Síndrome de Marfan. Presentación de un caso

El síndrome de Marfan es una enfermedad genética autosómica dominante del tejido conectivo, caracterizada por una combinación variable de manifestaciones cardiovasculares, músculo-esqueléticas y oftalmológicas. A pesar del descubrimiento de las mutaciones causales, su diagnóstico resulta complejo, al exhibir una gran diversidad en su presentación clínica y carecer de características patognomónicas. El diagnóstico actual de síndrome de Marfan se basa en una serie de criterios clínicos y genéticos denominados Criterios Gante revisados. Se describe el caso de una paciente de 44 años de edad, con antecedentes de luxación del cristalino, miopía y escoliosis, sin antecedentes patológicos familiares y que cumplió con los criterios diagnósticos actuales. Se sugiere la pesquisa etiológica de afecciones como luxación del cristalino y escoliosis, por parte de las especialidades correspondientes, como traducción orgánica de una enfermedad sistémica como el síndrome de Marfan.</p

Aplicación de puntaje en pacientes con enfermedad cerebrovascular

Se realizó un estudio prospectivo, descriptivo, de serie de casos. Se analizaron 192 pacientes egresados con diagnóstico de enfermedad cerebrovascular(ECV), desde el 1 de marzo al 31 de agosto de 1999, en el Hospital Clinicoquirúrgico "Dr. Gustavo Aldereguía Lima". Se aplicó un puntaje para ECV con planillas ulteriormente procesadas en computación en sistema EXCEL por paquete SPSS. Se halló que los accidentes cerebrovasculares isquémicos reportaron el 75,5 % y la hipertensión arterial, el 69,7%; predominaron las edades superiores a 50 años. El 65,1 % tenía índice de Katz A y el 78,6, Rankin 1. Se comprobó que el 56,2 % de los pacientes egresó con secuelas; el 17,7 %, sin secuelas y el 26 %, falleció. Los que ingresaron con puntaje inferior o igual a 5, grupo de bajo riesgo, constituyeron el 36,9 % y ninguno falleció; el 56,2 % correspondió a pacientes de mediano riesgo y aportaron el 19,2 % del total de fallecidos, este grupo muestra 3 veces la probabilidad de egresar fallecidos con una razón de prevalencia igual a 3 (PR=3); del grupo de alto riesgo ninguno egresó vivo, fueron el 6,7 % del total de pacientes; la razón de prevalencia arroja 65 veces (PR=65) más probabilidad de fallecer con un puntaje al ingreso superior a 20.A prospective and descriptive case-series study was conducted. 192 patients discharged with diagnosis of stroke from "Dr. Gustavo Aldereguia Lima" Clinical and Surgical Hospital between March 1 and August 31, 1999, were analyzed. A score was applied to stroke with forms that were later processed by computer in EXCEL system by SPSS package. It was found that ischemic strokes accounted for 75.5 % and arterial hypertension for 69.7 %. There was a predominance of patients over 50. 65.1 % had index of Katz A, whereas 78.6 % had Rankin 1. It was proved that 56.2 % of the patients were discharged with sequelae, 17.7 % without sequelae and 26 % died. Those who were admitted with score <= 5, low risk group, represented 36.9 % and none died. 56.2 % corresponded to mean risk patients and 19.2 % of them died. This group showed 3 times more the possibility of discharging dead patients with a PR = 3. No patient from the high risk group was discharged alive. They represented 6.7 % of the total of patients. The prevalence ratio showed that the probability of dying was 65 times higher (PR = 65) among patients with a score over 20 on admission

Clinical Practice Guidelines for Ventilation Associated Pneumonia.

