Eficacia del diclofenaco tópico vs. nepafenaco tópico en la reducción del dolor durante la fotocoagulación panretiniana

ResumenPropósitoComparar la eficacia del diclofenaco tópico 0.1% vs. nepafenaco tópico en reducir el dolor asociado a la fotocoagulación panretiniana con láser argón.Material y métodosEnsayo clínico aleatorizado doble enmascarado, 132 pacientes (183 ojos) con diagnóstico de retinopatía diabética proliferativa tratados con fotocoagulación panretiniana. Aleatorización en 2 grupos: diclofenaco y nepafenaco tópicos. Se aplicaron 2 dosis de los analgésicos tópicos previas a la fotocoagulación panretiniana, se evaluó el dolor inmediatamente y 15min después. Se analizó nivel de dolor, efectos adversos y síntomas asociados al finalizar la fotocoagulación retiniana.ResultadosLa mediana de la edad para ambos grupos fue de 55 años, relación H:M de 1:1.4. El nivel de dolor inmediato fue de 35.5 (RIC 14-72) para el nepafenaco y de 45 (RIC 14-70) para el diclofenaco (p=0.48). A los 15min fue de 30 (RIC 4-50) para el nepafenaco y de 20 (RIC 2-50) para el diclofenaco (p=0.48). No hubo diferencias significativas en síntomas asociados entre los grupos ni efectos adversos en la superficie ocular.ConclusionesEl tratamiento previo con nepafenaco y diclofenaco tópicos es igualmente eficaz y seguro para reducir el dolor asociado a la fotocoagulación panretiniana en pacientes con retinopatía diabética proliferativa.AbstractPurposeTo compare the efficacy of topical diclofenac 0.1% vs topical nepafenac in reducing pain associated to argon laser retinal photocoagulationMaterial and methodsDouble blinded, randomized clinical trial. One hundred thirty two patients with diagnosis of proliferative diabetic retinopathy treated with retinal photocoagulation. Randomization in to 2 groups: topical diclofenac and nepafenac. Before retinal photocoagulation 2 doses of topical non-steroidal anti-inflammatory drugs were applied, pain was assessed immediately and 15minutes after. Level of pain, adverse effects and associated symptoms at the end of retinal photocoagulation were analyzed.ResultsThe median for age in both groups was 55 years, M:F ratio of 1:1.4. The immediate level of pain was 35.5 (ICR 14-72) for nepafenac and 45 (ICR 14-70) for diclofenac (P=.48). At 15minutes the pain level was 30 (ICR 4-50) for nepafenac and 20 (ICR 2-50) for diclofenac. There was no difference in associated symptoms or adverse effects among groups.ConclusionsThe preventive treatment with topical nepafenac and diclofenac is equally effective and safe for reducing the pain associated with retinal photocoagulation in patients with proliferative diabetic retinopathy

La medicina y la enfermedad en Alfonso Reyes

En este ensayo se analizan los síntomas, las enfermedades y las terapias que sufrió el escritor mexicano Alfonso Reyes, reconocido como uno de los escritores más importantes de habla hispana. Se revisa su biografía, que muestra la evolución de sus síntomas cardiovasculares y se documentan las patologías principales que tuvo a lo largo de su vida. Algunas de las enfermedades que sufrió Alfonso Reyes influyeron en su creación literaria, y su condición de enfermo constante lo llevó a reflexiones nada casuales, siendo un ejemplar paciente. Abstract: In this essay, the symptoms, diseases and therapies that the Mexican writer Alfonso Reyes suffered are analyzed. In addition, his biography is reviewed, which shows the evolution of his cardiovascular symptoms and the main diseases and surgeries that he had throughout his life. The diseases suffered by Alfonso Reyes influenced his literary creation and, because of his constant diseases, he made very non-casual l reflections. He was also an exemplary patient

