Impacto del uso de plataformas de video llamadas en las preocupaciones con la apariencia física en pacientes con Trastornos Alimentarios y de la población general durante la Pandemia por COVID 19 / Video call platforms impact on physical appearance concerns in patients with Eating Disorders and general population during the COVID 19 Pandemic

Resumen: Objetivo: Explorar el impacto del uso cotidiano de plataformas de videollamadas en las cogniciones, emociones y comportamientos relacionados con la autoimagen en pacientes con Trastornos del Comportamiento Alimentario (TCA) y personas de la población general, durante la pandemia por COVID-19. Métodos: Sesenta y ocho pacientes con TCA en tratamiento y 106 personas de la población general respondieron a un cuestionario diseñado para el estudio a través de Lime Survey; (98.5 y 79.2% respectivamente eran mujeres), con edad promedio de 17.6 (DE:3.47) y 33.5 (DE:9.35) respectivamente. Las pacientes discutieron y explicaron sus respuestas en cinco sesiones de terapia grupal presenciales dirigidas por un psiquiatra. Posteriormente, se realizó un análisis temático reflexivo con un enfoque inductivo para determinar las categorías. Resultados: Los pacientes reportaron una mayor incomodidad frente a la cámara, preocupación con la apariencia física, miedo a la crítica, vergüenza y sentimientos de vulnerabilidad, comparados con las personas de la población general. Predominaron los pensamientos negativos sobre la forma y el tamaño del rostro y otras partes del cuerpo y las conductas de chequeo y/o evitación de la imagen corporal, que interfirieron con la concentración y el rendimiento. Conclusión: además del impacto negativo de la pandemia de COVID-19 en la salud mental, la nueva virtualidad desafía a los clínicos a enfrentar dificultades adicionales con la imagen corporal en pacientes con TCA y alerta a la detección de nuevas preocupaciones dismórficas también en la población general.

Abstract: Objective: To explore the impact of video call platforms on physical appearance concerns (cognitions, emotions and behaviors) in Eating Disorders (ED) patients and in general population, during COVID 19 pandemic. Methods: Sixty-eight patients attending a treatment program for ED, and 106 people from the general population responded to a questionnaire designed for the study through Lime Survey; (98.5 and 79.2% respectively were women), with a mean age of 17.6 (SD:3.47) and 33.5 (SD:9.35) respectively. Patients discussed and explained their answers in five in vivo group therapy sessions directed by a psychiatrist. Then, a reflective thematic analysis with an inductive approach to determine the categories was performed. Results: Patients reported a higher discomfort in front of the camera, preoccupation with physical appearance, fear of criticism, embarrassment, and feelings of vulnerability, compared with general population. Negative thoughts about the shape and size of the face and other body parts predominated, as well as body image checking/avoidance behaviors that interfered with concentration and performance. Conclusion: In addition to the negative impact of the COVID-19 pandemic on mental health, the new virtuality challenges clinicians to face additional body image difficulties in ED patients and alerts on the detection of dysmorphic concerns in the general population as well.

Pancreatic panniculitis: case report

Pancreatic panniculitis is a rare condition, affecting 2 to 3% of patients with pancreatic diseases, such as acute pancreatitis or pancreatic carcinoma. The clinical manifestations of panniculitis are painful erythematous nodules, predominantly affecting the lower limbs. From an anatomopathological point of view, the subcutaneous nodules are made of fat necrosis and vacuolated macrophages. The treatment consists in resolving the underlying diseases. We present the case of a 56-year-old female, admitted on the Emergency Department, who presented with acute abdominal pain and subcutaneous erythematous nodules. The combination of laboratory data, clinical and anatomopathological results confirmed the pancreatic panniculitis, in an underlying acute pancreatitis. The treatment focused on the resolution of the pancreatic disease.

