Picnodistosis: El caso de Toulouse-Lautrec

Resumen El pintor francés Henri de Toulouse-Lautrec fue el primer caso de picnodisostosis reconocido a nivel mundial. En este texto se analizan las distintas manifestaciones de la picnodisostosis y se hace énfasis en las que el artista presentó y se detallan desde el punto de vista que brindan los conocimientos surgidos a través del tiempo sobre la fisiopatología de esta enfermedad. Palabras claves: Picnodistosis, catepsina, fragilidad, displasia. Abstract The french painter, Henri de Toulouse-Lautrec, was the first recognized case of pycnodysostosis in the world. In the text, different signs and symptoms are told in detail, emphasizing on those that this artist presented, and are analyzed from an actual point of view achieved by the knowledge acquired through the years about the pathophysiology of this entity. Key words: Pycnodysostosis, cathepsin, fragility, dysplasia

Hipertensión de bata blanca

ResumenLa hipertensión de bata blanca (HBB) es una entidad frecuente, caracterizada por hipertensión (>140 / 90 mmHg) solamente durante la visita al médico, mientras que ambulatoriamente las cifras de tensión arterial se encuentran por debajo de 130 / 85 mmHg. Las personas con HBB desencadenan una reacción al estrés agudo en presencia del médico y, por tanto, activación del sistema nervioso simpático y liberación de moléculas de acción paracrina y endocrina. Existen estudios que relacionan la HBB con la presencia de otros factores de riesgo cardiovasculares y con el compromiso de órganos blanco, sin embargo, no se ha definido la conducta adecuada ante su diagnóstico. Palabras claves: Hipertensión, bata blanca, estrés agudo. Abstract White coat hypertension (HBB) is a frequent entity, characterized by hypertension only during physician visit (>140 / 90 mmHg), while ambulatory blood pressure is below 130 / 85 mmHg. People with HBB unchain an acute stress reaction and then sympathetic activation and liberation of endocrine and paracrine action molecules. There are some studies that related HBB with the presence of others risk factors and with target organ damage, although there is not an adequate approach when is diagnosed. Key words: Hypertension, white coat, acute stress

Hearing loss detection through auditory brainstem evoked potentials and transitory acoustic otoemissions in Children from Instituto Colombiano de Bienestar Familiar (Colombian Family Welfare Institute). Barranquilla (Colombia), 2009

Objetivo: Determinar la prevalência de hipoacusia infantil en una población de 0-5 anos de edad atendida en el Instituto Colombiano de Bienestar Familiar (ICBF). Materiales y Métodos: Estudio descriptivo, con análisis correlacional multivariado; muestra de 300 ninos. Se realizo la caracterización sociodemográfica, ambiental, domiciliaria y de antecedentes patológicos de los padres, prenatales y perinatales del nino(a), senales de factores relacionados con problemas audiológicos. Los ninos(as) fueron examinados(as) clinicamente y se realizo sistematicamente prueba de otoemisiones acústicas transitorias evocadas y potenciales evocados auditivos troncoencefálicos. Los ninos con exámenes anormales fueron reevaluados por audiología y aquellos con alteraciones persistentes fueron estudiados por un otorrinolaringólogo y un neurofisiólogo clinico.Objective: To determine the prevalence of infantile hearing loss in a population of 0-5 years old treated in the Instituto Colombiano de Bienestar Familiar (Colombian Family Welfare Institute). Materials and Methods: Descriptive study, with correlational multivariate analysis in 300 children. A sociodemographic, environmental, home, and parental characterization was made as well as the one of the prenatal and perinatal child's background, and signals of factors related to audiological problems. The children were examined clinically and transient evoked otoacoustic emissions and brain-stem auditory evoked potentials were systematically performed. Children with abnormal tests were reevaluated by audiology and those with persistent abnormalities were evaluated by an otolaryngologist and a Clinical Neurophysiologist

Detección de hipoacusia mediante potenciales evocados auditivos tronco-encéfalicos y otoemisiones acústicas transitorias en niños (as) del Instituto Colombiano de Bienestar Familiar. Barranquilla (Colombia) 2009

