Reconstrucción mamaria inmediata prepectoral / Immediate prepectoral breast reconstruction

Introducción. La reconstrucción mamaria inmediata con implantes prepectorales permite realizar la mastectomía oncológica con un resultado estético en un solo tiempo quirúrgico y con menor morbilidad del área dadora. Las indicaciones son precisas, en directa relación con las condiciones de la mastectomía. Material y métodos. Se presentan 83 pacientes en el período comprendido entre febrero de 2020 a febrero de 2022 con mastectomías uni- y bilaterales, con conservación del complejo areola-pezón los cuales fueron injertados en 7 casos. La incisión en surco submamario se realizó en 60 casos, radiada externa en 8 casos, vertical en 8 casos y 7 casos con patrón de reducción en el Instituto Oncológico Alexander Fleming. Los criterios de exclusión que utilizamos son tumores mamarios a menos de 1 cm del complejo areola pezón y tumores localmente avanzados. Resultados. En total se realizaron 98 mastectomías, de las cuales 86 fueron terapéuticas y 12 profilácticas por mutaciones genéticas. La extracción de ganglios se realizó por una incisión axilar, excepto en el patrón de reducción donde se realizó a través de la incisión de la mastectomía. En 42 pacientes se utilizaron implantes anatómicos y en 56 casos redondos texturizados. El seguimiento de las pacientes fue a 25 meses. Conclusión. La reconstrucción mamaria prepectoral lleva a la reconstrucción de la mama en el mismo espacio con una baja morbilidad y resultado natural. Las indicaciones para esta técnica deben ser muy precisas para lograr obtener los resultados deseados. En nuestra experiencia, la reconstrucción mamaria inmediata con implante directo es una técnica segura y reproducible, con excelentes resultados en pacientes en las que está debidamente indicada la técnica, con una baja tasa de complicaciones y disminución en el tiempo de tratamiento y de recuperación.

Introduction. Immediate breast reconstruction with pre pectoral implants allows to perform oncologic mastectomy with an aesthetic result in a single surgical time and with less morbidity of the donor area. The indications are precise and directly related to the conditions of the mastectomy. Material and methods. We present 83 patients in the period from February 2020 to February 2022 with uni and bilateral mastectomies, with preservation of the nipple-areola complex which was grafted in 7 cases. The incision in the submammary sulcus was performed in 60 cases, external radiated in 8 cases, vertical in 8 cases and 7 with reduction pattern at the Alexander Fleming Oncological Institute. The exclusion criteria we used are breast tumors less than 1 cm from the nipple areola complex and locally advanced tumors. Results. A total of 98 mastectomies were performed, of which 86 were therapeutic and 12 prophylactic for genetic mutations. Node removal was performed through an axillary incision, except in the reduction pattern where it was performed through the mastectomy incision. Anatomical implants were used in 42 patients and textured round implants in 56 cases. The follow-up of the patients was 25 months. Conclusion. Pre pectoral breast reconstruction leads to reconstruction of the breast in the same space with low morbidity and natural results. The indications for this technique must be very precise to achieve the desired results. In our experience, immediate breast reconstruction with direct implant is a safe and reproductible technique, with excellent results in patients in whom the technique is properly indicated, with a low rate of complications and decrease in treatment and recovery time.

Manifestaciones dermatológicas en kwashiorkor: reporte de caso y revisión de la literatura / Dermatological manifestations in kwashiorkor: case report and review of literature

RESUMEN Objetivo: presentar un reporte de caso y revisión de la literatura de una paciente diagnosticada con Kwashiorkor, por sus manifestaciones dermatológicas y clínicas. Métodos: se valora en el servicio de Urgencias a una lactante menor, femenina, de 4 meses de edad, con un cuadro de aproximadamente 15 días de lesiones asintomáticas, que se inician en miembros inferiores con posterior diseminación a tronco, miembros superiores y cara. La madre refiere alimentación exclusiva con avena desde el mes de vida. Resultados: se realizó un manejo interdisciplinario, con los servicios de Pediatría, Nutrición y Dermatología con adecuada evolución clínica de la paciente, observando importante mejoría del cuadro cutáneo, a los pocos días de su estancia hospitalaria. Conclusiones: aunque no es una patología muy frecuente hoy en día, sigue sucediendo en países en vía de desarrollo y desarrollados, por lo que es importante siempre tenerla como diagnóstico diferencial para un abordaje adecuado y educar a los padres y cuidadores.

