Atribución de síntomas en pacientes con síntomas médicamente inexplicables. Un estudio de validación y desarrollo de la escala / Symptom attribution in patients with medically unexplained symptoms. A scale development and validation study

Resumen Introducción: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. Objetivo: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. Métodos: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. Resultados: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. Conclusión.: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.

Abstract Introduction: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. Objective: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. Methods: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. Results: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and others with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demostrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. Conclusion: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.

Artrocentesis en el tratamiento de artritis séptica en articulación temporomandibular: reporte de un caso / Arthrocentesis in the treatment of septic arthritis in the temporomandibular joint: a case report

Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

Reconstrucción de Fracturas Orbitarias Utilizando Tecnología Digital Tridimensional: Una forma de Optimizar Resultados

RESUMEN: La reconstrucción de las paredes orbitarias fracturadas es compleja debido a la gran cantidad de parámetros volumétricos que posee. Una restitución inadecuada de ellas habitualmente está asociada a secuelas postquirúrgicas en el paciente. El contar con herramientas que optimicen la restitución de la forma anatómica de la órbita en su reconstrucción es de vital importancia, y la utilización de nuevas tecnologías ha permitido mejorar los resultados quirúrgicos, tanto anatómicos como funcionales. El objetivo de este artículo es mostrar dos herramientas quirúrgicas que permiten optimizar los resultados terapéuticos en pacientes con fractura de órbita, que son el modelo estereolitográfico con imagen en espejo y la tomografía computada intraoperatoria. Se presentan las características de estas herramientas, su utilización en tres casos de pacientes con fractura orbitaria y los resultados obtenidos en el post operatorio.

ABSTRACT: The reconstruction of fractured orbital walls is complex due to the many volumetric parameters involved. An inadequate restitution of these walls may be associated with postsurgical sequelae in the patient. Is vitally important to count with tools that optimize the restitution of the orbit's anatomic shape during its reconstruction, and the use of new technologies has allowed the improvement of the surgical results, both anatomical and functional. The aim of this article is to show two surgical tools that allow to optimize the therapeutic results in patients with orbital fracture, which are stereolithographic models with mirror image technique, and intraoperative computed tomography. Their characteristics, their use in three cases of patients with orbital fractures, and the postoperative results are shown.

Protocolo de ayuno peritransfusional en enterocolitis necrotizante, en recién nacidos colombianos / Implementation of a peri-transfusion fasting protocol in necrotizing enterocolitis, in Colombian newborns

Objetivo: Determinar la diferencia de incidencia de enterocolitis necrotizante asociada a transfusión en recién nacidos pretérmino con y sin implementación de un protocolo de ayuno peritransfusional. Métodos: Estudio observacional retrospectivo. Se incluyeron todos los recién nacidos pretérmino que fueron transfundidos con unidad de glóbulos rojos entre julio 2015 y octubre 2016 en la unidad de recién nacidos un centro de tercer nivel de Colombia. El protocolo de ayuno peritransfusional se inició a partir de abril 2016. La enterocolitis necrotizante asociada a transfusión se definió como enterocolitis necrotizante presentada dentro de las 48 horas posteriores a la transfusión. Se analizaron variables demográficas, alimentación, número de transfusiones y variables asociadas a enterocolitis necrotizante. Resultados: Durante el tiempo de estudio, 148 recién nacidos prematuros necesitaron al menos una transfusión de glóbulos rojos que representaron 385 eventos de transfusión. Se informaron siete casos de enterocolitis necrotizante asociada a transfusión. La incidencia acumulada global fue 4,7 por ciento (3,6 por ciento con protocolo de ayuno peritransfusional y 6,3 por ciento sin protocolo), la tasa de incidencia global de enterocolitis necrotizante asociada a transfusión fue 18/1000 personas-transfusión (IC95 por ciento 7-37/1000 personas-transfusión), mayor en el grupo sin protocolo (28/1000 personas-transfusión) que en el grupo con protocolo (12/1000 personas-transfusión), pero sin significación estadística. Conclusiones: La implementación del protocolo de ayuno peritransfusional podría disminuir la incidencia y gravedad de la enterocolitis necrotizante asociada a transfusión. Se requieren estudios prospectivos para establecer la relación entre la alimentación enteral durante la transfusión y la enterocolitis necrotizante(AU)

Objective: Determine the difference in incidence of transfusion-associated necrotizing enterocolitis in preterm newborns with and without implementation of a peri-transfusion fasting protocol. Methods: Retrospective observational study. All preterm newborns that were transfused with red blood cell units during the period from July 2015 to October 2016 in the newborns´ unit at a third level of care center in Colombia were included. The peri-transfusion fasting protocol started on April 2016. Transfusion-associated necrotizing enterocolitis was defined as necrotizing enterocolitis presented within 48 hours after the transfusion. Demographic variables, feeding, number of transfusions and variables associated with necrotizing enterocolitis were analyzed. Results: During the study time, 148 premature newborns needed at least one transfusion of red blood cells that accounted for 385 transfusion events. Seven cases of transfusion-associated necrotizing enterocolitis were reported. The overall cumulative incidence was 4.7 percent (3.6 percent with peri-transfusion fasting protocol and 6.3 percent without protocol), the overall incidence rate of transfusion-associated necrotizing enterocolitis was 18/1000 people-transfusion (IC 95 percent 7-37/1000 people-transfusion); it was higher in the group without protocol (28/1000 people-transfusion) than in the group with protocol (12/1000 people-transfusion), but without statistical significance. Conclusions: Implementation of the peri-transfusion fasting protocol may decrease the incidence and severity of necrotizing enterocolitis associated with transfusion. Prospective studies are required to establish the relationship between enteral feeding during transfusion and necrotizing enterocolitis(AU)

Manifestación de impétigo y herpes zóster relacionado con el uso de mascarilla durante la pandemia de COVID-19. Informe de caso / Mask-related manifestation of impetigo and herpes zoster during the COVID-19 pandemic. Case report

Objetivo: Presentar un caso clínico en el que el paciente cursa impétigo que podría estar relacionado con el uso de mascarillas faciales por un tiempo prolongado. Caso clínico: Se reporta el tratamiento y la evolución de un caso clínico en un paciente adulto que consultó en un centro clínico privado por la presencia de lesiones vesiculares en la región labial superior con aumento de volumen generalizado en ambos labios. El cuadro clínico es compatible con infección por impétigo y herpes zóster asociado al uso prolongado de una mascarilla de tela. Se describe la importancia del empleo correcto de estas mascarillas que se están usando como medida de protección personal en el contexto de la pandemia por COVID-19, ya que las mismas pueden contribuir a generar infecciones faciales si no se mantiene una higiene apropiada (AU)

