Efectividad de la insulina tópica en el tratamiento de patologías de la superficie corneal / Effectiveness of topical insulin for the treatment of surface corneal pathologies

El propósito es identificar a través de una revisión sistemática de la literatura, la evidencia actual frente a la eficacia del tratamiento de la insulina tópica en patologías de la superficie ocular. Se implementó una búsqueda de literatura en bases de datos de indexación médica Medline (Pubmed), Embase y Web Of Science a través de palabras claves como «insulin» AND «córnea» OR «corneal» OR «dry eye» artículos publicados en inglés o español en los últimos once años (2011-2022). Se identificaron nueve artículos con 180 participantes provenientes de Estados Unidos, España, Irlanda, Canadá, Portugal y Malasia, con defectos epiteliales persistentes refractarios y secundarios a vitrectomía, cuya extensión de la lesión fue de 3,75 mm2 hasta 65,47 mm2. La preparación fue disuelta con lágrimas artificiales y la concentración de insulina fue desde 1 UI/ml hasta 100 UI/ml. En todos los casos la resolución del cuadro clínico fue completa con un tiempo de curación desde 2,5 días hasta 60,9 días siendo este último un caso secundario a una quemadura por cáusticos de difícil control. La insulina tópica ha sido efectiva para el tratamiento de defectos epiteliales persistentes; la de acción intermedia y en bajas concentraciones demostró menor tiempo de resolución, en úlceras neurotróficas y secundarias a vitrectomías (AU)

The purpose is to identify, through a systematic literature review, the current evidence regarding the effectiveness of topical insulin treatment in ocular surface pathologies. A literature search was implemented in Medline (Pubmed), Embase and Web Of Science medical indexing databases by using keywords such as “insulin” AND “cornea” OR “corneal” OR “dry eye” in published papers in English or Spanish within the last eleven years (2011-2022). Nine papers were identified with 180 participants from the United States, Spain, Ireland, Canada, Portugal and Malaysia, with persistent refractory epithelial defects and secondary to vitrectomy, whose extension of the lesion was from 3.75 mm2 to 65.47 mm2. The preparation was dissolved with artificial tears and the insulin concentration ranged from 1 IU/ml to 100 IU/ml. In all cases, the resolution of the clinical picture was complete with a healing time from 2.5 days to 60.9 days, the latter being a secondary case to a difficult-to-control caustic burn. Topical insulin has been effective for the treatment of persistent epithelial defects. The intermediate action and low concentrations showed a shorter resolution time in neurotrophic ulcers and induced during vitreoretinal surgery (AU)

Effectiveness of topical insulin for the treatment of surface corneal pathologies.

The Purpose is to identify, through a systematic literature review, the current evidence regarding the effectiveness of topical insulin treatment in ocular surface pathologies. A literature search was implemented in Medline (Pubmed), Embase and Web Of Science medical indexing databases by using keywords such as "insulin" AND "cornea" OR "corneal" OR "dry eye" in published papers in English or Spanish within the last eleven years (2011-2022). Nine papers were identified with 180 participants from the United States, Spain, Ireland, Canada, Portugal and Malaysia, with persistent refractory epithelial defects and secondary to vitrectomy, whose extension of the lesion was from 3,75mm2 to 65.47mm2. The preparation was dissolved with artificial tears and the insulin concentration ranged from 1 IU/ml to 100 IU/ml. In all cases, the resolution of the clinical picture was complete with a healing time from 2.5 days to 60.9 days, the latter being a secondary case to a difficult-to-control caustic burn. Topical insulin has been effective for the treatment of persistent epithelial defects. The intermediate action and low concentrations showed a shorter resolution time in neurotrophic ulcers and induced during vitreoretinal surgery.

TOP2A/MCM2, p16INK4a, and cyclin E1 expression in liquid-based cytology: a biomarkers panel for progression risk of cervical premalignant lesions.

