Evolución histórica de las autopsias y situación actual

The autopsy is one of the oldest procedures with major contributions to the understanding of the human body and the origin of its diseases, its main objective is to determine the cause of death. Currently it is a technique of great relevance not only for its contributions in medicine, but also in legal aspects for different situations. Nowadays, advances in autopsies have allowed to increase the efficiency in the execution of more assertive diagnoses through X-ray images, postmortem computed tomography and magnetic resonance imaging, which are the techniques with the greatest boom in recent years. This evaluative practice of the corpse has had several advances that facilitate the detection of pathologies that could go unnoticed in antemortem diagnoses, or even determine if the death was due to hereditary chronic conditions, or violent mechanisms. It also allows the creation of statistical indexes where the causes of death of a given population or territory are reflected as a measure of public health and solving legal or hospital cases that are being carried out through an accusation or lawsuit. Reports in Latin America have demonstrated a higher frequency of this technique in male adults, they also show that these practices have a decrease in the last years, specifically in Ecuador there are no strong reports that indicate the continuity of autopsies, and however, the law presents the statutes in which it is mandatory to carry out this procedure. © 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica

Enfermedad cardiovascular y consumo de alcohol: Evidencia actual

Alcohol consumption is ubiquitous in all human societies, intimately imbricated in numerous cultures. This transcendence often obscures its true impact on health at a small and large scale. Alcohol exerts deleterious effects in various organ systems, being a well-known harm for the functioning of the mind-brain, as well as the gastrointestinal, endocrine-metabolic, immunologic, reproductive, and cardiovascular systems, among others. In particular, the effect of alcohol on the cardiovascular health-disease spectrum has been of special scientific and general interest. Classically, a J-shaped curve has been associated with the correlation between alcohol intake and cardiovascular mortality. This reflects an association of lower mortality with low and moderate doses, and the tendency of cardiovascular risk (CVR) to increase progressively with heavier forms of consumption. Nevertheless, in recent years, emergent evidence has placed doubt on the robustness and ubiquity of this type of link between alcohol and CVR. Considering the ever-present characteristic of alcohol in all demographics, it is understandable that this relationship would raise unprecedented degrees of scientific and general controversy and interest; especially surrounding reports describing some benefit for moderate alcohol intake. However, in light of more recent evidence, this precept becomes much less consolidated. This review summarizes and discusses novel findings regarding the relationship between alcohol and the development of cardiovascular disease. © 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica

Forensic entomology in Latin America

© 2020, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved. Solving criminal cases can be a complicated task, as there are numerous elements to consider when analyzing a body as its identification, reason for death, time of death, among others; this is where forensic entomology, a specialty in development whose potential cannot be neglected, its effective-ness in recognizing a deceased through the insect’s present providing abundant information about its state of decomposi-tion, death interval, and even evidence some events that led to death. Knowing which insects are found, their stage of evolution through their growth and/or development rates allows professionals to identify post-mortem characteristics. Thanks to this science, it is even possible to provide a timeline of the events, with the help of the post mortem interval during the first 72 hours, in addition there are other elements such as the identification of the types of insects, the amount present in the body, as well as its state of growth and development. There is also the modeling of the crime scene temperatures, these are compared with estimates of the meteorological condition to determine the circumstantial environment of the corpse, until determining if the event actually occurred in that place or the event was in another location and the deceased was moved to where he was found. In general, forensic entomology has great versatility and application. Despite this, in Latin America its boom is not as strong as expected, as few countries have done research on the matter, always ac-companied by the police institute and the educational and/or university entity for theoretical support. On the other hand, there are countries such as Mexico and Guatemala whose scientific advances are still very few and, if any, are found only in universities and research centers

