Prevalencia del consumo de bebidas energizantes y efectos adversos en estudiantes de medicina / Prevalence of energy drinks consumption and adverse effects among medical students

Introducción: las bebidas energizantes son preparados estimulantes e hidratos de carbono. Objetivo: determinar la prevalencia, características del consumo y los efectos adversos en estudiantes de un programa de medicina Metodología: estudio observacional, descriptivo, de corte transversal y retrospectivo, que incluyó estudiantes de medicina de una institución de educación superior, excluyendo a aquellos que no cursaban la carga académica completa para su semestre, quienes diligenciaron de manera inadecuada la encuesta o que no aceptaron la participación en el estudio. Resultados y discusión: participaron 241 estudiantes, de los cuales 72,20% eran mujeres. Solo 55 manifestaron trastornos patológicos de tipo insomnio (13,69%) y cefalea o migraña (8,30%) y 49,38% informaron sobre el consumo de bebidas energizantes. Existe la probabilidad de una mezcla con sustancias alcohólicas dada la elevada frecuencia de consumo (51,26%), lo que no ocurrió con el hábito de fumar. Los eventos adversos informados fueron insomnio (21,58%), taquicardia (17,43%), cefalea (14,52%), enrojecimiento facial (13,28%) y en menor medida temblor, ansiedad o trastornos gastrointestinales (17,42%). Conclusiones: el consumo de bebidas energizantes es alta durante la adolescencia y en especial en los universitarios, pero estas sustancias a largo plazo pueden generar efectos adversos cuyas principales complicaciones son cardíacas, por lo que es importante vigilar la comercialización de las mismas.

Introduction: energy drinks (ED) are stimulant and carbohydrate preparations. Objective: to determine the prevalence, characteristics of ED usage and adverse effects among students of a medical program Methodology: an observational, descriptive, cross-sectional, retrospective study, which included medical students of a higher education institution. Those who were not completing the full academic load for their semester, those who responded the survey inadequately or did not agree to participate in the study, were excluded. Results and discussion: 241 students participated, of which 72,20% were females. Only 55 reported symptoms such as insomnia (13.69%) and headache or migraine (8.30%) and 49.38% reported on ED consumption. To combine energy drinks with alcohol is probable, given the high alcohol consumption rate (51.26%), while it was not associated with smoking. Adverse events reported were insomnia (21.58%), tachycardia (17.43%), headache (14.52%), facial flushing (13.28%) and tremor; and to a lesser extent, anxiety, and gastrointestinal disorders (17.42%). Conclusions: energy drinks consumption is high at adolescence, especially among university students. These preparations can produce long-term adverse effects mainly cardiovascular complications. Thus, monitoring ED marketing is important.

Cross-cultural perspectives on patient expectations in cosmetic dermatology: A comparative analysis across countries and ethnicities.

Patient expectations in cosmetic dermatology exhibit significant variations across countries, cultures, and ethnicities, thereby reflecting individual desires, concerns, and goals. While some individuals seek aesthetic enhancements, others prioritize addressing specific skin conditions within the context of beauty norms in their respective countries. The provision of personalized and culturally sensitive care plays a crucial role in meeting these diverse expectations. Skin characteristics and concerns differ among ethnicities, influencing treatment preferences. For instance, individuals with darker skin tones may prioritize the treatment of pigmentation disorders, whereas those with lighter skin tones may focus on achieving a fair complexion. Furthermore, differences in facial anatomy among various ethnicities necessitate tailored treatment approaches. This commentary aims to contribute to the effective understanding and management of patient expectations, ultimately leading to satisfactory outcomes. Additional research and regional studies are required to further deepen our understanding of patient expectations in cosmetic dermatology and enable the delivery of improved and culturally appropriate care on a global scale.

Learning-related contraction of gray matter in rodent sensorimotor cortex is associated with adaptive myelination.

