Quantitative Studies of Diabetic Foot Ulcer Evolution Under Treatment by Digital Stereotactic Photography.

BACKGROUND: Imaging the lower extremity reproducibly and accurately remains an elusive goal. This is particularly true in the high risk diabetic foot, where tissue loss, edema, and color changes are often concomitant. The purpose of this study was to evaluate the reproducibility of a novel and inexpensive stereotaxic frame in assessment of wound healing. METHODS: The main idea is to keep constant and reproducible the relative position of extremities related to the sensor used for the examination during a serial studies by stereotaxic digital photographic sequence. Ten healthy volunteers were evaluated at 10 different time moments to estimate the foot position variations in the stereotaxic frame. The evolution of 40 of DFU patients under treatment was evaluated before and during the epidemical grow factor intralesional treatment. RESULTS: The wound closing and granulation speeds, the relative contribution of the contraction and tissue restauration mechanism were evaluated by stereotaxic digital photography. CONCLUSIONS: The results of this study suggest that the stereotaxic frame is a robust platform for serial study of the evolution of wound healing which allow to obtain consistent information from a variety of visible and hyperspectral measurement technologies. New stereotaxic digital photography evidences related to the diabetic foot ulcer healing process under treatment has been presented.

Relación entre rendimiento académico y agudeza visual, en niños de quinto, sexto y séptimo año de básica en la escuela. Juan Celio Secaira del cantón. San José de Chimbo provincia de Bolívar en el período de noviembre 2013 - abril del 2014 / Relationship between academic performance and visual acuity, in children of the fifth, sixth and seventh year of basic school. Juan Celio Secaira of the canton. San José de Chimbo province of Bolívar in the period from November 2013 - April 2014

La percepción visual o agudeza visual es el medio por el cual se recibe, aproximadamente, el 70% de la información y es clave para el desarrollo físico de un niño, para su éxito escolar y su bienestar general. El sistema óptico no está plenamente desarrollado en los bebés y en los niños pequeños y se requiere un insumo equilibrado de ambos ojos para que los centros de visión del cerebro se desarrollen normalmente. En nuestra investigación. Identificamos la relación directa que tiene la agudeza visual con el rendimiento académico. Se realizó un estudio descriptivo, correlacional, transversal en el universo de 130 alumnos con una edad comprendida entre 8 a 13 en la Escuela. Juan Celio Secaira del cantón. San José de Chimbo provincia de Bolívar. Se determinó que el 23,84% de toda la población presentó un tipo de trastorno en la agudeza visual (astigmatismo e hipermetropía) de los cuales únicamente el 16,91% de la población presentaron corrección con anteojos. El 6,93% restante de la población presentaron un rendimiento escolar tan solo del 49,23% siendo un valor que se encuentra por debajo de la media, demostrando que la agudeza visual influye directamente en el desarrollo intelectual del escolar. Alertándonos a realizar un tamizaje visual cada año especialmente a niños y adolescentes.

Visual perception or visual acuity is the means by which approximately 70% of information is received and is key to a child's physical development, school success, and overall well-being. The optic system is not fully developed in infants and young children and requires a balanced input of both eyes so that the centers of vision of the brain develop normally. In our research. We identified the direct relationship between visual acuity and academic performance. A descriptive, correlational, transversal study was carried out in the universe of 130 students with an age between 8 and 13 in the School. Juan Celio Secaira of the canton. San José de Chimbo province of Bolívar. It was determined that 23.84% of the entire population presented a type of visual acuity disorder (astigmatism and hypermetropia) of which only 16.91% of the population presented correction with glasses. The remaining 6.93% of the population had a school performance of only 49.23%, a value that is below the average, showing that the visual acuity directly influences the intellectual development of the school. Alert us to carry out a visual screening every year especially to children and adolescents

Modificaciones de la rigidez arterial, el grosor íntima-media carotídeo y la grasa epicárdica con tratamiento sustitutivo en el hipotiroidismo / Changes in arterial stiffness, carotid intima-media thickness, and epicardial fat after L-thyroxine replacement therapy in hypothyroidism