Ciencias de la implementación: de la evidencia a la práctica / Implementation science: from evidence to practice

Resumen La amplia gama de evidencias científicas que respaldan diversas intervenciones clínicas no son suficientes para que dichas intervenciones se utilicen en la práctica. De tal modo que la Medicina Basada en la Evidencia debe dar el paso hacia la Practica Basada en la Evidencia, a través de procesos de implementación que permitan desplegar y contextualizar intervenciones en salud respaldadas por la evidencia. Para tal fin se ha desarrollado la Ciencia de la implementación, la cual investiga los factores que influencian el uso efectivo y completo de las innovaciones científicas en la práctica, intentando maximizar los beneficios de las intervenciones en salud. Esta ciencia se define como el estudio de los métodos que promueven la incorporación sistemática de hallazgos de investigación en la rutina clínica, con el objetivo de mejorar la calidad y efectividad de los servicios e intervenciones en salud. El propósito de este artículo es introducir el concepto de Ciencia de la Implementación en relación con la epidemiología clínica y establecer las razones por las cuales existe una imperiosa necesidad de su desarrollo. Además, tiene el propósito de explicar el porqué de la necesidad de acelerar la aplicación efectiva de la Medicina Basada en Evidencia y definir los principales modelos que precisan el ámbito de trabajo de esta ciencia, incluyendo: las particularidades de los estudios de implementación, sus diferencias con los estudios clásicos de la epidemiología clínica, los modelos de implementación y evaluación, así como la definición de los desenlaces esperados en un estudio de implementación. (Acta Med Colomb 2018; 43: 207-216).

Abstract The wide range of scientific evidence supporting various clinical interventions is not sufficient for these interventions to be used in practice. For this reason, Evidence-Based Medicine must take the step towards Evidence-Based Practice, through implementation processes that allow deploying and contextualizing the health interventions supported by evidence. For this purpose, the Science of implementation has been developed, which investigates the factors that influence the effective and complete use of scientific innovations in practice, trying to maximize the benefits of health interventions. This science is defined as the study of methods that promote the systematic incorporation of research findings in the clinical routine, with the aim of improving the quality and effectiveness of health services and interventions. The purpose of this article is to introduce the concept of Implementation Science in relation to clinical epidemiology and establish the reasons by which there is an urgent need for its development. In addition, it has the purpose of explaining why the need to accelerate the effective application of Evidence-Based Medicine and define the main models that define the scope of work of this science, including: the particularities of implementation studies, their differences with the classic studies of clinical epidemiology, the implementation and evaluation models, as well as the definition of expected outcomes in an implementation study. (Acta Med Colomb 2018; 43: 207-216).

Por qué es importante lograr metas de hipertensión arterial sistémica... A propósito un caso clínico que inició como evento vascular cerebral isquémico / Why is it important to achieve the goals of treatment of hypertension.... About a case that began as ischemic stroke

Resumen La hipertensión arterial sistémica (HAS) es una de las condiciones más frecuentes que se ve en atención primaria de las enfermedades cardiovasculares y que tiene como consecuencias; dependiendo del "órgano blanco" que afecte, producir la cardiopatía isquémica, la vasculopatía cerebral o la nefropatía crónica. Dentro de la patogénesis de la HAS se encuentran implicados varios mecanismos fisiopatológicos; de los cuales actualmente, por señalar los más importantes y frecuentes, juegan un papel el incremento en los niveles de adrenalina, el sistema renina-angiotensina-aldosterona y en fecha reciente, mucho se menciona la participación de la resistencia a la insulina y la hiperinsulinemia. Dichos procesos conllevan un desequilibrio entre el tono simpático y el parasimpático, aunado a la hipersensibilidad por el sodio desencadenan uno de los mecanismos fisiopatogénicos de la HAS. Actualmente se define la HAS como el hallazgo de cifras de tensión arterial mayores a 140/90 mm Hg. Este es uno de los padecimientos que más afecta a la población mundial encontrando prevalencias en grupos etarios y de género de 45 al 55% en varones entre los 45 y 70 años y del 45 al 65% en mujeres de ese mismo grupo etario. En el 2013 se publicaron las guías clínicas más recientes para su tratamiento y las metas recomendadas, con lo que se ha logrado disminuir sus complicaciones y mortalidad; dentro de las que destacan enfermedades vasculares como la cardiopatía isquémica y la cerebral y renal. En el presente trabajo se comenta un caso clínico que ejemplifica las complicaciones secundarias en un diagnóstico tardío, el daño a "órgano blanco" por exposición a largo plazo y el inadecuado cumplimiento de las metas terapéuticas.

Abstract Systemic arterial hypertension (SAH) is one of the most common conditions seen in primary care of cardiovascular disease and whose consequences; depending on the "target organ" affecting produce ischemic heart disease, cerebral vascular disease or chronic kidney disease. In the pathogenesis of HAS are several physiopathological mechanisms involved; of which currently, to name the most important and frequent play a role in increasing adrenaline levels, the renin-angiotensin-aldosterone system and recently, much the participation of insulin resistance and hyperinsulinemia mentioned. These processes lead to an imbalance between the sympathetic and parasympathetic tone, coupled with hypersensitivity sodium trigger one of the pathophysiologic mechanisms of hypertension. SAH is currently defined as finding numbers of older blood pressure 140/90 mm Hg. This is one of the diseases that most affect the world population prevalences found in age and gender groups 45 to 55% in men between 45 and 70 years and 45 to 65% in women of the same age group. In 2013 most recent clinical guidelines for treatment and the recommended goals, which has managed to reduce its complications and mortality were published; among which include vascular diseases such as ischemic heart and brain and kidney. In this paper a case that exemplifies the secondary complications in late diagnosis, damage to "target organ" by long-term exposure and inadequate compliance with therapeutic goals discussed.

Modalidades de atención para el paciente adulto con diagnóstico de esquizofrenia en fase aguda y de mantenimiento / Types of Care for Adult Patients Diagnosed With Acute and Maintenance Phase Schizophrenia

Objetivos: Ayudar al clínico en la toma de decisiones sobre las modalidades de atención disponibles para el adulto con diagnóstico de esquizofrenia. Determinar cuáles son las modalidades de atención que se asocian a mejores desenlaces en personas adultas con diagnóstico de esquizofrenia. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se adoptó y actualizó la evidencia de la guía NICE 82, que contestaba la pregunta acá planteada. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: Se revisaron siete metaanálisis para la formulación de las recomendaciones de esta pregunta. Los pacientes que estuvieron en la modalidad de tratamiento asertivo comunitario presentaron un menor riesgo de nuevas hospitalizaciones. Para la modalidad de atención de manejo intensivo de caso se encontraron resultados concluyentes que favorecen a la intervención para rehospitalizaciones a mediano plazo, funcionamiento social y satisfacción con los servicios. Los equipos de resolución de crisis favorecen a esta frente al cuidado estándar en los desenlaces de rehospitalizaciones, funcionamiento social y satisfacción con el servicio. Conclusión: La utilización de diferentes modalidades de atención conlleva a la necesidad de ofrecer un abordaje integral a los pacientes. La evidencia muestra beneficios para la mayoría de los desenlaces estudiados sin encontrarse riesgos para la integridad o la salud de los pacientes. En esta evaluación se recomienda utilizar modalidades de prestación de servicios de salud que tengan una base comunitaria y que cuenten con un grupo multidisciplinario. No se recomienda usar la modalidad hospital día en la fase aguda de la esquizofrenia en adultos.

Objectives: To assist the clinician in making decisions about the types of care available for adults with schizophrenia. To determine which are the modalities of treatment associated with better outcomes in adults with schizophrenia. Methods: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Results: Patients who were in Assertive community treatment had a lower risk of new hospitalizations. For the intensive case management, the results favored this intervention in the outcomes: medium term readmissions, social functioning and satisfaction with services. The crisis resolution teamswas associated with better outcomes on outcomes of readmissions, social functioning and service satisfaction in comparison with standard care. Conclusion: The use of different modalities of care leads to the need of a comprehensive approach to patients to reduce the overall disability associated with the disease. Evidence shows overall benefit for most outcomes studied without encountering hazards for health of patients. This evaluation is recommended to use the professional ways of providing health services that are community-based and have a multidisciplinary group. It is not recommended the modality "day hospital" during the acute phase of schizophrenia in adults.

