Tratamiento de tabaquismo intenso después de un infarto agudo de miocardio / Treatment of severe smoking after an acute myocardial infarction

Resumen: El tabaquismo es una enfermedad crónica que afecta a una quinta parte de nuestra población. No obstante, la mayoría de los fumadores no busca tratamiento de su enfermedad ni la considera tal. Algunos pacientes logran controlar la dependencia por sí solos, pero la mayoría requiere apoyo por medio de un programa médico-psicológico para lograr la abstinencia. Según la etapa de cambio de la conducta en que se encuentre el paciente, será el programa y estrategia a seguir. Se comunica el caso de un paciente de 51 años de edad con tabaquismo excesivo (80 cigarrillos al día) y antecedente de accidente vascular cerebral que padeció un infarto agudo de miocardio sometido a cateterismo cardiaco con colocación de stent, que posteriormente ingresó a un programa de tratamiento de tabaquismo. El paciente disminuyó significativamente el consumo de cigarrillos después del tratamiento, pero la dependencia a la nicotina debe considerarse una enfermedad crónica que, como tal, puede tener recaídas. Este caso es el de mayor consumo de cigarrillos que hemos estudiado y es representativo del grado de dependencia de una sustancia como la nicotina que, a pesar de las graves consecuencias por su consumo, los pacientes no pueden controlarla fácilmente.

Abstract: Tobacco smoking is a chronic disease affecting one fifth of our population. Most smokers, however, are not conscious nor seek treatment for their problem. Some patients are able to reach abstinence by themselves but the majority need some kind of medical-psychological therapy. The best therapy to reach abstinence or improvement will depend on the stage of behavioral change. We present a case of extreme smoking (80 cigarettes a day) who presented a heart stroke and who was successfully treated with a stent. After he was discharged from hospital he was admitted to the smoking cessation program. He attended the program for 8 weeks and decreased his smoking by 94% at the end of the program. This case represents the clinical challenges and complexity of treatment for patients with a high degree of nicotine dependence in spite of life threatening consequences of tobacco smoking.

Human papillomavirus in tonsillar and nasopharyngeal carcinoma: isolation of HPV subtype 31.

We retrospectively studied biopsy specimens obtained from 16 patients who had carcinoma of the tonsil or nasopharynx. Polymerase chain reaction testing detected the presence of human papillomavirus (HPV) in 13 samples (81.3%)--six tonsillar and seven nasopharyngeal. Eleven of the 13 positive samples (84.6%) contained HPV subtype 31. We believe that this is the first report of the presence of HPV subtype 31 in these carcinomas. In addition to the significant association between tonsillar and nasopharyngeal cancer and HPV, our analysis of descriptive variables confirmed the association between the incidence of these neoplasms and poor oral hygiene and low socioeconomic status in older adults.

[Mathematical modelling in medicine and biology. Theoretical basis and fundamentals]. / Modelos matemáticos en medicina y biología. Bases teóricas y fundamentos.

Mathematical modelling is currently a common tool in the study of physiological and biochemical systems. Its basis and fundaments are not, however, well known by the non-specialist. Its aims are to describe, explain and predict physiological and biochemical phenomena. Mathematical models provide a concise and objective description of complex dynamic processes by defining, through mathematical equations, the relationships between quantitative measurements; they indicate, also, ways to improve experimental designs, and allow the testing of hypotheses about physiological or biochemical phenomena. Mathematical models can be developed from simple non-compartmental representations to large scale multi-compartmental models. The basic steps in the formulation of a model include conceptualization, realization and solution of the model. Each step has to be verified and validated. In the case of compartmental models, mass-balance equations are used to represent each compartment. A brief review of the theory of system's analysis and the general aims of mathematical modelling is presented here. The modelling process is usually started with a definition of the problem and a parameter identification followed by the setting up of a clear conceptual model of the system. The model consists of the description of the principal flows of material (in and out) and of the main components which store, convert or transmit these flows. A selection of the class of mathematical representation follows, i.e. linear or non-linear, in order to formulate the equations relating the input and output flows of material for each individual component of the system.(ABSTRACT TRUNCATED AT 250 WORDS)

[Obesity. Its medico-surgical treatment]. / Obesidad. Tratamiento médico-quirúrgico.

Obesity has been defined as excessive deposition of body fat tissue that risks the health and survival of the patient. It affects almost 30 per cent of whole population in western societies and it's also becoming a common problem in developing countries as rural areas are slowly decreasing in face of urban growing. In Mexico obesity affects as much as 28 per cent of the population of selected urban areas and the trend seems to follow the incidence in North America. There are genetic, environmental, physiological, psychological, social and cultural factors that determine or influence the presence of obesity in modern societies. To date the most accepted approach to the management of this problem lays on 3 main aspects: diet, exercise and behaviour modification. Pharmacological therapy should be limited to selected cases in which associated clinical risks warrant more urgent intervention. Surgical therapy is indicated for morbid obesity in which there is greater than 70 per cent excess weight. Prevention of obesity should remain one of the top priorities in public health and should take genetic, physiological, environmental, social, psychological, cultural and economic factors into consideration.

[Knowledge, application, and diffusion of results of clinical research: the case of porto-systemic encephalopathy]. / Conocimiento, aplicación y difusión de los resultados de la investigación clínica: el caso de la encefalopatía portosistémica.

The objectives of this survey were to evaluate the medical knowledge, acceptance and application of research results, and to identify the main sources of information in our environment. Portal-systemic encephalopathy (PSE) was the specific health problem addressed. Three hundred seventy-seven attendants to the National Mexican Gastroenterology Week (december 14-19, 1991) were surveyed. The results point out: 1) Gaps in PSE knowledge, since 30% or more incorrect answers were obtained for some PSE manifestations and therapeutic measures; 2) A persistent use of measures with doubtful efficacy, which is exemplified by the regular use of neomycin by (80%) of the respondents, 3) frequent influence of the availability of therapeutic measures (68%), as the satisfaction with therapeutic response (66%) on PSE treatment patterns, and 4) important role of continuing education courses and/or scientific meetings (> 66%) and medical journals (> 57%) as sources of information.