OBJETIVO: Determinar la relación del hipotiroidismo primario con la aterosclerosis carotídea subclínica y sus posibles modificaciones con la terapia sustitutiva. MÉTODOS: Se realizó un estudio de cohorte prospectivo que incluyó 101 pacientes con diagnóstico de hipotiroidismo primario y 101 pacientes eutiroideos como controles, desde julio del año 2011 hasta diciembre del 2013. Se incluyeron variables clínicas, antropométricas, bioquímicas y ultrasonográficas, evaluadas al inicio del estudio y al año de tratamiento sustitutivo con levotiroxina sódica. RESULTADOS: Los sujetos afectos de hipotiroidismo al inicio mostraron valores significativamente mayores de tensión arterial, colesterol total, colesterol VLDL, masa del ventrículo izquierdo, grasa epicárdica y grosor íntima-media carotídeo, respecto a los controles. El colesterol total, el colesterol VLDL, la función diastólica ventricular, la grasa epicárdica, el grosor íntima media, la velocidad de propagación del pulso carotídeo, la elastancia y el índice de rigidez arterial β mostraron una correlación positiva y significativa con las concentraciones de TSH. Al año de tratamiento, los pacientes afectos de hipotiroidismo tuvieron modificaciones para el colesterol total, el colesterol VLDL, la TSH, el grosor íntima-media y los parámetros de rigidez arterial. CONCLUSIONES: Los pacientes afectos de hipotiroidismo primario se caracterizan por mayor riesgo cardiometabólico. La sustitución con levotiroxina sódica en estos pacientes se relaciona con una mejoría de la dislipidemia, y mejoría de los indicadores de aterosclerosis carotídea subclínica al año de iniciado el tratamiento

OBJECTIVE: To assess the relationship between primary hypothyroidism and subclinical atherosclerosis and its potential changes with L-thyroxine replacement therapy. METHODS: A prospective cohort study including 101 patients with primary hypothyroidism and 101 euthyroid patients as controls was conducted from July 2011 to December 2013. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of L-thyroxine replacement therapy. RESULTS: At baseline, hypothyroid patients had significantly greater values of blood pressure, total cholesterol, VLDL cholesterol, left ventricular mass, epicardial fat, and carotid intima-media thickness as compared to controls. Total cholesterol, VLDL cholesterol, ventricular diastolic function, epicardial fat, carotid intima-media thickness, carotid local pulse wave velocity, pressure strain elastic modulus, and β arterial stiffness index showed a significant and positive correlation with TSH levels. After one year of replacement therapy, patients with hypothyroidism showed changes in total cholesterol, VLDL cholesterol, TSH, carotid intima-media thickness, and arterial stiffness parameters. CONCLUSIONS: Primary hypothyroidism is characterized by an increased cardiovascular risk. In these patients, L-thyroxine replacement therapy for one year is related to decreased dyslipidemia and improvement in markers of subclinical carotid atherosclerosis

Changes in arterial stiffness, carotid intima-media thickness, and epicardial fat after L-thyroxine replacement therapy in hypothyroidism.

OBJECTIVE: To assess the relationship between primary hypothyroidism and subclinical atherosclerosis and its potential changes with L-thyroxine replacement therapy. METHODS: A prospective cohort study including 101 patients with primary hypothyroidism and 101 euthyroid patients as controls was conducted from July 2011 to December 2013. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of L-thyroxine replacement therapy. RESULTS: At baseline, hypothyroid patients had significantly greater values of blood pressure, total cholesterol, VLDL cholesterol, left ventricular mass, epicardial fat, and carotid intima-media thickness as compared to controls. Total cholesterol, VLDL cholesterol, ventricular diastolic function, epicardial fat, carotid intima-media thickness, carotid local pulse wave velocity, pressure strain elastic modulus, and ß arterial stiffness index showed a significant and positive correlation with TSH levels. After one year of replacement therapy, patients with hypothyroidism showed changes in total cholesterol, VLDL cholesterol, TSH, carotid intima-media thickness, and arterial stiffness parameters. CONCLUSIONS: Primary hypothyroidism is characterized by an increased cardiovascular risk. In these patients, L-thyroxine replacement therapy for one year is related to decreased dyslipidemia and improvement in markers of subclinical carotid atherosclerosis.

Tumor del estroma gastrointestinal del intestino delgado / Gastrointestinal stromal tumor of small intestine

Los tumores del estroma gastrointestinal fueron catalogados originalmente como otros tumores (leiomioma, leiomioblastoma o leiomiosarcoma), debido a su apariencia histológica similar; sin embargo, los avances en la biología molecular y la inmunohistoquímica, han permitido diferenciarlos de otras neoplasias digestivas, y definirlos como una entidad clínica e histopatológica propia. Se presenta un paciente, de sexo femenino, de la raza negra, de 79 años de edad, con dolor abdominal de 3 días de evolución, que se había iniciado en fosa ilíaca derecha y luego se mantuvo en bajo vientre, acompañado de vómitos, fatiga y decaimiento. Se decide intervenir quirúrgicamente y se lleva al salón de operaciones con el diagnóstico de una apendicitis aguda, del muñón, tipo oclusiva en el anciano, sin descartar una oclusión por bridas. Al realizar laparotomía se encuentra sangre libre en cavidad que no coagula, y se observó tumor hemorrágico, pediculado, muy móvil, hacia íleon terminal. Se realiza exéresis de este, se resecan aproximadamente 5 cm de intestino delgado y se realiza sutura termino-terminal posteriormente. Se realizó amplia toillette de la cavidad peritoneal y el cierre habitual, con evolución satisfactoria, y con alta a los 7 días. Se mantiene asintomática al año y medio de operada, y la biopsia arrojó tumor de intestino delgado, de bajo grado de malignidad, de 5 cm de diámetro(AU)

