A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability

Background: The clinical features and epidemiological data about patients with phebolymphedema or lymphedema related to Chronic Venous Disease in Mexico is limited and has been understudied; at the same time, the relationships between its clinical features, physical activity level and disability remained unknown. Methods: This is a longitudinal cohort study based on the analysis of clinical data of 90 patients gathered between 2021 and 2022. The statistical analysis was carried out using the software SPSS version 25 and GrandhPad Prism 8; a descriptive analysis was developed using measures of central tendency for the variables of a quantitative nature and frequency distribution for those categorical variables. The behavior of the variables was revealed through the Shapiro-Wilk statistic. The mean difference analysis was carried out with the Student’s T for independent samples. To identify the effect of gender, age, and severity of the disease on the study variables, a three-way analysis of variance was obtained with a Sidak comparison analysis. For the associations between qualitative and dichotomous nature variables, the Chi-Square statistic was obtained along with the odds ratio to determine the intensity of the relationships found. Results: A total of 90 patients were included in the analysis; 71% (64) were female and 29% (26) were male; with a mean age of 62.7 years old (± 30.5). A mean BMI of 33.2, 79.9% (77) of patients reached overweight and obesity ranges. 50% (45) of patients reported disability to perform one or more daily life activities related to the disease’s condition (signs, symptoms, volume). Only 12% (10) of all patients performed at or above the minimum physical activity recommended for their population group, and 88% (80) of patients had no physical activity or performed under the proper population group’s recommendation of minimal physical activity. It was found that the practice of physical activity, the number of compromised segments, the stage of the pathology, and the presence of cardiological and metabolic antecedents provide a statistically significant association with disability. Notable statistical difference among sex as a risk factor was not found. Regarding the BMI, the only differences were observed in the level of severity of the disease, regardless of the presence of any disability (p=0.006), evidencing that the greater the severity, the higher the BMI in both men and women. About physical activity, it is observed that inactivity or minimal practice of physical activity is a risk factor for referred disability (p<0.05), since it is prolonged that the non-practice of physical activity increases by 230% the chances of referring a disability associated to the disease compared to those people who referred to practice minimal or above minimal physical activity; the presence of a cardiological and/or metabolic history is related to an increase of about 150% to 180% of presenting disability compared to patients who do not have these pathologies. Conclusion: This study shows clinical and epidemiological features of phlebolymphedema and their relationship with the level of physical activity and reported disability of 90 patients. Further studies are needed to improve and broaden the understanding of the clinical characteristics of phlebolymphedema and its correlations.

Cancer-Related Lymphedema: Clinical and Epidemiological Features in Mexico

Background? There is a lack of clinical and epidemiological knowledge about cancer-related lymphedema in Mexico. The objective of this study is to present a broad and deep report of cancer-related lymphedema’s clinical characteristics and epidemiological features based on the analysis of CRL patients’ data, collected from a specialized rehabilitation clinic in Mexico. Methods? This is a cohort study based on the analysis of clinical data gathered between 2015 and 2022. The study was developed in a private clinic that specializes in oncological patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering diverse clinical characteristics and demographic information, classified in a matrix, and statistically evaluated. Results? Among 307 lymphedema patients, gender distribution was represented by 87.9% (270) female and 12.1% (37) male; mean age of 54.5 years (± 32.5); 79.8% of the patients corresponded to breast cancer diagnosis, the rest of them were associated with other 19 different types of cancer. 90.2% of patients underwent some lymph node removal procedure, 68.1% of patients received fractioned radiotherapy sessions, and 87.7% received some chemotherapy scheme treatment. 64% of patients had a diagnosis of lymphedema and had onset symptoms of lymphedema in the first 5 years after oncological interventions and/or cancer diagnosis, most of them during the first 2 years. The general distribution of clinical staging was: 23.7% in stage 0; 20.1% in stage I; 44.6% in stage II, and in stage III 11.4%. Regarding body mass index, it was found a mean of 26.7 BMI. 61.2% of patients ranged between overweight and obesity. 43.3% of patients with CRL reported a disability to perform one or more activities due to lymphedema. 80% of patients had no physical activity or performed under the minimal physical activity recommended for the population group they belong. Conclusion? This study reports broad epidemiological and clinical features of a group of cancer-related lymphedema patients in Mexico, it was possible to identify diverse potential factors and relations that influence the clinical features of CRL; it is necessary to explore all factors and the interactions among them for a better understanding of CRL patients in the country.