BACKGROUND: To improve the efficiency of early diagnosis systems for cervical cancer, the use of cellular and viral markers for identifying precancerous lesions with a greater probability to progress to cancer has been proposed. Several cellular proteins and markers of oxidative DNA damage have been suggested as possible biomarkers of cervical carcinogenesis; however, they have not been evaluated together. In this study, we analyzed the expression of the cellular markers p16INK4a, Ki-67, CyclinE1, TOP2A/MCM2, and telomerase, as well as the DNA oxidative damage markers ROS and 8-OHdG. The analyses were performed in liquid-based cervical cytology samples or biopsies with premalignant lesions or cervical cancer diagnosis, with the purpose of selecting a panel of biomarkers that allow the identification of precursor lesions with greater risk of progression to cervical cancer. METHODS: We analyzed 1485 liquid-based cytology samples, including 239 non-squamous intraepithelial lesions (NSIL), 901 low-grade squamous intraepithelial lesions (LSIL), 54 high-grade squamous intraepithelial lesions (HSIL), and 291 cervical cancers (CC). The biomarkers were analyzed by immunocytochemistry and Human Papilloma Virus (HPV) genotyping with the INNO-LiPA genotyping Extra kit. RESULTS: We found that all tested cellular biomarkers were overexpressed in samples with high risk-HPV infection, and the expression levels increased with the severity of the lesion. TOP2A/MCM2 was the best biomarker for discriminating between LSIL and HSIL, followed by p16INK4a and cyclinE1. Statistical analysis showed that TOP2A/MCM2 provided the largest explanation of HSIL and CC cases (93.8%), followed by p16INK4a (91%), cyclin E1 (91%), Ki-67 (89.3%), and telomerase (88.9%). CONCLUSIONS: We propose that the detection of TOP2A/MCM2, p16INK4a and cyclin E1 expression levels is useful as a panel of biomarkers that allow identification of cervical lesions with a higher risk for progression to CC with high sensitivity and precision; this can be done inexpensively, in a single and non-invasive liquid-based cytology sample.

Regional Brain Perfusion Is Associated with Endothelial Dysfunction Markers in Major Depressive Disorder.

BACKGROUND: Major depressive disorder (MDD) is an important independent risk factor for cardiovascular disease. Cumulative data suggest that depressive patients exhibit derangement in regional cerebral blood flow (rCBF), although underlying mechanisms remain mostly unknown. Endothelial dysfunction (ED), defined as different forms of abnormal endothelial activity, plays a key role in the pathogenesis of vascular disease. ED is associated with several clinical conditions characterized by high cardiovascular risk. Diverse ED markers have been found in mood disorders. PURPOSE: To evaluate the association between rCBF and peripheral ED markers in MDD patients, at baseline and after selective serotonin receptor inhibitors (SSRIs) therapy. PATIENTS AND METHODS: Twenty-seven untreated unipolar MDD patients in their first episode were evaluated with the Hamilton Depression Rating Scale (HAM-D) and brain perfusion SPECT at baseline and after 2 months of SSRIs. Statistical Parametric Mapping (SPM) was employed to evaluate rCBF; circulating endothelial cells (CECs), plasma soluble intercellular adhesion molecule (sICAM), and high-sensitivity C-reactive protein (hsCRP) were used as independent covariates. RESULTS: Baseline CECs and sICAM were increased in MDD patients compared with matching controls (p = 0.0001) and hsCRP (p = 0.03). HAM-D scores (21 items) and CECs diminished after SSRI therapy in MDD patients (p < 0.0001). There was a significant rCBF decrease, mainly in deep central structures. HAM-D change was associated with rCBF decrease at the left amygdala, right striatum levels, and Brodmann area 25. CEC change was associated with rCBF at deep brain level and sICAM with large rCBF areas at the left caudate and tectum; hsCRP was associated, to a lesser extent, with the left dorsal striatum and mesencephalic tectum. CONCLUSION: ED markers in patients with MDD are associated with significant changes in rCBF which are features of depression. These findings suggest that systemic damage/activation of the endothelium may contribute to the abnormal rCBF observed in MDD patients.

Impacto de la hipertensión arterial sobre la microcirculación pulpar / Impact of arterial hypertension on pulp microcirculation

Resumen Introducción: La hipertensión arterial, es una enfermedad crónica, la cual es considerada un problema de salud pública en todo el mundo. Se conoce que es causada por distintos mecanismos fisiopatológicos. De la misma forma las alteraciones pulpares son muy comunes, siendo un grupo de cuadros clínicos de origen infeccioso e inflamatorio. Objetivo: El propósito de este artículo es dar a conocer si existe algún impacto de la hipertensión arterial sobre la microcirculación pulpar. Métodos: Revisión de literatura Conclusiones: La pulpa dental no es propensa a alteraciones importantes ante fenómenos antihipertensivos.

Abstract Introduction: Hypertension, is a chronic disease, which is considered a public health problem throughout the world. It is known that it is caused by different physiopathological mechanisms. In the same way, the alterations are very common, as a group of clinical characteristics of infectious and inflammatory origin. Objective: The purpose of this article is to show if there is any impact of high blood pressure on the pulpal microcirculation. Methods: Literature Review Conclusions: The dental pulp does not develop considerable alterations when subjected to antihypertensive phenomena.

