Similar outcomes of constrained condylar knee and rotating hinge prosthesis in revision surgery for extension instability after primary total knee arthroplasty.

BACKGROUND: Instability is one of the most common reasons for total knee arthroplasty (TKA) failure. Constrained prosthesis can be used for significant ligamentous laxity, but there is not much evidence on the appropriate level of restriction for unstable varus-valgus TKA. The objective of this study was to compare the outcome and survival at a minimum follow-up of five years between rotating hinge knee prosthesis (RHK) and constrained condylar knee prosthesis (CCK) for extension instability following primary TKA. HYPOTHESIS: For symptomatic extension instability after primary TKA, good functional outcomes and survival can be achieved with both designs. MATERIAL AND METHODS: Consecutive patients with unstable primary TKA who underwent revision with either RHK (n=34) or CCK (n=30) were retrospectively compared. Assessments were performed by the Knee Society Scores (KSS), and visual analogue scales (VAS) for pain and patient satisfaction. Radiological evaluation was made. Complications and re-operations were analyzed. RESULTS: Mean post-operative follow-up was 10.3 (range 5-16) years for both groups. At the final follow-up, there was no significant difference between groups in the KSS-knee (p=0.228) or KSS-function (p=0.324) score, VAS-pain (p=0.563), VAS-satisfaction (p=0.780), major complication rate (p=0.194), or TKA survival at 10 years (p=0.091). CONCLUSION: The present study showed comparable good functional outcomes and survival at long-term between RHK and CCK arthroplasties. Both designs can be recommended for revision of total knee arthroplasty with symptomatic extension instability. LEVEL OF EVIDENCE: Level III.

Relation of outbursts of anger and the acute risk of placental abruption: A case-crossover study.

BACKGROUND: Roughly, a fourth of all placental abruption cases have an acute aetiologic underpinning, but the causes of acute abruption are poorly understood. Studies indicate that symptoms of stress, depression, and anxiety during pregnancy may be associated with a higher risk of abruption. OBJECTIVE: We examined the rate of abruption in the 2 hours immediately following outbursts of anger. METHODS: In a multicentre case-crossover study, we interviewed 663 women diagnosed with placental abruption admitted to one of the seven Peruvian hospitals between January 2013 and August 2015. We asked women about outbursts of anger before symptom onset and compared this with their usual frequency of anger during the week before abruption. RESULTS: The rate of abruption was 2.83-fold (95% confidence interval [CI] 1.85, 4.33) higher in the 2 hours following an outburst of anger compared with other times. The rate ratio (RR) was lower for women who completed technical school or university (RR 1.38, 95% CI 0.52, 3.69) compared to women with secondary school education or less (RR 3.73, 95% CI 2.32, 5.99, P-homogeneity = .07). There was no evidence that the association between anger episodes and abruption varied by hypertensive disorders of pregnancy (ie preeclampsia/ eclampsia) or antepartum depressive symptoms. CONCLUSION: There was a higher rate of abruption in the 2 hours following outbursts of anger compared with other times, providing potential clues to the aetiologic mechanisms of abruption of acute onset.

Neurocirugía estereotáctica ablativa para trastorno neuroagresivo irreductible en pediátricos / Ablative stereotactic neurosurgery for irreducible neuroaggressive disorder in pediatric patients

Introducción y objetivos: El trastorno neuroagresivo irreductible (TNI) es una entidad bien descrita asociada con comportamiento impulsivo y agresivo. Es un dilema tanto para el tratamiento farmacológico como para el no farmacológico en la psiquiatría moderna, implicando un riesgo individual y social importante. A pesar de los avances en la terapia estereotáctica dirigida para TNI persiste una ausencia de información cuando se compara la eficacia de los diferentes blancos anatómicos validados. En el presente trabajo se describen los resultados quirúrgicos de los pacientes con TNI tratados con cirugía estereotáctica ablativa, con enfoque en los criterios de selección y métodos utilizados en nuestra institución. El objetivo es analizar la eficacia y seguridad de los diferentes blancos estereotácticos más utilizados para agresividad irreductible en niños. Materiales y métodos: Seleccionamos a 8 pacientes pediátricos con TNI bajo un estricto protocolo. Se les realizó electroencefalograma, videoelectroencefalograma y resonancia magnética previo a la cirugía. El síntoma neuroagresivo irreductible fue tratado con cirugía estereotáctica hacia los blancos cerebrales más descritos para agresividad, y posteriormente evaluado mediante la Overt Agressive Scale en el prequirúrgico y a los 6 meses de seguimiento, usando el test de Wilcoxon para el análisis estadístico. Resultados y conclusiones: La edad promedio de los pacientes fue de 13 años y 2 meses, 7 de los 8 pacientes incluidos tenían discapacidad intelectual, un paciente tenía secuelas neurológicas por síndrome de Dandy Walker y 7 pacientes no tenían alteraciones anatómicas preoperatorias. Después de la cirugía los pacientes mostraron mejoría en la escala Overt Agressive Scale con un promedio de 39,29% (p=0,0156), lo cual se encuentra dentro del rango descrito para TNI en adultos. Los resultados más satisfactorios tuvieron en común la inclusión del complejo nuclear amigdalino dentro de los blancos quirúrgicos. No hubo muertes ni secuelas permanentes atribuibles al procedimiento. La presente serie es la más grande descrita en la literatura hasta el momento para pacientes pediátricos con TNI tratados con ablación estereotáctica