Estimulación cerebral profunda en el núcleo accumbens en pacientes con depresión resistente al tratamiento: reporte de casos / Nucleus accumbens deep brain stimulation in patients with treatment-resistant depression: report of four cases

INTRODUCCIÓN: La estimulación cerebral profunda (DBS) se ha propuesto como una alternativa terapéutica para el manejo de la depresión resistente al tratamiento (DRT). Sin embargo, existen múltiples blancos para neuroestimulación y se desconoce el punto neuroanatómico óptimo en esta patología. Como parte del circuito de recompensa, el núcleo accumbens (NAc) ha sido estudiado en modelos de depresión y anhedonia. El objetivo de este artículo fue describir la experiencia clínica de la implantación de electrodos bilaterales de DBS en el NAc. REPORTE DE CASOS: Se describe la experiencia en cuatro mujeres entre los 17 a 41 años con DRT. Los casos presentaban antecedente de múltiples hospitalizaciones e intentos de suicidio serios, a pesar de haber sido tratadas previamente con terapia farmacológica, psicoterapia y TECAR (Terapia electroconvulsiva con anestesia y relajación). A los 6 meses del inicio del DBS, se observó una mejoría de los síntomas depresivos en la escala de Hamilton y un incremento en la escala de funcionalidad global. La anhedonia y la abulia persistieron luego de la cirugía, aunque con menor intensidad. CONCLUSIÓN: La DBS del NAc puede ser una estrategia efectiva en el tratamiento de pacientes con DRT, impactando en la funcionalidad y en la disminución del riesgo suicida.

INTRODUCTION: Deep brain stimulation (DBS) has been proposed as a therapeutic alternative for Treatment-resistant depression (TRD) patients. However, there are multiple targets for neurostimulation and the optimal neuroanatomical landmark for this pathology is unknown. Nucleus accumbens (NAc) is a crucial part of the reward circuit and has been studied extensively in models of depression and anhedonia. The objective of this study was to describe our clinical experience with DBS of the NAc patients with TRD. CASE SERIES: It described the experience in four females between 17 and 41 years of age. All cases presented with a history of multiple hospitalizations and serious suicide attempts, despite having been treated with optimal pharmacological regimes, psychotherapy and ECT (Electroconvulsive therapy). Six months after the initiation of DBS, an improvement in the Hamilton Depression Scale and in the Global Assessment of Functioning Scale was observed. Anhedonia and abulia persisted after the surgery, although less severe. CONCLUSION: DBS of NAc seems to offer favorable surgical outcomes in patients with TRD, impacting functionality and suicidal risk.

Enfermedad neurllógica bovina con diagnóstico n conclusivo en la región norte de Colombia. analisis histológico e inmunohistoquímico / Neurologiol diseeases in cttle with non-conclusive diagnostic in the Coloombia northern region. histological and inmunohistochemical analyses

La enfermedad neurológica bovina genera altas pérdidas económicas en las ganaderías y algunos de sus agentes etiológicos son zoonóticos, hechos que hacen prioritario su estudio. El objetivo del trabajo fue identificar antígenos del virus de la rabia y del herpes virus bovino-5 (BoHV-5) en muestras de encéfalos de bovinos archivados como casos de enfermedad neurológica con diagnóstico no conclusivo. Se seleccionaron 10 muestras del laboratorio del Instituto Colombiano Agropecuario -ICA- de Montería. Los tejidos fueron analizados mediante histopatología e inmunohistoquímica; para esta última técnica fueron utilizados tres anticuerpos: dos contra antígenos del virus de la rabia a una dilución de 1:200 y uno contra BoHV-5 a una dilución de 1:100. Histológicamente en nueve casos se observaron lesiones que variaron de tipo y severidad; la identificación de antígenos del virus de la rabia se demostró en 20% (2/10) de los casos y en ningún caso se demostró la presencia BoHV-5. Se discute sobre los resultados histopatológicos e inmunohistoquímicos y se concluye la importancia de asociar los hallazgos de las dos técnicas para establecer la etiología de la enfermedad neurológica, especialmente en casos con diagnóstico inconcluso.

