Principales acciones terapéuticas y rehabilitadoras en pacientes con insensibilidad congénita al dolor

Introduction: congenital insensitivity to pain is a hereditary whose main characteristic is absolute analgesia to pain.Objective: to describe the main existing therapeutic actions for patients with congenital insensitivity to pain in its diverse subtypes.Method: a total of 30 scientific articles were reviewed, which met the inclusion criteria. Databases such as Medline (PubMEd) and SciELO were consulted. All studies with limited or insufficient quality of evidence, or those in which full-text information was not available, were excluded.Development: at present, studies related to the use of bisphosphonates and minimal scale surgical interventions for the reduction of bone complications of the disease and the use of opioid receptor antagonists such as naloxone with the aim of reducing analgesia in these patients stand out. It also highlights research related to nerve growth factor in conjunction with the expression of the high affinity tyrosinkinase receptor for this factor, which produces a relative improvement with respect to the absolute analgesia that is evidenced in this disease.Conclusions: although the mechanisms by which it is established are not yet fully clarified, there is strong scientific evidence that supports a central role of genetics in the etiology of the disease. There is no highly effective therapeutic alternative in the current medical literature; that is why the basic role of these actions is based on prevention, education and interdisciplinary treatment.Introducción: la insensibilidad congénita al dolor es una enfermedad hereditaria cuya característica principal es la analgesia absoluta al dolor.Objetivo: describir las principales acciones terapéuticas existentes para los pacientes con insensibilidad congénita al dolor en sus diversos subtipos.Método: se consultaron un total de 30 artículos científicos que cumplieron con los criterios de inclusión. Se consultaron bases de datos como Medline (PubMed) y SciELO. Se excluyeron todos los estudios con limitada o insuficiente calidad de la evidencia, o aquellos en los cuales no estuvo disponible la información a texto completo.Desarrollo: en la actualidad resaltan estudios relacionados con el uso de bisfosfonatos e intervenciones quirúrgicas a mínima escala para la reducción de las complicaciones óseas de la enfermedad y la utilización de antagonistas de los receptores opiodes como la naloxona con el objetivo de disminuir la analgesia en dichos pacientes. Destaca, además, investigaciones relacionadas con el factor de crecimiento nervioso en conjunción con la expresión del receptor tirosinkinasa de alta afinidad para dicho factor, el cual produce un mejoramiento relativo respecto a la analgesia absoluta que se evidencia en dicha enfermedad.Conclusiones: aunque los mecanismos por los cuales se instaura aún no están del todo esclarecidos, existe fuerte evidencia científica que fundamenta en la etiología de la enfermedad un rol central de la genética. No existe una alternativa terapéutica de elevada eficacia, hecho por el cual el papel fundamental de dichas acciones tiene como pilares básicos la prevención, la educación y el tratamiento interdisciplinario

Caracterización de pacientes con hemorragia cerebral espontánea en Cienfuegos, enero-octubre 2017

