Síndrome cardiorrenal: aspectos clínicos y ecocardiográficos / Cardiorenal syndrome: Clinical and echocardiographic aspects

Resumen El síndrome cardiorrenal (SCR) es un trastorno en el que intervienen el corazón y los riñones, interactuando y produciendo una disfunción entre ellos en forma aguda o crónica. Existen diferentes fenotipos clínicos bien identificados como «desórdenes del corazón y riñón en los que la disfunción aguda o crónica en un órgano induce la disfunción aguda o crónica del otro¼. La alta incidencia de morbimortalidad cardiovascular presente en los pacientes con enfermedad renal crónica terminal (ERCT), en especial la insuficiencia cardiaca (IC), origina inicialmente una lesión miocárdica que conlleva remodelamiento ventricular, lo cual induce a la activación de mecanismos compensadores, entre los cuales el riñón es pieza fundamental, ya que regula la homeostasis hidroelectrolítica y así el volumen circulante, siendo esto en la etapa dialítica más evidente. Los cambios funcionales y anatómicos cardiovasculares que se producen en estos pacientes son muy prevalentes e incluyen las interacciones hemodinámicas del corazón y los riñones en la insuficiencia cardiaca, y el impacto de la enfermedad aterosclerótica en ambos sistemas de órganos. También describimos estrategias diagnósticas y terapéuticas aplicables al síndrome cardiorrenal, que determinan la importancia de la ecocardiografía como modelo de diagnóstico útil. Finalmente, se analizan las posibilidades de tratamiento y la remisión de las alteraciones funcionales cardiacas con el trasplante renal en los pacientes con ERCT.

Abstract Cardiorenal syndrome (CRS) is a disorder in which the heart and kidneys are involved, interacting and producing a dysfunction between them in an acute or chronic way. There are different clinical phenotypes well identified as "heart and kidney disorders in which acute or chronic dysfunction in one organ induces acute or chronic dysfunction in the other". The high incidence of cardiovascular morbimortality in patients with chronic terminal kidney disease (CKD), especially heart failure (HF), initially causes a myocardial lesion that leads to ventricular remodeling, which induces the activation of compensatory mechanisms, among which the kidney is a fundamental part since it regulates the hydroelectrolytic homeostasis and thus the circulating volume, being this in the dialytic stage more evident. The functional and anatomical changes at cardiovascular level that occur in these patients are very prevalent, and include hemodynamic interactions of the heart and kidneys in heart failure and the impact of atherosclerotic disease in both organ systems. We also describe diagnostic and therapeutic strategies applicable to cardiorenal syndrome, which determine the importance of echocardiography as a useful diagnostic model. Finally, we analyze the possibilities of treatment and remission of cardiac functional alterations with renal transplantation in patients with T-CKD.

Efecto de la hipertensión arterial en la función cognitiva de pacientes de 45 a 65 años. Hospital Luis Vernaza, Guayaquil, Ecuador / Impact of arterial hypertension on the cognitive function of patients between 45 and 65 years. Luis Vernaza Hospital, Guayaquil, Ecuador

Resumen Introducción: El deterioro cognitivo leve es una alteración de la función cognitiva que no afecta de manera negativa a las actividades diarias de la persona. Factores de riesgo modificables como la hipertensión arterial podrían intervenir en el aceleramiento de este proceso y afectar a personas menores de 65 años. Una detección temprana del deterioro cognitivo leve por medio del Montreal Cognitive Assesment (MoCA) en personas con hipertensión arterial ayudaría a idear medidas para su control eficaz. Materiales y métodos: Se diseñó un estudio de tipo observacional transversal. La población se integra con pacientes hipertensos de 45 a 65 años de Guayaquil. De una base de datos de 570 pacientes, se realizó un llamado a sujetos que cumplieran los criterios de inclusión y exclusión, para la evaluación de la función cognitiva por medio del MoCA. Resultados: El 93.3% de los participantes sometidos a la prueba MoCA presentó un puntaje menor de 26. El promedio del puntaje total fue de 18.9 y el 51.6% de los participantes reveló deterioro cognitivo leve. Se obtuvo una correlación negativa del 40% (-0.40) con una p = 0.0015 entre años con hipertensión arterial y el resultado total de la prueba MoCA. Conclusiones: Por medio del MoCA se pudo cuantificar la magnitud del deterioro cognitivo en estos pacientes. Se identificó que la mayoría de los participantes examinados presentaba un puntaje promedio menor del intervalo normal. Las cifras obtenidas de los valores de correlación de Pearson muestran una actividad tendencial y relación de la hipertensión arterial con el deterioro de la función cognitiva.