Main diseases of the nervous system in children: a narrative review

© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. In children the appearance of neurological disorders is associated with embryonic development until early childhood, these imply an important socioeconomic burden for the family nucleus, as well as for the health sector. It is important to have clear knowledge about the most frequent neurological alterations in this age group, which affect the development of the nervous system and the embryological mechanisms that are compromised. Among these diseases, there are congenital diseases such as anencephaly, holoprosencephaly, and spina bifida, such as those common in central nervous system group alterations. There are also other pathologies linked to the cranial nerves and the autonomic nervous system, as well as childhood cerebral palsy that is a group of disorders that affect the psychomotor child development associated with lesions during brain development with various risk factors such as genetic malformations, peritnatal asphyxia, among others. Other types of diseases that affect the nervous system are tumors, the most frequent being medublastoma, glioma, and ependymoma. Similarly, seizures constitute a broad heterogeneous syndrome that can be caused by some of the previously exposed diseases or be found as a unique condition, in general this type of disease generates a burden on different levels for both children and their caregivers. Therefore, prevention or timely diagnosis is essential through assertive pregnancy control since they are conditions that can be detected during pregnancy.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. In children the appearance of neurological disorders is associated with embryonic development until early childhood, these imply an important socioeconomic burden for the family nucleus, as well as for the health sector. It is important to have clear knowledge about the most frequent neurological alterations in this age group, which affect the development of the nervous system and the embryological mechanisms that are compromised. Among these diseases, there are congenital diseases such as anencephaly, holoprosencephaly, and spina bifida, such as those common in central nervous system group alterations. There are also other pathologies linked to the cranial nerves and the autonomic nervous system, as well as childhood cerebral palsy that is a group of disorders that affect the psychomotor child development associated with lesions during brain development with various risk factors such as genetic malformations, peritnatal asphyxia, among others. Other types of diseases that affect the nervous system are tumors, the most frequent being medublastoma, glioma, and ependymoma. Similarly, seizures constitute a broad heterogeneous syndrome that can be caused by some of the previously exposed diseases or be found as a unique condition, in general this type of disease generates a burden on different levels for both children and their caregivers. Therefore, prevention or timely diagnosis is essential through assertive pregnancy control since they are conditions that can be detected during pregnancy

Complications associated with peritoneal dialysis catheter of patients in the Hospital General del Norte de Guayaquil IESS Los Ceibos

Objetivo: Identificar las complicaciones más frecuentes asociadas al uso de catéter de diálisis peritoneal en pacientes del Hospital General del Norte de Guayaquil IESS Los Ceibos. Materiales y métodos: Se trató de un estudio descriptivo y retrospectivo en pacientes adultos, ingresados al Hospital General del Norte de Guayaquil IESS los Ceibos, con alguna complicación asociada al uso de catéter de diálisis peritoneal durante el periodo comprendido entre mayo y agosto de 2018. Se emplearon los datos clínicos de las historias que se encuentran en el departamento de registros médicos del mencionado hospital. Resultados: De los 42 pacientes evaluados, la complicación más frecuente fue la presencia de peritonitis o infección (57%; n=24), seguido de la aparición de hernias (12%; n=5), cambio de modalidad (12%; n=5) y cambio de catéter (2%; n=1). Conclusión: Los pacientes sometidos a DP en el Hospital General del Norte de Guayaquil IESS los Ceibos presentan una alta frecuencia de complicaciones específicamente infección o peritonitis.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Objective: To identify the most frequent complications associated to peritoneal dialysis catheter of patients in the Hospital General del Norte de Guayaquil IESS Los Ceibos. Materials and methods: This was a descriptive and retrospective study in adult patients admitted to the Hospital General del Norte de Guayaquil IESS Los Ceibos with any complication associated to peritoneal dialysis catheter during the period from May to August 2018. The clinical data from the hospital´s clinical records department was used in this study. Results: Out of the 42 patients evaluated, the most frequent complication was the presence of peritonitis or infection (57%, n=24), followed by the appearance of hernias (12%, n=5), modality change (12%; n=5) and catheter change (2%, n=1). Conclusion: Patients undergoing peritoneal dialysis in the Hospital General del Norte de Guayaquil IESS Los Ceibos presented a high frequency of complications, specifically infection or peritonitis