Introduction and objectives: The irreducible neuroaggressive disorder (IND) is a well-described entity known to be associated with impulsive and aggressive behavior. While various studies have assessed available pharmacological and non-pharmacological treatment regimens, patients with IND continue to pose a major threat to themselves and society. While targeted stereotactic therapy for IND has gained traction in recent years, there is a paucity of information describing comparative effectiveness of different validated anatomic regions. In this paper, we discuss the surgical results for patients with IND following targeted lesional therapy with a special focus on selection criteria and operative methods. The objective is to analyze the efficacy and safety of the different described targets for this disorder in pediatric patients. Materials and methods: Eight pediatric patients met strict criteria for IND and were enrolled in this study. Electroencephalography (EEG), video electroencephalography (VEEG) and magnetic resonance imaging (MRI) were performed in all patients prior to surgery. Irreducible neuroagressive symptom was approached by lesional therapy based on most described targets for this disorder and assessed by The Overt Agressive Scale (OAS) pre-operatively and 6 months following surgery, using Wilcoxon test for statistical analysis. Results and conclusions: The average patient age was 13 years 2 months. 7 of the 8 patients enrolled had intellectual disabilities, 1 patient suffered neurologic sequelae referable to Dandy Walker syndrome and 7 patients had no preoperative anatomical alterations. Following surgery, patients with IND noted improvement in their OAS. On average, the OAS improved by 39.29% (P=.0156), a figure similar in comparison to studies assessing treatment of IND in adult patients. The most satisfactory results were achieved in patients whose ablative therapy involved the Amygdala in their targets. There were no deaths or permanent neurological deficits attributable to procedure. To the author's knowledge, this is the largest series described in the literature for pediatric patients with IND treated with lesional stereotactic therapy

Ablative stereotactic neurosurgery for irreducible neuroaggressive disorder in pediatric patients. / Neurocirugía estereotáctica ablativa para trastorno neuroagresivo irreductible en pediátricos.

INTRODUCTION AND OBJECTIVES: The irreducible neuroaggressive disorder (IND) is a well-described entity known to be associated with impulsive and aggressive behavior. While various studies have assessed available pharmacological and non-pharmacological treatment regimens, patients with IND continue to pose a major threat to themselves and society. While targeted stereotactic therapy for IND has gained traction in recent years, there is a paucity of information describing comparative effectiveness of different validated anatomic regions. In this paper, we discuss the surgical results for patients with IND following targeted lesional therapy with a special focus on selection criteria and operative methods. The objective is to analyze the efficacy and safety of the different described targets for this disorder in pediatric patients. MATERIALS AND METHODS: Eight pediatric patients met strict criteria for IND and were enrolled in this study. Electroencephalography (EEG), video electroencephalography (VEEG) and magnetic resonance imaging (MRI) were performed in all patients prior to surgery. Irreducible neuroagressive symptom was approached by lesional therapy based on most described targets for this disorder and assessed by The Overt Agressive Scale (OAS) pre-operatively and 6 months following surgery, using Wilcoxon test for statistical analysis. RESULTS AND CONCLUSIONS: The average patient age was 13 years 2 months. 7 of the 8 patients enrolled had intellectual disabilities, 1 patient suffered neurologic sequelae referable to Dandy Walker syndrome and 7 patients had no preoperative anatomical alterations. Following surgery, patients with IND noted improvement in their OAS. On average, the OAS improved by 39.29% (P=.0156), a figure similar in comparison to studies assessing treatment of IND in adult patients. The most satisfactory results were achieved in patients whose ablative therapy involved the Amygdala in their targets. There were no deaths or permanent neurological deficits attributable to procedure. To the author's knowledge, this is the largest series described in the literature for pediatric patients with IND treated with lesional stereotactic therapy.