Abstract Introduction: Mild cognitive impairment is an alteration of cognitive function that does not negatively affect the daily activities of the person. Modifiable risk factors such as hypertension could be involved in the acceleration of this process affecting people under 65 years of age. Early detection of mild cognitive impairment through the Montreal Cognitive Assessment (MoCA) in people with high blood pressure, would help to formulate strategies for its effective control. Materials and methods: A cross-sectional observational study was designed. The population is hypertensive patients between 45 and 65 years old in Guayaquil. From a database of 570 patients, a call was made to patients who met the inclusion and exclusion criteria, for the evaluation of cognitive function through MoCA. Results: 93.3% of the participants who underwent the MoCA test had a score lower than 26. The average of the total score was 18.9, with 51.6% of the participants suffering from mild cognitive impairment. A negative correlation of 40% (-0.40) was obtained with a p = 0.0015 between years with arterial hypertension and the total result of the MoCA test. Conclusions: Through MoCA, the magnitude of cognitive deterioration in these patients could be quantified. It was detected that the majority of the examined participants had a lower average score of the normal range. The figures obtained from the Pearson correlation values show trend activity, relating arterial hypertension and deterioration of cognitive function.

Periodontal disease defects and mandibular cortical index in lupus patients / Defeitos ósseos periodontais e índice da cortical mandibular em pacientes com lupus

Introduction: Systemic lupus erythematosus is an autoimmune disease that affects multiple organs. It is well known that lupus patients have higher risk of osteoporosis, but if the disease affects mandibular cortical bone and alveolar bone is not fully established. Objective: The objective of this study was to evaluate periodontal disease defects and mandibular osteoporotic alterations in patients with lupus as compared to healthy patients using panoramic radiographs. Material and Methods: The panoramic radiographs of 72 patients with lupus and 360 healthy patients were evaluated for the presence of bone loss secondary to periodontal disease, classified as horizontal and vertical bone loss. We also assessed mandibular osteoporotic alterations by using the mandibular cortical index. Logistic regression analysis was applied to estimate the risk of mandibular osteoporotic alterations as well as horizontal and vertical bone loss in patients with lupus as compared to healthy patients. Results: There were no statistically significant differences between groups in the presence of horizontal bone defects and mandibular cortical indexes. However, patients with lupus demonstrated that patients with lupus were 2.17 more likely to present vertical bone loss than healthy patients. Conclusions: Patients with lupus might have higher risk of vertical bone loss than healthy patients due to pathophysiology of their disease. Further larger prospective studies should be performed to confirm our findings (AU)

Introdução: Os lúpus eritematoso sistêmico é uma doença autoimune que afeta múltiplos órgãos. Pacientes com lúpus têm maior risco de osteoporose, mas é necessário elucidar-se como a doença afeta o esqueleto maxilo-mandibular. Objetivo: O objetivo deste estudo foi avaliar defeitos ósseos por doença periodontal e alterações osteoporóticas mandibulares em pacientes com lúpus, em comparação com pacientes saudáveis, utilizando-se radiografias panorâmicas. Material e Métodos: As radiografias panorâmicas de 72 pacientes com lúpus e 360 pacientes saudáveis foram avaliadas quanto à presença de defeitos ósseos verticais e horizontais por doença periodontal. Foram também avaliadas as alterações osteoporóticas da mandíbula por meio do índice da cortical mandibular. A regressão logística foi aplicada para estimar o risco de alterações osteoporóticas mandibulares, bem como a perda óssea horizontal e vertical em pacientes com lúpus, em comparação com pacientes saudáveis. Resultados: Não houveram diferenças estatisticamente significantes entre os grupos no tocante à presença de defeitos ósseos horizontais quanto à redução da densidade mineral óssea aferida por meio do índice da cortical mandibular. No entanto, pacientes com lúpus apresentaram 2,17 mais risco à perda óssea vertical do que pacientes saudáveis. Conclusões: Pacientes com lúpus podem ter maior risco de apresentar defeito ósseo vertical do que pacientes saudáveis devido à fisiopatologia de sua doença. Novos estudos prospectivos devem ser realizados para confirmar estes achados (AU)

Un novedoso agente en el tratamiento de la insuficiencia cardiaca con función sistólica deprimida / A novel agent in the treatment of heart failure with depressed systolic function

