Muerte accidental atípica. A propósito de un caso / Fortuitous atypical death. A case report

En la Medicina Legal se presentan con frecuencia casos que tienen como etiología médico-legal la accidental, en sus más variadas situaciones. Accidente es cualquier hecho o fenómeno traumático o morboso espontáneo que sobreviene en el individuo sano, o en el curso de una enfermedad. La amplitud de los términos de esta definición obliga a tener presente que los diferentes tipos de accidentes se hallan condicionados por múltiples fenómenos de carácter imprevisible e incontrolable. En el presente estudio, se expone un caso poco común y atípico de accidente doméstico, que lamentablemente culminó con la muerte de la víctima. Se trata de una anciana de 72 años que, según datos aportados por la instrucción policial, fue hallada en su domicilio, tendida en la cocina, con una herida incisa penetrante en la cavidad torácica. Tenía antecedentes de epilepsia desde la infancia, para lo cual seguía un tratamiento, y se pudo conocer que había manifestado sentirse mal antes de quedarse sola en la vivienda

In Legal Medicine, there are frequently cases having an accidental medico-legal etiology in its more varied situations. An accident is any spontaneous traumatic or morbid fact or phenomenon that happens in a healthy individual or in the course of an illness. The wideness of this definition terms obliges us to take into the account that the different kinds of accidents are conditioned by multiple phenomena of unforeseeable and uncontrollable character. In the current work, we expose an uncommon, atypical home accident, unfortunately ending in the victim’s death; it deals with an elder woman aged 72 years who, according with the data provided by the police instruction was found lying in the kitchen of her house with an incised penetrating wound in the thoracic cavity. She had antecedents of epilepsy since childhood, and for that was treated; it was obtained information that she referred feeling bad before staying alone at home

Esquizofrenia paranoide y peritación psiquiátrica forense. Presentación de un caso / Paranoid schizophrenia and forensic-psychiatric expert assessment. Case presentation

La Medicina Legal y la Psiquiatría son ciencias estrechamente relacionadas, y es habitual que los peritos médicos asesoren a los tribunales y jueces en materias de carácter psiquiátrico, para ayudar a esclarecer hechos delictivos. Establecer el estado mental de una persona que comete un delito, analizar de forma retrospectiva a qué nivel funcionaba el sujeto cuando lo cometió, y a su vez, establecer su facultad para comprender el alcance de su acción y dirigir su conducta en dicho momento, es una de las tareas más difíciles que se le presenta a la Psiquiatría Forense. En este artículo, se aborda de manera conjunta, por un equipo multidisciplinario, la presentación de un caso que se llevó a la comisión de peritación mental de la ciudad de Matanzas, en Cuba, ya que se acusaba a un joven con antecedentes de esquizofrenia paranoide del delito de homicidio en grado de tentativa, y era imperativo para el tribunal poder dilucidar si el sujeto en cuestión, en el momento de agredir a su víctima, conservaba o no la facultad para comprender el alcance de su acción y dirigir su conducta

Legal Medicine and Psychiatry are tightly related sciences, being usual that medical experts advise our courts and judges in the subjects of psychiatric character for helping in clarifying criminal acts. To establish the mental status of a person committing a criminal offence, to analyze retrospectively the level the subject functioned at when he committed it, and at the same time, to establish his faculty to understand the reach of his actions and to direct his behaviour at that moment, are the most difficult tasks that Forensic Psychiatry could afford. In this article, a multidiscipline team works in the presentation of a case that was taken to the mental assessment commission of Matanzas, Cuba, because a young man, with antecedents of paranoid schizophrenia, was accused in attempted murder, and it was imperative for the court to elucidate if, at the moment of assaulting his victim, the judged kept or not the faculty of understanding the reach of his action and directing his behavior

Frecuencia de desnutrición pediátrica en hospitales de Cuba / Incidence of hospital pediatric malnutrition in Cuba