Cuerpo carotídeo: un enfoque anatómico y fisiológico / Carotid body: an anatomical and physiological approach

Resumen:Este trabajo describe la presencia del cuerpo carotídeo y su relación con el seno carotídeo. Además, se presenta una revisión bibliográfica de la historia, anatomía y fisiologia del órgano y su importancia como quimioreceptor del cuerpo humano.

Abstract:This work describes the presence of carotid body and its relationship to the carotid sinus. In addition, a literature review of the history, anatomy and physiology of the body and its importance as chemoreceptory the human body is presented.

Placental genetic variations in circadian clock-related genes increase the risk of placental abruption.

The genetic architecture of placental abruption (PA) remains poorly understood. We examined variations in SNPs of circadian clock-related genes in placenta with PA risk. We also explored placental and maternal genomic contributions to PA risk. Placental genomic DNA samples were isolated from 280 PA cases and 244 controls. Genotyping was performed using the Illumina Cardio-MetaboChip. We examined 116 SNPs in 13 genes known to moderate circadian rhythms. Logistic regression models were fit to estimate odds ratios (ORs). The combined effect of multiple SNPs on PA risk was estimated using a weighted genetic risk score. We examined independent and joint associations of wGRS derived from placental and maternal genomes with PA. Seven SNPs in five genes (ARNTL2, CRY2, DEC1, PER3 and RORA), in the placental genome, were associated with PA risk. Each copy of the minor allele (G) of a SNP in the RORA gene (rs2899663) was associated with a 30% reduced odds of PA (95% CI 0.52-0.95). The odds of PA increased with increasing placental-wGRS (Ptrend<0.001). The ORs were 1.00, 2.16, 3.24 and 4.48 across quartiles. Associations persisted after the maternal-wGRS was included in the model. There was evidence of an additive contribution of placental and maternal genetic contributions to PA risk. Participants with placental- and maternal-wGRS in the highest quartile, compared with those in the lowest quartile, had a 15.57-fold (95% CI 3.34-72.60) increased odds of PA. Placental variants in circadian clock-related genes are associated with PA risk; and the association persists after control of genetic variants in the maternal genome.

Placental genome and maternal-placental genetic interactions: a genome-wide and candidate gene association study of placental abruption.

While available evidence supports the role of genetics in the pathogenesis of placental abruption (PA), PA-related placental genome variations and maternal-placental genetic interactions have not been investigated. Maternal blood and placental samples collected from participants in the Peruvian Abruptio Placentae Epidemiology study were genotyped using Illumina's Cardio-Metabochip platform. We examined 118,782 genome-wide SNPs and 333 SNPs in 32 candidate genes from mitochondrial biogenesis and oxidative phosphorylation pathways in placental DNA from 280 PA cases and 244 controls. We assessed maternal-placental interactions in the candidate gene SNPS and two imprinted regions (IGF2/H19 and C19MC). Univariate and penalized logistic regression models were fit to estimate odds ratios. We examined the combined effect of multiple SNPs on PA risk using weighted genetic risk scores (WGRS) with repeated ten-fold cross-validations. A multinomial model was used to investigate maternal-placental genetic interactions. In placental genome-wide and candidate gene analyses, no SNP was significant after false discovery rate correction. The top genome-wide association study (GWAS) hits were rs544201, rs1484464 (CTNNA2), rs4149570 (TNFRSF1A) and rs13055470 (ZNRF3) (p-values: 1.11e-05 to 3.54e-05). The top 200 SNPs of the GWAS overrepresented genes involved in cell cycle, growth and proliferation. The top candidate gene hits were rs16949118 (COX10) and rs7609948 (THRB) (p-values: 6.00e-03 and 8.19e-03). Participants in the highest quartile of WGRS based on cross-validations using SNPs selected from the GWAS and candidate gene analyses had a 8.40-fold (95% CI: 5.8-12.56) and a 4.46-fold (95% CI: 2.94-6.72) higher odds of PA compared to participants in the lowest quartile. We found maternal-placental genetic interactions on PA risk for two SNPs in PPARG (chr3:12313450 and chr3:12412978) and maternal imprinting effects for multiple SNPs in the C19MC and IGF2/H19 regions. Variations in the placental genome and interactions between maternal-placental genetic variations may contribute to PA risk. Larger studies may help advance our understanding of PA pathogenesis.