Clinical Practice Guidelines for Ventilation Associated Pneumonia. Conceptualized as the bacterial pneumonia that develops in patients receiving mechanical ventilation for more than 48 hours, which is not present at the beginning of the ventilation. We review the concept, prevention and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished

Factors related to lethality of admitted patients with pneumonia acquired in the community

Foundation: acquired pneumonia is an important health problem in many countries including Cuba.Objective: to determine the main factors related to lethality, in admitted patients with pneumonia acquired in the community.Method: prospective study of case series, with correlational descriptive design; a number of 521 admitted patients were studied between April the 1st 2016 and March 31st 2018. The information was obtained from clinical records, grouped in four variable categories: those related to patient´s conditions, to pathological process, analytic and therapeutic intervention. For the statistical analysis it was used odds ratio (OR) and confidence interval.Results: lethality was higher in patients older than 75 years (40 %); in patients previously laid in bed (47 % vs 22 %), in cases with chronic diseases (31 % vs 18 %), and those with history of cardio-sclerosis (35 % vs 24 %) and dementia (50 % vs 26 %). In addition, there was an association between lethality and severity of the disease on admission, extension of the lesions on thoracic x-ray over a lobule limit and lying in bed during admission.Conclusion: the importance of factors related to the patient´s conditions is confirmed, the morbid process itself with lab tests and therapeutic intervention, in the final evolution of the patient with community acquired pneumonia.</p

Modelación espacial de área basal y volumen de madera en bosques manejados de Pinus patula y P. teocote en el ejido Atopixco, Hidalgo

Basal area (AB m2/ha) and tree volume (VOL m3/ha) were modeled for even-aged Pinus patula and P. teocote forest stands located in Hidalgo, Mexico. Variables such as tree crown cover (COB), field recorded Leaf Area Index (LAI5 m2/m2), allometric Leaf Area Index (LAIAL m2/m2); GIS variables and reflectance data derived from a multispectral SPOT 5 image were used as independent variables. Environmental conditions were characterized by digitizing the INEGI�s chart of climatic effects (scale 1: 250 000) and processing the Digital Elevation Model (MDE) of the study area. A geographic information system (GIS) was set up with variables such as Elevation, Slope�s angle and aspect, Temperature, Precipitation, SPOT derived spectral bands, and two sets of vegetation indices based either on a) the ratio of spectral bands (NDVI and CTVI) or on b) the spectral distance between vegetation and bare soil (PVI and SAVI). Multiple linear regression models were fitted based on field and GIS data. AB was significantly related to LAIAL, Mean Annual Temperature (TMA), ALTITUD and SPOT Band 4 reflectance (P < 0,001, R2 = 0,9662). VOL was significantly related to LAIAL, Mean Annual Temperature (TMA) and ALTITUD (P < 0,001, R2 = 0,8856).Se modeló el área basal (AB m2/ha) y volumen de madera (VOL m3/ha) de rodales coetáneos de Pinus patula y P. teocote localizados en Hidalgo, México, utilizando variables de porcentaje de cobertura arbórea (COB), índice de área foliar en sitio (LAI5 m2/m2) y alométrico (LAIAL m2/m2), variables cartográficas y de reflectancia obtenidas de una imagen multiespectral del satélite SPOT 5. Para la caracterización de las condiciones ambientales se digitalizó la carta de Efectos Climáticos (escala 1: 250 000) de INEGI y el Modelo Digital de Elevación (MDE) correspondiente a la zona. Se integró un Sistema de Información Geográfica (SIG) constituido por las siguientes capas de información: altitud, pendiente, exposición, temperaturas, precipitaciones, bandas espectrales, y dos grupos de índices de vegetación basados en a) la relación espectral de bandas (NDVI - CTVI) y b) la distancia espectral entre vegetación y suelo desnudo (PVI � SAVI). Con datos de campo y del SIG se ajustaron modelos de regresión lineal múltiple. Para el AB la relación más significativa fue con LAIAL, Temperatura Media Anual (TMA), ALTITUD y la Banda 4 de SPOT (P < 0,001, R2 = 0,9662). Para el VOL la relación más significativa fue con LAIAL, Temperatura Media Anual (TMA) y ALTITUD (P < 0,001, R2 = 0,8856)

Acquired severe pneumonia in the community in seropositive HIV patients.