Introducción: La desnutrición es un problema de salud generalizado. En combinación con una enfermedad subyacente, reduce la calidad de vida e incrementa la mortalidad general y la de grupos específicos. Objetivo: Determinar la frecuencia de desnutrición pediátrica en hospitales de Cuba. Métodos: Estudio prospectivo, multicéntrico y descriptivo, que se desarrolló en 8 hospitales de Cuba. La población de estudio estuvo constituida por todos los niños de ambos sexos, de entre 1 mes y 19 años de edad, que ingresaron en el hospital, durante un periodo de 3 meses (desde el 1 de julio al 31 de septiembre de 2011). A todos los pacientes incluidos en el estudio se les realizó una encuesta en las primeras 48 horas de su ingreso. Las variables antropométricas utilizadas fueron el peso y la talla. Con ambos datos de determinó el índice de masa corporal (IMC), que nos permitió clasificar el estado nutricional, según las curvas de crecimiento de la Organización Mundial de la Salud: de 2006 para los menores de 5 años y de 2007 para los de ≥5 años. El análisis de datos se realizó con el paquete estadístico SPSS versión 18.0. Resultados: Se encontró una frecuencia de desnutrición del 12,1% según el Z Score IMC/edad, y un 30,1% de sobrepesoobesidad. De los pacientes desnutridos, el 18% correspondió al grupo de escolares, seguidos por los adolescentes (15%) y los lactantes (9%). El 82,9% de los niños ingresó por causas médicas. Conclusiones: El estudio demostró que la herramienta utilizada permitió evaluar y clasificar el estado nutricional al ingreso hospitalario (AU)

Title: Incidence of hospital pediatric malnutrition in Cuba Introduction: Malnutrition is a generalized health problem. There is an increased morbimortality when it appears combined with another disease, mainly in some specific groups of patients. Objective: To determine how frequent is the hospital pediatric malnutrition in Cuba. Methods: A descriptive, prospective and multicentre study was conducted in 8 cubans hospitals. Population included children from 1 month to 19 years old who were interned at hospital from July 1 to September 31, 2011. Interviews were made in the first 48 hours at hospital. Anthropometrics variable were collected. Body mass index (BMI) was calculated and nutrition state was determined with WHO curves, 2006 and 2007 in patients with less and 5 or more than 5 years old respectively. Statistic analysis was made with SPSS version 18.0. Results: Malnutrition incidence was 12.1% according to Z Score BMI/age and obesity or overweigh was 30.1%. Malnutrition were more frequent in scholar group (18%) followed by teenagers (15%) and infants 9%. Medical causes were the main indication of hospitals admissions (82.9%). Conclusions: The study demonstrated that the tool used allowed to evaluate and classify the nutritional status at admission (AU)

[Mycotic aneurysm caused by Aspergillus of the aortic suture line after heart transplantation]. / Aneurisma micótico por Aspergillus en la línea de sutura aórtica tras el trasplante cardíaco.

The first case of mycotic aneurysm of aorta by Aspergillus in a patient with heart transplantation is described, in which the infection was produced by direct surgical contamination of the aortic suture. The period of latency was of eight months. The unusualness of the case and its diagnostic difficulties, are is commented.

[Pulmonary arterial hypertension and heart transplantation: hemodynamic evolution and survival]. / Hipertensión arterial pulmonary y trasplante cardíaco: evolución hemodinámica y supervivencia.

BACKGROUND: Patients with chronic heart failure and pulmonary arterial hypertension are at risk of developing fatal right graft failure after transplantation, and there is no agreement about the limit of pulmonary vascular resistance for such risk. PURPOSE: To study what the impact is on the survival of a degree of pulmonary hypertension not considered to be an exclusion for orthotopic heart transplantation and to analyze the hemodynamic profile in the minor circuit after surgery. PATIENTS AND METHODS: We studied a group of 69 patients consecutively transplanted and with followup of at least one year. Patients were classified in two groups depending on the hemodynamic factors previous to transplant: group A (without pulmonary hypertension, 22 patients) and group B (with pulmonary hypertension, 47 patients). After heart transplantation we analyzed the causes of mortality and the evolution hemodynamic profile in both groups. RESULTS: In the group of patients with pulmonary hypertension there was an increase in perioperative mortality due to graft failure (p < 0.05), although at the end of the first year, the survival rate was similar in both groups. After heart transplantation, the level of pulmonary pressures dropped in the same group, but at the end of the first year, a 17% of the patients maintains some criteria of pulmonary hypertension. CONCLUSIONS: Our results confirm that degrees of pulmonary hypertension classically not considered as an exclusion for orthotopic heart transplantation were associated with an increase mortality by graft failure. The majority of survivors after heart transplantation normalize pulmonary pressures at one year of transplantation.