From observations in rodents, it has been suggested that the cellular basis of learning-dependent changes, detected using structural MRI, may be increased dendritic spine density, alterations in astrocyte volume, and adaptations within intracortical myelin. Myelin plasticity is crucial for neurological function, and active myelination is required for learning and memory. However, the dynamics of myelin plasticity and how it relates to morphometric-based measurements of structural plasticity remains unknown. We used a motor skill learning paradigm in male mice to evaluate experience-dependent brain plasticity by voxel-based morphometry (VBM) in longitudinal MRI, combined with a cross-sectional immunohistochemical investigation. Whole-brain VBM revealed nonlinear decreases in gray matter volume (GMV) juxtaposed to nonlinear increases in white matter volume (WMV) within GM that were best modeled by an asymptotic time course. Using an atlas-based cortical mask, we found nonlinear changes with learning in primary and secondary motor areas and in somatosensory cortex. Analysis of cross-sectional myelin immunoreactivity in forelimb somatosensory cortex confirmed an increase in myelin immunoreactivity followed by a return towards baseline levels. Further investigations using quantitative confocal microscopy confirmed these changes specifically to the length density of myelinated axons. The absence of significant histological changes in cortical thickness suggests that nonlinear morphometric changes are likely due to changes in intracortical myelin for which morphometric WMV in somatosensory cortex significantly correlated with myelin immunoreactivity. Together, these observations indicate a nonlinear increase of intracortical myelin during learning and support the hypothesis that myelin is a component of structural changes observed by VBM during learning.

Pridopidine Promotes Synaptogenesis and Reduces Spatial Memory Deficits in the Alzheimer's Disease APP/PS1 Mouse Model.

Sigma-1 receptor agonists have recently gained a great deal of interest due to their anti-amnesic, neuroprotective, and neurorestorative properties. Compounds such as PRE-084 or pridopidine (ACR16) are being studied as a potential treatment against cognitive decline associated with neurodegenerative disease, also to include Alzheimer's disease. Here, we performed in vitro experiments using primary neuronal cell cultures from rats to evaluate the abilities of ACR16 and PRE-084 to induce new synapses and spines formation, analyzing the expression of the possible genes and proteins involved. We additionally examined their neuroprotective properties against neuronal death mediated by oxidative stress and excitotoxicity. Both ACR16 and PRE-084 exhibited a concentration-dependent neuroprotective effect against NMDA- and H2O2-related toxicity, in addition to promoting the formation of new synapses and dendritic spines. However, only ACR16 generated dendritic spines involved in new synapse establishment, maintaining a more expanded activation of MAPK/ERK and PI3K/Akt signaling cascades. Consequently, ACR16 was also evaluated in vivo, and a dose of 1.5 mg/kg/day was administered intraperitoneally in APP/PS1 mice before performing the Morris water maze. ACR16 diminished the spatial learning and memory deficits observed in APP/PS1 transgenic mice via PI3K/Akt pathway activation. These data point to ACR16 as a pharmacological tool to prevent synapse loss and memory deficits associated with Alzheimer's disease, due to its neuroprotective properties against oxidative stress and excitotoxicity, as well as the promotion of new synapses and spines through a mechanism that involves AKT and ERK signaling pathways.

Increase of vesicular glutamate transporter 2 co-expression in the deep cerebellar nuclei related to skilled reach learning.

Motor learning induces plasticity in multiple brain regions involving the cerebellum as a crucial player. Synaptic plasticity in the excitatory collaterals to the cerebellar output, the deep cerebellar nuclei (DCN), have recently been shown to be an important part of motor learning. These synapses are composed of climbing fiber (CF) and mossy fiber synapses, with the former conveying unconditioned and the latter conditioned responses in classical conditioning paradigms. The CF synapse on to the cerebellar cortex and the DCN express vesicular transporter 2 (vGluT2), whereas mossy fibers express vGluT1 and /or vGluT2 in their terminals. However, the underlying regulatory mechanism of vGluT expression in the DCN remains unknown. Here we confirm the increase of vGluT2 in a specific part of the DCN during the acquisition of a skilled reaching task in mice. Furthermore, our findings show that this is due to an increase in co-expression of vGluT2 in vGluT1 presynapses instead of the formation of new vGluT2 synapses. Our data indicate that remodeling of synapses - in contrast to synaptogenesis - also plays an important role in motor learning and may explain the presence of both vGluT's in some mossy fiber synapses.