SUMMARY Objective: wepresent a case report and review of the literature of a patient, diagnosed with Kwashiorkor due to its dermatological and clinical manifestations. Methods: a 4-month-old female infant was evaluated in the Emergency department for approximately 15 days of asymptomatic lesionsthat began in the lower limbs with subsequent dissemination to the trunk, upper limbs and face. The mother refers a diet since four months of age only with oats, denies maternal lactation. Results: an interdisciplinary management was carried out, with the Pediatric service, Nutrition and Dermatology with adequate clinical evolution of the patient, observing an important improvement of the cutaneous lesions, after a few days in the hospital. Conclusions: although it is not a very frequent pathology, it is still happening in developing countries and developed, so it is important to always have it as a differential diagnosis for an adequate approach and always educate parents and caregivers.

Efecto de la dieta en psoriasis moderada a severa, en pacientes con sobrepeso y obesos con tratamiento tópico y sistémico con metotrexato / Effect of diet on moderate or severe psoriasis in patients with obese and overweight under treatment with topical and systemic methotrexate

INTRODUCTION: Psoriasis is a chronic inflammatory disease with significant impact on quality of life. There are environmental factors that can change the course of the disease. OBJECTIVE: To investigate whether moderate weight loss, improves response to methotrexate in obese or overweight patients who suffer from the disease. METHODOLOGY: A controlled pilot project of 8 weeks was performed in 15 patients with moderate to severe psoriasis under treatment with Methotrexate and topical therapy. The intervention corresponded to a nutritional assessment, a strict diet and physical activity suggestion. Patients were evaluated using PASI, at 0, 4 and 8 weeks. RESULTS: After 8 weeks, mean PASI decreased by 13% and a decrease in weight, BMI and waist circumference was achieved, but without statistical significance. CONCLUSION: Further studies are required to demonstrate the importance of weight loss in obese or overweight psoriatic patients under methotrexate treatment.

INTRODUCCIÓN: La Psoriasis es una enfermedad inflamatoria crónica con importante impacto en la calidad de vida.Existen factores ambientalesque pueden modificar el curso de la enfermedad. OBJETIVO: Investigar si una pérdida moderada de peso, aumenta la respuesta a Metotrexato en pacientes obesos o con sobrepeso que padecen la enfermedad. METODOLOGÍA: Proyecto Piloto, controlado, de 8 semanas en 15 pacientes con psoriasis moderada a severa,en tratamiento con Metotrexato y terapia tópica, atendidos en Santiago de Chile. La intervención correspondió a una evaluación nutricional, una dieta estricta y sugerencia de actividad física. Los pacientes fueron evaluadas con PASI, a las 0, 4 y 8 semanas. RESULTADOS: Después de 8 semanas, se logró una disminución del PASI promedio en un 13% y una disminución del peso, IMC y circunferencia abdominal, pero sin significancia estadística. CONCLUSIÓN: Se requieren realizar estudios con un mayor número de pacientes para demostrar la importancia de una disminución de peso en el tratamiento con metotrexato en pacientes psoriáticos obesos o con sobrepeso.

Lipasa endotelial y su relación con la enfermedad cardiovascular y diabetes mellitus tipo 2 / The role of endothelial lipase in atherogenesis

Endothelial lipase (EL) is synthetized by endothelial cells and its main substrates are lipoprotein phospholipids. Over expression of EL reduces high density lipoprotein (HDL) cholesterol and phospholipids, in vivo and in vitro. Inhibition of the enzyme achieves the opposite effects. The synthesis of the enzyme is regulated by interleukin 1 and tumor necrosis factor a. These inflammatory cytokines play a role in diabetes and vascular disease. An increase in vascular mechanical forces, that play a role in atherogenesis, also increase the synthesis of EL. There is expression of EL in endothelial cells, macrophages and muscle cells of atherosclerotic lesions of coronary arteries of humans. This evidence leads to the suspicion that EL plays a role in atherogenesis. There are also higher plasma levels of EL in subjects with type 2 diabetes, who are especially susceptible to the development of vascular lesions. Therefore the inhibition of EL could play an important role in HDL metabolism and could be a new therapeutic strategy for the prevention of atherosclerosis.