Cambios en el perfil funcional de pacientes con patología psiquiátrica resistente sometidos a neurocirugía funcional estereotáctica / Changes in the functional profile of patients with resistant psychiatric disorders subjected to stereotactic functional neurosurgery / Mudanças no perfil funcional de pacientes con patologia psiquiátrica resistente submetidos a neurocirurgia funcional estereotáxica

Con el objetivo de evaluar los resultados de la Neurocirugía Funcional Estereotáctica (NFE) sobre el perfil funcional de los pacientes diagnosticados con Patología Psiquiátrica Resistente (PPR), se realizó un diseño pre/post tratamiento. 13 pacientes fueron evaluados ( = 31 ± 8 años): siete mujeres diagnosticadas con algún Trastorno de la Conducta Alimentaria Resistente (TCAR); tres mujeres diagnosticadas con Trastornos Resistentes Obsesivo Compulsivo y Depresivo (TOC y DR) y tres pacientes (dos mujeres y un hombre) diagnosticados con Depresión Resistente (DR). A estos pacientes se les aplicó la Escala de funcionamiento del paciente Eje K, la cual consta de siete subescalas, y una Escala de Evaluación de la Actividad Global (EAG) antes del tratamiento y después de éste (seis meses posteriores a la NFE). Todos los grupos diagnósticos y el total de los pacientes evaluados presentaron cambios clínicos positivos; sin embargo, sólo el grupo de TCAR mostró importantes cambios clínicos de mejoría en el perfil de funcionamiento, siendo esta diferencia estadísticamente significativa (pre Md = 56; post Md = 84; z= - 2.36, p <0.05). Con la evidencia obtenida se observó que la NFE representa una opción terapéutica emergente efectiva orientada a disminuir el sufrimiento de los pacientes con PPR, así como a mejorar el nivel de funcionamiento global y por ende su calidad de vida. Todos los pacientes del estudio presentaban una condición de resistencia a tratamientos convencionales indicados, la cual había sido documentada por un equipo interdisciplinario experto.

In order to evaluate the results of the Stereotactic Functional Neurosurgery (SFN) on the functional profile of patients diagnosed with Resistant Psychiatric Pathology (RPP), a pre / post treatment design was performed. Thirteen patients were assessed ( = 31 ± 8 years): seven women diagnosed with some type of Resistant Eating Disorder (RED); three women diagnosed with Resistant Obsessive Compulsive Disorder and Resistant Depression (TOC and RD), and three patients (two women and one man) diagnosed with Resistant Depression (RD). The Patient's Functioning Scale, axis K, consisting of seven subscales, and the Assessment of Global Activity Scale (AGAS) were applied before and after treatment (6 months after FSN). All diagnostic groups and all the patients assessed showed positive clinical changes. However, only the RED group showed important clinical improvement in the performance profile with a statistically significant difference (pre Md = 56, Md = 84 post , z = - 2.36, p <0.05). With the evidence obtained it was noted that SFN represents an effective therapeutic option aimed at reducing the suffering of patients with RPP and improve their overall level of functioning and therefore their quality of life. All patients in the study had a condition indicating resistance to conventional treatments which had been documented by an expert multidisciplinary team.