Pridopidine modifies disease phenotype in a SOD1 mouse model of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a lethal and incurable neurodegenerative disease due to the loss of upper and lower motor neurons, which leads to muscle weakness, atrophy, and paralysis. Sigma-1 receptor (σ-1R) is a ligand-operated protein that exhibits pro-survival and anti-apoptotic properties. In addition, mutations in its codifying gene are linked to development of juvenile ALS pointing to an important role in ALS. Here, we investigated the disease-modifying effects of pridopidine, a σ-1R agonist, using a delayed onset SOD1 G93A mouse model of ALS. Mice were administered a continuous release of pridopidine (3.0 mg/kg/day) for 4 weeks starting before the appearance of any sign of muscle weakness. Mice were monitored weekly and several behavioural tests were used to evaluate muscle strength, motor coordination and gait patterns. Pridopidine-treated SOD1 G93A mice showed genotype-specific effects with the prevention of cachexia. In addition, these effects exhibited significant improvement of motor behaviour 5 weeks after treatment ended. However, the survival of the animals was not extended. In summary, these results show that pridopidine can modify the disease phenotype of ALS-associated cachexia and motor deficits in a SOD1 G93A mouse model.

Dynamical Descalarization in Binary Black Hole Mergers.

Scalar fields coupled to the Gauss-Bonnet invariant can undergo a tachyonic instability, leading to spontaneous scalarization of black holes. Studies of this effect have so far been restricted to single black hole spacetimes. We present the first results on dynamical scalarization in head-on collisions and quasicircular inspirals of black hole binaries with numerical relativity simulations. We show that black hole binaries can either form a scalarized remnant or dynamically descalarize by shedding off its initial scalar hair. The observational implications of these findings are discussed.

Square Peg in a Circular Hole: Choosing the Right Ansatz for Isolated Black Holes in Generic Gravitational Theories.

The metric of a spacetime can be greatly simplified if the spacetime is circular. We prove that in generic effective theories of gravity, the spacetime of a stationary, axisymmetric, and asymptotically flat solution must be circular if the solution can be obtained perturbatively from a solution in the general relativity limit. This result applies to a broad class of gravitational theories that include arbitrary scalars and vectors in their light sector, so long as their nonstandard kinetic terms and nonmininal couplings to gravity are treated perturbatively.

Astrophysical and Theoretical Physics Implications from Multimessenger Neutron Star Observations.

The Neutron Star Interior Composition Explorer (NICER) recently measured the mass and equatorial radius of the isolated neutron star PSR J0030+0451. We use these measurements to infer the moment of inertia, the quadrupole moment, and the surface eccentricity of an isolated neutron star for the first time, using relations between these quantities that are insensitive to the unknown equation of state of supranuclear matter. We also use these results to forecast the moment of inertia of neutron star A in the double pulsar binary J0737-3039, a quantity anticipated to be directly measured in the coming decade with radio observations. Combining this information with the measurement of the tidal Love number with LIGO/Virgo observations, we propose and implement the first theory-agnostic and equation-of-state-insensitive test of general relativity. Specializing these constraints to a particular modified theory, we find that consistency with general relativity places the most stringent constraint on gravitational parity violation to date, surpassing all other previously reported bounds by 7 orders of magnitude and opens the path for a future test of general relativity with multimessenger neutron star observations.

Predicting the risk of postinflammatory hyperpigmentation: The palmar creases pigmentation scale.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) may affect any skin type but has been linked more often to darker skin. While propensity to hyperpigmentation has not been fully elucidated, there may be a direct correlation to one's palmar crease pigmentation. OBJECTIVE: The aim of this study is to validate the reliable use of a palmar creases pigmentation (PCP) scale, and its accuracy in predicting the risk of PIH. METHODS: A prospective, comparative, and blinded study was conducted through photo-numeric analysis of 126 photographs of pairs of palms. We utilized a 4-point visual scale based on the level of contrast between palmar crease pigment and that of the surrounding skin. Score 0 indicated no difference, score 1 referred to a low difference, score 2 meant a moderate difference, and score 3 related to a high difference. Scores were subdivided based on the risk of PIH. Scores 0-1 are low risk and scores 2-3 are high risk. A panel of 8 medical experts independently evaluated and re-evaluated the photographs that were shown in a random order. RESULTS: A significant degree of inter-rater reliability was found at both evaluation visits, with an intra-class correlation coefficient (ICC) = 0.908, P <.001, at the first evaluation and an ICC = 0.924, P <.001, at the second evaluation, demonstrating a validity of the scale. Global Fleiss kappa for intra-rater reliability for all physicians was 0.514. CONCLUSION: The PCP scale can be effectively used by any physician to predict hyperpigmentation risk.

Spin-Induced Scalarized Black Holes.