Introduction: a spontaneous cerebral hemorrhage constitutes a global health problem; being the third cause of death, the first of disability in the adult and the second of dementia all over the world.Objective: to characterize clinically and epidemiologically the patients admitted as a consequence of a spontaneous cerebral hemorrhage, at “Dr. Gustavo Aldereguía Lima” General Teaching Hospital, from January to October 2017.Methods: a descriptive cross-sectional observational study, carried out at the Dr. Gustavo Aldereguía Lima General Teaching Hospital in 2017. A sample of 62 patients diagnosed with spontaneous hemorrhagic stroke was reviewed between January 1 and October 31, 2017, reported by the statistics department of this health institution. Socio-demographic and clinical variables, risk factors, among others were analyzed. Statistical processing was performed using SPSS 21.0 for better description of the results.Results: patients older than 50 years, male sex (58,1 %) and white race (74,2 %) predominated, with intraparenchymal hemorrhage being the main stroke (48,4 %). There was also a predominance of a hospital stay greater than 48 hours (79 %), with a mortality of 21 % at discharge, being higher in cerebral meningeal hemorrhage (75 %).Conclusions: intraparenchymal hemorrhage is the most evident cerebral vascular accident; in addition to presenting combined with other types. The minority underwent neurosurgical intervention. Hypertension was the main risk factor associated with stroke in these patients.Introducción:  una hemorragia cerebral espontánea constituye un problema de salud mundial; siendo la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el mundo.Objetivo: caracterizar clínica y epidemiológicamente a los pacientes que fueron ingresados por una hemorragia cerebral espontánea, en el Hospital General Docente "Dr. Gustavo Aldereguía Lima", de enero a octubre del año 2017.Métodos: estudio observacional descriptivo de corte transversal, efectuado en el Hospital General Docente "Dr. Gustavo Aldereguía Lima" en el año 2017. Se trabajó con una muestra conformada por 62 pacientes con diagnóstico de ictus hemorrágico espontáneo, entre el 1 de enero y el 31 de octubre del año 2017, reportados en el departamento de estadística del. Se analizaron variables sociodemográficas, clínicas, factores de riesgo, entre otras. Se realizó el procesamiento estadístico a partir del SPSS 21.0 para mejor representación de los resultados.Resultados: preponderaron los pacientes mayores que 50 años, el sexo masculino (58,1 %) y color blanco (74,2 %), siendo la hemorragia intraparenquimatosa el principal accidente cerebrovascular (48,4 %). Se tuvo además predominio de una estadía hospitalaria superior a las 48 horas (79,0 %), contándose con una mortalidad del 21,0 % al egreso, siendo superior en la hemorragia cerebromeníngea (75,0 %).Conclusiones: La Hemorragia Intraparenquimatosa constituye el accidente vascular encefálico que más se evidenció; además de presentarse combinado con otros tipos. La minoría fue sometida a intervención neuroquirúrgica. La Hipertensión Arterial constituyó el principal factor de riesgo asociado a pacientes con ictus

Main therapeutic and rehabilitation actions in patients with congenital insensitivity to pain

Introduction: congenital insensitivity to pain is a hereditary whose main characteristic is absolute analgesia to pain. Objective: to describe the main existing therapeutic actions for patients with congenital insensitivity to pain in its diverse subtypes. Method: a total of 30 scientific articles were reviewed, which met the inclusion criteria. Databases such as Medline (PubMEd) and SciELO were consulted. All studies with limited or insufficient quality of evidence, or those in which full-text information was not available, were excluded. Development: at present, studies related to the use of bisphosphonates and minimal scale surgical interventions for the reduction of bone complications of the disease and the use of opioid receptor antagonists such as naloxone with the aim of reducing analgesia in these patients stand out. It also highlights research related to nerve growth factor in conjunction with the expression of the high affinity tyrosinkinase receptor for this factor, which produces a relative improvement with respect to the absolute analgesia that is evidenced in this disease. Conclusions: although the mechanisms by which it is established are not yet fully clarified, there is strong scientific evidence that supports a central role of genetics in the etiology of the disease. There is no highly effective therapeutic alternative in the current medical literature; that is why the basic role of these actions is based on prevention, education and interdisciplinary treatment

Result of Surgery to Patients with Brain Tumor in Cienfuegos

Foundation: brain tumors cause high mortality, decrease in quality of life and impact negatively family health. Objective: to describe the results of surgical interventions to patients with brain tumors in Cienfuegos between January 2012 and December 2015. Methods: a cross-sectional descriptive study was carried out at the General University Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos, covering the period between January 2012 and December 2015. The universe consisted of 53 patients. The variables studied were: age, sex, history of chronic diseases, history of neoplasia of another location, onset syndrome, anatomical location according to the imaging study performed, degree of macroscopic cytoreduction, Karnofsky scale, tumor type, postoperative complications and survival after six months of surgery. The analysis was based on descriptive and inferential statistics. Results: there was a slight predominance of females over males. 67.9 % of the patients did not present associated comorbidity, 45.3 % started as an endocranial hypertension syndrome, 81.9 % had supratentorial localization and 73.6 % had total macroscopic tumor cytoreduction. The most frequent histological type was astrocytoma 34 %. There was a 60.4 % survival at six months and only 6.2 % had a quality of life lower than 70 points according to the Karnofsky Scale. Conclusion: a greater survival was associated with meningothelial meningioma, emphasizing lethality in grade IV astrocytomas and lung metastasis. The most frequent and associated mortality complication was postoperative neurological deterioration