Aim: To present a clinical case in which the patient has impetigo that could be related to the use of facial masks for a long time. Clinical case: The treatment and evolution of a clinical case of an adult patient who attended a private clinical centre due to the presence of vesicular lesions in the upper labial region with generalized increase volume in both lips is reported. The clinical presentation is compatible with impetigo and herpes zoster infection associated with prolonged use of a cloth mask. The importance of the correct use of cloth masks that are being used as a personal protection measure in the context of the COVID-19 pandemic is described, since they can contribute to facial infections if proper hygiene is not observed (AU))

Factores asociados con enfermedades no transmisibles en el personal docente y administrativo de una institución universitaria

Objetivo : Determinar la asociación entre los factores de riesgo para enfermedades no trasmisibles comportamentales y metabólicos con algunas variables demográficas y comorbilidades en personal docente y administrativo de una institución universitaria. Material y métodos : Estudio descriptivo, de asociación con diseño transversal. La investigación se realizó en los locales de la Universidad (Campus Universitario y Sede Administrativa-ciudad), según programación, entre los meses de diciembre 2018 a febrero de 2019, con una muestra de 150 participantes elegidos aleatoriamente. Se aplicó test de Chi2, prueba exacta de Fisher y se determinó Odd ratio (OR) e IC al 95%; se consideró significativo p ≤ 0,05. Resultados: El 21,3% de participantes tenía alguna enfermedad, 11,3% fumaba y 25,3% consumía bebida alcohólica; el 66,7% consumía verduras/hortalizas inadecuadamente, 82% realizaba deficiente actividad física y 87,3% tenía dislipidemia; además, el 10,7% presentó hipertensión arterial, 46,7% sobrepeso y 27,3% obesidad. Los factores asociados con hipertensión arterial fueron ser varón (OR=3,59, IC 95%: 1,10-11,70), edad ≥ 40 años (OR=4,21, IC 95%: 1,15-15,44), casado (OR=3,06, IC 95%: 1,01-9,31), enfermedad previa (OR=6,21, IC 95%: 2,09-18,36) y consumir alcohol (OR=4,66, IC 95%:1,60-13,57). Para la obesidad, ser varón (OR=4,54, IC 95%:1,97-10,46), residir fuera de Barranca (OR=3,12, IC 95%: 1,27-7,68) y triglicéridos elevados (OR=10,48, IC 95%: 1,37-80,33). Conclusiones : Los factores asociados con enfermedad no transmisible en los trabajadores de la Universidad fueron la deficiente actividad física, el bajo consumo de frutas y verduras, el consumo de tabaco y alcohol; y están asociados con los metabólicos y comorbilidades como la hipertensión arterial, obesidad, dislipidemia.

SUMMARY Objective : To determine the association between behavioral and metabolic risk factors for non-communicable diseases (NCDs) with some demographic variables and comorbidities in teaching and administrative staff of a university institution. Methods : A descriptive study of association with a cross-sectional design was carried out. The research was carried out in the premises of the University (University Campus and Administrative Headquarters-city), according to programming, between the months of December 2018 to February 2019, with a sample of 150 randomly chosen participants. Chi2 test, Fisher's exact test were applied and Odd ratio (OR) with 95% CI was determined, being significant if the CI in the lower limit is greater than 1, in addition if the p value ≤ 0.05. Results: among the risk factors for NCDs, 21.3% of participants had some disease, 11.3% smoked and 25.3% consumed alcoholic beverages; 66.7% consumed vegetables improperly, 82% carried out poor physical activity and 87.3% had dyslipidemia; in addition, 10.7% had high blood pressure, 46.7% were overweight, and 27.3% had obesity. The risk factors for arterial hypertension were being male (OR = 3.59, 95% CI: 1.10-11.70), age ≥ 40 years (OR = 4.21, 95% CI: 1.15- 15.44), married (OR = 3.06, 90% CI: 1.01-9.31), previous illness (OR = 6.21, 95% CI: 2.09-18.36) and consume alcohol (OR = 4.66, 95% CI: 1.60-13.57). For obesity, being male (OR = 4.54, 95% CI: 1.97-10.46), residing outside of Barranca (OR = 3.12, 95% CI: 1.27-7.68) and High triglycerides (OR = 10.48, 95% CI: 1.37-80.33). Conclusions : The risk factors for NCDs in the University workers as well as the behavioral ones were the deficient physical activity, the low consumption of fruits and vegetables, the consumption of tobacco and alcohol; and are associated with metabolic and comorbidities such as hypertension, obesity, dyslipidemia.

Validación del modelo de cinco factores de la Escala de Actitud hacia la Estadística en estudiantes mexicanos de psicología / Validation of the five-factor model of the Attitude Scale towards Statistics in Mexican psychology students

Resumen La actitud positiva hacia la estadística promueve el estudio y uso de esta disciplina fundamental para analizar datos; de ahí la relevancia de evaluar el nivel actitudinal y desarrollar estrategias que lo potencien. La Escala de Actitud hacia la Estadística (EAE-25) de Auzmendi es uno de los instrumentos más usados en español para medir esta actitud, pero no se ha validado en México, lo que es importante para su uso en este país y para aportar evidencias de validez. Los objetivos del estudio fueron contrastar el modelo propuesto originariamente, comprobar su consistencia interna, describir su distribución, comparar los promedios entre sexos y verificar su validez concurrente. Este estudio instrumental usó un muestreo no probabilístico. Se analizó una muestra de 383 estudiantes de psicología mexicanos (73.6 % mujeres y 26.4 % hombres) que respondieron a dos escalas de actitud. El modelo de cinco factores (confianza, ansiedad, agrado, utilidad y motivación) mostró buen ajuste a los datos. Sus factores presentaron confiabilidad y validez discriminante. La distribución de las puntuaciones en EAE-25 fue normal. La actitud se polarizó, aproximadamente, en cuatro de cada diez estudiantes hacia la aceptación y en uno de cada diez hacia el rechazo. No hubo diferencias de medias entre sexos. La EAE-25 tuvo correlación alta con actitud hacia la investigación y baja con la calificación en la materia de investigación del semestre anterior. Se concluye que la EAE-25 presenta consistencia interna y validez de constructo.