It was recently shown that a scalar field suitably coupled to the Gauss-Bonnet invariant G can undergo a spin-induced linear tachyonic instability near a Kerr black hole. This instability appears only once the dimensionless spin j is sufficiently large, that is, j≳0.5. A tachyonic instability is the hallmark of spontaneous scalarization. Focusing, for illustrative purposes, on a class of theories that do exhibit this instability, we show that stationary, rotating black hole solutions do indeed have scalar hair once the spin-induced instability threshold is exceeded, while black holes that lie below the threshold are described by the Kerr solution. Our results provide strong support for spin-induced black hole scalarization.

Epidemiology, Outcomes, and Associated Factors of Coronavirus Disease 2019 (COVID-19) Reverse Transcriptase Polymerase Chain Reaction-Confirmed Cases in the San Pedro Sula Metropolitan Area, Honduras.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused substantial morbidity and mortality worldwide. Few reports exist in Latin America, a current epicenter of transmission. Here, we aim to describe the epidemiology and outcomes associated with coronavirus disease 2019 (COVID-19) in Honduras. METHODS: Baseline clinical and epidemiological information of SARS-CoV-2 reverse transcriptase polymerase chain reaction-confirmed cases detected between 17 March-4 May in the San Pedro Sula Metropolitan area was collected; for hospitalized cases, clinical data were abstracted. Logistic regression models were fit to determine the factors associated with hospitalization. RESULTS: We identified 877 COVID-19 cases, of which 25% (n = 220) were hospitalized. The 19-44-year age group (57.8%) and males (61.3%) were predominant in overall COVID-19 cases. Of the cases, 34% (n = 299) had at least 1 preexisting medical condition. Individuals aged 45-69 years (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI], 2.85-5.76) or ≥70 years (aOR = 9.12; 95% CI, 5.24-15.86), of male sex (aOR = 1.72; 95% CI, 1.21-2.44), and those with a preexisting condition (aOR = 2.12; 95% CI, 1.43-3.14) had higher odds of hospitalization. Of inpatients, 50% were hospitalized more than 7 days. The median length of hospitalization was 13 days (interquartile range [IQR], 8-29) among individuals aged 19-44 years, and 17 days (IQR, 11-24.6) among those aged 45-69. Of the fatal cases, 42% occurred among adults under 60 years old. CONCLUSIONS: Our findings show that a high proportion of COVID-19 cases in Honduras occurred among younger adults, who also constituted a significant proportion of severe and fatal cases. Preexisting conditions were associated with severe outcomes independently from age and were highly prevalent in Honduran COVID-19 cases.

Erratum: Fundamental Physics Implications for Higher-Curvature Theories from Binary Black Hole Signals in the LIGO-Virgo Catalog GWTC-1 [Phys. Rev. Lett. 123, 191101 (2019)].

This corrects the article DOI: 10.1103/PhysRevLett.123.191101.

Fundamental Physics Implications for Higher-Curvature Theories from Binary Black Hole Signals in the LIGO-Virgo Catalog GWTC-1.

Gravitational-wave astronomy offers not only new vistas into the realm of astrophysics, but it also opens an avenue for probing, for the first time, general relativity in its strong-field, nonlinear, and dynamical regime, where the theory's predictions manifest themselves in their full glory. We present a study of whether the gravitational-wave events detected so far by the LIGO-Virgo scientific collaborations can be used to probe higher-curvature corrections to general relativity. In particular, we focus on two examples: Einstein-dilaton-Gauss-Bonnet and dynamical Chern-Simons gravity. We find that the two events with a low-mass m≈7 M_{⊙} BH (GW151226 and GW170608) place stringent constraints on Einstein-dilaton-Gauss-Bonnet gravity, α_{EDGB}^{1/2}≲5.6 km, whereas dynamical Chern-Simons gravity remains unconstrained by the gravitational-wave observations analyzed.

Comportamiento pernicioso: el efecto de las consecuencias en la elección entre perjudicar/no perjudicar a un compañero / Pernicious Behavior: the Effect of the Consequences in the Choice between to Harm/do not harm a Classmate

Resumen La presente investigación, se realizó con base en dos supuestos interconductuales: 1) el comportamiento es susceptible de modularse por factores históricos y/o situacionales; 2) el comportamiento pernicioso puede regularse por factores situacionales como las consecuencias. El objetivo fue evaluar el efecto de las consecuencias (positivas y negativas) sobre la elección entre perjudicar o no a un compañero durante la solución de una tarea. Participaron 35 estudiantes universitarios distribuidos aleatoriamente en cinco grupos. La tarea experimental consistió en la solución de operaciones aritméticas proporcionalmente puntuadas (1 a 5 puntos). El principal resultado fue que las consecuencias negativas por no perjudicar modulan mayoritariamente la ocurrencia de comportamiento pernicioso. Los resultados se discuten en términos del papel regulador de las consecuencias (en relación con el comportamiento pernicioso) en tanto factor situacional.