Prevención y tratamiento de los efectos adversos agudos más frecuentes por el uso de antipsicóticos en pacientes adultos con diagnóstico de esquizofrenia / Prevention and Treatment of Common Acute Adverse Effects With Antipsychotic Use in Adults With Schizophrenia Diagnosis

Objetivo: Determinar las estrategias más adecuadas para la prevención y tratamiento de los efectos adversos agudos más frecuentes con el uso de Antipsicóticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se realizó una búsqueda sistemática de la literatura de novo. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: Resultados: Las intervenciones no farmacológicas tales como los consejos nutricionales por nutricionista, el ejercicio y la psicoterapia son efectivas para prevenir la ganancia de peso con el uso de antipsicóticos (disminución de peso en kg DM -3.05 [-4.16, -1.94]). La estrategia de cambio de antipsicótico fue efectiva para demostrar disminución de peso e IMC con el paso de olanzapina a aripiprazol (disminución del peso en kg DM -3.21 [-9.03; -2.61]). El uso de betabloqueadores comparado con placebo, usando como desenlace la reducción del 50% de los síntomas de acatisia, no mostró ser efectivo en la reducción de la acatisia inducida por antipsicóticos con un RR de 1.4 (0.59, 1.83). Conclusión: En esta evaluación se recomienda realizar acompan˜ amiento psicoterapéutico y por nutrición para el manejo del sobrepeso en pacientes en tratamiento farmacológico. En caso de que estas alternativas no sean efectivas se sugiere cambiar el antipsicótico a uno con menor riesgo de presentar incremento de peso o considerar el inicio de metformina. Para el manejo de acatisia inducida por medicamentos se recomienda la disminución de la dosis del medicamento y la adición de benzodiacepinas tipo lorazepam. No se recomienda el uso de betabloqueadores.

Objective: To determine the most adequate strategies for the prevention and treatment of the acute adverse effects of the use of antipsychotics. Methods: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. A systematic literature search was carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Results: The non-pharmacological interventions such as nutritional counseling by a nutritionist, exercise and psychotherapy are effective in preventing weight gain with the use of antipsychotics. (Kg Weight reduction in DM of −3.05 (−4.16, −1.94)). The antipsychotic change from olanzapine to aripiprazole showed weight loss and decreased BMI (decreased weight in KG DM −3.21 (−9.03, −2.61). The use of beta blockers was ineffective in reducing akathisia induced by antipsychotic; using as outcome the 50% reduction of symptoms of akathisia comparing beta-blockers with placebo RR was 1.4 (0.59, 1.83). Conclusion: It is recommended to make psychotherapeutic accompaniment and nutrition management of overweight for patients with weight gain. If these alternatives are ineffective is suggested to change the antipsychotic or consider starting metformin. For the management of drug-induced akathisia it is recommended to decrease the dose of the drug and the addition of lorazepam. It is recommended using 5 mg biperiden IM or trihexyphenidyl 5 mg orally in case of secondary acute dystonia and for the treatment of antipsychotic-induced parkinsonism to decrease the dose of antipsychotic or consider using 2 -4 mg/day of biperiden or diphenhydramine 50 mg once daily.

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte I: Factores de riesgo, tamización, diagnóstico y evaluación de riesgo de suicidio en pacientes con diagnóstico de depresión / Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive DisorderPart I: Risk Factors, Screening, Suicide Risk Diagnosis and Assessment in Patients with a Depression Diagnosis

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte I: Factores de riesgo, tamización, diagnóstico y evaluación de riesgo de suicidio en pacientes con diagnóstico de depresión...

Integral care guide for early detection and diagnosis of depressive episodes and recurrent depressive disorder in adults. integral attention of adults with a diagnosis of depressive episodes and recurrent depressive disorderpart i: risk factors, screening, suicide risk diagnosis and assessment in patients with a depression diagnosis...