Con o objetivo de avaliar os resultados da Neurocirurgía Funcional Estereotáxica (NFE) sobre o perfil funcional dos pacientes diagnosticados com Patologia Psiquiátrica Resistente (PPR), realizou-se um desenho pré/pós tratamento. 13 pacientes foram avaliados ( = 31 ± 8 anos): sete mulheres diagnosticadas com algum Transtorno da Conduta Alimentar Resistente (TCAR); três mulheres diagnosticadas com Transtornos Resistentes Obsessivo Compulsivo e Depressivo (TOC e DR) e três pacientes (duas mulheres e um homem) diagnosticados com Depressão Resistente (DR). A estes pacientes foi aplicada a Escala de funcionamento do paciente Eixo K, a qual consta de sete sub-escalas, e uma Escala de Avaliação da Atividade Global (EAG) antes do tratamento e depois dele (seis meses posteriores à NFE). Todos os grupos diagnósticos e o total dos pacientes avaliados apresentaram mudanças clínicas positivas; porém, só o grupo de TCAR mostrou importantes mudanças clínicas de melhoria no perfil de funcionamento, sendo esta diferença estatisticamente significativa (pré Md= 56; pós Md= 84; z= - 2.36, p <0.05). Com a evidência obtida observou-se que a NFE representa uma opção terapêutica emergente efetiva orientada a diminuir o sofrimento dos pacientes com PPR, bem como a melhorar o nível de funcionamento global e portanto sua qualidade de vida. Todos os pacientes do estudo apresentavam uma condição de resistência a tratamentos convencionais indicados, a qual havia sido documentada por uma equipe interdisciplinar de especialistas.

Genome-wide and candidate gene association studies of placental abruption.

Placental abruption (PA), a pregnancy-related vascular disorder, is a leading cause of maternal and perinatal morbidity and mortality. The success of identifying genetic susceptibility loci for PA, a multi-factorial heritable disorder, has been limited. We conducted a genome-wide association study (GWAS) and candidate gene association study using 470 PA cases and 473 controls from Lima, Peru. Genotyping for common genetic variations (single nucleotide polymorphisms, SNPs) was conducted using the Illumina Cardio-Metabo Chip platform. Common variations in 35 genes that participate in mitochondrial biogenesis (MB) and oxidative phosphorylation (OS) were selected for the candidate gene study. Regression models were fit to examine associations of each SNP with risk of PA. In pathway analyses, we examined functions and functional relationships of genes represented by the top GWAS hits. Genetic risk scores (GRS), based on top hits of the GWAS and candidate gene analyses, respectively, were computed using the risk allele counting method. The top hit in the GWAS analyses was rs1238566 (empirical P-value=1.04e-4 and FDR-adjusted P-value=5.65E-04) in FLI-1 gene, a megakaryocyte-specific transcription factor. Networks of genes involved in lipid metabolism and cell signaling were significantly enriched by the 51 genes whose SNPs were among the top 200 GWAS hits (P-value <2.1e-3). SNPs known to regulate MB (e.g. CAMK2B, NR1H3, PPARG, PRKCA, and THRB) and OP (e.g., COX5A, and NDUF family of genes) were associated with PA risk (P-value <0.05). GRS was significantly associated with PA risk (trend P-value <0.001 and 0.01 for GWAS and candidate gene based GRS, respectively). Our study suggests that integrating multiple analytical strategies in genetic association studies can provide opportunities for identifying genetic risk factors and novel molecular mechanisms that underlie PA.

Cura bioquímica en pacientes con adenomas de la hipófisis productores de hormona de crecimiento con tratamiento quirúrgico y radioterapéutico: experiencia de 7 años / Biochemical cure in patients with growth hormone-secreting pituitary adenoma treated with surgery and radiotherapy: 7 years experience

Introducción: Los adenomas de la hipófisis representan el 10 al 25 por ciento de las neoplasias intracraneales. La acromegalia es definida como el crecimiento anormal y exagerado de las extremidades, producido por la sobresecreción de hormona de crecimiento. Es una enfermedad rara con una prevalencia de 60 por millón y una incidencia de 3-4 nuevos casos por millón por año. Métodos: Se incluyeron 59 pacientes con diagnóstico de acromegalia, en el periodo de 2000-2007. Evaluamos la respuesta endocrinológica al tratamiento, basado en el análisis clínico, de imagen y bioquímica de GH e IGF-1. Resultados: Los resultados revelaron reducción de GH y de IGF-1, 67 por ciento con niveles por debajo de 2.5ng/ml de GH, 58 por ciento con niveles de IGF-1 por debajo de 250 ng/ml. 15 pacientes (25 por ciento) presentaron criterios clínicos y bioquímicos de cura, 7 (46 por ciento) posterior al procedimiento quirúrgico, 4 (27 por ciento) posterior a cirugía y radioterapia, 3 (20 por ciento) cirugía más radiocirugía, y un paciente (7 por ciento) requirió los tres procedimientos. 23 pacientes (39 por ciento), no presentaron niveles significativos de reducción y fueron considerados no curados. Conclusiones: Estos resultados sugieren que la acromegalia continua siendo una enfermedad que requiere un tratamiento multimodal, sospecha clínica y búsqueda acuciosa para un diagnóstico temprano, a fin de obtener mejores resultados en estos pacientes. La cirugía continúa siendo el tratamiento primario de la acromegalia secundaria a adenomas de la hipófisis productores de GH. En pacientes con lesiones extensas o invasión se cuenta con nuevas terapias como la radiocirugía y continúan desarrollándose tratamientos médicos con excelentes resultados adyuvantes en el tratamiento.