Abstract This research was based on two main interbehavioral suppositions: 1) Behavior is likely modulated by historical and/or situational factors; 2) Pernicious behavior can be regulated by situational factors such as the consequences. The objective was to evaluate the effect of the consequences (positives and negatives) on the choice between to harm or do not harm a classmate while solving a task. Thirty-five college students were randomly assigned into one of five experimental groups. The task consisted in solving arithmetic operations proportionally scored from 1 to 5 points. The results are discussed in terms of the regulatory role of the consequences (in relation to pernicious behavior) as a situational factor. The main result was that the negative consequences by the choice of do not harm the partner mainly modulated the occurrence of pernicious behavior.

Spontaneous Scalarization of Black Holes and Compact Stars from a Gauss-Bonnet Coupling.

We identify a class of scalar-tensor theories with coupling between the scalar and the Gauss-Bonnet invariant that exhibit spontaneous scalarization for both black holes and compact stars. In particular, these theories formally admit all of the stationary solutions of general relativity, but these are not dynamically preferred if certain conditions are satisfied. Remarkably, black holes exhibit scalarization if their mass lies within one of many narrow bands. We find evidence that scalarization can occur in neutron stars as well.

Experiencia de 25 años con la fiebre de origen desconocido en el Hospital Clínico Quirúrgico Hermanos Ameijeiras / Twenty-five years experience with fever of unknown origin at Hermanos Ameijeiras Surgical Clinical Hospital

La fiebre de origen desconocido (FOD) constituye uno de los problemas más complejos y difíciles con que se enfrenta el clínico en su práctica diaria. En la mayoría de los casos no se trata de una enfermedad exótica o rara, sino de enfermedades comunes y frecuentes que por determinadas condiciones, no bien conocidas, se expresan en forma predominante como una fiebre prolongada. Puede ser causada por más de 200 enfermedades y día a día se añaden nuevas entidades nosológicas a esta larga lista, y lograr su diagnóstico se convierte en un gran dilema e incertidumbre para el médico y motivo de preocupación y ansiedad para el paciente y familiares. En el año 1930, Alt y Baker publican por primera vez un artículo donde se presenta un grupo de pacientes hospitalizados con fiebre prolongada como manifestación clínica fundamental entre los años 1913 y 1930 en los que no se conocía la causa después de egresados; en este artículo los autores no delimitaron el tiempo necesario para considerar un caso como FOD ni clasificación por grupos de enfermedades.1 A lo largo de la década de 1950 los clínicos continuaron describiendo pacientes con fiebre prolongada sin explicación, pero estas series eran retrospectivas y diferían en los criterios de definición, además de que no incluían una evaluación uniforme de estos pacientes: en la mayoría de los casos no se conocía la causa de la fiebre. Entre los pacientes que se identificó la etiología, las más frecuentes eran las infecciones, en especial la tuberculosis, además de sífilis, brucelosis y endocarditis.2 Entre 1952 y 1957, Peterdorsf y Besson realizaron un estudio prospectivo de 100 casos y en el año 1961 publicaron su experiencia y definieron por primera vez los criterios de FOD: fiebre mayor de 38,3 °C en varias ocasiones, que se prolonga por más de 3 semanas y cuya causa se mantiene incierta después de permanecer una semana en un centro hospitalario. En esta publicación se propone crear 4 grupos principales de enfermedades causantes de FOD: enfermedades infecciosas, tumorales, colágenas/vasculitis y misceláneas. El grupo más frecuente en esta publicación fue el de las enfermedades infecciosas, seguido por las neoplasias, colágenas/vasculitis y misceláneas.3 En el año 1991, Durack y Street añadieron a la forma clásica de Peterdorsf 3 nuevos tipos de FOD: nosocomial, FOD en pacientes neutropénicos y FOD asociada al VIH-SIDA. En esta propuesta se reduce el tiempo a 3 días para considerarlo como una FOD y resulta de utilidad en pacientes ingresados en unidades de atención al grave, por lo general inmunocomprometidos, que necesitan de una acción terapéutica rápida.4 En la década de 1970-80 Larson, Featherstone y Peterdorsf publican una serie de 105 casos que cambian la frecuencia de grupos establecidos, el cual mostró que si bien inicialmente la primera causa de FOD eran las enfermedades infecciosas, con el paso del tiempo estas disminuyeron para ocupar el primer escaño las enfermedades neoplásicas con el 38 por ciento del total de casos.5 En este período, particularmente en la década del 70, llamó la atención que la primera causa infecciosa de FOD fue la tuberculosis. Sin embargo, con el transcurrir de los años la incidencia de esta enfermedad disminuyó notablemente y cedió su lugar a la endocarditis infecciosa, lo cual está en relación con el desarrollo de fármacos antituberculosos. En esta publicación los estudios imagenológicos tuvieron gran importancia, pues orientaron el curso que debían seguir las investigaciones ante el hallazgo de determinadas alteraciones como visceromegalias, abscesos, adenopatías profundas, imágenes tumorales, entre otras. Además, en muchos casos permiten realizar procederes invasivos dirigidos bajo control ultrasonográfico. A partir de ese momento se han publicado diversas...(AU)