Abstract The positive attitude towards statistics promotes the study and use of this fundamental discipline to analyze data, hence the relevance of evaluating the attitudinal level and developing strategies that promote a positive attitude. The Auzmendi's Scale of Attitude towards Statistics (EAE-25) is one of the most used instruments in Spanish language to assess this attitude; however, it has not been validated in Mexico, which is important for its use in this country and to provide evidence of validity. The objectives of the study were to test the originally proposed model, to verify its reliability, to describe its distribution, to compare the averages between both sexes, and to verify its concurrent validity. A non-probabilistic sampling was used in this instrumental study. A sample of 383 Mexican psychology students was analyzed (73.6 % women and 26.4 % men). The EAE-25 and a scale assessing attitude towards research were applied. Confirmatory factor analysis was used to test the Auzmendi's five-factor model. The parameter estimation was performed by unweighted least squares, using polychoric correlation matrix. The internal consistency was estimated by the McDonald's omega coefficient (ω), the convergent validity by the average variance extracted (AVE), and the discriminant validity by the heterotrait-monotrait ratio of correlations (HTMT). The mean differences between both sexes were tested through the t-test and concurrent validity through Pearson's correlation coefficients. The model of five correlated factors (confidence, anxiety, pleasure, usefulness, and motivation) showed good fit (χ./df =1.79, GFI = .98, AGFI = .97, NFI = .97, CFI =.99, RMSEA = .04, and SRMR = .07). The five factors showed reliability (ω > .80 in confidence, anxiety, pleasure, and usefulness, and ω = .72 in motivation) and discriminant validity (HTMT < .85 in nine out of ten factor pairs, and < .90 in the pair of the anxiety and confidence factors). The values of AVE were higher than .50 in the factors of confidence, anxiety and pleasure, which shows convergent validity in these three factors. A value of AVE very close to .50 in utility (AVE = .49) was compensated by an omega coefficient of .82, which suggests an acceptable convergent validity. However, the value of AVE was lower than .50 in motivation (AVE = .34). The EAE-25 and its factors presented normal distribution, with the exception of the motivation factor. The scores in the scale and its factors were obtained through the quotient between the sum of the items scored in the sense of acceptance attitude and the number of items added. These scores were interpreted in an absolute sense, by dividing the continuum from 1 to 5 into five intervals in correspondence with the five ordered categories of response to the items: [1, 1.8) y [1.8, 2.6) rejection, [2.6, 3.4) neutral, and [3.4, 4.2) y [4.2, 5] acceptance. The average attitude was positive in confidence (. = 3.53) and utility (. = 3.52), and neutral in the EAE-25 total score and its other three factors. The EAE-25 total scores were polarized towards acceptance in approximately four out of ten students and towards the rejected in approximately one out of ten; in the rest, they were neutral. There were no differences of means between both sexes. The EAE-25 total score had a high correlation with the total score in the scale of attitude towards research (. = .52, . < .001) and low with the qualification in the research subject of the previous semester (. = .13, . < .001). It is concluded that EAE-25 presents internal consistency and construct validity. It is suggested to use this scale in applied research in the field of university education and upper secondary education.

Auto- medicación y auto-prescripción en el personal de salud del primer nivel de atención de México, Bolivia y Ecuador / Selfmedication and selfprescription in health care workers in primary care in Mexico, Bolivia and Ecuador

Introducción. La prevalencia general de la automedicación en la población general fluctúa de 27.3% a 61.3%. En trabajadores de la salud está menos documentado (Definido como auto prescripción), así como su frecuencia y las características del personal médico. Material y métodos. Se trata de un estudio comparativo transversal de 3 países, México (178), Bolivia (250) y Ecuador (130) en población de Médicos Familiares y Médicos Generales de Primer nivel de atención en salud; sexo y edad indistintos, activos en consulta pública o institucional. El muestreo fue por conveniencia calculado por fórmula. Se usó una encuesta con datos demográficos, Frecuencia de automedicación y auto prescripción, patologías donde se usaron, y razones de uso y fuentes de información. Se capturaron y analizaron en SPSS versión 20. Se utilizaron estadísticas descriptivas e inferenciales como ji-cuadrada y Kruskal Wallis. Aprobado por el comité de ética de dos países. Resultados. De los participantes 58.0% son médicos familiares, la mayoría femeninas (p<.05), con pareja, y con promedio de edad de 39.3. Laboran en el sistema público 42.2%. Se automedicaron y auto prescribieron más medicamentos los médicos en México y menos en Ecuador (p<.0001). En general, en el último mes, 61.5% de los profesionales estudiados se auto medicó (media 2.99 veces), y menor porcentaje se auto prescribió 35.8%, (media 1.28 veces) principalmente analgésicos y antibióticos (p<.0001) y por patologías respiratorias (p<.05). Las variables numéricas no cumplieron los supuestos de normalidad. Conclusión. Más de la mitad de los profesionales estudiados se auto medicó y más de un tercio se auto prescribió (antibióticos y analgésicos), esto más en México (AU)

Introduction. The general prevalence of selfmedication in the general population fluctuates from 27.3% to 61.3%. It is less documented in health workers (denominated as selfprescription), as well as its frequency and the characteristics of medical personnel. Material and methods. This is a cross- sectional, comparative study of 3 countries, Mexico (178), Bolivia (250) and, Ecuador (130) in the population of Family Physicians and General Practitioners of the first level of care; indistinct sex and age, active practice in public or institutional consultation. Sampling was for convenience calculated by a formula. A survey with demographic data, II Frequency of self-medication and self-prescription, pathologies where they were used, reasons for use and, sources of information were used. They were captured and analyzed in SPSS version 20. Descriptive and inferential statistics such as chi-square and Kruskal Wallis were used. It was approved by the ethic committee from two countries. Results. Of the participants, 58.0% are family doctors, the majority female (p <.05), with a partner, and with an average age of 39.3 years; 42.2% work in the public system. More physicians in Mexico and fewer in Ecuador used self-medicated and self- prescribed medications (p <.0001). In general in the last month, 61.5% of the professionals self-medicated (average 2.99 times), and a lower percentage (35.8%,)self-prescribed (average 1.28 times) mainly pain relievers and antibiotics (p <.0001) and for respiratory pathologies (p <.05). The numerical variables did not meet the assumptions of normality. Conclusion. More than half of the professionals studied practice self-medication and more than third antibiotics and analgesics as self-prescription this more in Mexico (AU)

Satisfacción marital e impacto del confinamiento por COVID-19 en México / Couple satisfaction and impact of confinement by COVID-19 pandemic in Mexico / Marital satisfaction and impact of confinement by COVID-19 pandemic in Mexico

RESUMEN Introducción : El propósito del estudio fue evaluar la relación entre la satisfacción marital, medida por la Escala de Valoración de la Relación y el impacto percibido por el confinamiento debido al COVID-19 en diferentes ámbitos de la vida de las personas en una muestra mexicana. Método : Se evaluó a 101 personas que viven en pareja, con edad promedio de 41.2 años (DE = 10.7), 54.5% mujeres y 45.5% hombres. Resultados : El principal resultado fue la correlación negativa y significativa que indica que, a mayor satisfacción en la relación, menor impacto del confinamiento en los ámbitos de tranquilidad, felicidad, salud, condición física y bienestar emocional. Conclusión : Las personas que evalúan su relación de pareja como satisfactoria perciben menor impacto durante la contingencia por COVID-19 en los diferentes ámbitos de su vida.

