; It is for this reason that the mobilization of individual and family resources becomes the challenge for healthcare personnel, since this will largely depend on the way in which the situation is dealt with and the links that are generated, so the approach must be carried out in an interdisciplinary way.(AU)

Riesgo biomecánico por carga estática y morbilidad sentida en docentes universitarios, Medellín 2018 / Biomechanical Risk Due to Static Load and Morbidity Felt in University Teachers, Medellín 2018 / Risco biomecânico por carga estática e morbidade sentida em docentes universitários, Medellín 2018

Resumen Introducción: Los desórdenes musculoesqueléticos son la principal causa de ausentismo laboral, debido a factores biomecánicos por posturas mantenidas e inadecuadas. Además, existe una alta prevalencia de morbilidad sentida que afecta las condiciones laborales, por lo que es necesario estudiar dichas condiciones y sus componentes en la población de docentes universitarios, conociendo las posiciones que adoptan y sus características durante su jornada laboral. Materiales y métodos: Se condujo un estudio descriptivo, transversal, que incluyó a 70 docentes universitarios de medio tiempo y tiempo completo, quienes desempeñan funciones administrativas, de clase magistral o clase práctica. Se evaluó la percepción de morbilidad sentida con el Cuestionario Nórdico modificado, y el riesgo biomecánico por medio del método Rapid Entire Body Assessment (REBA). Se realizó análisis uni, bi y multivariado para las variables del estudio. Resultados: El riesgo biomecánico según el REBA de esta población fue medio para el 64,7 %. Se encontró que 7 de cada 10 docentes reportaron alguna condición de morbilidad, siendo más prevalente en las zonas de cuello, hombro y zona lumbar. Conclusión: El 68,5 % de los docentes universitarios participantes refieren algún tipo de morbilidad sentida (sintomatologia musculoesquelética) y, en el nivel de riesgo biomecánico, se encuentra una mayor proporción en riesgo medio y alto. Esto sugiere que se debe implementar de manera inmediata una intervención en los docentes y en sus puestos de trabajo, con el fin de mejorar su desempeño laboral y su bienestar.

Abstract Introduction: Musculoskeletal disorders are the principal cause of absenteeism, due to biomechanical factors such as inadequate and static prolonged postures. Also exists a high prevalence of musculoskeletal symptoms that affect work conditions; based on that is necessary to study these conditions and its components in the university teacher's community, taking care of adopted postures while working. Materials and methods: A descriptive, transversal study was conducted, which involved 70 university teachers with full time and part-time jobs, who perform administrative functions, master classes, or practical classes. The perception of musculoskeletal symptoms was assessed using the Nordic Musculoskeletal Questionnaire and the biomechanical risk, using the Rapid Entire Body Assessment method (REBA). The study took place at a university of Medellin (Colombia); researchers used a bi and multivariate analysis for the variables of the study. Results: The biomechanical risk was on medium level for the 64.7 % of this community. Results showed that 7 of 10 professors reported any skeletal muscle symptoms with a prevalence in the neck, shoulder, and lumbar zone. Conclusion: The percentage of teachers who referred to musculoskeletal symptoms was 68,5 %; the level of biomechanical risk has a higher ratio from medium to high, which suggest the necessity of immediately incorporating interventions for teachers and their work stations, which will improve their job performance and wellness.

