Relación entre obesidad y enfermedades crónicas no transmisibles e infecciosas / Relationship between obesity and chronic non-communicable and infectious diseases

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas. (AU)

Introduction: Obesity increases the risk of chronic non-communicable diseases (NCDs) and affects the course of diseases of infectious origin. Objective: Reviewing the literature on how obesity influences the severity of the clinical picture of some of the non-communicable and communicable diseases of greatest impact in Peru. Methods:Documentary research, from studies developed in various contexts associated with the presence of obesity along with infections or NCDs. Results: The condition of obesity reached by bad consumption habits and low physical activity is the main responsible for the high rate of NCDs, consequently, mortality. Conclusions: Excess weight affects the immune system, contributing specifically to exacerbated phenomena of a systemic inflammatory response, determined by increased secretion of adipocytokines, which predisposes the body to develop and contract NCDs and infectious diseases. (AU)

Attention to rhotacism language problem by oral surgery and vibrostimulatory therapy: a case report / Tratamiento para el problema del lenguaje de rotacismo mediante cirugía oral y terapia vibroestimulatoria: reporte de un caso

Ankyloglossia may prevent the tongue from contacting the anterior palate, which promotes an infantile swallow and hamper the progression to an adult-like swallow. This can result in an open bite deformity and in some cases it can be associated to mandibular prognathism and language problems like rhotacism, described as the inability or difficulty in pronouncing the sound / r /. The surgical cut of the frenum tissue that connects the tongue to the jawbone (frenulectomy) and the language rehabilitation treatment with functional oral devices, represent an alternative treatment for this problem. An 11-year-old boy reported with language performance problems, dental malposition and diagnostic of ankyloglossia condition, received frenulectomy surgery and language rehabilitation treatment with functional oral devices during six months. Language diagnosis was carried out in three periods of time: prior to the surgery, four weeks after the surgery and six months later. Combined surgical and functional therapies proved to be a better alternative than only surgical therapy. Combined therapies increased the speech abilities as well as swallowing functions, therefore, the patient's self-esteem.

La anquiloglosia puede evitar que la lengua entre en contacto con la región anterior del paladar, lo que promueve una deglución infantil y dificultan la adecuada deglusión en el adulto. Esto también puede dar lugar a una mordida abierta y en algunos casos, estar asociada con prognatismo mandibular y problemas de lenguaje como el rotacismo, que se describen como la incapacidad o dificultad para pronunciar el sonido / r /. La exsición quirúrgica del tejido que conecta frenillo de la lengua a la mandíbula (frenectomía) y el tratamiento rehabilitador del lenguaje con dispositivos orales funcionales, representan una alternativa de tratamiento para este problema. Un niño de 11 años de edad, con problemas de lenguaje, malposición dental y diagnóstico de anquiloglosia, fue sometido a frenectomía y tratamiento de rehabilitación dellenguaje mediante dispositivos orales funcionales durante seis meses. El diagnóstico del lenguaje se llevó a cabo en tres periodos de tiempo: antes de la cirugía, cuatro semanas después de la cirugía y seis meses más tarde. La combinación de tratamiento quirúrgico y funcionales demostraron ser una alternativa mejor que la terapia quirúrgica por sí sola. Las terapias combinadas aumentaron la capacidad del habla, así como funciones de deglución, por lo tanto, la autoestima del paciente.

Supraestructure maxillectomy and orbital exenteration for treatment of basal cell carcinoma of inferior eyelid: case report and review.

Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor for development of illness such as severe solar burns during childhood or adolescence. BCC is mainly located on sun-exposed sites, head and neck being the areas of more incidences; although nose, eyelids and periorbitary tissue are unfavorable due to cosmetic results that BCC involves. Tumors can be classified as nodular, superficial, micronodular, morphea variety, infiltrating, pigmented, metatypic and fibroepithelioma of Pinkus. Several treatment options such as surgical and nonsurgical are available. The goal of treatment is complete excision of the tumor with preservation of surrounding structures in a way aesthetically acceptable. Mohs' micrographic surgery is the standard treatment for all nonmelanoma skin cancers. Orbital exenteration is also used for treatment of malignancies of ocular tissues, mainly squamous cell carcinoma, sebaceous cell carcinoma and BCC. The tissue beneath the surgical site can be left for second-intention granulation or covered with a cutaneous implant of partial thickness. The case of a 77-year-old patient is presented with BCC of inferior eyelid of 14 years' duration, formerly managed with radiotherapy; however, due to recurrent illness and invasion to the maxillary antrum, he needed supraestructure maxillectomy with left orbital exenteration.