Resumen Objetivo: Determinar la prevalencia de hipoacusia infantil en una población de 0-5 años de edad atendida en el Instituto Colombiano de Bienestar Familiar. Materiales y Métodos: Estudio descriptivo, con análisis correlacional multivariado, muestra de 300 niños. Se realizó la caracterización socio-demográfica, ambiental, domiciliaria y de antecedentes patológicos de los padres, pre-natales y peri-natales del niño(a), señales de factores relacionados con problemas audiológicos. Los niños(as) fueron examinados(as) clínicamente y se realizó sistemáticamente prueba de otoemisiones acústicas transitorias evocadas y potenciales evocados auditivos tronco-encefálicos. Los niños con exámenes anormales fueron reevaluados por audiología y aquellos con alteraciones persistentes fueron estudiados por un otorrinolaringólogo y un Neurofisiólgo Clínico. Resultados: La prevalencia de hipoacusia infantil fue de 6,3% tras la primera evaluación y 2,3% tras la segunda: todos con hipoacusia conductiva, de los cuales dos casos correspondieron a hipoacusia leve y cinco moderados. Las causas de hipoacusia fueron: en cuatro casos, hipertrofia amigdalina y/o disfunción de la Trompa de Eustaquio; en dos niños, otitis media serosa y/o rino-sinusitis aguda; y en un niño, se diagnosticó otitis media adhesiva con perforación timpánica. Conclusiones: Los factores predictores para hipoacusia infantil más prevalentes en la población de estudio fueron medio-ambientales; cercanía con avenidas, exposición a ruidos industriales, basureros y exposición a humo. El análisis de regresión logística arrojó significancia estadística solo para señales de factores relacionados con problemas audiológicos. La prevalencia de hipoacusia infantil es similar a la descrita en países desarrollados de Norteamérica y Europa. Asimismo, todos los trastornos identificados fueron causantes de hipoacusia conductiva. Palabras clave: potenciales evocados, tallo cerebral, hipoacusia, sordera, emisiones otoacústicas espontáneas. Abstract Objective: To determine the prevalence of infantile hearing loss in a population of 0-5 years old treated in the Instituto Colombiano de Bienestar Familiar (Colombian Family Welfare Institute). Materials and Methods: Descriptive study, with correlational multivariate analysis in 300 children. A socio-demographic, environmental, home, and parental characterization was made as well as the one of the pre-natal and peri-natal child’s background, and signals of factors related to audiological problems. The children were examined clinically and transient evoked otoacoustic emissions and brain-stem auditory evoked potentials were systematically performed. Children with abnormal tests were reevaluated by audiology and those with persistent abnormalities were evaluated by an otolaryngologist and a Clinical Neurophysiologist. Results: Prevalence of childhood hearing loss was 6.3% after the first evaluation, and 2.3% after the second: all of them with conductive hearing loss, in which two cases were mild, and five moderate hearing loss. The causes of hearing loss were: in four cases tonsillar hypertrophy and/or dysfunction of the Eustachian tube; otitis media and/or rhino-acute sinusitis with effusion were detected in two children; and adhesive otitis media with tympanic membrane perforation in one child. Conclusions: The most predictors factor for infant hearing loss in the studied population were environmental, including proximity to roads, exposure to industrial noise, landfills, and exposure to smoke. Logistic regression results statistic significance only factors in relation with audiologic problem reported. Prevalence of childhood hearing loss is similar to the one described in developed countries of North America and Europe. All the identified disorders were the cause of conductive hearing loss. Keywords: evoked potentials, auditory, brain stem, hearing loss, deafness, otoacoustic emissions