The tumors of the gastrointestinal stroma were originally classified as other type of tumors (leiomyoma, leiomyobastoma or leiomyosarcoma) due to it similar histological appearance; however, the advances in the molecular biology and the immunohistochemistry have allowed its differentiation of other digestive neoplasms and to define them as an own clinical and histopathological entity. This is the case of a black female patient aged 79 presenting with abdominal pain during 3 days of evolution started in the right iliac fossa and then it remains in the low belly accompanied by vomiting, fatigue and weakness. She was operated on and is diagnosed with a stump acute appendicitis and of occlusive type en elderly without to rule out an adhesion occlusion. Carrying out the laparotomy it was found that this not-coagulating cavity was blood-free and also a stalked hemorrhagic tumor with movements towards the terminal ileum. Authors carried out its exeresis resecting approximately 5 cm of small intestine with a termino-terminal suture later. A significant cleaning of peritoneal cavity was carried out with the habitual closure achieving a satisfactory evolution with her discharge at 7 days. Patient remains asymptomatic at one a half year postoperative and biopsy yielded a 5 cm-small intestine tumor with a low grade of malignancy(AU)

Tumor del estroma gastrointestinal del intestino delgado / Gastrointestinal stromal tumor of small intestine

Los tumores del estroma gastrointestinal fueron catalogados originalmente como otros tumores (leiomioma, leiomioblastoma o leiomiosarcoma), debido a su apariencia histológica similar; sin embargo, los avances en la biología molecular y la inmunohistoquímica, han permitido diferenciarlos de otras neoplasias digestivas, y definirlos como una entidad clínica e histopatológica propia. Se presenta un paciente, de sexo femenino, de la raza negra, de 79 años de edad, con dolor abdominal de 3 días de evolución, que se había iniciado en fosa ilíaca derecha y luego se mantuvo en bajo vientre, acompañado de vómitos, fatiga y decaimiento. Se decide intervenir quirúrgicamente y se lleva al salón de operaciones con el diagnóstico de una apendicitis aguda, del muñón, tipo oclusiva en el anciano, sin descartar una oclusión por bridas. Al realizar laparotomía se encuentra sangre libre en cavidad que no coagula, y se observó tumor hemorrágico, pediculado, muy móvil, hacia íleon terminal. Se realiza exéresis de este, se resecan aproximadamente 5 cm de intestino delgado y se realiza sutura termino-terminal posteriormente. Se realizó amplia toillette de la cavidad peritoneal y el cierre habitual, con evolución satisfactoria, y con alta a los 7 días. Se mantiene asintomática al año y medio de operada, y la biopsia arrojó tumor de intestino delgado, de bajo grado de malignidad, de 5 cm de diámetro(AU)

The tumors of the gastrointestinal stroma were originally classified as other type of tumors (leiomyoma, leiomyobastoma or leiomyosarcoma) due to it similar histological appearance; however, the advances in the molecular biology and the immunohistochemistry have allowed its differentiation of other digestive neoplasms and to define them as an own clinical and histopathological entity. This is the case of a black female patient aged 79 presenting with abdominal pain during 3 days of evolution started in the right iliac fossa and then it remains in the low belly accompanied by vomiting, fatigue and weakness. She was operated on and is diagnosed with a stump acute appendicitis and of occlusive type en elderly without to rule out an adhesion occlusion. Carrying out the laparotomy it was found that this not-coagulating cavity was blood-free and also a stalked hemorrhagic tumor with movements towards the terminal ileum. Authors carried out its exeresis resecting approximately 5 cm of small intestine with a termino-terminal suture later. A significant cleaning of peritoneal cavity was carried out with the habitual closure achieving a satisfactory evolution with her discharge at 7 days. Patient remains asymptomatic at one a half year postoperative and biopsy yielded a 5 cm-small intestine tumor with a low grade of malignancy(AU)

Dermatitis atópica / Atopic dermatitis

La Dermatitis Atópica (DA) es una entidad cuya incidencia se encuentra en alarmante incremento y que no obstante existir avances en el conocimiento de sus factores etiopatogénicos, aún no se ha podido comprender y demostrar la patogenia exacta que permita establecer una terapéutica específica. Presentamos una revisión de la Dermatitis Atópica donde brevemente pretendemos actualizar a los interesados en el tema, enfatizando en la epidemiología, etiopatogenia, cuadro clínico, diagnóstico y terapéutica(AU)