Introduction: Pituitary adenomas account for the 10-25 percent of intracranial tumors. Acromegaly is defined as abnormal and excessive growth of the extremities, caused by growth hormone oversecretion. It is a rare disease with a prevalence of 60 per million and an incidence of 3-4 new cases per million per year. Methods: We included 59 patients diagnosed with acromegaly, in the period 2000-2007. Endocrinology assess, response to treatment based on clinical analysis, imaging and biochemical GH and IGF-1. Results: The results showed reduction of GH and IGF-1, 67 percent with levels below 2.5ng/ml of GH, 58 percent with IGF-1 levels below 250 ng/ml. 15 patients (25 percent) had clinical and biochemical criteria for cure, 7 (46 percent) after the surgical procedure, 4 (27 percent) after surgery and radiotherapy, 3 (20 percent) surgery over radiosurgery, and one patient (7 percent) required three procedures. 23 patients (39 percent) showed no significant levels of reduction and were considered not cured. Conclusions: These results suggest that the acromegaly remains a disease that requires a multimodal treatment, clinical suspicion and thorough search for an early diagnosis in order to obtain better results in these patients. Surgery remains the primary treatment of acromegaly secondary to pituitary adenomas producing GH. In patients with extensive lesions or invasion we have new therapies such as radiosurgery and continue to develop medical treatments with excellent results in the adjuvant treatment.

El registro de contratos administrativos en el sistema estatal de contrataciones en el marco del derecho de acceso a la información

El objetivo es promover en las autoridades ejecutivas de las entidades públicas, el registro de los contratos administrativos, debidamente firmados por las partes, en el sistema estatal de contrataciones en el marco del derecho de acceso a la información del proceso de contratción

Estudio del dermatoglifo en 530 pacientes esquizofrénicos del Hospital Psiquiátrico de La Habana / Dermatoglyphic study of 530 schizophrenic patients of the psychiatric hospital of Havana

Se han descrito alteraciones dermatoglíficas en la esquizofrenia, especialmente en el número de crestas en el espacio interdigital a-b. El propósito de nuestra investigación fue determinar si existen estas alteraciones en una población de esquizofrénicos cubanos (N=530) en relación con controles sanos (N=530) con iguales características étnicas y sociodemográficas. En este sentido se realizaron determinaciones a ciegas de los conteos de líneas en el espacio a-b de la mano derecha, y se aplicó un programa de análisis computarizado de las imágenes obtenidas mediante escáner. Los resultados que informan un menor número de crestas en el espacio a-b de la mano derecha coinciden con los reportados en estudios anteriores en otras latitudes y en poblaciones con características étnicas y sociodemográficas diferentes de la nuestra, lo que sugiere un origen común de la enfermedad independientemente de la influencia de estos factores. Se analizan los resultados obtenidos a la luz de la teoría del neurodesarrollo haciendo énfasis en los factores medioambientales, específicamente los virus, dados los elementos aportados en la literatura en este sentido y los hallazgos nuestros en estudios anteriores en esquizofrénicos adultos, fetos de madres esquizofrénicas y animales experimentalmente inoculados con líquido cefalorraquídeo. Se sugiere la posibilidad de un estudio de las células del líquido amniótico mediante técnicas de microscopia electrónica en mujeres con riesgo de tener una descendencia con esquizofrenia con el objetivo de aplicar medidas preventivas, interrupción del embarazo o tratamiento antiviral temprano, en caso de demostrarse la presencia de una infección viral en etapas tempranas del neurodesarrollo en las células del líquido amniótico(AU)