Infection due to the Human Immunodeficiency Virus (HIV)has become a principal health problem worldwide mainly in underdeveloped countries. In these patients, respiratory infections constitute the greatest cause of morbimortality rate in which Pneumocystis Carinii is the most frequently found pathogen. However, this article describes the case of a woman who is seropositive to HIV and who developed a severe and rapidly fatal community acquired pneumonia dur to Sthaphylococcus aureus, a very rare and less common infection in this kind of patients.</span

Modelación dinámica de distribuciones diamétricas en masas mezcladas de Pinus en Durango, México

The characterization of the diameter distributions provides information on the structure of a stand and support in the planning of silvicultural treatments in forests with management. We estimated the parameters of location, scale and shape of the Weibull function to characterize the diameter distribution of species mixture of Pinus. We used 59 plots for model fitting (900 m²) and 100 temporary forest inventory plots for validation (1000 m²). The method of moments was better to estimate the parameters of the Weibull function as statistics used to measure the goodness of fit (lower mean absolute error, lower mean square error and fewer rejected plots with Kolmorogov-Smirnov test) compared with maximum likelihood and percentile methods. The prediction models of the parameters with stand variables represent a flexible and simple way to characterize and project the theoretical distribution of diameter classes easily and accurately. The kurtosis of the Weibull distribution has less peakedness with the projection of the number of trees in diameter classes, the shape of the curve tends to normalize and a slight positive skewness, while basal area in the form is more theoretical platykurtic distribution. The projection of the Weibull distribution can be used to determine forest management regimes or to regularize diameter structures in uneven-aged stands.La caracterización de las distribuciones diamétricas proporciona información sobre la estructura de un rodal y ayuda en la planeación de los tratamientos silvícolas en masas forestales bajo manejo. Se presenta la evaluación de la función Weibull para caracterizar las distribuciones diamétricas en masas mezcladas de especies del género Pinus. Se usaron 59 parcelas permanentes (900 m²) para el ajuste y 100 parcelas temporales de inventario forestal (1000 m²) para la validación. El método de momentos resultó mejor para estimar los parámetros de la función Weibull (menor error medio absoluto, menor error medio cuadrático y menor número de parcelas rechazadas con la prueba de Kolmorogov-Smirnov) en comparación con los métodos de máxima verosimilitud y percentiles. Los modelos de predicción de los parámetros con variables del rodal permiten caracterizar y proyectar la distribución teórica de clases diamétricas de manera sencilla y precisa. La curtosis (kurtosis) de la distribución Weibull es menos apuntada con la proyección del número de árboles por categoría diamétrica, la forma de la curva tiende a normalizarse, con una ligera asimetría positiva, mientras que para el área basal la forma de la distribución teórica es más apuntada. La proyección de la distribución Weibull puede ser utilizada para determinar regímenes de manejo forestal o para la regularización de las estructuras diamétricas en masas incoetáneas

Sistema de crecimiento y rendimiento maderable para plantaciones de teca (Tectona grandis L. f.) en Campeche, México