ABSTRACT Background : The aim of the study was to evaluate the relationship between marital satisfaction, measured by the Relationship Assessment Scale and the perceived impact of confinement due to COVID-19 in different areas of people's lives, in a Mexican sample. Method : 101 people living as a couple, with an average age of 41.2 years (SD = 10.7), 54.5% women and 45.5% men were evaluated. Results : The main result was a negative and significant correlation that indicates that the greater the satisfaction in the relationship, the less impact of confinement in the areas of tranquility, happiness, health, physical condition and emotional well-being. Conclusion : The people with higher marital satisfaction will perceive less impact during the contingency by COVID-19 in the different areas of the person's life.

ABSTRACT Background : The aim of the study was to evaluate the relationship between marital satisfaction, measured by the Relationship Assessment Scale and the perceived impact of confinement due to COVID-19 in different areas of people's lives, in a Mexican sample. Method : 101 people living as a couple, with an average age of 41.2 years (SD = 10.7), 54.5% women and 45.5% men were evaluated. Results : The main result was a negative and significant correlation that indicates that the greater the satisfaction in the relationship, the less impact of confinement in the areas of tranquility, happiness, health, physical condition and emotional well-being. Conclusion : The people with higher marital satisfaction will perceive less impact during the contingency by COVID-19 in the different areas of the person's life.

RESUMEN Introducción : El propósito del estudio fue evaluar la relación entre la satisfacción marital, medida por la Escala de Valoración de la Relación y el impacto percibido por el confinamiento debido al COVID-19 en diferentes ámbitos de la vida de las personas en una muestra mexicana. Método : Se evaluó a 101 personas que viven en pareja, con edad promedio de 41.2 años (DE = 10.7), 54.5% mujeres y 45.5% hombres. Resultados : El principal resultado fue la correlación negativa y significativa que indica que, a mayor satis- facción en la relación, menor impacto del confinamiento en los ámbitos de tranquilidad, felicidad, salud, condición física y bienestar emocional. Conclusión : Las personas que evalúan su relación de pareja como satisfactoria perciben menor impacto durante la contingencia por COVID-19 en los diferentes ámbitos de su vida.

Social influences in a model of body dissatisfaction, weight worry and bodily discomfort in Mexican women / Influencias sociales en un modelo de insatisfacción corporal, preocupación por el peso y malestar corporal en mujeres mexicanas

Abstract The aim of this study was to analyze the explanatory level of the variables advertising influence, verbal messages, social models and social situations as regards body dissatisfaction, weight worry, and bodily discomfort. The study was conducted in a convenience sample of 206 Mexican women with an average age of 22.12 years (SD = 4.21). Structural equation modeling was used to analyze the direct and indirect effects of the independent variables on the dependent ones in three hypothetical models proposed. In the case of the model proposed for body dissatisfaction, it was found that the set of vari ables had 79% of variance explained and showed adequate goodness-of-fit indices (χ2/gl = .877; GFI = .982; CFI = .978; AGFI = .980; SRMR = .068; RMSEA = .079). The model for weight worry had 62% of variance explained and an acceptable goodness of fit (χ2/gl = 1.556; GFI = .981; CFI = .975; AGFI = .978; SRMR = .068; RMSEA = .080). Finally, the model for bodily discomfort had 72% of variance explained and showed adequate goodness of fit (χ2/gl = .173; GFI = .976; CFI = .969; AGFI = .972; SRMR = .062; RMSEA = .072). It is concluded that social influences have a significant impact on body image. Verbal messages had the strongest impact on the variables studied.

Resumen El objetivo del presente estudio fue analizar el grado explicativo de las variables "influencia de la publicidad", "mensajes verbales", "modelos sociales" y "situaciones sociales" frente a la insatisfacción corporal, la preocupación por el peso y el malestar corporal en una muestra seleccionada por conveniencia de 206 mujeres mexicanas con promedio de edad de 22.12 años (DT = 4.21). Específicamente, se utilizó un modelamiento de ecuaciones estructurales para identificar los efectos directos e indirectos de las variables independientes sobre las dependientes en tres modelos hipotéticos propuestos, y como resultados se encontró que el conjunto de variables tuvo un valor explicativo de 79 % para el modelo planteado para la insatisfacción corporal, con buenos indicadores de bondad de ajuste (χ2/gl = .877; GFI = .982; CFI = .978; AGFI = .980; SRMR = .068; RMSEA = .079); de 62 % para el modelo de preocupación por el peso, con una adecuada bondad de ajuste (χ2/gl = 1.556; GFI = .981; CFI = .975; AGFI = .978; SRMR = .068; RMSEA = .080); y de 72 % para el modelo de malestar corporal, con buenos valores de bondad de ajuste (χ2/gl = .173; GFI = .976; CFI = .969; AGFI = .972; SRMR = .062; RMSEA = .072). Se concluye que las influencias sociales tienen un impacto significativo en la imagen corporal y que los mensajes verbales presentan un mayor impacto en las variables estudiadas.

Cuestionario de bruxismo autoinformado. Estudio piloto en el noreste de México / Self-reported bruxism questionnaire. A pilot study in northeastern Mexico

Resumen El diagnóstico adecuado del bruxismo incluye el análisis y la correlación de signos y síntomas con diferentes métodos de diagnóstico, siendo esencial la interpretación y evaluación de los síntomas que reporta el paciente. El presente es un trabajo inicial sobre las propiedades psicométricas del cuestionario de bruxismo autoinformado (CBA). Participaron 100 personas (34 hombres y 66 mujeres) del noreste de México, la muestra se dividió en dos grupos, uno con diagnóstico clínico y autoinforme de bruxismo (N = 50) y otro sin bruxismo. Se evaluó la confiablidad por consistencia interna, la estructura factorial y la validez convergente entre la escala de estrés percibido PSS-14 y el CBA. Los resultados muestran consistencia interna entre los 11 ítems (α = .88). El análisis factorial confirmatorio para un solo factor presentó índices estadísticos de bondad de ajuste adecuados (χ2/gl = 1.461; GFI = .916; AGFI = .857, CFI = .967, RMSEA = .068). La correlación entre las escalas PSS-14 y CBA fue positiva (r = .27; p = .001), y entre la escala de estrés percibido y las subescalas bruxismo de sueño r = .20 (p = .039) y bruxismo de vigilia r = .29 (p = .002), La correlación entre las subescalas BS y BV fue r = .71 (p = .001), Los resultados del CBA muestran alta confiabilidad, consistencia interna y correlación inter-ítems apropiada, y respaldan la validez convergente del cuestionario. Asimismo, contribuyen a mejorar los estándares de calidad al evaluar los datos subjetivos aportados por personas con bruxismo y se considera de interés continuar con el análisis del CBA, evaluando su comportamiento en otras poblaciones.