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte II: Aspectos generales del tratamiento, manejo de la fase aguda, continuación y mantenimiento del paciente con diagnóstico de depresión / Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive DisorderPart II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis. Integral Care

Introducción: El presente artículo busca presentar las recomendaciones basadas en la evidencia que surgieron como respuesta a una serie de preguntas clínicas respecto al episodio depresivo y al trastorno depresivo recurrente, haciendo hincapié en los aspectos generales de tratamiento, el tratamiento en la fase aguda y el manejo de la fase de continuación/mantenimiento, con el fin de brindar parámetros de atención en salud basados en la mejor y más actualizada evidencia disponible para lograr los estándares mínimos de calidad en el abordaje de adultos con dichos diagnósticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de la Protección Social. Se adaptaron las recomendaciones de las guías NICE90 y CANMAT para las preguntas que estas guías contestaban y se desarrollaron de novo para las preguntas no encontradas. Resultados: Se presentan las recomendaciones 5-22 correspondientes al manejo de la depresión...

Introduction: This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. Methodology: A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Results: Recommendations 5-22 corresponding to management of depression are presented...

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte III: Tratamiento de la depresión resistente y la depresión con psicosis, tratamiento con terapia ocupacional y hospital día / Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder Part III: Treatment of Resistant Depression and Psychotic Depression, Occupational Therapy and Day Hospital Treatment

Introducción: El objetivo del presente artículo es presentar las recomendaciones basadas en la evidencia que surgieron como respuesta a una serie de preguntas clínicas con respecto al episodio depresivo y al trastorno depresivo recurrente, haciendo hincapié en los aspectos generales del tratamiento de la depresión resistente y la depresión con psicosis, el tratamiento con terapia ocupacional y el hospital día, con el fin de brindar parámetros de atención en salud basados en la mejor y más actualizada evidencia disponible para lograr los estándares mínimos de calidad en el abordaje de adultos con dichos diagnósticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de la Protección Social. Se adaptaron las recomendaciones de las guías NICE90 y CANMAT para las preguntas que estas guías contestaban y se desarrollaron de novo para las preguntas no encontradas. Resultados: Se presentan las recomendaciones 23-25 correspondientes al manejo de la depresión...

Introduction: This article presents recommendations based on the evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder. Emphasis was given to general treatment issues of resistant depression and psychotic depression, occupational therapy and day hospital treatment so as to grant diagnosed adult patients the health care parameters based on the best and more updated evidence available and achieve minimum quality standards. Methodology:A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while denovo questions were developed. Results: Recommendations 23-25 corresponding to the management of depression are presented...

Evaluación de las aberraciones de alto orden corneales y oculares mediante el índice Root Mean Square(RMS) con dos lentes de contacto blandos asféricosen pacientes con astigmatismo miópico bajo / Evaluation of higher-order corneal and ocular aberrations using

Objetivo: determinar cuál lente de contacto blando asférico (Pure Vision o Definition AC) modifica más el valor Root Mean Square (RMS ) de alto orden en las aberraciones oculares y corneales en pacientes con astigmatismo miópico bajo. Materiales y métodos: se estudiaron cuarenta ojos con astigmatismo miópico con la regla con esferas no mayores a -3,00 D y cilindros menores a-1,25 D, no usuarios de lentes de contacto a quienes se les realizaron aberrometrías con el aberrómetro Coas y con el topógrafo Keratron Scout en tres momentos: sin lente de contacto, con lente Pure Vision y con Definition AC. Resultados: con ambos lentes se aumenta el RMS de alto orden ocular y corneal. El lente Pure Vision aumenta más el RMS de alto orden corneal (16%) que el Definition AC (12,9%), y este aumenta más el RMS de alto orden ocular (19%) que el Pure Vision (8%). La aberración corneal que más se modificó fue la de coma, y la esférica para las aberraciones oculares. Ambos lentes tuvieron un efecto significativo en la aberración esférica disminuyéndola, tanto en las aberraciones oculares como en las corneales. Conclusiones: aunque los dos lentes de contacto aumentan el RMS de alto orden, tanto el ocular como el corneal, en el presente estudio el lente que tuvo un mejor rendimiento óptico fue el Pure Vision, ya que fue el que menos aumentó el RMS ocular de alto orden.