Dermatogly phic alterations in schizophrenia especially in the number of ridges in a-b interdigital space have been described. This research was aimed to determine if these anomalies are present in a schizophrenic Cuban population (n=530) related to heal thy controls (n=530) with similar ethnic and socio demographic characteristics .In his sence, blind determination of line counts in the a-b space of the right hand were carried out and a computerized analysis program of images obtained by scanner was also applied. The obtained results, giving a smaller number of ridges in the a-b space of the right hand coincide with those reported in previous studies at other latitudes and populations with ethnic and socio demographic characteristics different from ours. Thus, a common origin of the illness is suggested, independtly of the influence of these factor. The results are analyzed through the neuro developmental theory making emphasis on the environmental factors, especially viruses. These elements were given to literature in this sense, as well as taking in to account findings from our previous studies on adult schizophrenic patients, foetuses of schizophrenic mothers and animals, experimentally inoculated with cerebrospinal fluid. The possibility of a study on amniotic fluid cells is suggested , using electro-microscopic techniques in women at a risk of having a schizophrenia off spring in order to apply preventive measures , pregnancy interruptions or early antiviral treatment of a viral infections present in early neurodevelopment al stages in amniotic fluid cells(AU)

Psicocirugía en un paciente con trastorno obsesivo compulsivo resistente / Psychosurgery in a patient with refractory obsessive-compulsive disorder

El término psicocirugía fue introducido por primera vez por Egaz Moniz en 1937 para los procedimientos ablativos o resectivos del lóbulo frontal para disminuir síntomas psiquiátricos. La psicocirugía es un tratamiento disponible actualmente en varios centros mundiales, como tratamiento definitivo en pacientes bien seleccionados para enfermedades como el trastorno obsesivo-compulsivo resistente (TOC-R) y la agresividad resistente (AR) al tratamiento. En México no existen comités multidisciplinarios para el tratamiento de estas enfermedades psiquiátricas, ya que este tipo de pacientes tiene períodos de estancias hospitalarias prolongados e incapacidad laboral y personal, ésta es una alternativa no convencional que ha brindado la oportunidad de reincorporar a este tipo de pacientes y llevar una mejor observancia del tratamiento, se sabe que los centros más destacados en este ámbito están en Inglaterra, Estados Unidos y Chile. El presente artículo es un reporte de un caso en el que se demuestra la efectividad del procedimiento para disminuir los síntomas obsesivo y compulsivo resistentes, y al mismo tiempo corroborar que las funciones mentales superiores no están afectadas

The term psychosurgery was first used by Egaz Moniz in 1937 to describe ablative or resective procedures in the frontal lobe to reduce psychiatric symptoms. Psychosurgery is currently available in various centers throughout the world as the definitive treatment in selected patients with disorders such as refractory obsessive-compulsive syndrome and refractory aggression. In Mexico, multidisciplinary committees for the treatment of these psychiatric disorders are lacking since this type of patient undergoes long periods of hospitalization, as well as occupational and personal disability. Psychosurgery is an unconventional alternative that offers the possibility of reintegrating this type of patient and of achieving greater treatment compliance. The most important centers for psychosurgery are found in England, the USA and Chile. The present article reports a case that demonstrates the effectiveness of psychosurgery in reducing refractory obsessive-compulsive symptoms and corroborates that higher mental functions are left intact

[ENCOPREVENIMSS 2003, 2004 AND 2005. 3. Advances in Women, Men and Seniors' Health Programs]. / ENCOPREVENIMSS 2003, 2004 y 2005. 3. Avances en los Programas de Salud de la Mujer, del Hombre y del Adulto Mayor.

This paper presents the results of the National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS) 2003, 2004 and 2005, with regard to the coverage of Women, Men and Seniors' Health Programs. ENCOPREVENIMSS are nationwide probabilistic population-based surveys with delegation (state) representativeness of insured population of the Mexican Institute of Social Security. The sampling frame was stratified, with several stages, and by clusters. The surveys gathered information of sociodemographic characteristics, use of health services and coverage of the main components of the Health Integrated Programs (PREVENIMSS), as well as other complementary variables. For the purpose of this article, the main variables studied were those related to health promotion, weight, height and waist measurement, as well as other related to early detection of certain diseases. The results show an increase in the coverage during the period 2003-2005 in the three groups; however, the lowest were found in the group of men from 20 to 59 years old and the highest, in the group of seniors older than 59, except for those related to the detection of cervical and breast cancer, which were higher in women from 20 to 59 years old. Coverage analysis is useful to ascertain the degree of imposition of the different preventive activities and it is also a good basis for planning.

Cor triatriatum with single atrium presenting in adulthood.