Resumo Introdução: As desordens musculoesqueléticas são a principal causa de absentismo laboral, devido a fatores biomecánicos por posturas mantidas e inadequadas. Para além disso, existe uma alta prevalência de mor-bidade sentida que afeta as condições laborais, pelo que é necessário estudar ditas condições e seus componentes na população de docentes universitários, conhecendo as posições que adotam e suas características durante seu horário de trabalho. Materiais e métodos: Conduzira-se um estudo descritivo transversal, que incluiu a 70 docentes universitários de tempo parcial e tempo completo, quem desempenham funções administrativas, de aula magistral ou aula prática. Avaliou-se a percepção de morbidade sentida com o Questionário Nórdico modificado, e o risco biomecânico através do método Rapid Entire Body Assessment (REBA). Realizou-se uma análise uni, bi e multivariada para as variáveis do estudo. Resultados: o risco biomecánico segundo o REBA desta população foi meio para o 64,7 %. Encontrou-se que 7 de cada 10 docentes reportaram alguma condição de morbidade sendo mais prevalente nas zonas do pescoço, ombro, e zona lombar. Conclusões: O 68,5 % dos docentes universitários participantes referem algum tipo de morbidade sentida (sintomatologia musculoesquelética) e, no nível de risco biomecánico, se encontra uma maior proporção em risco meio e alto. Isto sugere que se deve implementar de maneira imediata uma intervenção nos docentes e em seus lugares de trabalho, com o objetivo de melhorar seu desempenho laboral e seu bem-estar.

Síndrome compartimental en rabdomiólisis severa / Compartment syndrome in severe rhabdomyolysis

No disponible

[Ecologic study in Mexico (2003-2009) on cleft lip and/or palate and associated sociodemographic, socioeconomic and pollution factors]. / Estudio ecológico en México (2003-2009) sobre labio y/o paladar hendido y factores sociodemográficos, socioeconómicos y de contaminación asociados.

OBJECTIVE: To analyze the rates of cleft lip and/or cleft palate (CLP) in Mexico between 2003 and 2009 and assess their association with variables at ecological level, sociodemographic, socioeconomic, and pollution. MATERIAL AND METHODS: An ecological study was conducted with data from the 32 states of Mexico for incidence of CLP, obtained from the Ministry of Health. We included sociodemographic, socioeconomic, and pollution information, obtained from governmental agencies. CLP incidence rates were used as dependent variable; independent variables were socioeconomic, demographic and pollution indicators. Statistical analysis was performed using Spearman correlation and chi(2) tests. RESULTS: During the study period 10573 new cases presented (mean 1510.43 per year). The States with the highest rate (per 1000 births) were: in 2003 the Federal District (Mexico City) (1.76), in 2004 Jalisco (2.62), in 2005 Oaxaca (1.66), in 2006 the State of Mexico (1.29), in 2007, 2008 and 2009 Jalisco (2.17, 2.92, and 1.99). For all the years men were more likely affected than women (P<.05). Variables found positively correlated to LPH rates were total population, solid waste, life expectancy, urban solid waste. The variables negatively correlated were population percentages of high alcohol users, and of alcohol abuse or addiction. CONCLUSIONS: The State of Jalisco was one of the most affected locations over the years. Ecologic positive correlations existed between cleft lip and/or palate and sociodemographic, socioeconomic, and pollution factors. Incidence rate was negatively correlated with alcohol use and abuse. More detailed epidemiological studies are needed to fully characterize risk factors in Mexican populations.

Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population.

OBJECTIVE: To investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) in a young Hispanic population. METHODS: A cross-sectional study was performed in Bogotá, Colombia, during 2006 in 263 males from the Colombian Air Force (age range 29-54 years). Anthropometric measurements and biochemical determinations (glycemia, lipid profile, insulin, and HOMA-IR) were obtained in order to determine the presence of metabolic syndrome (MS) criteria and insulin resistance in this population. In addition, ultrasound studies were performed to evaluate the presence of NAFLD. RESULTS: NAFLD was detected in 26.6% (n=70) of the subjects. Thirty four individuals had complete MS criteria (48.5%). The presence of NAFLD was associated with higher insulin levels (11.0±5.1 vs. 6.6±3.6, p=0.001), and its prevalence increased from 11% (n=8), to 24% (n=17) to 64% (n=45) from the lowest to the highest HOMA-IR tertile. Body mass index, triglycerides and subcutaneous and visceral fat were found to be independent predictors of NAFLD. CONCLUSIONS: These results suggest that NAFLD is associated with insulin resistance and extrahepatic adiposity in nondiabetic young Hispanic population.