Estudio transversal: evaluación de prevalencia de comorbilidades metabólicas y factores de riesgo cardiovascular, y su correlación con la severidad clínica, en 106 pacientes con psoriasis / Prevalence of metabolic comorbidities and cardiovascular risk factors in patients with psoriasis: cross-sectional study

Introducción: Diversos estudios epidemiológicos han demostrado que los pacientes con psoriasis presentan mayor mortalidad general, mortalidad cardiovascular (CV) e incidencia de infarto al miocardio que la población general. Esto se explican o sólo por la mayor prevalencia de factores de riesgo CV clásicos (obesidad, diabetes, hipertensión arterial, entre otros) en estos pacientes, sino que también la psoriasis constituye un factor de riesgo CV independiente en directa relación con su severidad, con mayor impacto en pacientes jóvenes. Objetivos: Evaluar la prevalencia de comorbilidades metabólicas y factores de riesgo CV en 106 pacientes con psoriasis, y su correlación su severidad clínica. Además de comparar dichas prevalencias con las reportadas por la Encuesta Nacional de Salud (ENS) 2010 para la población chilena. Material y método: Se realizó una evaluación antropométrica y una encuesta sobre antecedentes mórbidos y de la psoriasis a 106 pacientes. Se definieron dos grupos de severidad. Se compararon prevalencias entre los grupos de severidad, así como entre la muestra total y la población chilena. Posteriormente se realizó la comparación considerando exclusivamente al grupo etario de 25 a 64 años (84,8 por ciento, tanto para hombres y mujeres. También se compararon prevalencias entre el grupo de pacientes jóvenes con psoriasis severa y la ENS, siendo éste el grupo de mayor riesgo CV asociado a la psoriasis. Resultados: La muestra correspondió a 106 pacientes, 47 mujeres y 59 hombres, con edad media de 43,5 +/- 14 años. La mitad presentó sobrepeso, un 26 por ciento peso normal y un 34 por ciento obesidad, con IMC promedio de 27,8 kg/m2 y gran prevalencia de comorbilidades metabólicas y factores de riesgo CV, siendo los más frecuentes el tabaquismo (41 por ciento) y la hipertensión arterial...

Background: Epidemiologic studies have demonstrated that patients with psoriasis have an increased risk of mortality, cardiovascular (CV) mortality and myocardial infarction, than general population. Some explanation for this is related to an increased incidence of classical CV risk factors (e.g: obesity, diabetes, blood hypertension) on psoriasis patients. Additionally, psoriasis itself is considered as an independent CV risk factor, directly related to its severity and with higher impact on young patients. Objective: To determinate the prevalence of metabolic comorbidities and CV risk factors in patients with psoriasis, and its correlation with the severity of the psoriasis. To compare such prevalence with those reported by the national health database for Chilean population developed in 2010. Materials and Methods: An observational and analytic study was conduced at the Dermatology Department of the Pontificia Universidad Católica de Chile. Patients with psoriasis were evaluated and classified as having as severity in two groups. The prevalence of metabolic comorbidities was determined, comparing outcomes among patients with mild and severe psoriasis and between all psoriasis patients and Chilean population. Results: One hundred and six patients with psoriasis were included in the study. The mean (SD) age was 43.5 (14) years and 55.6 percent were male. Overweight was present on half of the patients, normal weight was present on 26 percent, and obesity was present on 34 percent. Mean body mass index (IMC) was 27.8kg/m2. The most frequent CV risk factor was tabaquism (41 percent), followed by blood hypertension (22.6 percent). The group with severe psoriasis presented higher prevalence of obesity (31.6 vs.13 percent, p=0.02) and abdominal obesity (86.7 vs. 76 percent, p=0.04),that the group with mild psoriasis...

Hipertrigliceridemias de origen genético / Hypertriglyceridemias of genetic origen

Hypertriglyceridemia (HTG) is defined as plasma triglycerides (TG) > 150 mg/dL, and it is a frequent disease in the general population. When plasma TG reach concentrations > 500 mg/dL (severe HTG), there is usually a genetic defect involved. This defect can involve a single gene or be of polygenic inheritance. In polygenic HTG, the phenotypic expression of the disease is usually associated to the presence of certain diseases such as diabetes, obesity or insulin resistance. The most common known genes associated with monogenic hypertriglyceridemia are LPL and APOC2, but in recent years a few cases caused by mutant APOA5, GPIHBP1 and LMF1, have been identified. Furthermore, genome wide association studies (GWA) have brought up new genes that are related to discrete changes in triglyceride plasma levels of the general population. Among them, it is worth mentioning GCKR, TRIB1, MLXIPL, GALNT2, APOB, APOC2, APOA5, APOE, LPL, ANGPTL3 and NCAN. It is remarkable that most severe hypertriglyceridemias are of polygenic origin, and they could involve a major susceptibility gene. Only in a few cases of severe or very severe HTG (TG > 2.000 mg/dL) the genetic cause is known.