Epileptic status on children: diagnostic and therapeutic general aspects

© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Epileptic status (ES) is a very common neurological pathology in children that requires immediate attention. Seizures are abnormal and excessive synchronous discharges of neurons in the brain that are reflected through an electroencephalogram, these have a classification based on states according to their duration and their clinical expression depends on brain activity extension. Several international guidelines define ES as a clinical or electrographic activity continues for more than 5 minutes, its incidence varies according to age, with children under 5 years being the most affected ones. However, recurrence rates are considerably higher due to central nervous system infections and affect children in developing countries to a greater extent. Specifically, febrile seizures affect infants who have greater exposure to infections of any origin, this in turn implies a mortality rate that is higher in this age group compared to adults. Its diagnosis is focused on identifying the episodes and carrying out complementary studies to discover the underlying cause, which will vary according to the case: laboratory tests, lumbar puncture and / or computed tomogra-phy. On the other hand, the treatment of ES should be aimed at stopping seizures as soon as possible, focusing on general measures with special attention to good airway management and assertive medication use.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Epileptic status (ES) is a very common neurological pathology in children that requires immediate attention. Seizures are abnormal and excessive synchronous discharges of neurons in the brain that are reflected through an electroencephalogram, these have a classification based on states according to their duration and their clinical expression depends on brain activity extension. Several international guidelines define ES as a clinical or electrographic activity continues for more than 5 minutes, its incidence varies according to age, with children under 5 years being the most affected ones. However, recurrence rates are considerably higher due to central nervous system infections and affect children in developing countries to a greater extent. Specifically, febrile seizures affect infants who have greater exposure to infections of any origin, this in turn implies a mortality rate that is higher in this age group compared to adults. Its diagnosis is focused on identifying the episodes and carrying out complementary studies to discover the underlying cause, which will vary according to the case: laboratory tests, lumbar puncture and / or computed tomogra-phy. On the other hand, the treatment of ES should be aimed at stopping seizures as soon as possible, focusing on general measures with special attention to good airway management and assertive medication use

Clinical and epidemiological characteristics of amputee patients admitted to diabetic foot unit from Hospital Abel Gilbert Pontón, Ecuador

Objetivo: Evaluar las características clínico epidemiológicas de los pacientes amputados ingresados a la unidad de pie diabético del Hospital Abel Gilbert Pontón, Ecuador. Materiales y métodos: Se trató de un estudio descriptivo y retrospectivo en pacientes mayores de 25 años ingresados a la unidad de pie diabético del Hospital de Especialidades de Guayaquil Dr. Abel Gilbert Pontón que hayan sido sometidos a amputación, relacionada a diabetes mellitus, en el periodo comprendido entre enero a diciembre de 2014. Se emplearon los registros clínicos de las historias que se encuentran en el departamento de datos y estadísticas del mencionado hospital. Resultados: De los 147 pacientes evaluados, el 63% (n=93) fueron del sexo masculino, el grupo etario más frecuente fue el de 50-70 años (37%; n=54), la mayoría sólo tenía estudios de educación primaria (69%; n=102) y procedían de zonas urbanas (87%; n=125), la comorbilidad más frecuente fue la hipertensión arterial (44,9%; n=66), la infección de piel y partes blandas fue la causa de ingreso más prevalente (49%; n=72), mientras que un 69% (n=101) tenía más de 10 años con la DM y la amputación suprarotuliana fue el procedimiento más utilizado (52%; n=76). Conclusión: Existe una alta frecuencia de pacientes con pie diabético admitidos al Hospital Abel Gilbert Pontón que ameritan amputación, cuyos factores más prevalentes fueron el sexo masculino, la edad entre 50-70 años, el bajo estatus educativo, la procedencia urbana, la coexistencia de hipertensión arterial, la infección como causa de ingreso más importante y el tiempo de evolución de la DM mayor de 10 años.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Objective: To evaluate the clinical epidemiological characteristics of amputee patients admitted to the diabetic foot unit of the Hospital Abel Gilbert Pontón, Ecuador. Materials and methods: This was a descriptive and retrospective study in patients older than 25 admitted to the dia-betic foot unit of the Hospital de Especialidades de Guayaquil Dr. Abel Gilbert Pontón who had undergone amputation, related to diabetes mellitus in the period from January to December 2014. The clinical records found in the data and statistics department of the aforementioned hospital were used for this study. Results: Out of the 147 patients evaluated, 63% (n=93) were male, the most common age group was 50-70 years old (37%, n=54), most of them had only primary education (69%, n=102) and came from urban areas (87%, n=125), the most frequent comorbidity was hypertension (44.9%, n=66), skin and soft tissue infection was the most prevalent cause of admission (49%, n=72), while 69% (n=101) was more than 10 years of diabetes evolution, and suprarotulian amputation was the most used procedure (52%, n=76). Conclusion: There is a high frequency of patients with diabetic foot admitted to the Hospital Abel Gilbert Pontón undergoing amputation, whose most prevalent factors were the male gender, the age between 50-70, the low educational status, urban living, the coexistence of hypertension, infection as the most important cause of admission and the diabetes evolution over 10 years

Prevalencia de HDL-C bajas en adultos mayores de la parroquia de Baños, Cuenca

Introduction: Low HDL-C is one of the most frequent metabolic alterations in Latin America populations, so the aim of this study was to determine the prevalence of low HDL-C and its associated factors in elderly patients from Baños parish, Cuenca, Ecuador. Materials and methods: This is a descriptive and cross-sectional study in which 200 elderly residents from Baños parish participated, intentionally selected in 2 ambulatory primary care centers. To this end, a questionnaire was used to collect data, determining HDL-C levels, habits, sociodemographic and clinical factors, using a logistic regression model. Results: The prevalence of low HDL-C was 35.5% (n=71), being higher in men (62%) and older than 80 years (43.7%), being obesity measured by BMI (OR: 3.25, 95% CI: 1.49-7.12) and personal history of arterial hypertension (OR: 2.10, 95% CI: 1.07-4.15) the main associated factors. Conclusion: There is a high prevalence of low HDL-C in the older adult population from rural parish of Baños, having subjects with obesity and hypertension the highest risk of low HDL-C. © 2018 Revista Latinoamericana de Hipertension. All Rights Reserved.Introduction: Low HDL-C is one of the most frequent metabolic alterations in Latin America populations, so the aim of this study was to determine the prevalence of low HDL-C and its associated factors in elderly patients from Baños parish, Cuenca, Ecuador. Materials and methods: This is a descriptive and cross-sectional study in which 200 elderly residents from Baños parish participated, intentionally selected in 2 ambulatory primary care centers. To this end, a questionnaire was used to collect data, determining HDL-C levels, habits, sociodemographic and clinical factors, using a logistic regression model. Results: The prevalence of low HDL-C was 35.5% (n=71), being higher in men (62%) and older than 80 years (43.7%), being obesity measured by BMI (OR: 3.25, 95% CI: 1.49-7.12) and personal history of arterial hypertension (OR: 2.10, 95% CI: 1.07-4.15) the main associated factors. Conclusion: There is a high prevalence of low HDL-C in the older adult population from rural parish of Baños, having subjects with obesity and hypertension the highest risk of low HDL-C. © 2018 Revista Latinoamericana de Hipertension. All Rights Reserved

Epidemiological characteristics of newborns from the Hospital General José María Velasco Ibarra, Ecuador