Neumomediastino y enfisema subcutáneo como manifestación de una perforación duodenal / Pneumomediastinum and subcutaneous emphysema like manifestation of duodenal ulcer perforation

No disponible

Embolización por radiología intervencionista de un angioma yeyunal recidivado / Embolization by interventional radiology of relapsed jejunal haemangioma

No disponible

[Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors]. / Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo.

INTRODUCTION: In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. PATIENTS AND METHOD: 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied. RESULTS: After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. CONCLUSIONS: The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.

Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo / Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors

Introducción. En el bocio multinodular no existe consenso sobre cuál es la técnica quirúrgica más adecuada, pues, aunque las técnicas resectivas parciales presentan menor riesgo de complicaciones, conllevan un alto riesgo de recidivas. El objetivo es determinar los factores de riesgo de recidiva del bocio multinodular tras la cirugía en una serie con un seguimiento medio postquirúrgico superior a los 12 años. Pacientes y método. Se analizan 231 bocios multinodulares con cirugía tiroidea parcial. La recidiva se valora mediante exploración clínica y se confirma mediante ecografía. Las variables analizadas son edad, sexo, antecedentes familiares de patología tiroidea, residir en áreas bociógenas, asintomático, hipertiroidismo, síndromes compresivos, prolongación intratorácica del bocio, experiencia en cirugía endocrina del cirujano, peso del tiroides y técnica quirúrgica. Se aplica la prueba de χ2, la de la «t» de Student y una prueba de regresión logística. Resultados. Con un seguimiento medio de 152 ± 71 meses recidivaron 67 bocios (29%) con un tiempo medio de recidiva de 85 ± 67 meses. Los factores de riesgo detectados en el estudio multivariante fueron la edad más joven, la no experiencia en cirugía endocrina del cirujano y la técnica quirúrgica. Cuarenta y seis pacientes (69%) fueron intervenidos de la recidiva, la mayoría por cirujanos con experiencia en cirugía endocrina. En todos los casos se completó la tiroidectomía y se presentaron dos complicaciones postoperatorias definitivas. Conclusiones. El índice de recidivas clínicas es alto y aumenta con la evolución, siendo los principales factores de riesgo la juventud, la experiencia del cirujano y la técnica quirúrgica. Por lo que que estas técnicas resectivas parciales deben realizarse por cirujanos con experiencia y evitarse en pacientes jóvenes

Introduction. In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. Patients and method. 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, χ2 test, Student’s «t» test and a logistic regression test are applied. Results. After a mean postoperative follow-up of 152±71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 ± 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. Conclusions. The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients

Effect of dietary level of protein on the activity of mouse liver calpain.

The effect of protein depletion and refeeding with a normal diet on mouse liver soluble homogenate calpain activity was studied. It was unchanged when expressed in terms of whole liver (units/liver). However, when expressed in terms of degradable protein (units/mg protein) it increased with depletion and decreased with refeeding. DEAE Sephacel chromatography of soluble homogenate yielded three calpain activities which were eluted at 0.04, 0.16 and 0.23 M NaCl, respectively. On the basis of whole liver, they decreased with depletion and increased with refeeding. Immunochemical analysis revealed similar changes in the mass of the calpain eluted with 0.16 M NaCl. The sum of these three activities (total liver calpain activity) was higher than the activity displayed by the soluble homogenate, indicating that they were separated from calpastatin. Furthermore, the percentage of total calpain activity displayed by soluble homogenate increased with depletion and decreased with refeeding, suggesting that depleted liver had the lowest calpastatin content. This was confirmed by direct measurements which indicated that depleted homogenate had in average 5.5 and 3.1 times less calpastatin compared to normal and 16 hours refed liver, respectively. It is concluded that a remarkable decrease in calpastatin content maintained unchanged whole liver soluble homogenate calpain activity during protein depletion and refeeding and contributes to an increased calpain activity related to degradable protein in depleted livers. This increase is in accordance with the high in vivo rate of protein breakdown depicted by these livers.