Abstract Bruxism is defined as a repetitive jaw-muscle activity, characterized by grinding or clenching the teeth, and /or by bracing or thrusting of the mandible, which has different circadian manifestations, either during sleep (sleep bruxism) or when wakefulness (awake bruxism). For an appropriate clinical diagnosis of bruxism different techniques have been proposed; the most common technique is the usage of a self-reported questionnaire combined with a professional evaluation. While the first is a questionnaire in which the patient expresses their symptoms, the second depends on the presence of observed signs associated according to an evaluator, including tooth wear as well as identify symptoms associated to this jaw-muscle activity, to confirm a clinical diagnosis, there must be a correlation between the self-report questionnaire and clinical diagnosis. Therefore, there is no quantifiable measure that may help to evaluate, from a patient's perspective, the signs and symptoms that belongs to his/her muscle and mandibular activity while assessing both its proportion and measure. To strengthen the self-report technique as a reliable procedure for assessing the information expressed by patient with bruxism, this initial study reports the reliability and validity proprieties of the self-report bruxism questionnaire (CBA). The present study was conducted in Mexico and includes one hundred participants. Fifty percent of them presented a clinical diagnosis of bruxism (n = 50), the other half (control group) do not. In both groups the perceived stress scale (PSS) and the self-reported bruxism questionnaires (CBA) were equally completed on a self-administered way. Both a high internal consistency (α = .884) was found on the eleven items and a corrected item-total correlation ranged from .43 to .78, reflects an adequate reliability. The exploratory factor analysis was used to group the CBA variables; the extraction was made using a main component with Varimax rotation method. The sample adequacy coefficients, the Kaiser Meyer-Olkin (KMO = .826) and Bartlett's Sphericity test (χ2 = 579.866, p = .000) were assessed and expressed an appropriate intercorrelation between items. The factor analysis showed a bifactorial: the latent variables explained one factor of 47.8 % (eigenvalue = 5.26) variance and another of 11.5 % (eigenvalue = 1.27), thus its cumulative variance of this model was 59.36 %. Due to amount of explained variance and the difference between the eigenvalues of this initial solution we considered to prove a unidimensional model. A one solution factor scale was feasible, with factor weights greater than .52 on all items. This single-factor structure was verified in a confirmatory factor analysis, which presented significant values and suitable goodness of fit indexes (χ2/df = 1.461; GFI = .916; AGFI = .857, CFI = .967, RMSEA = .068). Also, a convergent analysis was performed proving a positive (r = .27; p = .001) correlation between the PSS-14 and CBA scales, the correlation with the subscales of self-reported awake bruxism, SAB was positive (r = .299, p = .002). Regarding self-reported sleep bruxism, SAB the correlation was also positive (r = .207, p = .039). The correlation between the subscales was both positive and strong (r = .713, p = .001). Based on the results obtained, we can conclude that, there are a positive, significant, and adequate correlation between PSS-14 scale and the scale of self-reported bruxism, as though as in the sub-scales SAB and SSB. These results suggested that the one factor solution of the CBA has high reliability, internal consistency, and an appropriate inter-item correlation; also, it supports the convergent validity of the questionnaire. Due to the possible contributions of the CBA to the improvement of the quality standards of the evaluation of subjective data provided by people with bruxism, it is suggested to continue with the analysis of the scale in future studies with other populations.

Factores asociados a dentición funcional en adultos mayores de la subred centro oriente, Bogotá, 2017 / Fatores associados à dentição funcional em adultos do centro subred oriente, Bogotá, 2017 / Factors associated with functional dentition in older adults of the subred centro oriente, Bogotá, 2017

Resumen Introducción y objetivo: determinar los factores relacionados con la dentición funcional según el concepto de la Organización Mundial de la salud -OMS-; y su prevalencia en un grupo de adultos mayores usuarios del servicio de odontología de la Subred Centro Oriente de Bogotá en 2017. Materiales y métodos: estudio transversal en el que se tomó como variable dependiente la dentición funcional. Mediante regresión logística binaria se identificaron las variables independientes que explican mejor la dentición funcional. Los datos fueron tomados de historias clínicas diligenciadas por odontólogos capacitados y para los análisis estadísticos se empleó el software IBM-SPSS versión 24. Se analizaron 394 historias de adultos, mayores de 60 años, valorados en el servicio de odontología. Resultados: la prevalencia de dentición funcional fue del 17%. El análisis multivariado determinó que los factores que mejor explicaron la dentición funcional fueron sexo (RP^1,6), edad (β^-0,08), presencia de comorbilidades (RP^3,4), y uso de seda dental (RP^1,2). Conclusiones: los datos evidencian baja prevalencia de dentición funcional en la población estudiada. Ser de edad más avanzada, ser mujer y no usar la seda dental, fueron factores relacionados con menor dentición funcional, mientras que la presencia de comorbilidades, por su parte, se asoció a mayor dentición funcional en la población estudiada. Los hallazgos del estudio sugieren la importancia de fortalecer el componente de actividades preventivas a lo largo del ciclo vital, e incluso, desde edades tempranas para disminuir la pérdida dental.

Abstract Introduction and objective: To determine the factors related to functional dentition according to the concept of the World Health Organization -OMS-and its prevalence in a group of elderly users of the dentistry service of the Central East Subred of Bogotá in 2017. Materials and methods: a cross-sectional study in which the functional dentition was taken as a dependent variable. By means of binary logistic regression, the independent variables that better explain the functional dentition were identified. The data were taken from clinical records filled by trained dentists and for the statistical analysis the software IBM-SPSS version 24 was used. We analyzed 394 clinical records of adults, older than 60 years, assessed in the dentistry service. Results: the prevalence of functional dentition was 17%. The multivariate analysis determined that the factors that best explained the functional dentition were sex (RP ^ 1.6), age (β ^ -0.08), presence of comorbidities (RP ^ 3.4), and use of dental floss (RP ^ 1,2) Conclusions: the data show a low prevalence of functional dentition in the studied population, being older, being a woman and not using dental floss, were factors related to lower functional dentition, while the presence of comorbidities on the other hand, it was associated with greater functional dentition in the study population. The findings of the study suggest the importance of strengthening the component of preventive activities throughout the life cycle, and even, from an early age to reduce dental loss.