Resumen Introducción: Se revisará la evolución del tratamiento farmacológico de la insuficiencia cardiaca (IC) en los últimos 25 an˜os, desde el concepto de tratamiento con vasodilatadores, pasando por el bloqueo o inhibición del sistema renina-angiotensina-aldosterona y la inhibición betaadrenérgica y su importante contribución en la disminución de la morbimortalidad por IC, el papel de los péptidos natriuréticos y, finalmente, se conocerá uno de los estudios más importantes en el área cardiológica y específicamente en el manejo de la IC, en el cual se demuestra un enfoque modulador de los sistemas neuro humorales que se activan en estos pacientes. Objetivos: La IC constituye la etapa final de la mayoría de las enfermedades cardiovasculares, con una alta tasa de hospitalización y de morbimortalidad cardiovascular, siendo, por lo tanto, de interés constante la necesidad de encontrar un agente terapéutico innovador que disminuya significativamente estas complicaciones y también que mejore la calidad de vida de los que la presentan. Metodología: Se realizará una descripción del PARADIGM-HF Clinical Trial, que utilizó un compuesto sacubitrilo/valsartán para el manejo de la IC con un mecanismo modulador diferente del concepto de bloqueador de sistemas deletéreos que se activan cuando un paciente presenta síntomas y signos de IC. Conclusiones: La muerte por causas cardiovasculares u hospitalización por IC (el punto final primario) se produjo en 914 pacientes (21.8%) en el grupo sacubitrilo/valsartán y 1,117 pacientes (26.5%) en el grupo de enalapril (razón de riesgo en el grupo sacubitrilo/valsartán, 0.80; intervalo de confianza (IC) del 95%: 0.73 a 0.87; p < 0.001 (exacta p = 4.0 × 10 - 7)). De los pacientes que recibieron sacubitrilo/valsartán, 537 (12.8%) fueron hospitalizados por IC, en comparación con los 658 pacientes (15.6%) que recibieron enalapril (razón de riesgo, 0.79; IC del 95%, 0.71 a 0.89; p < 0.001). Un total de 711 pacientes (17.0%) en el grupo sacubitrilo/valsartán y 835 pacientes (19.8%) en el grupo de enalapril murió (razón de riesgo de muerte por cualquier causa, 0.84; IC del 95%, 0.76 a la 0.93; p < 0.001).

Abstract Introduction: A review is presented on the evolution of the pharmacological treatment of heart failure (HF) in the last 25 years, from the concept of treatment with vasodilators to the blocking or inhibition of the renin angiotensin aldosterone system. Beta-adrenergic inhibition and its important contribution in the reduction of morbidity and mortality due to HF will be discussed along with the role of the natriuretic peptides. One of the most important studies in the cardiology area, and specifically in the management of HF, is presented, in which an approach is demonstrated of the modulator of the neurohumoral systems that are activated in these patients. Objectives: HF is the final stage of most cardiovascular diseases, and has a high rate of hospital admission, as well as cardiovascular morbidity and mortality. Therefore, there is constant interest in the need to find an innovative therapeutic agent that significantly reduces these complications and that improves the quality of life of those who suffer from it. Methods: A description will be presented of the PARADIGM-HF Clinical Trial using a sacubitril/valsartán compound for the management of HF with a modulating mechanism different from the concept of a deleterious system blocker that is activated when a patient has symptoms and signs of heart failure. Conclusions: Death due to cardiovascular causes, or hospital admission due to heart failure (the primary endpoint) occurred in 914 patients (21.8%) in the Sacubitril / valsartán group, and 1117 patients (26.5%) in the enalapril group (risk ratio in the sacubitril / valsartán group, 0.80, with a 95% confidence interval [CI]: 0.73 to 0.87, P<0.001 ;exact P= 4.0 × 10 --7;). Of the patients receiving sacubitril / valsartán, 537 (12.8%) were hospitalised due to heart failure, compared with 658 patients (15.6%) receiving enalapril (hazard ratio 0.79, 95% CI: 0.71 to 0.89, P<.001). A total of 711 patients (17.0%) in the sacubitril / valsartán group, and 835 patients (19.8%) in the enalapril group, died (all-cause death rate, 0.84, 95% CI: 0.76 to 0.93, P<.001)

Epidemiological dynamic modeling of human papillomavirus-related diseases to assess vaccination strategies in Argentina

Our objective was to develop and test a dynamic simulation model of human papillomavirus (HPV)- related diseases to assess rational vaccination strategies in Argentina. A dynamic stochastic transmission model for hetero- and homosexual transmission of HPV oncogenic and low-risk oncogenic types among females and males was developed. The model included HPV transmission and vaccination, the natural history of HPV-related diseases, disease outcomes, and cervical cancer screening. Considering all cervical cancers, covered or not by the current quadrivalent vaccine, the existing coverage rate would lead to 60% reduction in the global incidence of cervical cancer at 25 years, and to 79% at 50 years. Isolated current female vaccination without a screening program would need around 100 years to eliminate cervical cancer from the local population. Current coverage rate would lead to 59% reduction of vulvar cancer, 76% of vaginal cancer, 85% of anal cancer, and 87% of oropharyngeal cancer, estimated over a 25-year time prospect. Female HPV vaccination within the context of current cervical cancer screening should reach a minimum long-term mean coverage of 60% of girls, receiving at least a two-dose vaccine schedule, to significantly reduce or virtually eliminate cervical cancer at 50 years. Including vaccination to boys to improve herd immunity did not influence the incidence of cervical cancer over time, as long as female coverage did not fall below 50%. Regarding vulvar, vaginal, anal, penile, and some oropharyngeal cancers, current girls-only based vaccination could virtually eliminate these cancer types after 35-40 years, both in women and men.