LASIK monocular en pacientes adultos con ambliopía por anisometropía

ResumenObjetivoDeterminar la eficacia y la seguridad del LASIK en el tratamiento de la ambliopía por anisometropía en pacientes adultos.MétodosSerie de casos. Estudiamos a 12 pacientes adultos ambliopes por anisometropía a los cuales se realizó LASIK monocular de nuestro servicio de Córnea y Cirugía Refractiva. Evaluamos el error refractivo pre y postoperatorio, equivalente esférico (ES), la agudeza visual sin corrección (AVSC) y la agudeza visual mejor corregida (AVMC). La agudeza visual medida por la cartilla de Snellen fue convertida a LogMAR con fines de análisis estadístico.ResultadosLa edad promedio fue de 31.92 (± 12.13) años. El ES preoperatorio promedio en el ojo tratado fue de –3.49 D (± 3.24), el ES promedio del ojo no tratado fue de 0.25 D (± 0.30). La AVSC preoperatoria fue de 1.12 (± 0.3) LogMAR y la AVMC preoperatoria fue 0.31 (± 0.1) LogMAR. El seguimiento promedio fue de 19.1 (rango 6-74) meses. El ES promedio postoperatorio disminuyó a –0.28 (± 0.48). Cinco pacientes (42%) ganaron una línea de visión, un (8%) paciente ganó 2 líneas de visión y un (8%) paciente ganó 3 líneas de visión. El resto (42%) permaneció sin cambios comparados a la AVMC preoperatoria. Se encontraron diferencias estadísticamente significativas entre la AVSC preoperatoria (1.12 [±0.3]) y la AVSC postoperatoria (0.27 [±0.1]) (p=0.002, Z-Wilcoxon) y entre la AVMC postoperatoria (0.23 [±0.12]) y la AVMC preoperatoria (0.31 [±0.1]) (p=0.014, Z-Wilcoxon). No hubo complicaciones relacionadas con la cirugía.ConclusionesLa cirugía refractiva monocular en pacientes con ambliopía por anisometropía es una opción terapéutica segura y efectiva que ofrece resultados visuales satisfactorios, preservando o incluso mejorando la AVMC preoperatoria.AbstractPurposeTo investigate the efficacy and safety of LASIK for the correction of anisometropic amblyopia in adult patients.MethodsA retrospective, case series. We found 12 amblyopic adult patients that underwent monocular LASIK for anisometropía in our Cornea and Refractive service. We evaluated the preoperative and postoperative refractive error, spherical equivalent (SE), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Snellen visual acuity measurements were converted to LogMAR for statistical purposes.ResultsThe mean age was 31.92 (±12.13) years. The average preoperative SE in the treated eyes was -3.49 (±3.24), the average SE of the untreated eye was 0.25(±0.30). Preoperative UCVA was 1.12 (±0.3) and average preoperative BCVA was 0.31 (±0.1). All patients had LASIK with an average follow-up time of 19.1(6-74) months. The average postoperative SE decreased to -0.28 (±0.48). Five patients (42%) gained 1 line of vision, 1 (8%) patient gained 2 lines of vision, 1 (8%) patient gained 3 lines of vision and the rest (42%) remained unchanged compared to preoperative BCVA. Statistically significant differences were observed between the preoperative UCVA [1.12 (±0.3)] with the postoperative UCVA [0.27 (±0.1)](p=0.002, Z-Wilcoxon) and between the postoperative BCVA [0.23 (±0.12)] with the preoperative BCVA [0.31 (±0.1)] (p=0.014, Z-Wilcoxon). There were no complications related to the surgical procedures.ConclusionsMonocular refractive surgery in adult patients with anisometropic amblyopia is a safe and effective therapeutic option that offers a satisfactory visual outcome, preserving or even improving the preoperative BCVA

Frecuencia de prolongación del intervalo QTc en adultos infectados con VIH de Paraguay en 2020

Introduction: the prolonged QTc interval predisposes to serious arrhythmias. Various medications, including antiretrovirals, can prolong it. The objectives were to determine the demographic, clinical characteristics and the frequency of the prolonged QTc interval in patients with HIV. Methods: we conducted a prospective, observational study with a control group. Men and women, over 18 years of age, with HIV infection, who attended the National Hospital (Itauguá, Paraguay) during 2020, were included. Medical students acted as a control group. All subjects who did not give their consent and those with arrhythmias were excluded. Demographic, clinical, laboratory variables and 12-channel electrocardiogram at rest were measured. The study was approved by the Ethics Committee of the Universidad Privada del Este (Paraguay). Results: 39 HIV patients and 39 healthy controls entered the study. The mean age of the cases was 37 ± 11 years, being 59% male. The most frequent comorbidity in the cases was obesity (7.6%). The mean values ​​of urea, creatinine, K, Ca and Mg in the cases were in the normal range. Prolonged QTc was detected in 18% of the cases and in 0% of the controls. The subjects with the electrocardiographic alteration were all on antiretroviral and multiple antibiotic treatment known to be associated with prolonged Qtc. Conclusion: the frequency of prolonged QTc in HIV patients was 18% and in healthy controls it was 0%. Regular monitoring of the electrocardiogram is recommended in HIV patients receiving drugs that prolong the QT interval.Introducción: el intervalo QTc prolongado predispone a arritmias graves. Diversos medicamentos, entre ellos los antirretrovirales, pueden prolongarlo. Los objetivos fueron determinar las características demográficas, clínicas y la frecuencia del intervalo QTc prolongado en pacientes con VIH. Métodos: estudio observacional, prospectivo, con grupo control. Se incluyeron varones y mujeres, mayores de 18 años, portadores de infección por VIH, que acudieron al Hospital Nacional (Itauguá, Paraguay) durante 2020. Actuaron como grupo control los estudiantes de Medicina. Se excluyeron todos los sujetos que no dieron su consentimiento y los portadores de arritmias. Se midieron variables demográficas, clínicas, laboratoriales y electrocardiograma de 12 canales en reposo. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este (Paraguay). Resultados: ingresaron al estudio 39 pacientes con VIH y 39 controles sanos. La edad media de los casos fue 37 ± 11 años, siendo 59% del sexo masculino. La comorbilidad más frecuente en los casos fue la obesidad (7,6%). Los valores medios de urea, creatinina, K, Ca y Mg en los casos se hallaban en rango normal. Se detectó 18% de QTc prolongado en casos y 0% en los controles. Estos sujetos con alteración electrocardiográfica se hallaban todos en tratamiento antirretroviral y antibiótico múltiple de conocida asociación con QTc prolongado. Conclusión: la frecuencia de QTc prolongado en pacientes con VIH fue del 18% y en controles sanos fue del 0%. Se recomienda el control periódico del electrocardiograma en pacientes con VIH en tratamiento con fármacos que prolongan el intervalo QT

The epidemiology of renal replacement therapy in two different parts of the worldThe Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry

Publisher Copyright: © 2018 Pan American Health Organization. All rights reserved.Objective: To compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macro-economic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations. Methods: We used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis. Results: In 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confdence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions. Conclusions. There are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.Peer reviewe

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress