ABSTRACT
La tiroiditis subaguda (TSA) es un trastorno inflamatorio autolimitado de la glándula tiroides. Es más común en mujeres y se caracteriza por dolor cervical, síntomas inflamatorios sistémicos y disfunción tiroidea. La TSA se ha asociado a una infección viral previa, generalmente respiratoria o enteral. Múltiples virus se han relacionado con TSA. Desde mayo de 2020 se reportaron casos de TSA relacionados con la infección por SARS-CoV-2. Describimos 3 casos de SAT después de la vacuna COVID-19. Dos casos fueron inoculados con vacuna SARS-CoV-2 inactivada (CoronaVac) y uno con vacuna de ARNm Pfizer-BioNTech. Los síntomas clínicos comenzaron pocas semanas después de la inoculación. Presentaron dolor cervical anterior, fiebre, astenia y tirotoxicosis transitoria. En todos los casos la evolución fue favorable. Hasta donde sabemos, estos son los primeros casos de SAT posteriores a la vacuna COVID-19 descritos en Chile.
Subacute thyroiditis (SAT) is a self-limited inflammatory disorder of the thyroid gland. The disease is more common in women and is characterized by neck pain, systemic symptoms, and thyroid dysfunction. SAT It has been associated with viral, respiratory or enteral infection. Multiple viruses had been related to SAT. Since May 2020, cases of SAT related to SARS-CoV-2 infection were reported. We describe 3 cases of SAT following COVID-19 vaccine. Two cases were inoculated with inactivated SARS-CoV-2 vaccine (CoronaVac) and one with mRNA vaccine PfizerBioNTech. The clinical symptoms began few weeks after inoculation. They presented with neck pain, fever, general malaise and transient thyrotoxicosis. All cases revered spontaneously. To our knowledge, these are the first cases of SAT following COVID-19 vaccine described in Chile.
Subject(s)
Humans , Male , Female , Adult , Aged , Thyroiditis, Subacute/chemically induced , COVID-19 Vaccines/adverse effects , Vaccines, Inactivated/adverse effects , BNT162 Vaccine/adverse effectsABSTRACT
Introducción: en este curso inició el Plan D para la carrera Medicina, y estando inmersos en la preparación de las nuevas asignaturas rectoras que incluidas anteriormente en Morfofisiología, se propone una práctica de laboratorio con métodos de anatomía comparada. Objetivo: proponer la implementación de una práctica de laboratorio sobre la Anatomía del corazón para el segundo año de medicina, basada en métodos de anatomía comparada. Método: se realizó un estudio cuasiexperimental en la Filial de Ciencias Médicas Manuel Piti Fajardo durante los cursos 2015-16 y 2016-17. Donde se impartió la actividad propuesta al total de estudiantes (104) realizándose la observación de un corazón real de cerdo en comparación con el humano, mostrando aspectos de la anatomía externa e interna, y usando la guía de estudio de la anatomía cardiaca mediante la disección de un corazón porcino. Se aplicaron métodos teóricos: histórico lógico, analítico-sintético, inductivo-deductivo; de los empíricos se aplicó la observación, el análisis de documentos y la técnica del PNI. Resultados: los resultados de la evaluación sistemática fueron comparados con los alcanzados por los 128 estudiantes del curso anterior, encontrándose diferencias significativas entre ellas, se amplió el porcentaje de calificaciones con calidad, se disminuyó ligeramente el porcentaje de calificados de regular y disminuyó el porcentaje de suspensos. Conclusiones: los resultados han sido superiores con la introducción de esta práctica por lo que se propone como parte del programa de la asignatura "Sistemas cardiovascular, respiratorio, digestivo y renal", Plan D, segundo año, Medicina
Introduction: A Lab Practice is proposed to give an answer to methodological problems dealing with a new Curriculum of the Medical Career called Plan D in Medicine Career. It took place in Manuel Piti Fajardo Medical School in San Cristóbal during 2015-2016 and 2016-2017academic courses, is related to a new subject called Cardiovascular, Respiratory, Digestive and Renal systems which were taught before with the name of Morph-physiology. Objective: to offer a suggestion for a lab practice where students have to get familiar to the cardiovascular system using a pig's heart to observe its internal and external characteristics comparing it with a human heart. Methods: it consists of a quasi-experimental study based on a Lab Practice where students have to use a pig's heart to observe its internal and external characteristics comparing it with a human heart. Theoretical methods such us Inductive-Deductive method, Analytic- Synthetic method, Historical - Logical method were used and some empirical methods like observation, documentary analysis and P.N.I. were applied too. The methodology used for carrying out the study is similar to the one used by Biology students in the University of Havana. Results: Systematic evaluation results are presented comparing them, with the ones done before. The initial and final diagnoses are shown. Conclusion: the suggestion is made to work with the plan D curriculum, improving medical students' knowledge, related to a new subjecting Medicine Career called Cardiovascular, Respiratory, Digestive and Renal systems which were taught before with the name of Morph-physiology(AU)
Subject(s)
Animals , Students, Medical , Heart/anatomy & histology , Anatomy, Comparative/methods , Laboratories , SwineABSTRACT
Background: Basedow Graves disease (BGD) is the leading cause of hyperthyroidism. The characteristics of patients seen at a university hospital may differ from those described in the general population. Aim: To describe the clinical features of patients with BGD seen at a university hospital. Material and Methods: Review of medical records of all patients seen at our hospital between 2009 and 2014 with the diagnosis of thyrotoxicosis, hyperthyroidism or BGD. Clinical features, laboratory results and treatments were recorded. Results: We reviewed clinical records of 272 patients; 15 had to be excluded due to incomplete data. BGD was present in 77.9% (n = 212). The mean age of the latter was 42 years (range 10-81) and 76% were women. Ninety six percent were hyperthyroid at diagnosis and thyroid stimulating hormone was below 0.1 mIU/L in all patients. Median free thyroxin and triiodothyronine levels were 3.26 ng/dl and 3.16 ng/ml, respectively. Thyrotropin-receptor antibodies were positive in 98.5% and 85.7% had positive thyroid peroxidase antibodies. Graves orbitopathy (GO) was clinically present in 55% of patients. Of this group, 47% had an active GO, 26% had a moderate to severe disease and 7.8% had sight-threatening GO. As treatment, 26% received radioiodine, 44% anti-thyroid drugs exclusively, 28% underwent thyroidectomy and 2% did not require therapy. Conclusions: In this group of patients, we observed a greater frequency of severe eye disease and a high rate of surgical management. This finding could be explained by referral to highly qualified surgical and ophthalmological teams.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Patient Care Team , Thyrotoxicosis/therapy , Graves Disease/therapy , Hyperthyroidism/therapy , Retrospective Studies , Hospitals, UniversityABSTRACT
Introduction: fibromyalgia (FM) is characterized by diffuse chronic muscle pain, fatigue and disability, affecting quality of life. In recent years there are many reports that show a high prevalence of vitamin D deficiency in different populations. In patients with FM there are conflicting results about the associations with vitamin D deficiency. Method: Case control study matched controls by age and sex. A clinical interview, measurement of 25-OH vitamin D, calcium, phosphorus and intact PTH was measured. The definitions of the American Society of Endocrinology were used: Insufficient vitamin D levels of 21-29 ng/ml and deficiency when they are less than 20 ng/ml. Results: 39 female patients were included in each group. The average age was 46.33 years (SD 10.6) in patients with FM and 45.92 years (SD 11.9) in controls. VD average levels in women with FM was 26.13 ng/ml (SD 8.3) and the controls of 28.45 ng/ml (SD 8.7) p = 0.082. No group differences were found when using cutoffs of 30 ng/dl (OR 2.75 with p = 0.35 [95 percent CI 0.96 to 8.06]) or 20 ng/dl (OR 0,6 p = 0.38 [95 percent CI 0.15 to 2.18]). No VD patients with levels below 10 ng/dl were presented. Conclusions: We found no differences between groups in VD levels when considering the average levels of VD or using different cutoffs.
Subject(s)
Humans , Adult , Female , Middle Aged , Fibromyalgia/blood , Vitamin D/analysis , Case-Control StudiesABSTRACT
Introducción: los factores de crecimiento plaquetario son proteínas bioactivas que se sintetizan y almacenan en las plaquetas. Objetivo: evaluar la efectividad de los factores de crecimiento aportados por el lisado plaquetario alogénico en el tratamiento tópico de úlceras posflebíticas Métodos: se realizó un estudio cuasi-experimental con control simultáneo en la consulta de medicina regenerativa, Hospital General Docente "Comandante Pinares", entre enero de 2008 y diciembre de 2012. Se evaluaron 135 pacientes con el diagnóstico de úlceras posflebíticas con inadecuada respuesta al tratamiento convencional y ausencia de otras enfermedades de base que impidieran una respuesta a la terapia regenerativa. Los pacientes se dividieron en dos grupos: 90 recibieron tratamiento con la aplicación local del lisado plaquetario obtenido de las plaquetas alogénicas ABO compatibles y 45 mantuvieron el tratamiento convencional (grupo control). El tiempo de respuesta fue la característica distintiva para medir la eficacia entre ambos tratamientos. Resultados: predominó el sexo femenino y edad de más de 50 años. Los síntomas cardinales del síndrome posflebítico, estuvieron presentes en un mayor número de pacientes del grupo tratado con el lisado plaquetario, sin embargo, a los 30 días, se constató una mejoría de los mismos así como una disminución significativa del área promedio de las úlceras. En el grupo tratado con lisado, 86 pacientes remitieron sus síntomas en menos de seis semanas, frente a solo ocho en el mismo tiempo en el grupo convencional. Conclusiones: el uso de factores de crecimiento aportados por el lisado plaquetario alogénico fue efectivo en el tratamiento tópico de úlceras posflebíticas(AU)
Introduction: platelet-derived growth factors are bio-active proteins that are synthesized and stored in the platelets. Objective: to evaluate the effectiveness of allogenic platelet lysate-derived growth factors in the topical treatment of postphlebitis ulcers. Methods: a quasi-experimental study with simultaneous control was conducted from January 2008 through December 2012 in the regenerative medicine service of "Comandante Pinares" general teaching hospital located in San Cristobal, Artemisa province, Cuba. One hundred and thirty five patients with diagnosis of postphlebitis ulcers, inadequate response to the conventional treatment and absence of other illnesses that could hinder such response to regenerative therapy were evaluated. The patients were divided into two groups: 90 treated with local use of compatible ABO allogenic platelet-derived platelet lysate and 45 kept under the conventional treatment (control group). The reaction time was the distinctive characteristic to measure the effectiveness of both treatments. Results: females and over 50 years-old age predominated. The main symptoms of the posphlebitic syndrome were present in a high number of patients in the group treated with the platelet lysate. Thirty days later, these symptoms significantly improved and the average ulcer area dramatically decreased. There was observed symptoms remission in eighty six patients in less than six weeks in contrast with only eight in the conventional group during this period. Conclusions: the use of allogenic platelet lysate-derived growth factors was effective in the topical treatment of postphlebitis ulcers(AU)
Subject(s)
Humans , Postphlebitic Syndrome/complications , Intercellular Signaling Peptides and ProteinsABSTRACT
La utilización de lisado plaquetario alogénico abre otra posibilidad terapéutica en ortopedia. Se presenta su uso en una paciente femenina de 40 años de edad, con antecedentes de asma bronquial y tratamiento con esteroides, que como consecuencia de una caída sufrió herida avulsiva extensa en el tercio inferior de la pierna derecha con desgarro de piel de aproximadamente 11 cm con vértice distal y base proximal estrecha, que solamente tomó piel; y otra herida similar, aledaña a esta lesión, de aproximadamente 6 cm de diámetro. Se le realizó toilette y necreptomía de los bordes que tenían signos de necrosis, fundamentalmente los vértices. Se le realizaron puntos de afrontamiento donde se observó extrema fragilidad de la piel, se inició tratamiento con antibióticoterapia. A las 48 horas se observó necrosis de dos tercios del colgajo de piel, el cual se decidió mantener hasta pasados 10 días. Cuando se le retiró se comenzó a usar lisado plaquetario local en curaciones en días alternos. Se observó mejoría de la granulación, no así de la piel aledaña a la lesión. Posteriormente se le realizó infiltración perilesional con lisado plaquetario alogénico, con cuyo proceder mejoró el aspecto de la lesión y la cicatrización en un período de solo 7 días...
The use of allogenic platelet lysate opens another therapeutic possibility in orthopedics. Its use is presented in a 40 year-old patient with previous history of bronchial asthma and treated with steroids who, as a result a fall, suffered an extensive avulsive wound in her right foot of approximately 11 cm with skin laceration and necrosis of the torn piece, with vertex distal and proximal base that only took skin, with another torn piece of similar bodering and a diameter of approximatety 6 cm. A toilette and necrectomy of the cyanotic edge was made, mainly in the vertexes. Confrontation stitches were taken and an extreme fragility of the skin was observed when carrying this procedure. Treatment with antibiotics was started and after 48 hours necrosis of two third of the skin of the torn piece was observed which was not removed for ten days. After removal local therapy with alogenic platelet lysate was applied on alternate days. Improving of granulation was observed, but not in the surrounding skin lesion. Then, a perilessional infiltration with allogenic platelet lysate was made which improved the lesion appearance and its healing in a period of only 7 days...
Subject(s)
Humans , Adult , Female , Free Tissue Flaps/pathology , Platelet-Derived Growth Factor/therapeutic use , Necrosis/therapy , Transplantation, HomologousABSTRACT
Introducción: la osteoartrosis de la rodilla (OAR) es la causa más frecuente de artritis en la población por encima de los 55 años de edad. A menudo se asocia con discapacidad y deterioro variable de la calidad de vida. En la actualidad, el tratamiento con células madre ha abierto una alternativa más dentro del arsenal terapéutico con que se cuenta. Objetivo: evaluar la eficacia y seguridad del autotrasplante de células madre adultas en el tratamiento de la osteoartrosis de rodilla. Métodos: se realizó un estudio desde mayo 2009 hasta diciembre 2011, en el que se incluyeron 123 pacientes adultos con OAR atendidos en la consulta de medicina regenerativa, que no respondían a los tratamientos convencionales. Se les realizó el implante intrarticular de células mononucleares de sangre periférica (CMN-SP) autólogas, movilizadas mediante el factor estimulante de colonias granulocíticas. En todos los casos prevalecía el dolor y la dificultad a la marcha al inicio del tratamiento. Resultados: a los seis meses se observó mejoría clínica y radiológica en 117 pacientes (95,1 por ciento) y solo en seis enfermos (4,9 por ciento) no hubo la respuesta deseada, coincidiendo estos con los que presentaron trastornos de alineación marcados, en los cuales el dolor no desapareció, pero sí existió modificación de la intensidad. Conclusiones: el implante de CMN-SP es un método factible, simple, seguro y menos costoso para el tratamiento de OAR. Se recomienda que si existe deformidad angular acentuada marcada, esta debe corregirse antes del implante para que el proceder sea exitoso
Introduction: osteoarthrosis an every day more frequent degenerative disease affecting the quality of life of people over 55 years old and its treatment is a great challenge. The use of stem cells has open a new alternative in the available therapeutic arsenal. Objective: to assess the efficacy and safety of autologous adult stem cell transplantation in the treatment of knee osteoarthrosis. Methods: the study took place from May 2009 to December 2011 in 123 adult patients with OAR from the regenerative medicine outpatient service who had no response to conventional treatments. Intra-articular implantation of autologous peripheral blood mononuclear cells (MNC-SP) mobilized by granulocyte colony stimulating factor was performed. In all cases pain and gait difficulty at baseline prevailed. Results: after six months, clinical and radiological improvement in 117 patients (95,1 percent) were observed and only in six patients (4,9 percent) the expected response was not obtained. These last patients presented marked alignment disorders and the pain did not disappear, but there was a positive change in its intensity. Conclusions: the CMN-SP implant is a feasible, simple, safe and less expensive method for the treatment of knee osteoarthrosis. It is recommended that in cases with marked angular deformity, this disorder should be corrected prior to MNC-SP implantation so the procedure be successful
Subject(s)
Humans , Leukocytes, Mononuclear/transplantation , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/therapy , Health Impact Assessment/methodsABSTRACT
El tratamiento de las úlceras postrombóticas o posflebíticas constituye un reto para la medicina debido a su cronicidad y a sus frecuentes recidivas que condicionan múltiples trastornos locales y sistémicos, con una mala calidad de vida del paciente. En este trabajo se incluyeron 80 pacientes con úlceras posflebíticas en miembros inferiores que fueron divididos en 2 grupos: 40 tratados con lisados de plaquetas alogénicas conservadas y 40 tratados convencionalmente, que conformaron el grupo control. Se consideró como buen resultado cuando a los 30 días de tratamiento o antes, el paciente presentó una respuesta parcial o total. En el 95 por ciento de los enfermos tratados con el lisado se obtuvo una buena respuesta (suma de las totales y parciales) contra el 75 por ciento en el grupo control (p>0,001). El uso del lisado plaquetario resultó un proceder simple y efectivo en el tratamiento de úlceras posflebíticas en miembros inferiores, que puede ser recomendado, ya que los pacientes pueden mantenerse en sus hogares y así se elimina el costo hospitalario que generalmente tiene el tratamiento de este tipo de lesión
Treatment of post-thrombotic ulcers or postflebitic is a challenge to medicine because of its chronicity and frequent recurrences that determine multiple local and systemic disorders with poor quality of life for patients. This study included 80 patients with lower limb posflebitic ulcers, who were grouped into 2 groups: 40 treated with preserved allogeneic platelet lysates and 40 were treated conventionally. The latter was the control group. It was considered good result when the patient had a partial or complete response after 30 days of treatment or before. Good response was found in 95 percent of patients treated with lysate (sum of total and partial values) versus 75 percent in the control group (p> 0.001). The use of platelet lysate was a simple and effective procedure in the treatment of lower limb posflebitic ulcers. This treatment can be recommended, since patients can stay at home, thus eliminating the hospital costs incurred in this type of treatment
Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Platelet-Derived Growth Factor/therapeutic use , Blood Platelets/physiology , Postphlebitic Syndrome/epidemiology , Postphlebitic Syndrome/therapyABSTRACT
La medicina regenerativa ha abierto una posibilidad más para la consolidación efectiva y la recuperación rápida de los pacientes con lesiones traumáticas. Se presenta un paciente masculino, blanco, de 46 años de edad con antecedentes de accidente de tránsito. Se diagnosticó fractura del tercio medio del fémur izquierdo y las radiografías simples evidenciaron conminución Grado IV. Egresó después de 20 días de internamiento con persistencia del dolor a pesar de habérsele administrado analgésicos cada 4-6 horas. Se indicó terapia celular que se realizó en régimen ambulatorio. A partir de las primeras 48 horas la mejoría se incrementó progresivamente, logró estabilidad y desapareció el dolor en el foco de fractura, síntoma que mantenía desde el accidente. A las 8 semanas después de la terapia celular se observó mejoría radiológica. En general, su evolución se consideró satisfactoria por la pronta mejoría y su incorporación a la vida social. Este es el primer paciente en la provincia de Artemisa en que se ha realizado este nuevo tipo de terapia y hasta donde conocemos en el momento de la redacción de este trabajo, también el primero informado en la literatura científica en Cuba
Regenerative medicine has opened another opportunity for effective consolidation and rapid recovery of patients with traumatic injuries. We present a 46 year- old white male patient with a history of traffic accident. A middle third left femur fracture was diagnosed and plain radiographs showed IV grade comminution. He was released after 20 days of hospitalization with persistent pain despite of pain medication every 4-6 hours. Cell therapy was prescribed and it was performed on outpatient basis. After 48 hours the improvement was increased progressively, stability was achieved and pain disappeared in the fracture site, this was a symptom present since the accident. 8 weeks after cell therapy, radiological improvement was observed. In general, his eveolution was considered satisfactory for the fast recovery and its incorporation into social life. This is the first patient in Artemisa province who underwent this new type of therapy and as far as we know at the time of this writing, it is also the first reported in the scientific literature in Cuba