Bovine neurological disease generates high economic losses in herds and some of its etiological agents are zoonotic, situations that make priority their study. The aim of this study was to identify antigens rabies virus and bovine herpesvirus-5 (BoHV-5) in cattle brain samples archived as cases of neurological disease with no conclusive diagnosis. 10 samples were selected from laboratory of the Colombian Agricultural Institute -ICA- at Monteria. Tissues were analyzed by histopathology and immunohistochemistry techniques. For immunohistochemical analysis, three antibodies were used: two against antigens of rabies virus at a dilution of 1:200, and one against antigens of BoHV-5 at a dilution of 1:100. Histologically lesions i nine cases lesions that varied in type and severity were observed; antigens detection of rabies virus could be demonstrated by immunohistochemistry in 20% (2/10) of cases and could not be demonstrated in any case the presence BoHV-5. We discuss on the histopathological and immunohistochemical finding, it is concluded on the importance of perform association of the two techniques to assist the establishing of the neurological disease etiology, especially in case without diagnostic.

Síndrome de hígddo graso en un caballo criollo Colombiano / Fatty iver syndrrome in a native Colombian horse

El objetivo de este trabajo fue discutir sobre los hallazgos clínicos, los exámenes de patología clínica realizados y su utilidad como indicadores de pronóstico en un paciente equino hembra con hígado graso. Se describe el caso de una yegua de raza criollo colombiano que ingresó al servicio de consulta externa del Hospital Veterinario Diego Villegas Toro de la Universidad de Caldas con signos de tránsito intestinal lento y cólico. Previamente, el veterinario remitente inició un tratamiento con fluidos y aceite cristal oral sin resultados satisfactorios. Se realizó un examen físico completo y pruebas paraclínicas (creatinina, BUN, albúmina, fibrinógeno, fosfatasa alcalina [FA], gamma glutamiltransferasa [GGT], alanina aminotransferasa [ALT], aspartato aminotransferasa [AST] y análisis de orina) que sugirieron disfunción hepática y compactación del colon mayor. Se instauró un tratamiento dirigido a favorecer el peristaltismo y la eliminación fecal y se dispensó soporte para coadyuvar a la función hepática. Durante la hospitalización se observaron signos clínicos compatibles con falla hepática, encefalopatía e compactación grave; finalmente, el equino murió. Durante la necropsia se confirmó compactación del colon mayor a nivel de la flexura esternal y peritonitis. El diagnóstico histopatológico fue hígado graso y peritonitis. Se concluye que la falla hepática puede asociarse con compactación del colon.

The aim of this work was discuss on clinical findings, clinical pathology tests and their usefulness as prognostic indicators in a female equine patient with fatty liver. It is described a case in a native Colombian mare that entered the outpatient service at veterinary hospital Diego Villegas Toro of the University of Caldas with slow intestinal transit signs and mild colic. Previously the sender veterinarian began treatment with intravenous fluids and oral mineral oil oral without satisfactory results. It was performed a complete physical examination and paraclinical tests (creatinine, BUN, albumin, fibrinogen, alkaline phosphatase [AP], gamma glutamyl transferase [GGT], alanine suggestive of liver dysfunction and compaction of the large colon. It was established a treatment addressed to promote peristalsis, fecal elimination and support liver function. During the hospitalization of the patient, were observed different clinical signs consistent with liver failure, encephalopathy and severe compaction; the equine died. During the necropsy was confirmed the large colon compaction in the sternal flexure and peritonitis. The histopathological diagnosis was fatty liver and peritonitis. It is concluded that liver failure may be associated with compaction of the large colon. aminotransferase [ALT], aspartate aminotransferase [AST] and urinalysis) that were suggestive of liver dysfunction and compaction of the large colon. It was established a treatment addressed to promote eristalsis, fecal elimination and support liver function. During the hospitalization of the patient, were observed different clinical signs consistent with liver failure, encephalopathy and severe compaction; the equine died. During the necropsy was confirmed the large colon compaction in the sternal flexure and peritonitis. The histopathological diagnosis was fatty liver and peritonitis. It is concluded that liver failure may be associated with compaction of the large colon.