Forest management decisions are addressed using dynamic growth and yield equations, which predict the future forest dynamic as a function of stand-level attributes and providing information for decision-making in sustainable development. They are more widely used as practical tools in forestry and can be desirable for plantation management-planning. Teak (Tectona grandis L. f.) is an important commercial species in plantations from Mexico, although there is a lack of scientific knowledge as regards the management or modeling tools to support functional forest management decision making. In this study an explicit growth and yield system (G&YS) was developed for plantation of Teak in Campeche, Mexico. The G&YS was integrated for algebraic difference dynamic equations and they were fitted to pairs of dasometric variables of stem-mapped re-measurements plots. The G&YS components were selected according to the goodness-of-fit system, also the graphical analysis between actual and fitted values was used. Both analyses considered the statistic accuracy and biologically realistic predictions. The mortality function was associated with the initial planting density and also it was sensitive to the site index. The selected growth systems for the basal area and volume per hectare were based on Schumacher equation. For a site index of 18 m at a reference age equal to 7.5 years and forest rotation equal to 19-year, the global estimated yield was of 152.75 m3 ha−1, while for densities of 1,250 trees per hectare and 816 trees per hectare, the yields were 136.86 m3 ha−1 and 113.12 m3 ha−1, respectively. The G&YS generated allows estimating the total volume with bark per hectare under the specific local conditions of establishment, silvicultural management and site quality of the teak plantations analyzed.Los modelos dinámicos de crecimiento y rendimiento maderable son importantes para tomar decisiones en el manejo forestal. Estos modelos predicen la dinámica futura en función de atributos del rodal y son herramientas prácticas para aplicar silvicultura en la planeación del manejo de bosques naturales y plantaciones. En México, teca (Tectona grandis L. f.) es de importancia maderable en plantaciones comerciales; sin embargo, las herramientas de este tipo para el manejo técnico y científico son limitadas. Se desarrolló un sistema de crecimiento y rendimiento maderable (Scrm) explícito para plantaciones de teca establecidas en Campeche, México. El Scrm se conformó de ecuaciones dinámicas de diferencia algebraica ajustadas al utilizar información dasométrica de una red de parcelas permanentes con remediciones. La selección de cada componente del Scrm se basó en un análisis de la bondad de ajuste y en una inspección gráfica para comparar la similitud entre el patrón generado y la tendencia observada, se buscó un balance entre consideraciones estadísticas y tendencias biológicas de crecimiento. La mortalidad se determinó a través de la densidad de plantación inicial y fue sensible al índice de sitio. Se seleccionaron sistemas de crecimiento tipo Schumacher para el área basal y el volumen. A la edad del turno planeado a 19 años y con un índice de sitio de 18 m, se estimaron rendimientos de 152.75 m3 ha-1, 136.86 m3 ha-1 y 113.12 m3 ha-1 para toda la plantación en general, para la densidad de 1250 plantas por hectárea (pl ha-1)y para la densidad de 816 pl ha-1, respectivamente. El Scrm generado permite estimar el volumen total con corteza por hectárea bajo las condiciones locales específicas de establecimiento, de manejo silvícola y de calidad de sitio de las plantaciones de teca analizadas

Behavior of Mortality According to Necropsy in Internal Medicine and Geriatrics Services of Cienfuegos

Background: mortality is one of the main indicators of quality in hospital care and management because it is considered a measure of the effectiveness of health intervention Objective: to determine the causes of mortality according to autopsy in the Internal Medicine and Geriatrics Services of Cienfuegos in the period 2017-2019. Methods: a descriptive-retrospective case series was carried out, of the 730 deceased patients who underwent autopsy between January 2017 and December 2019. Clinical and epidemiological variables were used. The information obtained was stored and processed in the statistical package SPSS version 21.0 for Windows. Measures of central tendency were applied to the quantitative variables, the qualitative ones were measured in index, in absolute and relative frequencies, depending on the distribution of each one of them. Results: the mean age was 75 years. Male sex predominated (57.8 %). The most represented age group was 70-79 years (28.9 %). The highest number of autopsies was performed in 2017 (37.7 %). The mean hospital stay was 8 days. The stay of less than three days predominated in the series (39.9 %). The most commonly reported causes of direct death were bronchopneumonia / pneumonia (61.3 %), then cardioangiosclerosis-pulmonary edema (13.1 %) and end-stage lung neoplasia (5.3 %). Conclusions: the most declared causes of direct death were bronchopneumonia and pneumonia. There was an adequate clinical-pathological correlation in these groups. The best levels of clinicopathological agreement were found in diseases of the central nervous system, tumors, and respiratory diseases. There was a worse correlation between digestive diseases, some infections and circulatory pathologies