Diabetes mellitus y piel: lesiones cutáneas y su significado clínico / Skin lesions associated with diabetes mellitus

Approximately 30 to 70 percent of patients with diabetes will suffer a skin disorder during the course of their disease. The vast majority of these cases arise during the course of the disease. However, the skin disorder occasionally precedes the diagnosis of diabetes. Many of these lesions are highly associated with diabetes. Moreover, some of them are considered as markers of the disease. The most common skin lesion is diabetic dermopathy that presents as red or purple papules that last one to three weeks. Necrobiosis lipoidica diabeticorum is seen in 0.3 percent of diabetic patients, may precede the development of the disease and appears as oval or irregularly shaped, indurated plaques with central atrophy and yellow pigmentation. Granuloma annulare is seen in 10 to 24 percent of diabetic patients and appears as a skin-colored or erythematous, annular or arciform plaque with a moderately firm, rope-like border and central clearing. Physicians should be able to recognize these and other lesions associated with diabetes mellitus.

Prevalence and magnitude of body weight and image dissatisfaction among women in dietetics majors / Prevalencia y magnitud de la insatisfacción con el peso e imagen corporal en mujeres estudiantes de Dietética

Some authors have suggested that body weight dissatisfaction may be high in students majoring in dietetics. Therefore, this study was conducted to examine the extent of body weight and image dissatisfaction in a sample of women in dietetics major. Additionally, predictors of magnitude of body weight dissatisfaction were analyzed. Participants were 62 volunteers with normalweight whose mean age was 21.87±1.89 years old (non-random sample). The assessment instruments included anthropometric measurements, a somatomorphic matrix test and an eating disorders inventory (EDI-2). Data were analyzed using SPSS vs. 15.0. A larger proportion of students chose an ideal body weight lower than actual weight (67.7%) and body image with less body fat and more muscle mass than actual values (56.4%). The magnitude of body weight dissatisfaction was associated with muscle mass and body fat dissatisfaction, and with the subscale of EDI-2 “body dissatisfaction”. So, from a public health standpoint, we consider important to continue working in this line of research with the aim of better understanding the extent of body weight dissatisfaction in women dietitians, and how this dissatisfaction could interfere with their professional practice.

Algunos autores han sugerido que los estudiantes de Dietética pueden presentar una elevada insatisfacción con el peso corporal. Por este motivo, se llevó a cabo el presente trabajo con el objetivo de analizar la insatisfacción con el peso y la imagen corporal en una muestra de mujeres estudiantes de Dietética. Además, se analizaron predictores de la magnitud de la insatisfacción con el peso corporal. Las participantes fueron 62 voluntarias con normopeso que tenían una media de edad de 21,87±1,89 años (muestra no aleatoria). La evaluación incluyó medidas antropométricas, el test somatomórfico matrix y el eating disorders inventory (EDI-2). Los resultados se analizaron con el programa estadístico SPSS vs. 15.0. Un elevado porcentaje de estudiantes eligieron un peso ideal menor que su peso actual (67,7%) e imágenes corporales con menos grasa corporal y más masa muscular que la que tienen actualmente (56,4%). La magnitud de la insatisfacción con el peso corporal se asoció con la insatisfacción con la grasa corporal y la masa muscular, y con la subescala “insatisfacción corporal” del EDI-2. Por lo que, desde el punto de vista de salud pública, consideramos de interés seguir trabajando en esta línea de investigación con el objetivo de comprender mejor el grado de insatisfacción con el peso corporal en mujeres dietistas, y cómo esa insatisfacción podría afectar a su práctica profesional.

Aerobic and anaerobic degradation of tannic acid on water samples from Monjolinho reservoir (Säo Paulo, SP, Brazil)

In order to describe the transformations of tannic acid during its degradation (under aerobic and anaerobic conditions) incubations were performed. To evaluate the oxygen consumption, the tannic acid was added to 1 L of water sample from Monjolinho's reservoir (22º00'S and 47º54'W); these solutions were aerated and the dissolved oxygen was monitored for 16 days, the anaerobic process was avoided. For the anaerobic and aerobic degradation, the dissolved organic carbon and the acid tannic concentrations were estimated on the samples days. The results were fitted to first-order kinetic model, being possible to verify that during the 16 days the oxygen uptake was 3.6 mg.L-1, the deoxygenation rate (kD)of this process was 0.39 day-1. The degradation coefficients were calculated through the decay of the tannic acid and organic carbon concentrations. In the aerobic process, the global decay coefficient (kG) was 0.36 day-1 and in the anaerobic 0.28 day-1. Overall, the obtained degradation coefficients suggest that the bacterioplankton of the Monjolinho's reservoir possess a high capacity of polyphenols degradation

Aerobic and anaerobic degradation of tannic acid on water samples from Monjolinho reservoir (São Paulo, SP, Brazil)