Embarazo ectópico en un programa de fertilización in vitro / Ectopic pregnancy in an in vitro fertilization program

Se analizó la incidencia de embarazo ectópico durante dos años en el programa de la clínica de fertilización in vitro del Grupo de Reproducción y Genética de AGN y Asociados y se observó que se presentó en 2.58 por ciento de los casos. Se concluye que la tasa de embarazo ectópico se mantiene similar a la de la población general, se tiene como riesgo más importante el factor tubario, pero permanecen las demás características iguales a las presentadas por la población abierta, a pesar de que las cifras publicadas sean más elevadas para la fertilización in vitro.

Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina) / Comparison of two artificial insemination techniques-Sperm tubal perfusion and intrauterine insemination

En 1991 Kahn y col. describieron un método de inseminación intrauterina llamado Perfusión Tubárica de Esperma (PTE) utilizando un volumen inseminado de 4.0 ml, a diferencia de la Inseminación Intrauterina (IIU) clásica en la que el volumen inseminado es de 0.5 ml. El objetivo del estudio es comparar la tasa de embarazos de ambas técnicas. Durante un período comprendido entre agosto de 1993 a enero de 1994 se atendieron 60 pacientes con infertilidad se realizaron 131 ciclos de inducción de ovulación e inseminación intrauterina, 95 fueron con IIU y 36 con PTE. Se obtuvieron 18 embarazos clínicos, 11 con IIU y 7 con PTE, representando una tasa de éxito de 11.5 por ciento para la primera y de 19.4 por ciento para la segunda técnica. Estos resultados confirman los obtenidos por Kahn. La PTE representa una nueva posibilidad para el tratamiento de la infertilidad de diversas etiologías

Un caso de "Síndrome de Prune Belly". Diagnóstico prenatal / A case of \"Prune Belly Syndome\". prenatal diagnosis

El "Síndrome de Prune Belly" es una enfermedad rara y complicada, que afecta a órganos genitourinarios y pared abdominal, se le da este nombre por el aspecto del abdomen después de drenar la vejiga, en su forma totalmente desarrollada se presenta con la tríada: megaloquiste, deficiencia muscular abdominal y criptorquidia. Se presenta un caso de 22 semanas de gestación con diagnóstico por ultrasonografía de un gran quiste toracoabdominal. Se revisó la literatura

Variacion fenotipica de la poblacion de anopheles (K.) neivai (Dipteria Culicidae) en la Costa Pacifica de Colombia / Phenotypical variation of the anopheles population (K.) neivai (Diphteria Culicidae) in Colombian Pacific Coast

Entre los anos 1984 y 1985 se colectaron larvas y mosquitos de Anopheles (Kerteszia) en diferentes localidades de la costa del pacifico colombiano: El Trueno, Concherito y Santa Cruz, en el Rio Naya; Juanchaco y Ladrilleros, en el departamento del Valle del Cauca; y Charambira, en el Departamento del Choco. Los muestreos iniciales parecian indicar el hallazgo de dos especies: A.neivai y A.homunculus. Debido a ciertas dudas que se originaron en algunas diferencias morfologicas en los especimenes estudiados, se realizaron observaciones mas detalladas, y se llego a la conclusion de la presencia de una sola especie, A. neivai, con variaciones fenotipicas, que plantean algunos problemas de tipo taxonomico y posiblemente epidemiologico