Trastorno facticio en adultos: a propósito de un caso y revisión de literatura / Factitious disorder in adults: a case report and literature review

RESUMEN: El trastorno facticio consiste en falsificar, inducir o agravar las enfermedades para recibir atención médica, independientemente si están enfermas o no. El impacto que tiene esta patología va desde altos costos en salud asociado a la policonsulta, hospitalizaciones y tratamientos innecesarios; la funcionalidad y calidad de vida de estos pacientes, hasta el costo de vidas humanas. Este trastorno sigue siendo un desafío para los clínicos, puesto que no hay evidencia suficiente sobre la epidemiología, etiología, clínica y manejo dada su complejidad. En este artículo se presentará un caso clínico enfatizando en la evolución de la enfermedad, manejo inicial y posterior durante su hospitalización, junto con una actualización basada en la literatura, en torno al tratamiento de esta patología, con el fin de proponer intervenciones preventivas o protocolos que permitan evitar hospitalizaciones y tratamientos innecesarios. Luego se finalizará con la resolución del caso, pronóstico de esta enfermedad y una conclusión.

ABSTRACT Factitious disorder consists of falsifying, inducing or aggravating illnesses in order to receive medical attention, regardless of whether they are ill or not. The impact of this pathology ranges from high health costs associated with polyconsultation, hospitalizations and unnecessary treatments, the functionality and quality of life of these patients, up to the cost of human lives. This disorder continues to be a challenge for clinicians, since there is insufficient evidence on the epidemiology, etiology, clinic and management given its complexity. In this article, a clinical case will be presented, emphasizing the evolution of the disease, initial and subsequent management during hospitalization, together with an update based on the literature, on the treatment of this pathology, in order to propose preventive interventions or protocols that allow avoiding hospitalizations and unnecessary treatments. Then it ends with the resolution of the case, prognosis of this disease and a conclusion.

Prevalencia puntual de consumo de sustancias en individuos que cometen suicidio por asfixia secundario a ahorcamiento en Santiago, 2014-2015 / Point prevalence of consumption of substances in individuals who commit suicide for asphyxia by hanging in Santiago, 2014-2015

Introducción: El trastorno por consumo de sustancias se ha asociado a suicidio, el que constituye la segunda causa de muerte en individuos entre 15 y 29 años. Dentro de los mecanismos más comunes de suicidio, se encuentra la asfixia por ahorcamiento. Objetivo: Determinar la prevalencia puntual de consumo de sustancias en individuos que ingresaron al Servicio Médico Legal (SML) de Avenida La Paz #1.012, Independencia, Santiago de Chile por suicidio secundario a asfixia por ahorcamiento durante 2014-2015. Materiales y métodos: Estudio de corte transversal en individuos que ingresaron al SML entre los años 2014-2015, cuya causa de muerte correspondiera a suicidio por asfixia por ahorcamiento y que tuvieran registros de: sexo, edad, alcoholemia y examen toxicológico. Se utilizó una plantilla Excel® 2011, determinándose estadística descriptiva y análisis porcentual. Resultados: Durante los años 2014-2015, ingresaron 8.321 individuos al SML, de los cuales se seleccionaron aleatoriamente 1.218 individuos. De dicha muestra, un 11,58% correspondió a muertes secundarias a asfixia por ahorcamiento. De éstos un 74,47% eran varones. El rango etario más frecuente correspondió a los 40-49 años. Un 49,65 % tenía alcoholemia positiva en sangre y un 58,87 % examen toxicológico positivo, siendo lo más frecuente la asociación de dos o más sustancias al momento del suicidio (39,72 %). Discusión: Se observan resultados similares en relación a edad, sexo en comparación a estudios similares, no así cuando se comparan las sustancias consumidas, donde hubo mayor prevalencia de cocaína. La prevalencia de consumo de sustancias en casos de suicidios consumados es de un 58,86%.

Introduction: The disorder for consumption of substances has been associated to suicide, this constitute the second cause of death in individuals between 15 and 29 years old. Among the most common mechanisms of suicide we found asphyxia by hanging. Objective: Determine the point prevalence in the consume of substances of individuals that were admitted in the Medical Legal Service (MLS) of Avenida La Paz #1.012, Independencia, Santiago de Chile, for secondary suicide asphyxia by hanging during 2014-2015. Materials and methods: Cross-sectional study in individuals admitted in MLS between 2014-2015, whose cause of death corresponded to suicide due asphyxia by hanging wich had registers of: sex, age, blood alcohol test and toxicological exam. A 2011 Excel® template was used, determining descriptive statistics and percentage analysis. Results: During the years 2014-2015, 8.321 were admitted in MLS, of which 1.218 were randomly selected. Of this sample, 11.58 % corresponded to secondary death to asphyxia by hanging. Of these, 74.47 % were male. The most frequent age range corresponds to 40-49 years. 46.65 % hadethanol in blood and 58.87 % positive toxicological test, being the most frequent the association of two or more substances at the moment of the suicide (39.72 %). Discussion: Similar results are observed in relation to age, sex compared to similar studies, but not when comparing substances consumed, where there was a higher prevalence of cocaine. The prevalence of substances consumed in cases of completed suicides is 58.86%.