In order to describe the transformations of tannic acid during its degradation (under aerobic and anaerobic conditions) incubations were performed. To evaluate the oxygen consumption, the tannic acid was added to 1 L of water sample from Monjolinho's reservoir (22º00'S and 47º54'W); these solutions were aerated and the dissolved oxygen was monitored for 16 days, the anaerobic process was avoided. For the anaerobic and aerobic degradation, the dissolved organic carbon and the acid tannic concentrations were estimated on the samples days. The results were fitted to first-order kinetic model, being possible to verify that during the 16 days the oxygen uptake was 3.6 mg.L-1, the deoxygenation rate (kD)of this process was 0.39 day-1. The degradation coefficients were calculated through the decay of the tannic acid and organic carbon concentrations. In the aerobic process, the global decay coefficient (kG) was 0.36 day-1 and in the anaerobic 0.28 day-1. Overall, the obtained degradation coefficients suggest that the bacterioplankton of the Monjolinho's reservoir possess a high capacity of polyphenols degradation.

Tendo em vista descrever as transformações do ácido tânico durante sua degradação (sob condições aeróbias e anaeróbias), foram realizadas incubações. Para estimar o consumo de oxigênio, o ácido tânico foi adicionado a 1 L de amostra de água do reservatório do Monjolinho (22º00'S e 47º54'W); essas soluções foram aeradas e o oxigênio dissolvido foi monitorado durante 16 dias, sendo evitado o processo de anaerobiose. Para a degradação anaeróbia e aeróbia, as concentrações de carbono orgânico dissolvido e de ácido tânico foram periodicamente estimadas. Os resultados foram ajustados a um modelo cinético de primeira ordem, sendo possível verificar que durante os 16 dias de experimento o consumo de oxigênio foi 3,6 mg.L-1, apresentando coeficiente de desoxigenação (kD) de 0,39 dia-1. Os coeficientes de degradação foram calculados por intermédio dos decréscimos das concentrações de ácido tânico e de carbono orgânico. No processo aeróbio, o coeficiente global de decaimento (kG) foi de 0,36 dia-1 e, no anaeróbio, de 0,28 dia-1. De maneira geral, os coeficientes de degradação obtidos sugerem que o bacterioplâncton do reservatório do Monjolinho possui capacidade elevada de degradação de polifenóis.

Divertículo de Zenker nuestra experiencia / Zenker's diverticula authors'experience

Se presentan 29 pacientes con diagnóstico de divertículo de Zenker operados entre Junio de 1981 y Junio de 1995, a todos ellos se les realizó como tratamiento miotomía cricofaringea,asociado a diverticulectomía en 25 casos y a diverticulopexia en los 4 restantes.El porcentaje de complicaciones fue del17,2 por ciento y no hubo mortalidad en la serie

The use of botulinum toxin type A for the treatment of facial spasm

We describe our experience with the use of botulinum A toxin for the treatment of patients with facial spasms. Thirty four patients with blepharospasm, thirty eight with hemifacial spasms and three with spastic entropion were injected with the use of Botulinum A toxin. Length of follow up ranged from 6 to 60 months. The effect of toxin lasted an average of 12.1 weeks in patients with blepharospasm and 15.5 weeks in patients with hemifacial spasms. This difference in mean response was statistically significant (p = 0.0001). The most common side effect was ptosis and dry eyes. All side effects were transient in nature, lasting between three and twelve weeks. Botulinum toxin type A injections represent a good alternative for the treatment of facial spasms. It is a safe and effective office procedure. Most patients tolerate the procedure well. Its principal drawback is its transient effect and the need for repeated injections

Differential effect of culture epimastigotes and blood-form Trypamastigotes on normal mouse splenocyte responsiveness to mitogens

Tripomastigotas de sangue da cepa Y de T. cruzi mostraram uma forte inibiçäo da resposta de transformaçäo blástica a mitógenos de células T e B, nas estirpes C3H/He, C57BL/6 e BALB/cJ de camundongos, enquanto epimastigotas de cultura da cepa Y mantidos em meio que permite o crescimento dos parasitas a 26-, 30-, 34- e 37-C mostraram um forte efeito estimulante, que foi inclusive maior que o efeito dos mitógenos isolados. Os efeitos de inibiçäo e de estimulaçäo foram dependentes da dose. O efeito estimulante dos epimastigotas também foi dependente da temperatura, encontrando-se maiores índices de estimulaçäo à medida que a temperatura da cultura dos parasitas foi aumentada. Parasitas vivos, metabolicamente ativos, parecem ser necessários para a obtençäo de uma maior estimulaçäo dos linfócitos, o que sugere um papel potencial dos metabólitos segregados como ativadores policlonais dos linfócitos dos camundongos