Pramipexole reduces soluble mutant huntingtin and protects striatal neurons through dopamine D3 receptors in a genetic model of Huntington's disease.

Huntington's disease (HD) is a neurodegenerative disorder caused by abnormal expansion of the polyglutamine tract in the huntingtin protein (HTT). The toxicity of mutant HTT (mHTT) is associated with intermediate mHTT soluble oligomers that subsequently form intranuclear inclusions. Thus, interventions promoting the clearance of soluble mHTT are regarded as neuroprotective. Striatal neurons are particularly vulnerable in HD. Their degeneration underlies motor symptoms and striatal atrophy, the anatomical hallmark of HD. Recent studies indicate that autophagy may be activated by dopamine D2 and D3 receptor (D2R/D3R) agonists. Since autophagy plays a central role in the degradation of misfolded proteins, and striatal neurons express D2R and D3R, D2R/D3R agonists may promote the clearance of mHTT in striatal neurons. Here, this hypothesis was tested by treating 8-week old R6/1 mice with the D2R/D3R agonist pramipexole for 4weeks. Pramipexole reduced striatal levels of soluble mHTT and increased the size of intranuclear inclusions in R6/1 mice. Furthermore, striatal DARPP-32 levels and motor functions were recovered. These effects were accompanied by an increase in LC3-II and a decrease in p62 in the striatum. Tollip, a selective adaptor of ubiquitinated polyQ proteins to LC3, was also reduced in the striata of R6/1mice but not in their wild-type littermates. No changes were detected in the cerebral cortex where D3R expression is very low, and behavioral and biochemical effects in the striatum were prevented by a D3R antagonist. The findings indicate that PPX protects striatal neurons by promoting the clearance of soluble mHTT through a D3R-mediated mechanism. The evidence of autophagy markers suggests that autophagy is activated, although it is not efficient at removing all mHTT recruited by the autophagic machinery as indicated by the increase in the size of intranuclear inclusions.

Noninvasive submental fat reduction using colder cryolipolysis.

BACKGROUND: Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE: The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS: A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS: The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION: Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.

Linfoma no Hodgkin folicular primario del bazo / Follicular Non-Hodgkin Primary Splenic Lymphoma

Se presenta el caso de una paciente de 79 años que desde hace 3 meses presenta marcada sudoración nocturna, dolor abdominal en zona de hipocondrio y flanco izquierdo y ligera pérdida de peso. Al examen físico se observa palidez de piel y mucosas, esplenomegalia que rebasa 7 cm el reborde costal izquierdo, superficie lisa, superficie regular. El resto del examen físico fue normal. Se realizan múltiples investigaciones básicas sin poderse identificar el diagnostico. Por la presencia de gran esplenomegalia y la pancitopenia se decide realizar esplenectomía confirmándose un linfoma no Hogkin folicular primario del bazo(AU)

We present the case of a 79-year-old patient who had marked night sweats, abdominal pain in the hypochondrium area and left flank and slight weight loss for 3 months. Physical examination showed pale skin and mucous membranes, splenomegaly that exceeds the left costal margin by 7 cm, smooth surface, and regular surface. The rest of the physical examination was normal. Multiple basic studies were conducted out but the diagnosis was not identified. Due to the presence of great splenomegaly and pancytopenia, it was decided to perform splenectomy, confirming a follicular non-Hodgkin primary splenic lymphoma(AU)