Se desarrolló un modelo de simulación dinámica de enfermedades relacionadas con papilomavirus humano (VPH) para evaluar estrategias de vacunación. Se desarrolló un modelo dinámico estocástico para transmisión hetero/homosexual de VPH oncogénicos y de bajo riesgo oncogénico, entre mujeres y hombres. El modelo incluyó transmisión y vacunación contra VPH, historia natural de enfermedades relacionadas con VPH, mortalidad y programas de detección de cualquier cáncer de cuello uterino (CCU); teniendo en cuenta todos estos, con o sin vacunación cuadrivalente con la cobertura actual, la reducción sería 60% en la incidencia global de CCU en 25 años, y de 79% en 50 años. Vacunando solo mujeres, sin programa de detección precoz, necesitaría unos 100 años para eliminar el CCU localmente. La tasa de vacunación actual determinaría 59% de reducción del cáncer de vulva, 76% del cáncer vaginal, 85% del cáncer anal y 87% del cáncer orofaríngeo, a 25 años. La vacunación de mujeres, con el cribado actual del CCU, deberá alcanzar una cobertura media mínima a largo plazo del 60% de las niñas, con al menos dos dosis de vacunas, para reducir significativamente o eliminar el CCU en 50 años. La vacunación en niños para mejorar la inmunidad de grupo no influiría en la incidencia del CCU de n o caer la cobertura femenina por debajo de 50%. Con respecto a cánceres de vulva, vagina, ano, pene y algunos orofaríngeos, la vacunación actual solo en niñas podría eliminar virtualmente estos tipos de cáncer después de 35-40 años, tanto en mujeres como en hombres.

Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn / Estado nutricional de vitamina A de puérperas de alta e baixa renda e seu efeito sobre o colostro e a necessidade do recém-nascido a termo

Abstract Objective To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. Methods Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20 µg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400 µgRAE/day were considered as insufficient for term newborns. Results The mean maternal vitamin A intake during pregnancy was 872.2 ± 639.2 µgRAE/day in low-income women and 1169.2 ± 695.2 µgRAE/day for high-income women (p < 0.005). The prevalence of vitamin A deficiency was 6.9% (n = 18) in the low-income group and 3.7% (n = 6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3 µgRAE/day (85.8% AI) and 427.2 µgRAE/day (106.8% AI), respectively. Conclusions Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers.

Resumo Objetivo Avaliar o estado nutricional de vitamina A no soro e colostro de puérperas com diferentes condições de renda, comparando os níveis de retinol fornecido através do colostro coma necessidade de vitamina A do recém-nascido. Métodos Estudo transversal com 424 mulheres pós-parto. A ingestão de vitamina A dietética pelas mães foi estimada através de um questionário de frequência do consumo alimentar. Os níveis retinol no soro e colostro foram quantificados por cromatografia líquida de alta eficiência (CLAE). Concentrações de retinol <20 µg/dL no soro foram indicativas de vitamin A deficiency. Os níveis de vitamina A fornecidas pelo colostro < 400 µg/RAE/dia foram considerados insuficientespara os recém-nascidos a termo. Resultados A ingestão média de vitamina A das mães durante a gravidez foi de 872,2 ± 639,2 µgRAE/dia em mulheres de baixa renda e 1169,2 ± 695,2 µgRAE/dia em mulheresde alta renda (p < 0,005). A prevalência de vitamin A deficiency foi de 6,9% (n = 18) no grupo de baixa renda e de 3,7% (n = 6) no grupo de alta renda. A estimativa dos valores médios de ingestão de retinol por lactentes de mães de baixa e alta renda foi de 343,3 µg/RAE/dia (85,8%AI) e 427,2 µg/RAE/dia (106,8% AI), respectivamente. Conclusões A vitamin A deficiency no soro foi prevalente em ambas as populações, entretanto, recém-nascidos de mães de baixa renda foram mais propensos a receberem níveis inferiores de retinol no colostro em comparação com recém-nascidos de mães de alta renda.