Resumo Introdução e objetivos: determinar os fatores relacionados à dentição funcional de acordo com o conceito da Organização Mundial de Saúde -OMS; e sua prevalência em um grupo de idosos usuários de serviços de odontologia sub-rede Bogotá Center East em 2017. Materiais e Métodos: Estudo transversal que foi tomado como dentição funcional variável dependente. Por meio de regressão logística binária, foram identificadas as variáveis independentes que melhor explicam a dentição funcional. Os dados foram recolhidos a partir de fichas médicas diligenciadas por dentistas treinados e as análises estatísticas para o software IBM-SPSS versão 24 foi utilizado 394 histórias adultos, com mais de 60 anos, no valor de serviço dentário foram analisados. Resultados: a prevalência de dentição funcional foi de 17%. A análise multivariada determinou que os factores que melhor explicados a dentição funcional foram sexo (PR^ 1,6), idade (β^ -0,08), co-morbidades (RP^ 3,4), e fio dental (RP^ 1,2) Conclusão: dados mostram baixa prevalência de dentição funcional na população mais velha estudo Ser, sexo e uso de fio dental não, foram factores relacionados dentição funcional menor quando co-morbidades Enquanto isso, ele foi associado com maior dentição funcional na população do estudo. os resultados do estudo sugerem a importância de reforçar a componente de prevenção em toda as atividades do ciclo de vida, e até mesmo a partir de uma idade precoce para reduzir a perda do dente.

Intervention Approach to Improve Body Image Perception, from the Positive Psychology Perspective / Propuesta para mejorar la percepción de la imagen corporal, desde la psicología positiva / Proposta para melhorar a percepção da imagem corporal, desde a psicologia positiva

The following is a theoretical integration of two important topics: positive psychology and body image, in which tools of positive psychology and the importance of prevention based on it are detailed. Also, the concepts of body image in the population that is currently most vulnerable to this issue, adolescent women and young adult women, are highlighted. This review is complemented with a detailed proposal of psychological intervention designed from the approach of positive psychology and cognitive behavioral therapy. This proposal is composed of 11 sessions focused on improving the body image of women in two age ranges: adolescents and young adults who are normal weight, underweight or overweight; without falling into obesity or eating disorders. This proposal was created under two theoretical perspectives that are oriented towards the change of perceptions and behaviors that help self-acceptance of the body, with the purpose of avoiding body image distortion. Likewise, the necessary details are provided for the intervention to be applied in further investigations that offer evidence of its effectiveness and/or suggestions for improvements.

A continuación se presenta una integración teórica de dos tópicos de importancia actual: la psicología positiva y la imagen corporal, en donde se detallan herramientas de psicología positiva y la importancia de la prevención basada en ella. También se puntualizan los conceptos de imagen corporal en la población que actualmente es más vulnerable ante este tema, las mujeres adolescentes y las mujeres adultas jóvenes. Esta revisión se complementa con una detallada propuesta de intervención psicológica diseñada desde el enfoque de la psicología positiva y la terapia cognitivo conductual. La propuesta consta de 11 sesiones enfocadas en mejorar la imagen corporal de mujeres en dos rangos de edad, adolescentes y adultas jóvenes con normo peso, bajo peso o sobre peso, sin caer en obesidad o trastornos de conducta alimentaria. Esta propuesta se creó bajo dos perspectivas teóricas que están orientadas hacia el cambio de percepciones y conductas que favorezcan a la autoaceptación del cuerpo, con el fin de evitar la distorsión de la imagen corporal. Asimismo, se proporcionan los detalles necesarios para que la intervención se aplique en futuras investigaciones que ofrezcan evidencia de su efectividad o sugerencias de mejoras.

A seguinte é uma integração teórica de dois temas importantes: a psicologia positiva e a imagem corporal. No estudo são detalhadas as ferramentas da psicologia positiva e a importância da prevenção baseada em elas. Também, são ressaltados os conceitos da imagem corporal na população que é atualmente mais vulnerável em este aspeto, mulheres adolescentes e mulheres jovens adultas. Esta revisão é complementada com uma proposta detalhada da intervenção psicológica desenhada desde a perspectiva da psicologia positiva e a terapia cognitiva comportamental. Esta proposta esta composta de 11 sessões enfocadas em melhorar a imagem corporal de mulheres em dois rangos de idade: adolescentes e jovens adultas com peso normal ou com baixo ou sobrepeso, mais sem cair na obesidade ou desordens de alimentação. Esta proposta foi criada baixo duas perspectivas teóricas que estão orientada através da mudança das percepções e comportamentos que ajudam à auto aceitação do corpo, com o propósito de evitar a distorção da imagem corporal. Do mesmo jeito, são oferecidos os detalhes necessários de intervenção para ser aplicados em futuras pesquisas que proviam evidencia de sua efetividade e/ou sugestões para melhorar.

Tuberculosis cerebral sin meningitis en un niño inmunocompetente / Cerebral tuberculosis without meningitis in a immunocompetent child

Resumen La tuberculosis (TBC) cerebral o tuberculoma(s) sin meningitis es una enfermedad poco frecuente y de alta morbimortalidad. Presentamos el caso clínico de un lactante de 11 meses, previamente sano, que consultó por fiebre prolongada y síntomas neurológicos. La RM de encéfalo mostró múltiples imágenes micronodulares e hidrocefalia. El estudio de LCR para bacterias, hongos y micobacterias fue negativo. Se prescribió terapia empírica como una meningoencefalitis subaguda y tratamiento antituberculoso tetraconjugado y corticoesteroides. La confirmación del diagnóstico de TBC cerebral se realizó por biopsia de la lesión, con presencia de inflamación granulomatosa crónica necrosante y bacilos ácido-alcohol resistentes. Se enfatiza la importancia de considerar esta presentación de TBC en niños, y la necesidad de la búsqueda exhaustiva del agente etiológico en diferentes líquidos y tejidos, aun por métodos invasores.

Cerebral tuberculosis TB (tuberculomas) without meningitis is an uncommon disease with a high morbidity and mortality. We report on a case that illustrates the complexity of this clinical presentation. An 11 month old, previously healthy male infant was brought to the clinic due to fever present during the last 1.5 months, associated with loss of neurodevelopmental goals and signs of endocranial hypertension. CT scan of the skull revealed dilatation of the ventricular system with transependimary edema; MRI showed multiple intra- and extra-axial micronodular images and hydrocephalus. Studies of CSF (cyto-chemical analysis, staining, culture for aerobes, fungi, mycobacteria, and molecular tests for TB were negative). Empirical management for subacute meningoencephalitis was prescribed complemented with tetraconjugated treatment for TB and steroids. As there was no microbiological isolation, biopsy of a cerebellar lesion was performed, which revealed chronic necrotizing granulomatous inflammation and acid-alcohol resistant bacilli. The diagnosis of cerebral TB without meningeal involvement was confirmed. The objective of the present report is to emphasize the importance of considering this presentation of TB in children, to remark the need of exhaustive search for the etiologic agent by obtaining samples of the different fluids and tissues even if it implies recurring to invasive methods.