Objective: To determine which soft aspheric lens (Pure Vision or Definition AC) better modifies the higher-order RMS value in ocular and corneal aberrations in patients with low myopic astigmatism. Materials and Methodologies: Forty eyes with myopic astigmatism were studied using a lensometer with spheres no higher than -3.00 D and cylinders lower than -1.25 D, non contact lens users to whom aberrometries were performed with the COAS aberrometer and with topographer Keratron Scout at three different moments: without any contact lens, using Pure Vision and using Definition AC. Results: Higher-order ocular and corneal RMS increased with both lenses. Higher-order corneal RMS increases more with Pure Vision (16%) than with Definition AC (12.9%), while higher-order ocular RMS increases more with Definition AC (19%) than with Pure Vision (8%). Coma aberrations were the corneal aberrations that changed the most; spherical aberrations, on the other hand, were the ocular aberrations that experienced the most changes. Both lenses had a significant effect on the spherical aberration, diminishing it both in ocular andcorneal aberrations. Conclusions: Even though both contact lenses increase the higher-order ocular and corneal RMS , Pure Vision was the lens that showed the best optical performance in this study, as it is the one that increased higher-order ocular RMS the least.

Hipertensión arterial sistémica en el embarazo / Hypertension and pregnancy

Increasing evidence indicates that hypertension in pregnancy is an under recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Hipertensión arterial sistémica en la mujer / Hypertension in women

The cardiovascular disease is a crucial cause of morbidity and mortality in the woman mainly when they arrive at menopause. The pathophysiology and neurohormonal mechanisms widely vary with respect to the man. This finding has given the support to think that the estrogens may be playing a protector role in cardiovascular disease. However, the associated risk factors like obesity, diabetes, dislipidemia, smoking and sedentary life are increasing in an exponential form. In Mexico the population age distribution establishes that 60% of the women with hypertension are aged < 54 years old. This is reason why as factor of independent cardiovascular risk is commonest. Nevertheless, after the menopause cardiovascular mortality is greater in the woman than in the man. In this review, the importance of the new pathophysiological mechanisms and the clinical-therapeutic approach are analyzed, making emphasis in the importance of the change in the life style and also in the nutritional aspects. In Mexico the woman still have a unique role in the nutritional culture.

Abordaje clínico terapéutico del paciente adulto mayor con hipertensión arterial sistémica: recomendaciones para la práctica clínica / Therapeutic clinical approach for the elderly patient with hypertension: recommendations for clinical practice

The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.

Hipertensión arterial sistémica en el niño y adolescente / Hypertension in children and adolescence

The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus.

Elevación extrema de la presión arterial (crisis hipertensiva): recomendaciones para su abordaje clínico-terapéutico / Extreme elevation of the blood pressure (hypertensive crisis): recommendations for its clinical-therapeutic approach

From beginnings of last century the hypertensive emergency was defined as the association of acutely elevation from the arterial pressure and the appearance of damage to end organ. At present is recognized the effects of the hypertensive emergency, the aspects of its patophysiology in which are included phenomenon of vasomotricity and the participation of different substances with vasoactives properties. The clinical presentation includes not only the manifestations of the increase of the arterial pressure, the end organ damage too; for this reason the hypertensive emergency needs the immediate reduction of the arterial tension to prevent the damage to specific organs. The treatment in every case will have to be individualized, with a wide knowledge of the characteristics of every medicament to obtain the best results. The diagnosis and treatment of the hypertensive emergencies needs often of the attention of its complications if they have appeared and later, of a treatment of support for the arterial hypertension.

Prevención y tratamiento de la hipertensión arterial sistémica en el paciente con enfermedad arterial coronaria / Prevention and treatment of hypertension and coronary heart disease

The association between arterial systemic hypertension arterial coronary disease has been demonstrated by cumulated evidence of several epidemiological studies. Hypertension is an important independent risk factor for the development of coronary artery disease, vascular cerebral disease and nephropathy. Important advances exist in the knowledge of neurohumoral and hemodynamic factors that come together in the pathophysiology of the hypertension and in the development of coronary disease that allow to establish better strategies not only of treatment, but also of prevention, with the purpose of diminishing the cardiovascular mortality. The spectrum of the coronary artery disease secondary to atherosclerosis is wide and the strategies of treatment of hypertension must be adapted to each particular case. The treatment of both conditions needs of specific limits of agreement to the conditions of the patient and the form of presentation of each one of these disease.