Redes de atención en salud: alcances territoriales y colaboración institucional en el seguimiento de pacientes pediátricos en la Red del Sudeste Bonaerense / Health care networks: territories and institutional collaboration for extended treatments of pediatric patients within Southeastern Metropolitan Area of Buenos Aires

OBJETIVO: Este trabajo presenta el inicio de un proyecto de largo término que analiza la dinámica local de circulación de pacientes y colaboración profesional entre el conjunto de efectores localizados en los partidos de Florencio Varela, Berazategui, Alte. Brown y Quilmes, denominado la Red del Sudeste Bonaerense. Ésta articula efectores de primer, segundo y tercer nivel de atención (169 en total), asiste a 2 millones de personas anualmente en una de las áreas con mayor población del país y con altos niveles de necesidades básicas insatisfechas. METODOLOGÍA: La metodología se plantea desde los métodos mixtos que articulan técnicas cualitativas y cuantitativas para la recolección, procesamiento y análisis de la información de los efectores de la Red, a partir de: registros de pacientes pediátricos, datos epidemiológicos y trabajo de campo etnográfico. Complementariamente, se articulan tres líneas multi-disciplinarias: Análisis de sistemas y servicios de salud en red; Análisis espacial entre centros de salud; Análisis de redes sociales (identifica estructuras y dinámicas de flujo y colaboración). RESULTADOS: Los resultados sugieren: a) la estructura de derivaciones la HEC tiene una forma de "estrella", b) mayor cantidad de derivaciones desde los distritos de la Red del Sudeste que de otros efectores, c) Coeficiente de Jaccard es bajo, d) dificultades en el mecanismo de contra-referencia, e) la estructura de colaboración entre 25 especialidades es un modelo "centro/periferia", f) emergen subgrupos de acuerdo a las patologías derivadas. CONCLUSIÓN: Se concluye con una discusión sobre la importancia de la interacción estructural entre las especialidades para la atención compleja de patologías pediátricas. Finalmente, la centralidad del HEC en la dinámica de derivaciones pediátricas se corresponde con su condición de único efector de tercer nivel de la región, su robusta comunicación con los efectores en el territorio así como por su posicionamiento como referente nacional de derivación por patologías específicas.

OBJECTIVE: This paper presents the beginning of a long-term project that analyses local dynamics of patient transfers and professional collaboration among a formal assistance network of health providers called the "Southeastern Network" localized in four districts in the Metropolitan Area of Buenos Aires: F. Varela, Berazategui, Alte. Brown y Quilmes. This network connects primary, secondary and tertiary care levels (169 in total) and assists over 2 million people annually in the region, one of the most populated and deprived areas in Argentina. METHODS: Methodological strategies point toward a mixed methods approach, which articulates qualitative and quantitative methods for collecting, processing and analyzing the information from the network care providers: patients institutional registers, epidemiological data and ethnographic field work.Additionally, we follow three multi-disciplinary lines: health systems and services analysis, special analysis regarding care providers, Social Network Analysis (identifying structures and dynamics of patients flow and professional collaboration). RESULTS: Suggest: a) the structure of patients' referral is "star" model b) there are more referrals from the Network's districts than from other areas c) Jaccard Coefficient is low, d) there are some difficulties in counter-referral mechanisms e) professional collaboration structure among 25 medical specialties is a "center/periphery" model f) some subgroups emerge from assisting certain pathologies. CONCLUSIONS: We conclude with a discussion on the importance of structural interaction among medical specialties for complex pediatric care. Finally, the centrality of El Cruce Hospital within pediatric referrals in this area correspond to the fact that it is the only tertiary care provider, it maintains robust communications with other care providers and it is positioned as national reference for specific pathologies referral.

Mucocele del seno maxilar: Reporte de caso

Los mucoceles maxilares son lesiones que tienen un crecimiento gradual. Son de tipo quístico y contienen secreciones mucoides que causan erosiones a estructuras vecinas al aumentar su tamaño. Aunque la mayoría de las veces son completamente asintomáticas, pueden presentarse síntomas como dolor facial opaco, inflamación en la mejilla, y obstrucción nasal. Estos síntomas y cambios en la simetría facial se hacen presentes cuando hay erosión significativa de estructuras anatómicas circundantes. EL seno maxilar es el sitio menos frecuente donde se forman , y su diagnóstico se realiza con la ayuda de una tomografía computadorizada. La remoción quirúrgica completa es el mejor tratamiento indicado.