The use of reverse transcription-PCR for the diagnosis of X-linked chronic granulomatous disease

Chronic granulomatous disease (CGD) is an inherited disorder of the innate immune system characterized by a defective oxidative burst of phagocytes and subsequent impairment of their microbicidal activity. Mutations in one of the NADPH-oxidase components affect gene expression or function of this system, leading to the phenotype of CGD. Defects in gp91-phox lead to X-linked CGD, responsible for approximately 70 percent of CGD cases. Investigation of the highly heterogeneous genotype of CGD patients includes mutation analysis, Northern blot or Western blot assays according to the particular case. The aim of the present study was to use reverse transcription (RT)-PCR for the analysis of molecular defects responsible for X-linked CGD in eight Brazilian patients and to assess its potential for broader application to molecular screening in CGD. Total RNA was prepared from Epstein B virus-transformed B-lymphocytes and reverse transcribed using random hexamers. The resulting cDNA was PCR-amplified by specific and overlapping pairs of primers designed to amplify three regions of the gp91-phox gene: exons 1-5, 3-9, and 7-13. This strategy detected defective gp91-phox expression in seven patients. The RT-PCR results matched clinical history, biochemical data (nitroblue tetrazolium or superoxide release assay) and available mutation analysis in four cases. In three additional cases, RT-PCR results matched clinical history and biochemical data. In another case, RT-PCR was normal despite a clinical history compatible with CGD and defective respiratory burst. We conclude that this new application of RT-PCR analysis - a simple, economical and rapid method - was appropriate for screening molecular defects in 7 of 8 X-linked CGD patients.

Técnica de la nefroscopia percutánea en posición supina / Technique of percutaneous nephroscopy in supine position

With our simplified technique of percutaneous kidney access it is possible to perform nephrostomies, nephrolithotomies, antegrade ureterolithotripsies, endopielothomies, percutaneous resection of pielocalicial tumors, antegrade ureteral repermeabilizations, etc. We accomplish the percutaneous kidney access under local anesthesia, that we complement with intravenous sedation in the nephroscopy cases. Patients are supine, with a 3 liters serum bag below the ipsilateral flank. We locate the cutaneous access point between the 12th rib and the iliac bone, one centimeter over of the place that supports the flank (it coincides with the posterior axilar line). The directio followed by the puncture needle is cranial oblique and rising. As a radiological guide, the mark of the calicial crushing the needle causes when it pushes the renal cortex in front of the selected calix, is usually enough. Only seldom it is necessary to rotata the radiological C arm. We consider that this form of kidney percutaneous access confers a great simplicity to this surgery, facilitating to the maximum is execution in daily practice. On the other hand, it avoids the urologist's hand irradiation, and reports a significant reduction of the surgical risk for the patient

El psiquiatra en el hospital general / The psychiatrist in the general hospital

El autor describe la actuación del psiquiatra en un hospital público universitario. Resalta la importancia en la integración del psiquiatra con sus colegas clínicos y en la enseñanza de programas de residencia médica

Tratamiento de la hipertension arterial esencial con un bloqueador alfa solo o asociado a un diuretico. / Treatment of essential arterial hypertension with alfa blockers or associated with a diuretic

Se realizo un estudio abierto en 30 pacientes con hipertension arterial sistemica de tipo esencial, con edades que oscilaron entre 35 y 65 anos, para valorar la eficacia y tolerancia del clorhidrato de prazosin, medicamento al que se asocio clortalidona cuando no pudo obtenerse la normalizacion de la presion arterial. Los enfermos se dividieron en tres grupos de tratamiento, segun la severidad de la presion diastolica: ligeros, moderados y severos. Los resultados permitieron observar una respuesta hipotensora satisfactoria cuando se utilizo clorhidrato de prazosin solo en los hipertensos ligeros, que eran 6 y en 5 de los moderados; en los restantes 10, con hipertension moderada y los 9 enfermos con hipertension severa, fue necesaria la administracion de clortalidona.La combinacion prazosin/clortalidona logro la normalizacion de la mayoria de los pacientes. Los efectos secundarios observados fueron escasos y ligeros; en ningun paciente hubo necesidad de suspender la terapeutica