Guías clínicas para la detección, prevención, diagnóstico y tratamiento de hipertensión arterial sistémica en México (2008) / Clinical guidelines for detection, prevention, diagnosis and treatment of systemic arterial hypertension in Mexico (2008)

The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology [quot ]Ignacio Chávez[quot ] presents its update (2008) of [quot ]Guidelines and Recommendations[quot ] for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). [quot ]We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases[quot ]. In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes that hypertension is not an isolated disease; therefore its approach must be in the context of the prevalence and interaction with other cardiovascular risk factors such as obesity, diabetes, dislipidemia and smoking among others. The urgent necessity is emphasized to approach in a concatenated form the diverse cardiovascular risk factors, since independently of which they share common pathophysiological mechanisms, its suitable identification and cont

Implante de mala de polipropileno a la pared abdominal: comparación de técnicas preaponeurótica y preperitoneal / Polypropylene mala implant to the abdominal wall: comparison of preaponeurotic and preperitoneal techniques

Está establecido que la mejor técnica de reparación de las hernias incisionales consiste en el uso de mallas de polipropileno que permiten y proporcionan un mejor nivel de resistencia en la pared abdominal. El objetivo del presente trabajo es comparar las reacciones tisulares que resultan de la utilización de dos técnicas de implantación distintas, la implantación de la malla de polipropileno en el plano preaponeurótico (superficial) y la implantación de la malla de propileno en el plano preperitoneal (profundo). El estudio se realizó en 24 conejos de castilla empleando la primera técnica a la mitad de los conejos y la segunda a la otra mitad. Los resultados obtenidos a los 7, 14 y 21 días después de la cirugía fueron comparados microscópica y macroscópicamente, y concluimos que la técnica preaponeurótica presenta una menor Reacción Inflamatoria Aguda, mejor integración a la pared abdominal y mejor evolución clínica, en relación a la técnica preperitoneal.

It's has been known that the best repairing technique for incisional hernias consist in the use of polypropylene tights, which provides to abdominal wall a better resistance. The purpose if this Project is to compare tissue reactions that result of the use of these two implantation techniques, the implementation of the propylene tight on the preaponeurothic layer (superficial) and the implementation of the polypropylene tight on the preperitoneal layer (Deep). This study has been done in 24 rabbits using the first technique in half of the rabbits and the second technique in the other half The results that we have obtained at 7, 14 and 21 days after surgery, were compared microscope and macroscopically, and we conclude that preaponeurothic technique presents a less acule inflammatory reaction, better integration to the abdominal wall and better el clinical evolution, comparing to the preperitoneal technique.

De la placa vulnerable solitaria, a la coronariopatía de múltiples vasos. De sus fundamentos, a las implicaciones terapéuticas modernas. Una realidad clínica en el espectro de los SICA / From the single vulnerable plaque, to the multiple complex coronary plaques. From their basis, to the modern therapeutic approach. A clinical reality in the spectrum of the acute coronary syndromes

Contemporary clinical and laboratory data have challenged our classical concepts of the pathogenesis of the acute coronary syndromes [ACS]. Indeed, several independent lines of clinical evidence have supported that the critical stenoses cause only a fraction of the ACS. Acute myocardial infarction is believed to be caused by rupture of a vulnerable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and therefore result in multiple unstable lesions. Recent studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some ACS patients. It has also been reported that a ruptured plaque at the culprit lesion is associated with elevated C- reactive protein and other inflammatory markers, which indeed indicate a poor prognosis in patients with ACS. Also, multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Therefore some ACS patients [20-40%] may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. It should be accepted that this ACS population represent a part of the spectrum of the ACS, and in particular in this group of patients treatment should focus not only on the stabilization of the culprit site but also warrants a broader approach to systemic stabilization of the arteries. However, recurrent cardiovascular events in this population still remain unacceptably high, indicating that plaque rupture or vulnerability of multiple plaques is a current challenge in the management of ACS patients.