We present the case of an asymptomatic 21-year-old woman referred because of an abnormal routine electrocardiogram. Transthoracic and transesophageal echocardiography revealed a complete absence of the atrial septum, a common atrium septated posteriorly from the pulmonary venous chamber, a partial atrioventricular canal, a cleft mitral valve and a persistent left superior vena cava draining into an enlarged coronary sinus. These findings were confirmed during surgical correction. Our patient presented with an unusual and fascinating combination of congenital malformations that remained well tolerated and undiscovered into adulthood.

Breath markers of oxidative stress in patients with unstable angina.

Cardiac chest pain is accompanied by oxidative stress, which generates alkanes and other volatile organic compounds (VOCs). These VOCs are excreted in the breath and could potentially provide a rational diagnostic marker of disease. The breath methylated alkane contour (BMAC), a 3-dimensional surface plot of C4-C20 alkanes and monomethylated alkanes, provides a comprehensive set of markers of oxidative stress. In this pilot study, we compared BMACs in patients with unstable angina pectoris and in healthy volunteers. Breath VOCs were analyzed in 30 patients with unstable angina confirmed by coronary angiography and in 38 age-matched healthy volunteers with no known history of heart disease (mean age +/- SD, 62.7 +/- 12.3 years and 62.5 +/- 10.0, not significant). BMACs in both groups were compared to identify the combination of VOCs that provided the best discrimination between the 2 groups. Forward stepwise entry discriminant analysis selected 8 VOCs to construct a predictive model that correctly classified unstable angina patients with sensitivity of 90% (27 of 30) and specificity of 73.7% (28 of 38). On cross-validation, sensitivity was 83.3% (25 of 30) and specificity was 71.1% (27 of 38). We conclude that the breath test distinguished between patients with unstable angina and healthy control subjects.

Pénfigo foliáceo endémic en Ucayalí, Perú: Reporte de 16 caso / Pemphigus foliaceous in Ucayali, Peru: Report of 16 cases

Se reporta 16 casos de pénfigo foliáceo endémico en el departamento de Ucayali, en su mayoría procedentes de la provincia de Coronel Portillo (94 por ciento); el 50 por ciento corresponde al distrito de Campo Verde. El 80 por ciento de los pacientes provenían de un área rural y el 56 por ciento de los casos fueron de sexo femenino. Afecta a la población pediátrica en un 44 por ciento (7 casos); y el compromiso de las lesiones cutáneas fue generalizado en un 100 por ciento de los casos; sin compromiso de mucosas. El signo de Nikolsky estuvo presente en el 50 por ciento. En todos los casos se encontró acantólisis subcórnea y sólo el 40 por ciento tuvo inmunofluorescencia positiva para pénfigo.

Subependimoma intraventricular / Intaventricular subependimoma

Se presenta el caso de una paciente de 52 años de edad quien desarrolló un tumor neuroepitelial clasificado como subependimoma del septum pellucidum con una expresión clínica exclusiva de síntomas psiquiátricos. Se intervino quirúrgicamente y se cuido la resección del borde inferior hacia el hipotálamo y subtálamo asistido con neuroendoscopía, la evolución de la paciente hasta hoy ha sido satisfactoria. La presentación de este tumor en la paciente permite la revisión en la historia y características de esta lesión descritas hasta este momento.

Leishmaniasis cutánea, mucocutánea y cutánea difusa. Revisión clínica de los casos en el Hospital Regional de Pucallpa de 1997 a 1999 / Cutaneous, mucocutaneous and diffuse cutaneous leishmanisias. Clinical revision of cases from Hospital Regional de Pucallpa

La literatura actual reconoce para la región ciertos tipos de leishmaniasis pero no se tienen estudios originales que amplien estos conocimientos, siendo una incógnita su real implicancia socioeconómica, las áreas de mayor incidencia y las respuestas al tratamiento. Por ello el reconocimiento de estas variables facilitará la elaboración de recomendaciones para el mejor manejo de esta enfermedad en la región. En el presente estudio se revisan las fichas de investigación epidemiológica del Programa de Control de la Leishmaniasis en el Hospital Regional de Pucallpa con el objetivo de establecer en qué medida el programa fue efectivo en el manejo clínico de los casos atendidos durante los años 1997-1999. Los autores del presente trabajo estamos seguros que los aportes aquí expresados servirán de base para el desarrollo de futuros proyectos de investigación que mejorarán los actuales protocolos de tratamiento usados en el programa.