A possible association between the -2518 A>G MCP-1 polymorphism and insulin resistance in school children

ABSTRACT Objective Monocyte chemoattractant protein 1 (MCP-1) has been suggested to be involved in the pathophysiology of insulin resistance (IR); therefore, variants in the MCP-1 gene may contribute to the development of this disease. The aim of this study was to analyze the relationship of the -2518 A>G MCP-1 (rs1024611) gene polymorphism with insulin resistance in Mexican children. Subjects and methods A cross-sectional study was performed in 174 children, including 117 children without insulin resistance and 57 children with IR, with an age range of 6-11 years. Levels for serum insulin and high-sensitivity C-reactive protein were determined. The -2518 A>G MCP-1 polymorphism was identified by the polymerase chain reaction-restriction fragment length polymorphism method. Insulin resistance was defined as a HOMA-IR in the upper 75th percentile, which was ≥ 2.4 for all children. Results Genotype frequencies of the rs1024611 polymorphism for the insulin-sensitive group were 17% AA, 48% AG and 35% GG, and the frequency of G allele was 59%, whereas frequencies for the insulin-resistant group were 12% AA, 37% AG and 51% GG, and the frequency of G allele was 69%. The genotype and allele frequencies between groups did not show significant differences. However, the GG genotype was the most frequent in children with IR. The GG genotype was associated with insulin resistance (OR = 2.2, P = 0.03) in a genetic model. Conclusion The -2518 A>G MCP-1 gene polymorphism may be related to the development of insulin resistance in Mexican children.

Sindrome de Hamman y anorexia nerviosa: presentación de un caso y revisión de la literatura / Hamman's syndrome and anorexia nervosa: case report and literature review

Presentamos el caso de una adolescente de sexo femenino quien cumple criterios clínicos de anorexia nerviosa y presenta dolor torácico, documentándose pneumomediastino espontáneo (PE). El PE se define como presencia de gas libre en el mediastino en ausencia de causa precipitante. La incidencia es muy baja pero heterogénea. Se presenta principalmente en la población pediátrica en especial durante crisis asmáticas; es mayor en el sexo masculino. La anorexia es una causa inusual y han sido descritos únicamente 20 casos en la literatura hasta el momento. Clínicamente, el síntoma principal es el dolor torácico, seguido de disnea y a la exploración física es importante reconocer signos específicos, de los cuales el más frecuente es el enfisema subcutáneo, así como el signo de Hamman considerado patognomónico. Esta es una patología con un curso generalmente benigno y su manejo en la mayoría de los casos es conservador, aunque sigue siendo un tema controversial.

This is a case report of a severely malnourished young female patient, who met clinical criteria for anorexia nervosa and developed chest pain in whom spontaneous pneumomediastinum (SP) was documented. SP is defined as the presence of free air or any other gas in the mediastinum in the absence of an obvious precipitating cause. The incidence is very low. Spontaneous pneumomediastinum occurs mainly in the pediatric population especially during asthma attacks, is greater in the male. Anorexia is an unusual cause and have been reported only 20 cases in the literature up to now. The main symptom is chest pain, followed by dyspnea and in the physical examination is important to recognize specific signs, of which the most common is the subcutaneous emphysema and Hamman’s sign, considered pathognomonic. This is a clinical entity with a generally benign course. Although it remains controversial in most cases its management is conservative

Caracterización clínica paraclínica y epidemiológica de los pacientes con Lupus Eritematoso Sistémico del Hospital Universitario Hernando Moncaleano Perdomo de Neiva / Clinical, paradinical and epidemiological characterization of patients with Systemic Lupus Erythematosus at Hospital Universitario Hernando Moncaleano Perdomo, from Neiva Huila

Objetivo: Caracterizar clínica paraclínica y epidemiológicamente el Lupus Eritematoso Sistèmico en los pacientes del Hospital Universitario Hernando Moncaleano Perdomo de Neiva Diseño: Descriptivo de corte transversal. Población: Pacientes atendidos en el Hospital Universitario de Neiva Hernando Moncaleano Perdomo con diagnóstico de lupus eritematoso sistèmico. Método: Recolección de datos a través de revisión documental de historias clínicas del Hospital Universitario de Enero 2009 a Enero 2014. Resultados: De un total de 104 pacientes con lupus eritematoso sistèmico encontrados en el periodo de estudio, la relación mujer: hombre fue de 5:1. Las comorbilidades de mayor frecuencia en el género femenino fueron la hipertensión arterial con un 26,7%, la fibromialgia con 12,7% y el síndrome de antifosfolípidos con 12, 7%; en el género masculino la hipertensión arterial, la fibromialgia y la falla cardiaca se presentaron cada una en un 27,7%. El 61,5% de las pacientes femeninas tuvieron manifestaciones en piel, el 51,1% refirieron artralgias y solo un 25,5% presentaron compromiso articular caracterizado por derrame sinovial. En los hombres las manifestaciones en piel estuvieron presentes en un 50%, las artralgias y el compromiso articular caracterizado por derrame sinovial fueron un 50% y 22,2% respectivamente. En los exámenes paraclínicos entre el 12,7% y el 31,4% de los pacientes tenían un lupus activo, determinado por la presencia de leucopenia, proteinuria y C3-C4 consumidos. En la muestra de pacientes femeninas las alteraciones paraclínicas más frecuentes se caracterizaron por hemoglobina <12 g/dl en 53,4% y trombocitopenia en 26,7%. Por su parte, 33,3% de los hombres presentaron trombocitopenia y 6,3% hemoglobina <12 g/dl.

Objective: To characterize clinically, paraclinical, and epidemiologically Systemic Lupus Erythematosus in patients at Hospital Universitario in Neiva Design: Descriptive cross sectional. Place: Hospital Universitario Hernando Moncaleano Perdomo, Neiva-Colombia. Population: Patients at Hospital Universitario Hernando Moncaleano Perdomo with diagnosis of Systemic Lupus Erythematosus. Method: Data collection of medical histories was performed. Results: Of 104 medical histories, the disease occurs five times more often in women than in men (ratio of 5:1). The most frequent comorbidities in females were hypertension with 26.74%, fibromyalgia and anti-phospholipid syndrome both with 12, 79%; In male patients hypertension, fibromyalgia and heart failure were presented each in a 27.78%. 61.53% of female patients had skin manifestations, 51.16% reported arthralgia and only 25.58% had joint involvement characterized by synovial effusion; in men skin manifestations were 50%, 50% arthralgia and articular involvement characterized by synovial effusion was 22.22%. In the laboratory test between 12.79% and 31.40% of patients had active lupus, determined by the presence of leukopenia, proteinuria and C3 and C4 consumed. In the sample of female patients the most frequent paraclinical alterations were characterized by hemoglobin <12 g / dl in 53.48% and 26, 74% of patients present thrombocytopenia. Meanwhile, 33.33% of men had thrombocytopenia and 6.38% had hemoglobin <12 g / dl.