Evaluation of the association between the TAS1R2 and TAS1R3 variants and food intake and nutritional status in children

Abstract Taste perception plays a key role in determining individual food preferences and dietary habits and may influence nutritional status. This study aimed to investigate the association of TAS1R2 (Ile191Val - rs35874116) and TAS1R3 (-1266 C/T - rs35744813) variants with food intake and nutritional status in children followed from birth until 7.7 years old. The nutritional status and food intake data of 312 children were collected at three developmental stages (1, 3.9 and 7.7 years old). DNA was extracted from blood samples and the polymorphisms were analyzed by real-time polymerase chain reactions (qPCR) using hydrolysis probes as the detection method. Food intake and nutritional status were compared among individuals with different single nucleotide polymorphism (SNP) genotypes. At 3.9 years old, children homozygous (Val/Val) for the TAS1R2 Ile191Val polymorphism ingested less sugar and sugar-dense foods than children who were *Ile carriers. This finding demonstrated that a genetic variant of the T1R2 taste receptor is associated with the intake of different amounts of high sugar-content foods in childhood. This association may provide new perspectives for studying dietary patterns and nutritional status in childhood.

Evaluation of the predisposition and clinical impact of BK virus replication in kidney transplant patients

ABSTRACT The BK virus (BKV) produces a subclinical kidney infection in immunocompetent individuals. However, viremia may occur in kidney transplant patients with ongoing immunosuppression. BKV-associated nephropathy (BKVN) has no specific treatment and is a leading cause of organ transplant loss. In this study, we evaluated the predisposition and the clinical impact of BKV replication in kidney transplant patients during post-transplant monitoring in a reference institution in Brazil. Demographic, clinical and laboratory data generated during routine outpatient follow-up were retrospectively collected. BK viremia was investigated using real-time polymerase chain reaction. Of the 553 participants, 7.4% (n = 41) presented BKV replication. Of these, 16 (39%) lost their kidney graft and interstitial nephritis was identified on kidney biopsy in 50% of the cases. Among the evaluated variables, only the use of the immunosuppressant mycophenolate sodium was identified as a risk factor for viremia (OR 7.96; 95% CI 2.35 to 26.98). The graft survival estimate in BKV-positive patients was significantly reduced (24.8% vs. 85.6%) after 10 years of transplantation. We concluded that defining predisposing factors remains an important challenge for the prevention and control of BKV activity following kidney transplantation, especially considering the development of BKVN and its strong effect on graft maintenance.

The effect of indocyanine green‑mediated photodynamic therapy as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A comparative split‑mouth randomized clinical trial.

Objective: The aim of this study was to assess the effect of adjunctive photodynamic therapy (PDT) (using 810 nm diode laser and Indocyanine green as photosensitizer) in chronic periodontitis. Materials and Methods: Patients with untreated chronic periodontitis were included. Treatment was done according to a split mouth design. All sites received periodontal treatment comprising scaling and root-planing (SRP). Test group were additionally treated with PDT. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD) and Relative Attachment Level (RAL) were evaluated at baseline, 1 month and 3 months. Results: Mean baseline values for PI, GI, PPD and RAL were not different in the test group and control group. Statistical significant difference in PPD and RAL, 3 months after treatment was seen in test group as compared to the control group. Conclusions: In patients with chronic periodontitis, clinical outcomes of conventional SRP can be improved by adjunctive PDT.

Procesos de perdón y reconciliación intergrupal en Argentina: aportes psicosociales al estudio de los efectos de la violencia de estado / Intergroup forgiveness and reconciliation processes in argentina: psychosociological contributions to the study of the effects of state violence

Este trabajo evalúa el grado de conocimiento y la percepción de sinceridad y eficacia de las disculpas públicas efectuadas luego de la violencia de Estado ocurrida en la última dictadura militar. Asimismo, se indaga en la disposición al perdón y en la deseabilidad de reconciliación. La muestra estuvo compuesta por 518 participantes (Edad: M = 35.58; SD = 13.62) entre los que se encuentran víctimas directas e indirectas de la violencia y personas no afectadas. Los resultados revelan escaso conocimiento de las disculpas ofrecidas, así como bajos niveles de eficacia percibida en su objetivo restaurativo. Se observan diferencias según el auto-posicionamiento ideológico y la edad de los participantes. Los más jóvenes y las personas de izquierda son quienes consideran menos necesario el pedido de perdón, presentan una menor creencia sobre la disposición a perdonar por parte de los afectados y quienes, en menor medida, desean la reconciliación.

Pediatric lung transplantation: 10 years of experience

Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults.

Automedicación en estudiantes de la carrera de medicina, Facultad de Ciencias Médicas, UNAH / Self-medication among second to seventh year students of the Faculty of Medical Sciences, UNAH

El uso inadecuado de medicamentos sin prescripción médica o sobrantes de tratamientos anteriores impulsa el análisis sobre sus beneficios, consecuencias y la toma de decisiones al respecto. Objetivo: determinar la práctica y el conocimiento de automedicación de los estudiantes de la Carrera de Medicina de la Facultad de Ciencias Médicas (FCM), Universidad Nacional Autónoma de Honduras (UNAH). Metodos: Estudio descriptivo de corte transversal. La población fue de 3,447 estudiantes de la Carrera de Medicina de segundo a séptimo año y la muestra fue de 300 estudiantes. Se eligieron 50 estudiantes por cada año, en forma aleatoria. Se diseñó y facilitó un cuestionario que contempló cuatro aspectos: datos culturales, sociales, económicos y patológicos. Resultados: La prevalencia de automedicación fue de 70% (209) estudiantes, de estos, 34% (72) lo hacen una vez al mes, 33% (62) una vez al año, seguido por 29% (61) que lo practican cuando se enferman y 4% (8) una vez a la semana; 58% (121) eran mujeres y 42% (81) hombres. 39% (117) opinaron que es una práctica riesgosa que no se debe utilizar, 49% (151) afirmó tener amigos que se automedican, 48% (145) refirió tener familiares que lo realizan, 78% (164)lo hacen por tener síntomas leves, 24% (51) practican el hábito de fumar, 44% (92) ingieren bebidas alcohólicas.De los 209 estudiantes que se automedican 10% (20) han observado efectos secundarios, 82% (171) lo hacen con AINEs, 49% (102) se automedican cuando presentan resfriado común, 29% (61) por cefalea, 7%(14) por faringoamigdalitis y 8% (17) indicaron utilizar varios medicamentos. Conclusiones: La práctica de la automedicación es realizada en un 70% por estudiantes de la Carrera de Medicina en mejorar la sintomatología de procesos infecciosos y cefalea...

La CONADEP y el informe Nunca Más: conocimiento, eficacia y emociones asociadas / CONADEP truth commission and

La Comisión Nacional sobre la Desaparición de Personas (CONADEP) y el Informe Nunca Más constituyen las primeras acciones basadas en el principio de verdad implementadas en Argentina para hacer frente al pasado represivo de la última dictadura militar (1976-1983). En este marco, se realizó un estudio empírico con el objetivo de explorar el grado de conocimiento que las personas tienen acerca de estas medidas, el grado de aprobación/desaprobación, la eficacia percibida y las emociones suscitadas. La muestra es intencional, compuesta por 470 sujetos de varias ciudades de Argentina. Si bien los resultados muestran bajos niveles de conocimiento acerca del trabajo de la CONADEP, se valoran muy positivamente estas medidas y se percibe que el trabajo realizado ha contribuido para juzgar a los responsables, ayudar a las familias de víctimas, evitar que se repita y construir una historia integradora. Asimismo, se observaron diferencias en función del posicionamiento ideológico de los participantes.

Inusual caso de revascularización espontánea en una paciente con arteriopatía carotídea significativa / A Rare Case of Spontaneous Revascularization in a Patient with Significant Carotid Artery Disease

La enfermedad grave de las carótidas primitivas y externas es una entidad poco frecuente, que en general ocurre en pacientes con aterosclerosis avanzada. En esta presentación se describe el caso de una mujer de 83 años, derivada por presentar episodios de mareos, cefaleas y pérdida del equilibrio, amaurosis definitiva del ojo derecho, disminución de la agudeza visual del ojo izquierdo e hipoacusia bilateral a altas frecuencias. El eco-Doppler color de los vasos del cuello mostró enfermedad significativa de las carótidas primitivas y externas bilaterales y del bulbo carotídeo derecho, con un circuito de revascularización inverso a través de las arterias carótidas externas bilaterales, las cuales, a su vez, presentaban estenosis significativas en sus respectivos orígenes.

External common carotid artery disease is a severe and rare entity, which generally occurs in patients with advanced atherosclerosis. This report describes the case of a 83-year-old woman, who was referred due to dizziness, headaches and loss of balance, permanent amaurosis of the right eye, decreased acuity of the left eye and bilateral hypoacusis at high frequencies. A color Doppler ultrasound of the neck vessels revealed significant bilateral disease of the external common carotid arteries and right carotid bulb, with an inverse revascularization circuit through bilateral external carotid arteries, which also showed significant stenosis in their respective origins.

Queilitis glandular / Glandular cheilitis

La queilitis glandular es un proceso muy raro y poco estudiado, donde se observan varios grados de macroquelia (agrandamiento labial) asociada a secreción de saliva espesa en la superficie labial, ocasionando disconfort al paciente. La causa permanece desconocida, pareciendo estar involucrados factores como el daño solar crónico, siendo una enfermedad significativamente más frecuente en personas de piel clara, particularmente en los albinos. Recientemente fueron demostrados alteraciones en la expresión de los canales de transporte del agua en los conductos de las glándulas afectadas por la queilitis glandular, un hecho que puede estar relacionado con la presencia de saliva mucoide espesa que se observa con frecuencia en esta enfermedad. El tratamiento es difícil, obteniéndose mejores resultados después de la exéresis del bermellón labial asociada con disección y remoción cuidadosa de las glándulas salivales menores involucradas.

Prevalence and factors associated with darunavir resistance mutations in multi-experienced HIV-1-infected patients failing other protease inhibitors in a referral teaching center in Brazil

Information about resistance profile of darunavir (DRV) is scarce in Brazil. Our objectives were to estimate the prevalence of DRV resistance mutations in patients failing protease inhibitors (PI) and to identify factors associated with having more DRV resistance mutations. All HIV-infected patients failing PI-based regimens with genotyping performed between 2007 and 2008 in a referral teaching center in São Paulo, Brazil, were included. DRV-specific resistance mutations listed by December 2008 IAS-USA panel update were considered. Two Poisson regression models were constructed to assess factors related to the presence of more DRV resistance mutations. A total of 171 HIV-infected patients with available genotyping were included. The number of patients with lopinavir, saquinavir, and amprenavir used in previous regimen were 130 (76 percent), 83 (49 percent), and 35 (20 percent), respectively. The prevalence of major DRV resistance mutations was 50V: 5 percent; 54M: 1 percent; 76V: 4 percent; 84V: 15 percent. For minor mutations, the rates were 11I: 3 percent; 32I: 7 percent; 33F: 23 percent; 47V: 6 percent; 54L: 6 percent; 74P: 3 percent; 89V: 6 percent. Only 11 (6 percent) of the genotypes had > 3 DRV resistance mutations. In the clinical model, time of HIV infection of > 10 years and use of amprenavir were independently associated with having more DRV resistance mutations. In the genotyping-based model, only total number of PI resistance mutations was associated with our outcome. In conclusion, the prevalence of DRV mutations was low. Time of HIV infection, use of amprenavir and total number of PI resistance mutations were associated with having more DRV mutations.

La deshabituación tabáquica con técnicas de medicina tradicional y natural / Smoking cessation with natural and tradictional technniques

Se realizó un estudio longitudinal en la Clínica de Medicina Tradicional Natural Boyeros, en los años 2004 al 2006, con los objetivos de evaluar la efectividad de las técnicas auriculoterapia, terapia floral y la terapia grupal en la deshabituación tabáquica; describir síntomas más frecuentes que aparecen en la abstinencia según tratamiento e identificar posibles causas de recaída. Se incorporaron 1 080 pacientes de ambos sexos y se dividieron en tres grupos de tratamientos al azar: Auriculoterapia, Terapia Floral y Terapia Grupal. Las Terapias constaron de 12 sesiones. Los puntos que se utilizaron en la auriculoterapia fueron el Shen Men, hígado, pulmón y punto hambre, la esencia floral fue el Rescue Remedy. El 65.0 por ciento de los pacientes tuvieron una evolución satisfactoria. La terapia floral fue la técnica más eficaz. Las situaciones estresantes fueron motivos de recaídas. Los síntomas presentes en la abstinencia fueron la ansiedad, irritabilidad y la sensación de hambre.

A longitudinal study was carried out in the Clinic of Medicine Traditional Natural Cowherds, City of the Havana, from year 2004 to 2006, with the objectives of evaluating the effectiveness of the technical auriculoterapia, floral therapy and the group therapy in the Smoking cessation, to describe more frequent symptoms that appear in the abstinence according to treatment and Identifying its possible relapse causes. 1080 patients of both sexes incorporated, and they were divided at random in three groups of treatments: Auriculotherapy, Floral Therapy and Group Therapy. The Therapies consisted of 12 sessions. 65.0 percent of the patients had a satisfactory evolution. The floral therapy was the most effective technique. The stress situations were reasons of relapses. The symptoms of the abstinence were: anxiety, irritability and the sensation of hunger.

Relato da história da inserção e evolução do atendimento psicológico a bebês e suas famílias em uma Unidade de Neonatologia / The history of the inception and evolution of psychological care for infants and their families in a Neonatal Unit

OBJETIVO: Este artigo apresenta o histórico de atuação de uma psicóloga na área de Neonatologia e sua evolução, desde as primeiras tentativas de mudar certas rotinas da unidade para que favorecessem a humanização do atendimento até a sua completa inserção na equipe multidisciplinar. São descritas em detalhes as atuações específicas junto aos bebês e suas famílias no contexto da internação hospitalar, com o intuito de auxiliar os profissionais de saúde que trabalham na área de implementação de programas afins. DESCRIÇÃO DO CASO: Relato da história de inserção e da evolução do trabalho de uma psicóloga na equipe de Neonatologia do Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadual de Campinas (Unicamp), num período de dez anos (1993 a 2003). Descrevem-se as atividades específicas da Psicologia, o embasamento teórico dos programas desenvolvidos na unidade e os recursos técnicos utilizados no atendimento à clientela. COMENTÁRIOS: O saber específico do psicólogo pode ser estendido a toda a equipe, favorecendo ações de prevenção em Saúde Mental, principalmente a proteção da relação mãe-bebê. Além disso, pode ser disseminado, ganhar relevância e fazer parte do cotidiano de todas as unidades de terapia neonatais.

OBJECTIVE: This article describes the evolution of a psychologist's work in a Neonatal Care Unit, from simple interventions that changed certain routines to foster humanization of care, to the complete integration of this professional into the multidisciplinary neonatal team. Detailed descriptions of the work's implementation in the hospital setting offer health professionals of the field a model for similar programs. CASE DESCRIPTION: The history of the inception and evolution of a psychologist's work at the Neonatal Care Unit of Universidade Estadual de Campinas in a ten-year period (1993 to 2003) was described. Specific activities developed within this period have been described, as well as the theory supporting every action. The base techniques utilized within this time frame are also commented. COMMENTS: The specificity of the psychologist's knowledge can be extended to other health professionals of the same field, promoting preventive mental health measures, especially actions that benefit the bonding between mothers and their babies. It could also be disseminated, grow in importance, and become routine in every neonatal care unit.

Parasitosis intestinales y su relación con factores socioeconómicos y condiciones de habitat en niños de Neuquén, Patagonia, Argentina / Intestinal parasitosis in relation to socioeconomic factors and habitat conditions in children of Neuquen, Patagonia, Argentina

Se investigó la prevalencia y distribución de parásitos intestinales (PI) en niños de 2 poblaciones de diferente nivel socioeconómico del área periurbana de la ciudad de Neuquén (Sectores I y II) a fin de evaluar su relación con las condiciones de hábitat y factores socio-económicos. Se procesaron muestras seriadas de materia fecal y de escobillado anal de 126 niños entre 2 y 14 años de edad. Se registraron datos acerca de condiciones de hábitat y factores socioeconómicos mediante visitas domiciliarias y encuestas observaciones estructuradas. Se detectó presencia de PI en el 50,7 por ciento de los niños del Sector I (barrio suburbano con adecuadas condiciones sanitarias y nivel socioeconómico medio o medio-bajo) y en el 92,9 por ciento de los niños del Sector II (asentamiento marginal con deficientes condiciones sanitarias y bajo nivel socioeconómico). Se identificaron 7 especies de protozoos intestinales y 4 especies de helmintos. Blastocystis hominis fue la especie más frecuente encontrada en ambas poblaciones. No se encontraron helmintos diferentes de Enterobius vermicularis en el Sector I y la prevalencia de tales especies fue muy baja en el Sector II. Las condiciones de hábitat deficientes y los bajos parámetros socioeconómicos se relacionaron con una mayor prevalencia de PI de transmisión directa como protozoos y E. vermicularis en las poblaciones estudiadas. Sin embargo, aún en ese contexto favorable a la transmisión, las especies parasitarias que requieren estadíos intermedios de maduración en el suelo no encuentran un hábitat adecuado para su diseminación en esta región patagónica.

The prevalence and distribution of intestinal parasites (IP) were investigated in children from two populations of different socioeconomic level, located in the same area of the city of Neuquén, in order to evaluate their relationship with habitat conditions and socioeconomic factors. Serial samples of faeces and anal scraping of 126 children between 2 and 14 years from two sectors of the suburban area of Neuquen (Sector I and Sector II) were analyzed. Data concerning habitat conditions and socioeconomic parameters were obtained by home visits and an observational structured survey. Presence of IP was detected in 50.7% of children from Sector I (suburban neighborhood with adequate sanitary conditions and middle or middle low socioeconomic level) and in 92.9% from children of Sector II (marginal settlement with poor sanitary conditions and low socioeconomic status). Seven intestinal protozoan and 4 helminth species were identified. Blastocystis hominis was the most frequent species found in both populations. No helminths different from Enterobius vermicularis were found in Sector I and the prevalence of such species was very low in Sector II. Deficient habitat conditions and low socioeconomic parameters showed relation with a higher prevalence of IP of direct transmission as protozoan and E.vermicularis in the studied populations. Nevertheless, even in this context favourable to transmission, the parasitic species which require intermediate stages of development in soil, don't find an adequate habitat for dissemination in this region