The maxillary sinus mucoceles are lesions which grow gradually. They are cyst like lesions which have mucoid secretions that cause erosion to neighboring structures as they increase in size. Although they are often asymptomatic, they can be present as dull orofacial pain, inflammation on the cheek and nasal obstruction. These symptoms and changes in facial symmetry are present when there is significant erosion to surrounding anatomic structures. The Maxillary Sinus is the less frequent site where these lesions will form, and the diagnosis is done with the assistance of Computerized Tomography. Complete surgical removal is the best treatment option.

Adenocarcinoma NOS de glándula salival menor en paladar: Reporte de un caso clínico

El adenocarcinoma no especificado o adenocarcinoma NOS de glándula salival, como comúnmente se le llama por sus siglas en inglés "Not Otherwise Specified", es un tipo de neoplasia que no cumple con los requisitos histológicos establecidos para lograr categorizarla dentro de los tumores que afectan las glándulas salivales. A causa de que son muy poco frecuentes, se ha dificultado su estudio, y el conocimiento que se tiene sobre esta entidad es escaso. El objetivo del presente artículo es el de reportar el caso de un paciente masculino de 68 años de edad, quien desarrolla un adenocarcinoma NOS a partir de una glándula salival menor a escala del paladar. Se detalla el alcance que tiene este tipo de patología en cuanto a la invasión, destrucción y alteración que puede generar localmente en el paciente, así como su comportamiento bajo la radio y quimioterapia.

Adenocarcinoma NOS of a minor salivary gland is a type of tumor that does not meet the histological requirements that it needs to be categorized within other salivary gland tumors. Because of their infrequency, there is little known about these tumors. The aim of this paper is to report the case of a 68 years old male patient, who developed an adenocarcinoma NOS arising from a minor salivary gland in the palate. The local invasion and destruction, as well as its behavior under radio and chemotherapy is discussed.

Dentinogénesis imperfecta: reporte de un caso clínico y revisión literaria

La dentinogénesis imperfecta (DI), es una enfermedad poco frecuente que puede afectar ambas denticiones, y las implicaciones de un mal manejo podría traer consecuencias tanto estéticas como funcionales al paciente, por lo que es importante poder identificar las principales características de esta patología para brindar un adecuado diagnóstico y manejo en la práctica odontológica.

Dentinogenesis imperfect is a rare disease that can affect both dentitions, and implications of an inadequate management could bring aesthetic and functional consequences to the patient, so there is important to identify the main features of the disease to provide adequate diagnosis and management in the dental practice.

Impacto de la hipertensión arterial sobre la microcirculación pulpar

Introducción: La hipertensión arterial, es una enfermedad crónica, la cual es considerada un problema de salud pública en todo el mundo. Se conoce que es causada por distintos mecanismos fisiopatológicos. De la misma forma las alteraciones pulpares son muy comunes, siendo un grupo de cuadros clínicos de origen infeccioso e inflamatorio. Objetivo: El propósito de este artículo es dar a conocer si existe algún impacto de la hipertensión arterial sobre la microcirculación pulpar. Métodos: Revisión de literatura Conclusiones: La pulpa dental no es propensa a alteraciones importantes ante fenómenos antihipertensivos.

Introduction: Hypertension, is a chronic disease, which is considered a public health problem throughout the world. It is known that it is caused by different physiopathological mechanisms. In the same way, the alterations are very common, as a group of clinical characteristics of infectious and inflammatory origin. Objective: The purpose of this article is to show if there is any impact of high blood pressure on the pulpal microcirculation. Methods: Literature Review Conclusions: The dental pulp does not develop considerable alterations when subjected to antihypertensive phenomena.

Trends in infant mortality rate and mortality for neonates born at less than 32 weeks and with very low birth weight.

The aim of the study was to assess the trend of the infant mortality rate between 1990-2004 and the neonatal mortality between 2000-2005 in infants born at less than 32 weeks of gestational age or with very low birth-weight. Based on secondary data, infant mortality rate and by its component for Valdivia city were compared with national indicators. Mortality at <32 weeks and <1500g was calculated, establishing causes of death and evaluating its relation with specific interventions, such as the use of surfactant and antenatal corticoids. Since the year 2000, infant mortality rates have stopped their decrease in comparison to the preceding decade and the gap between national and local rates before 2000 was drastically reduced. Mortality at <32 weeks and <1500g varied between 88% and 200% of liveborns, emphasizing respiratory distress as the main cause of death. The use of corticoids and surfactant was in line with reductions in mortality rates.