Obesidad y análisis proteómico: su utilidad en la búsqueda de biomarcadores y blancos terapéuticos de enfermedades metabólicas / Utility of proteomic analysis in the search for biomarkers and therapeutic targets in metabolic alterations associated with obesity

La obesidad es una enfermedad compleja y multifactorial, caracterizada por un aumento de grasa corporal que puede ser ocasionado por un desequilibrio entre la ingesta de alimentos y el gasto energético. En el proceso de aumento de peso intervienen factores como la susceptibilidad genética, factores ambientales y el estilo de vida. Está bien documentado que la obesidad aumenta el riesgo de padecer numerosas enfermedades y trastornos metabólicos como la resistencia a la insulina, diabetes tipo 2, hipercolesterolemia, enfermedades cardiovasculares, hígado graso, inflamación de bajo grado, algunos tipos de cáncer y trastornos sicológicos. Debido al incremento de la obesidad y sus comorbilidades en los últimos años en la población mundial, los gastos médicos erogados para su tratamiento representan un problema grave para los sistemas de salud pública. El análisis proteómico a gran escala, es una herramienta potente y prometedora para el descubrimiento de biomarcadores tempranos y para la comprensión de los mecanismos moleculares que subyacen a las alteraciones metabólicas asociadas con la obesidad. No obstante, es imprescindible considerar las limitaciones técnicas y el análisis e interpretación de los hallazgos proteómicos, para avanzar en la comprensión funcional integral de la dinámica del proteoma ligado a la obesidad. Adicionalmente, los abordajes con un enfoque proteómico, permitirán el desarrollo de nuevas terapias preventivas, así como el descubrimiento de agentes terapéuticos potenciales en el tratamiento de disfunciones metabólicas. El objetivo de esta revisión es analizar las contribuciones más recientes de la proteómica en la búsqueda de biomarcadores relacionados con la obesidad.

Obesity is a complex and multifactorial disease characterized by an increase in body fat that can be caused by an imbalance between food intake and energy expenditure. In the process of weight gain, factors such as genetic susceptibility, environmental factors and lifestyle are involved. It is well documented that obesity increases the risk of numerous diseases and metabolic disorders such as insulin resistance, type 2 diabetes, hypercholesterolemia, cardiovascular disease, fatty liver, low grade inflammation, some types of cancer and psychological disorders. Due to the increase in obesity and its comorbidities in recent years at the global level, medical expenses incurred for its treatment represent a serious problem for public health systems. Large-scale proteomic analysis is a powerful and promising tool for the discovery of early biomarkers and for the understanding of the molecular mechanisms underlying the metabolic alterations associated with obesity. Nevertheless, it is essential to consider the technical limitations and the analysis and interpretation of the proteomic findings, to advance in the integral functional understanding of the dynamics of the proteome linked to obesity. In addition, approaches with a proteomic viewpoint will allow the development of new preventive therapies, as well as the discovery of potential therapeutic agents in the treatment of metabolic dysfunctions. The aim of this review is to analyze the most recent contributions of proteomics in the search for biomarkers related to obesity.

TRANSEXUALIDAD Y SÍNDROME DE KLINEFELTER. ¿CARIOTIPO, IMPRESCINDIBLE EN ELPROTOCOLO DE REASIGNACIÓN DE SEXO? A PROPÓSITO DE UN CASO / TRANSEXUALITY AND KLINEFELTER SYNDROME. CARIOTIPO, IMPRESCINDIBLE IN THE PROTOCOL OF REASIGNATION OF SEX? ABOUT A CASE

Objetivo: Presentar un caso de transexualidad y síndrome de Klinefelter, asociación infrecuente. Caso Clínico: Paciente masculino de 32 años de edad, quien refiere disconfort con su sexo fenotípico y orientación conductual hacia patrón sexual femenino desde la infancia temprana, conocido y tratado por Psiquiatría. Acudió a nuestra consulta ocho años atrás, con modales y apariencia femenina, para manejo farmacológico. Se indicó tratamiento con terapia estrogénica y análogos de GnRH (Triptorelina 11,25 mg cada tres meses). Antecedentes personales: Ginecomastia desde la infancia. Diagnóstico genético de síndrome de Klinefelter (46XY/47XXY). Examen físico: Peso 71,5 kg, Talla: 1,66 m, IMC: 26 kg/m2, desproporción de segmentos corporales con predominio del inferior, ginecomastia grado II, genitales con hipoplasia escrotal, volumen testicular 10 cc ambos. Paciente quien inicia transición de hombre a mujer hace más de 10 años, actualmente integrado a la sociedad en su rol de género femenino, en espera de reasignación de sexo definitiva. Conclusión: La transexualidad es la condición según la cual una persona nace con un sexo específico (genético, gonadal, genital y fenotípico) pero se siente y se percibe del sexo opuesto. Como consecuencia busca adecuar su cuerpo y cambiar su apariencia física, a través de métodos farmacológicos y quirúrgicos. En nuestro caso el paciente es portador de una anomalía cromósomica que conduce a un fallo testicular primario, que en la mayoría de los casos no se asocia con trastornos de identidad de género, según lo revisado en la literatura. A pesar de que el análisis cromosómico no es considerado transcendental en el manejo de la reasignación de sexo, se impone como exploración complementaria para descartar la asociación de alteraciones hormonales que pudieran condicionar algún tipo de trastorno conductual y otras complicaciones.

Objective: To present a case of transsexuality and Klinefelter syndrome, an uncommon association. Case Report: A 32-year-old male patient, who reported discomfort with his phenotype sex and behavioral orientation towards female sexual pattern from early childhood, known and treated by Psychiatry. She came to our practice eight years ago, with manners and feminine appearance, for pharmacological management. Treatment with estrogen therapy and GnRH analogues (Triptorelin 11.25 mg every three months) was indicated. Personal history: Gynecomastia since infancy. Genetic diagnosis of Klinefelter syndrome (46XY/47XXY). Physical examination: Weight 71.5 kg, Height: 1.66 m, BMI: 26 kg/m2, disproportion of body segments with predominance of inferior, gynecomastia grade II, genitalia with scrotal hypoplasia, testicular volume 10 cc both. Patient who initiates transition from man to woman more than 10 years ago, currently integrated into society in her role of female gender, awaiting definitive reassignment of sex. Conclusions: Transsexuality is the condition according to which a person is born with a specific sex but feels and is perceived of the opposite sex. As a consequence he seeks to adapt his body and change his physical appearance, through pharmacological and surgical methods. In our case, the patient has a chromosomal anomaly leading to a primary testicular failure, which in most cases is not associated with gender identity disorders, as reviewed in the literature. Although the chromosomal analysis is not considered transcendental in the management of the sex reassignment, it is imposed as complementary exploration to rule out the association of hormonal alterations that could condition some type of behavioral disorder and other complications.