Objetivo: Describir las características epidemiológicas de los neonatos nacidos en el Hospital General José María Velasco Ibarra, Ecuador. Materiales y métodos: Se trató de un estudio descriptivo y retrospectivo en neonatos vivos del Hospital General José María Velasco Ibarra, atendidos durante el periodo comprendido entre enero a diciembre de 2018. Se utilizaron los datos de las historias clínicas que se encuentran en el departamento de registros médicos del mencionado hospital, identificando las principales complicaciones perinatales. Resultados: De los 2108 recién nacidos, 50,9% (n=1073) fueron del sexo femenino, el 77,1% nació por parto vía vaginal, más del 95% presentó puntajes APGAR ≥7 al minuto y a los 5 minutos, el 86,6% (n=1825) tenía un peso normal, sólo 9,9% (n=208) presento alguna complicación perinatal, siendo la hiperbilirrubinemia (40,4%), el síndrome de distrés respiratorio (37,5%) y la prematuridad (6,7%) los más frecuentes. Conclusión: Las complicaciones perinatales sólo se presentaron en 9,9% de los casos, siendo la hiperbilirrubinemia, el síndrome de distrés respiratorio y la prematuridad los cuadros clínicos más frecuentes; aunque es un porcentaje bajo en comparación con otras series, la identificación temprana y el manejo oportuno de estas patologías son fundamentales en este grupo poblacional.© INRA and Springer-Verlag France 2015. Objective: To describe the epidemiological characteristics of newborns from the Hospital General José María Velasco Ibarra, Ecuador. Materials and methods: This was a descriptive and retrospective study in live births from the Hospital General José María Velasco Ibarra that were attended during the period from January to December 2018. The medical records found in the statistics department of the mentioned hospital were used, identifying the main perinatal complications. Results: Out of the 2108 newborns, 50.9% (n=1073) were female, 77.1% were born by vaginal delivery, more than 95% presented APGAR scores ≥7 at a minute and at 5 minutes, the 86.6% (n=1825) had a normal weight, only 9.9% (n=208) presented some perinatal complications, being hyperbilirubinemia (40.4%), respiratory distress syndrome (37.5%), and prematurity (6.7%) the most frequent ones. Conclusion: Perinatal complications only occurred in 9.9% of cases, with hyperbilirubinemia, respiratory distress syndrome, and prematurity being the most frequent clinical conditions; although it is a low percentage compared to other series, early identification and timely management of these pathologies are essential in this population group

Open Fractures in patients from the Teodoro Maldonado Carbo Hospital in Guayaquil city

Objetivo: Caracterizar epidemiológicamente las fracturas expuestas y las complicaciones infecciosas en pacientes atendidos en el servicio de emergencia de Traumatología del Hospital Teodoro Maldonado Carbo de la ciudad de Guayaquil, Ecuador. Método: Se realizó un estudio descriptivo, retrospectivo, mediante un análisis del sistema de registro del Teodoro Maldonado Carbo incluyéndose pacientes con diagnóstico de fracturas expuestas durante el período 2015-2017. Resultados: Se incluyeron 438 pacientes, con predominio en hombres (75,1%; n=329) y jóvenes <35 años 61% (n=267), la región tibial fue la zona corporal más afectada (62,3%; n=273). En cuanto a la severidad del grado de exposición, la fractura tipo IIIB fue la más frecuente 36,1% (n=158), siendo la fijación externa el procedimiento más empleado (57,8%; n=253). El 39,7% (n=174) de las fracturas se infectó y el staphylococcus aureus fue el agente más común con 40,8% (n=71). Conclusiones: La frecuencia de casos de fracturas expuestas en el Hospital Teodoro Maldonado Carbo de la ciudad de Guayaquil es alta en comparación con otros estudios, con un predominio en hombres, en sujetos jóvenes y con afectación tibial. Asimismo, se observa una alta frecuencia de infección en la fracturas, siendo el staphylococcus aureus el principal microorganismos aislado.© 2019, Sociedad Venezolana de Farmacologia y de Farmacologia Clinica y Terapeutica. All rights reserved. Objective: To characterize epidemiologically the open fractures and their infectious complications in patients attended in the orthopedic emergency service of the Teodoro Maldonado Carbo Hospital in Guayaquil city, Ecuador. Method: A descriptive, retrospective study was carried out through a record analysis of this hospital, including patients with open fractures diagnosis during the 2015-2017 period. Results: 438 patients were included, predominantly men (75.1%, n=329) and young people <35 years 61% (n=267), the tibial region was the most affected area (62.3%; n=273). Regarding the degree of exposure, type IIIB fracture was the most frequent one 36.1% (n=158), with external fixation being the most used procedure (57.8%, n=253). Likewise, 39.7% (n=174) of the fractures were infected and staphylococcus aureus was the most common agent with 40.8% (n=71). Conclusions: The frequency of open fractures cases in the Teodoro Maldonado Carbo Hospital in Guayaquil city is high in comparison to other studies, especially in men, young subjects and tibial affectation. Also, a high frequency of infection in the fractures is observed, staphylococcus aureus being the main isolated microorganism