Trends in Infant mortality rate and mortality for neonates born at less than 32 weeks and with very low birth weight / Tendência da mortalidade infantil e dos neonatos menores de 32 semanas e de muito baixo peso / Tendencia de la mortalidad infantil y de neonatos menores de 32 semanas y de muy bajo peso

The aim of the study was to assess the trend of the infant mortality rate between 1990-2004 and the neonatal mortality between 2000-2005 in infants born at less than 32 weeks of gestational age or with very low birth-weight. Based on secondary data, infant mortality rate and by its component for Valdivia city were compared with national indicators. Mortality at <32 weeks and <1500g was calculated, establishing causes of death and evaluating its relation with specific interventions, such as the use of surfactant and antenatal corticoids. Since the year 2000, infant mortality rates have stopped their decrease in comparison to the preceding decade and the gap between national and local rates before 2000 was drastically reduced. Mortality at <32 weeks and <1500g varied between 88‰ and 200‰ of liveborns, emphasizing respiratory distress as the main cause of death. The use of corticoids and surfactant was in line with reductions in mortality rates.

Para avaliar a tendência da mortalidade infantil, entre 1990 e 2004, a mortalidade de prematuros <32 semanas de idade gestacional e crianças de muito baixo peso ao nascer, entre 2000 e 2005, compararam-se dados secundários globais e por componentes do Serviço de Saúde Valdivia, e do total do país (Chile). Calculou-se a mortalidade específica em <32 semanas e <1.500g, por mil nascidos vivos, estabelecendo causas de óbito e avaliando sua relação com intervenções específicas, como uso de surfactante e corticoides pré-natais. A mortalidade infantil deteve sua queda a partir do ano 2000, com referência à década precedente, e a brecha que existia, entre os valores nacionais e locais antes de 2000, reduziu drasticamente. A mortalidade em <32 semanas e <1.500g variou entre 88 e 200‰ nascidos vivos, destacando a síndrome da angústia respiratória como principal causa de morte. O uso de corticoides e surfactante coincidiu com reduções da mortalidade.

Para evaluar la tendencia de la mortalidad infantil entre 1990-2004 y la mortalidad de prematuros menores de 32 semanas de edad de gestación y niños de muy bajo peso al nacer, entre 2000-2005, se compararon los datos secundarios globales por componentes del Servicio de Salud Valdivia con los totales del país, en Chile. Se calculó la mortalidad específica, por mil nacidos vivos, para los <32 semanas y <1500g, estableciendo causas de muerte y evaluando su relación con intervenciones específicas, como el uso de surfactante y corticoides prenatales. Respecto a la década precedente, la mortalidad infantil detuvo su descenso a partir del año 2000 y la brecha existente entre los valores nacionales y locales previa al 2000 se redujo drásticamente. La mortalidad en los nacidos vivos con <32 semanas y <1500g varió entre 88‰ a 200‰, destacándose el síndrome de distrés respiratorio como la principal causa de muerte. El uso de corticoides y surfactante coincidió con las reducciones de la mortalidad.

El derecho a la muerte digna: 2 parte / The right to die with dignity: part 2

El derecho a la muerte digna -en nuestro país- ha sido producto de una creación jurisprudencial constitucional. Es decir, se creó un derecho fundamental, vía jurisprudencia, al desarrollar conceptos plasmados en la Constitución Política. Es importante resaltar el criterio de don Rubén Hernández Valle en cuanto al aspecto teleológico que el derecho a la vida encierra. Dice que lógicamente este derecho se refiere, en primer término, a la vida física, biológica del ser humano. No obstante, es conveniente recordar que la vida humana no se agota, como en el caso de los animales, en su manifestación netamente biológica. En él, por el contrario, lo más importante de su existencia es el aspecto espiritual, dado que es el único ser de la naturaleza cuya conducta es teleológica, es decir, el único ser que introduce fines en ella, para tratar de conformarla de acuerdo con sus ideas

El derecho a la muerte digna: 1 parte / The right to die with dignity: part 1

El ser humano no solo tiene derecho a existir (vivir biológicamente) sino a tener una adecuada calidad de vida. El derecho a la vida comprende tener derecho a un buen vivir. Sin embargo, todos tenemos la certeza de que un día moriremos, a pesar de no saber cómo ni bajo qué circunstancias. Así como existe de derecho humano a vivir con dignidad, debe existir también el derecho a morir dignamente. El objetivo del presente trabajo es analizar el derecho a la muerte digna desde el punto de vista de la ortotanasia, llamada por algunos eutanasia pasiva, que supone el no alargar la vida del enfermo incurable para evitarle sufrimientos inútiles