Potencial terapéutico de las células madre en la enfermedad cerebrovascular

La enfermedad cerebrovascular es una importante causa de muerte e incapacidad en todo el mundo. Esta enfermedad es consecuencia de un complejo grupo de procesos fisiopatológicos que afectan la vasculatura del sistema nervioso, resultando en isquemia y modificaciones del metabolismo neuronal. Se ha demostrado que células neurales han ayudado a reparar los daños asociados a la enfermedad cerebrovascular en modelos animales y han conducido a mejoras en su capacidad física. Además, se ha observado que la aplicación endógena de células madre ocasiona neurogénesis espontánea en respuesta a la lesión isquémica y se puede mejorar a través de una adecuada infusión de citoquinas. En esta revisión se analizan diversos aspectos de la potencial aplicación de las células madre como estrategia terapéutica en el manejo de la enfermedad cerebrovascular.  Palabras clave: Células madre. Enfermedad cerebrovascular. Ictus. Cerebro.     Therapeutic potential of stem cells in Cerebrovascular Disease. Cerebrovascular disease is a major cause of death and disability in the worldwide, this disease results from a complex set of pathophysiologic processes that affect the nervous system vasculature, resulting in ischemia and changes in neuronal metabolism. It has been shown that neural cells helped repair damage associated with cerebrovascular disease in animal models and have led to improvements in physical capacity. Furthermore, it appears that the application of endogenous stem cells causes spontaneous neurogenesis in response to ischemic injury and can be improved through proper infusion of cytokines. This review discusses various aspects of the potential application of stem cells as a therapeutic strategy in the management of cerebrovascular disease.  Key words: Stem cells. Cerebrovascular disease. Stroke. Brain

Hyperosmolar myelinolysis

The central pontine myelinolysis is a metabolic disorder that affects the central nervous system; it is considered that a quick correction of hyponatremia leads to pontine and extra-pontine demyelination. This article briefly discusses some interesting aspects of this condition which is often diagnosed and should be known by the medical body that manages critical patients. (MED.UIS. 2010;23(2):120-5).   Key words: Mielinolisis hiperosmolar. Hyponatremia. Coma.    La mielinolisis osmótica es una patología metabólica que repercute sobre el sistema nervioso central; se considera que ocurre por la rápida corrección de una hiponatremia, lo que conduce a la desmielinización pontina y extrapontina. En este artículo se comentaran brevemente algunos aspectos de esta interesante patología que muchas veces no es diagnosticada y debe ser conocida por el cuerpo médico que maneja paciente críticos. (MED.UIS. 2010;23(2):120-5).   Palabras clave: Mielinolisis hiperosmolar. Hiponatremia. Coma.         &nbsp

Remote supratentorial hemorrhage after posterior fossa surgery: A brief case report

The supratentorial hemorrhage after posterior fossa surgery is an unusual but delicate complication that carries high mortality and morbidity. A 50 year old woman presented vertigo 6 months of evolution, which worsened in the last 2 months accompanied by ataxia. She showed left cerebellar signs, had no focal motor or sensory deficits. A brain MRI identified cerebellopontine angle lesion with mass effect. The patient was treated on suboccipital craniectomy and resection of right posterior fossa tumor, the histopathological diagnosis was consistent with typical meningioma. (WHO Class I).The postoperative period was satisfactory. A month later, presented clinical symptoms of right-sided hemiparesis, brain CT revealed left frontal supratentorial hematoma, receiving conservative management. Patient was discharged after 10 days. Reports in the literature on this rare complication, detailed cases where the hematoma was presented in hours to days. To our knowledge this is the first report in the literature of supratentorial hemorrhage and posterior fossa surgery one month after the surgical procedure has been performed

Acute subdural hematoma as a complication of diagnostic lumbar puncture: Case report

Background: Intracranial hemorrhagic complications are unusual after diagnostic lumbar puncture.Case report: A diagnostic lumbar puncture was performed in a 55 year-old male for acute bacterial meningitis workup. Immediately after the procedure he developed intense headache and a head Computed Tomography (CT) was done which identified an acute subdural fluid collection. No surgical management was offered and conservative medical follow-up was indicated.Conclusion: The occurrence of a headache with red flags after a lumbar puncture may suggest the possibility of an acute subdural hematoma

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation