Síndrome de médula anclada en el periodo neonatal: comunicación de un caso / Neonatal tethered cord syndrome: a case report

El hallazgo de una alteración cutánea en la región dorsal de los recién nacidos constituye un signo infrecuente aunque de gran importancia clínica debido a su posible asociación con disrafismo espinal. El disrafismo espinal oculto es un defecto en el cierre del tubo neural en el que la lesión no se encuentra expuesta al exterior sino cubierta por piel. Su principal complicación es la asociación con el síndrome de médula anclada, que puede causar un daño neurológico irreversible. De ahí la relevancia de un diagnóstico y tratamiento precoces. Presentamos el caso de un neonato varón con disrafismo espinal oculto asociado a médula anclada en el que se realizó un diagnóstico y tratamiento precoces

The finding of a cutaneous alteration in the dorsal region of a newborn is an uncommon sign. It is an important manifestation due to its possible association with spinal dysraphism. Occult spinal dysraphism is a defect in the closure of the neural tube without exposure of the malformation, which is covered by skin. The main complication of occult spinal dysraphism is the association with the tethered cord syndrome that leads to important neurological manifestations which can be irreversible. Because of that, an early diagnosis and treatment must be a priority for clinicians. We present a case of a male newborn with occult spinal dysraphism associated with tethered cord syndrome. In this case an early diagnosis and treatment was successfull

Comportamiento de las muertes por asfixias mecánicas, Mayabeque 2013- 2017 / Behaviour of the deaths by mechanical asphyxias, Mayabeque 2013- 2017

Introducción: las muertes violentas, y dentro de ellas las asfixias mecánicas, representan un porciento elevado de los fallecidos en todo el mundo, por lo que se hace necesario dotar a la comunidad científica de datos actualizados sobre el comportamiento de las mismas que respalde la toma de decisiones ante estas muertes. Objetivo: caracterizar el comportamiento epidemiológico de las muertes por asfixias mecánicas en la provincia Mayabeque. Métodos: se realizó un estudio descriptivo, de corte transversal en pacientes fallecidos por asfixias mecánicas en la provincia Mayabeque del 2013 al 2017. El universo estuvo constituido por 175 fallecidos por asfixias mecánicas y los datos se obtuvieron del registro del Departamento de Medicina Legal, así como de los expedientes médico legales. Se utilizaron técnicas estadísticas de distribución de frecuencia absoluta y valor porcentual y la comparación de proporciones se realizó calculando desviación estándar considerándose un nivel de significación de P<0.05. Resultados: predominó el sexo masculino en 93.71 por ciento y la edad de 60 años y más en 36.57 por ciento. Según el mecanismo de producción, el tipo de muerte más frecuente fue el ahorcamiento de etiología suicida (69.71 por ciento), donde el alcohol prevaleció como factor de riesgo asociado en 48.00 por ciento. Conclusiones: las muertes por asfixias mecánicas se identifican con elevada frecuencia en el sexo masculino, la edad de 60 años y más, el ahorcamiento de etiología suicida y el alcohol como factor de riego asociado, existiendo relación estadísticamente muy significativa entre el mecanismo de producción por asfixias mecánicas y su etiología(AU)

Introduction: violent deaths, and among them mechanical asphyxias, represent a high percent of dead people all over the world so it is necessary to give the updated information to the scientific community in relation to their behavior in order to take decisions about them. Objective: to characterize el epidemiologic behavior of deaths by mechanical asphyxias in Mayabeque. Methods: a descriptive, transversal study was carried out in dead patients for mechanical asphyxias in Mayabeque province from 2013 to 2017. The universe was formed by 175 dead patients because of mechanical asphyxias and the information was obtained from the Forensic Medicine Department, as well as from the forensic physicians records. Statistical techniques related to absolute frequencies and percentages were used, as well as the comparison of proportions calculating the standard deviation considering a level of meaning of P<0.05. Results: male sex prevailed with a 93.71 percent and he 60 and older age group in a 36.57 percent. According to the production mechanism, the most frequent type of death was hanging of suicide etiology (69.71 percent), where alcohol prevailed as associated risk factor in 48.00 percent. Conclusions: deaths because of mechanical asphyxias identified with a high frequency in the male sex, age of 60 years old and more, hanging of suicide etiology and alcohol as associated risk factor existing a significant statistical relation between the production mechanism for mechanical asphyxias and their etiologies (AU)

Utilidad de la PET-TAC 18F-FDG en la valoración prequirúrgica del mesotelioma pleural maligno tras quimioterapia neoadyuvante / Usefulness of 18F-FDG PET-CT in the presurgical assessment of malignant pleural mesothelioma treated with neoadjuvant chemotherapy

El mesotelioma pleural maligno es un tumor relativamente raro pero altamente agresivo, con una expectativa media de vida entre 9 y 17 meses, relacionado con la exposición al asbesto. El dolor torácico y la disnea son sus manifestaciones clínicas más frecuentes. La terapia más empleada es la cirugía acompañada de tratamiento quimioterápico. La valoración prequirúrgica, tras el tratamiento quimioterápico, ha sido realizada a través de la resonancia magnética y la tomografía axial computarizada (TAC). Sin embargo, estas técnicas no permiten predecir de forma precoz la respuesta a la terapia, dada la lenta modificación estructural del tumor. La presentación de esta nota clínica invita a revisar y conocer la creciente utilidad de la imagen PET-TAC, con 18F-FDG, en la estadificación prequirúrgica del mesotelioma pleural maligno y su influencia en la selección del tipo de cirugía más apropiada(AU)

Malignant pleural mesothelioma is a relatively rare, but highly aggressive, tumor, associated to exposure to asbestos, with a life expectancy between 9 and 17 months. Chest pain and dyspnea are the most frequent symptoms. The most commonly used therapy is surgery accompanied by chemotherapy. Preoperative assessment, after chemotherapy, has been done using magnetic resonance imaging and computed tomography (CT). However, these techniques cannot predict early response to therapy, because of the slow structural change of the tumor. The aim of this case report is to review and learn about the growing use of PET-CT imaging with 18F-FDG in the preoperative staging of malignant pleural mesothelioma and its influence in selecting the most appropriate type of surgery(AU)

[Usefulness of 18F-FDG PET-CT in the presurgical assessment of malignant pleural mesothelioma treated with neoadjuvant chemotherapy]. / Utilidad de la PET-TAC 18F-FDG en la valoración prequirúrgica del mesotelioma pleural maligno tras quimioterapia neoadyuvante.

Malignant pleural mesothelioma is a relatively rare, but highly aggressive, tumor, associated to exposure to asbestos, with a life expectancy between 9 and 17 months. Chest pain and dyspnea are the most frequent symptoms. The most commonly used therapy is surgery accompanied by chemotherapy. Preoperative assessment, after chemotherapy, has been done using magnetic resonance imaging and computed tomography (CT). However, these techniques cannot predict early response to therapy, because of the slow structural change of the tumor. The aim of this case report is to review and learn about the growing use of PET-CT imaging with (18)F-FDG in the preoperative staging of malignant pleural mesothelioma and its influence in selecting the most appropriate type of surgery.

Scaling differences of heartbeat excursions between wake and sleep periods.

We study the statistical properties of excursions in heart interbeat time series. An excursion is defined as the time employed by a walker to return to its mean value. We consider the homeostatic property of the heartbeat dynamics as a departing point to characterize the dynamics of excursions in beat-to-beat fluctuations. Scaling properties of excursions during wake and sleep periods from two groups are compared: 16 healthy subjects and 11 patients with congestive heart failure (CHF). We find that the cumulative distributions of excursions for both groups follow stretched exponential functions given by g(τ)~e(-aτ(b)) with different fitting parameters a and b, leading to different decaying rates. Our results show that the average characteristic scale associated with the excursion distributions is greater for healthy data compared to CHF patients whereas sleep-wake transitions are more significant for healthy data. Next, we explore changes in the distributions of excursions when considering (i) a shifted mean value to define an excursion and (ii) the sum of the kth excursion successor. Besides, the presence of temporal correlations in the excursions sequences is evaluated by means of the detrended fluctuation analysis. We observe the presence of long-range correlations for healthy subjects, whereas for the CHF group, correlations are described by two regimes; over short scales the fluctuations are close to uncorrelated noise, and for large scales the fluctuations reveal long-range correlations. Finally, we apply a stability analysis of excursions based on the Allan variance which reveals that healthy dynamics is more stable than heart failure excursions.

Effectiveness of nursing intervention for adult patients experiencing chronic pain: a systematic review.

OBJECTIVES: To determine the best available evidence regarding the effectiveness of nursing interventions for adult patients experiencing chronic pain. TYPES OF STUDIES: Randomized Controlled Trials (RCT) and Quasi-Randomized Controlled Trials. TYPES OF PARTICIPANTS: Participants were adults, aged at least 18 years, suffering from chronic pain (lasting for longer than six months). Pain of oncological origin and patients admitted in a hospital, were excluded. TYPES OF INTERVENTIONS: Non pharmacological nursing interventions for chronic pain. TYPES OF OUTCOME MEASURES: The primary outcome measure was chronic pain, and secondary outcome measures were: disability, depression, dependence and health related quality of life. SEARCH STRATEGY: All studies, published and unpublished, in English and Spanish, carried out between January 1997 and December 2007 were retrieved.. SELECTION OF STUDIES: The methodological quality of included articles was assessed by two independent reviewers using appropriate critical appraisal tools from the Joanna Briggs Institute. DATA EXTRACTION AND ANALYSIS: Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute.A meta-analysis was not possible as the trials were heterogeneous in their interventions, characteristics of the populations, intervention duration measurement instruments and outcomes measures. RESULTS: 1,666 references were identified that fit the aim of the review. 92 articles were retrieved, of which 13 were chosen to be critically appraised for their methodological quality. In the end, eight controlled trials were included.The main results were:Other outcome measures showed an improvement in the quality of life (sensorial stimulation and guided imagery), in depression, disability and empowerment (music therapy) and physical functioning (program of psycho-education).The main limitations of this review were: excluding studies were the professional performing the interventions were not detailed or the intervention was not carried out by a nurse and that the search strategy was limited up to 2007. IMPLICATIONS FOR PRACTICE: Listening to music, a cognitive-behavioural treatment programme, magnetic therapy, sensorial stimulation, a psychoeducation programme and guided imagery are nursing interventions that helps to reduce the chronic pain in adults and may be used as contributory to the pharmacological treatment. Short exercises for increasing endurance does not reduce pain. IMPLICATIONS FOR RESEARCH: For future reviews we do not recommend the inclusion of different interventions for the reduction of chronic pain, due to the great number and variability of intervention, but the development of a SR on specific interventions.

Alteraciones gammagráficas en las enfermedades metabólicas óseas / Scintigraphic alterations in metabolic bone disease

La enfermedad metabólica ósea es un término genérico que involucra a una serie de enfermedades sistémicas que producen repercusión ósea alterando el equilibrio existente entre la reabsorción y la formación de hueso. Existen, según la patología, diferentes herramientas diagnósticas que suelen incluir determinaciones analíticas, estudios radiológicos y gammagrafía ósea entre otras. Hemos realizado una revisión bibliográfica de las patologías metabólicas óseas más frecuentes, describiendo la utilidad de la gammagrafía ósea en su diagnóstico, su seguimiento así como en la valoración de la respuesta al tratamiento(AU)

Metabolic bone disease is a generic term involving a group of systemic diseases that develop bone repercussion altering the existing balance between re-absorption and bone formation. According to the pathology, there are different tools we can usually use for diagnosis, such as analytic determinations, radiologic studies and bone scan, among others. We have made a bibliographical review of the most frequent metabolic bone pathologies, describing the utility of bone scintigraphy for diagnosis, follow up and assessment of treatment response(AU)

[Massive paracentesis and administration of dextran 70 vs albumin in cirrhotic patients with tense ascites]. / Paracentesis masiva con reposición de dextran 70 vs albúmina en pacientes cirróticos con ascitis a tensión.

Some studies have demonstrated that paracentesis for large-volume extraction of ascites produces renal failure and hyponatremia, and intravenous infusion of plasma expanders can overcome this complications. We performed a survey where we compared effectiveness of dextran 70 vs albumin on prevention of adverse effects and cost differences. Two random groups were formed, 8 cirrhotic patients with tense ascites in each group. Paracentesis with extraction of more than 5 liters was performed. The group A received human albumin and group B dextran 70, both received 6 g per liter of extracted liquid. 24 hours before and 48 hours after of ascites extraction, we performed hepatic function test, blood chemistry with renin and aldosterone. Clinical results and biochemistry test were similar in both groups without statistical significance (p > 0.05). Amount of plasma expander was almost the same, but the cost in group A was $266 USD and in group B $20.8 USD. Azotemia was present in 12.5% in group A and hyponatremia in 12.5% in both groups, without symptoms. The results show that dextran 70 produces the same effect like albumin in the treatment of ascites after large-volume paracentesis with lower cost.

[The seroprevalence of antibodies against the hepatitis C virus in blood donors at the Hospital Central Militar]. / Seroprevalencia de anticuerpos contra el virus de la hepatitis C en donadores de sangre del Hospital Central Militar.

The main transmission mechanism for hepatitis C virus is through blood products. In order to know seroprevalence of antibodies in military personnel, 2,564 samples at the Central Military Hospital with a second generation Enzymatic Immunoassay (EIA-2) were studied. All participants were males; the mean age was 25 years (range 17-47). Positive results were found in 19 potential donors (0.74%); similar seroprevalences have been reported by others. Patient selection helps to improve the safety of transfusions.

[The transjugular intrahepatic portosystemic stent-shunt (TIPS) in the management of portal hypertension. A preliminary report]. / Fístula portosistémica con prótesis intrahepática por vía transyugular (TIPS) en el manejo de la hipertensión porta. Communicación preliminar.

Transjugular intrahepatic portosystemic shunt-stent (TIPS) was performed in 5 patients with cirrhosis and portal hypertension. Bleeding varices occurred in 4 patients and refractory ascites in one. We used 2 Wallstents and 3 Strecker stents. Shunt patency, recurrent variceal hemorrhage and ascites were evaluated. The shunts were created from a transjugular approach between the hepatic and portal vein, with diameters of 10 mm. Portal pressure was adequately decreased in all cases. The hospital stay, following TIPS was 3 days. Complete variceal decompression was identified endoscopically in 3 patients, and partial in one. Four shunts were patent by ultrasound and color Doppler at 1 to 6 months of follow up. One patient presented encephalopathy and one died at third day after TIPS. Initial results suggest that TIPS is an effective method of portal decompression for treatment of variceal hemorrhage and refractory ascites. The main complication was encephalopathy and only one patient died.

Symmetrical deforming cutaneous sporotrichosis of long duration.

A symmetrical deforming cutaneous sporotrichosis with verrucous lesions on both hands and of long clinical duration is reported. The difficulties in making an etiological diagnosis are considered.