Efectos del ejercicio en adultos mayores / Effects of exercise in older adults

Elederly seems to be caracterized for a declinaion in physical performance, and it’s associated with frailty, and the appearance of diseases, expressed in geriatric syndromes, functional discapacity, or higly prevalent sickness. Immobility worsenes thee processes. Exercise, however, may prevent, or delay those processes and may a useful resource in most of sckness. This article is a brief review of effects of excercise in normal aging and pathologic phenomenons.

Cambios fisiológicos asociados al envejecimiento / Physiological changes associated with normal aging

La población envejece en forma acelerada, y la comprensión de los cambios fisiológicos asociados al envejecimiento es una herramienta importante para enfrentar las demandas biomédicas y sociales de ese grupo etario. El objetivo de la presente revisión es definir los principales cambios morfológicos y funcionales en los sistemas cardiovascular, renal, nervioso central, muscular y metabolismo de la glucosa asociados a la edad. La evidencia de estudios clínicos y experimentales muestra que el envejecimiento de los vasos sanguíneos y el corazón se asocia a la pérdida de células musculares y menor distensibilidad. La fracción de eyección se mantiene constante. El riñón muestra disminución moderada de la velocidad de filtración glomerular, esclerosis vascular y glomerular, menor capacidad de concentración/dilución y de hidroxilación de la vitamina D. El cerebro disminuye su volumen, pero no por una pérdida generalizada de neuronas ni de arborización dendrítica. Hay menor capacidad de atención, memoria de trabajo y trastornosmotores. La masa muscular disminuye y aumenta su infiltración grasa, asociado a disminución progresiva de la fuerza. El aumento de grasa corporal, especialmente visceral, participaría en una mayor resistencia insulínica que asociada a la disminución de la masa de células beta facilitaría el desarrollo de diabetes. La evidencia disponible muestra importantes cambios morfológicos y funcionales asociados a la edad. El conocimiento de la población en edad media de la vida no debiera generalizarse a los adultos mayores. El reconocimiento de cambios debidos al envejecimiento normal es difícil por la gran variabilidad entre sujetos y la alta prevalencia de comorbilidad.

The population worldwide is aging rapidly and the understanding of physiological changes associated with aging is a key tool for answering the biomedical and social needs of elderly people. The aim of the present review is to describe the main morphological and functional changes of the cardiovascular system, central nervous system, kidney, skeletal muscle and glucose metabolism associated with normal aging. Clinical and experimental studies show that cardiovascular aging is associated with a reduction of muscular cells and wall distensibility. The cardiac ejection fraction does not change. With aging, the kidney develops vascular and glomerular sclerosis, with moderate reduction in glomerular filtration rate, lower concentration/dilution ability and a reduction of vitamin D synthesis. Aging associates with reduced brain volume, but without a generalized loss of neurons or dendritic arborization. Elderly people presents reduced attention span, lower work memory and motor impairment. There is a decrease in skeletal muscle mass, with increased in adipose infiltration associated with progressive force loss. The proportion of body fat, particularly the visceral fat, could play a role in the development of insulin resistance, which associated with a decrease in pancreatic beta cells may lead to the development of diabetes mellitus. The available evidence shows important morphological and physiological changes associated with aging. The knowledge of morphological characteristics and function a capabilities of middle age adults may not be extrapolated to elderly people. The identification of changes due to normal aging is hampered by the high variability among individuals and the high prevalence of co-morbidities.

Envejecimiento, proceso biológico y oportunidad de intervención preventiva o terapéutica / Aging, biological process and opportunity of preventive or therapeutic intervention

Ageing is a complex biological process that has been explained through different theories. Each one of these theories has produced a great body of knowledge and now days it seems possible find means of intervention the ageing process and develop therapeutical strategies from them. In this paper these theories are revised and some intervention means are mentioned.

Evaluación de la asociación entre marcadores de microsatélite en 6p22-25 y fisura labiopalatina no sindrómica utilizando el diseño de tríos caso-progenitores en la población chilena / Evaluation of the association between microsatellite markers located on 6p22-25 and no syndromic cleft lip palate using the case-parents trio design in Chilean population

BACKGROUND: Genetic studies indicate that nonsyndromic cleft lip/palate (NSCLP) has the characteristics of a complex genetic trait. Reports from different authors have suggested several candidate genes mapping in different chromosome regions. Association studies have suggested that a clefting locus is located on chromosome 6p. On these grounds we have investigated the possible association between five microsatellite markers located on 6p22-25 and NSCLP. AIM: To test the hypothesis on the possible association of a clefting locus with microsatellite markers located in 6p22-25. PATIENTS AND METHODS: The sample consisted of 54 unrelated case-parent trios that comprise 54 NSCLP probands and 108 parents. Five microsatellite markers spanning the region 6p22-25 were analyzed for each individual by means of polymerase chain reaction with fluorescent labeled microsatellite markers. Electrophoresis of the PCR products was performed on a laser-fluorescent DNA sequencer. Nonparametric ETDT and MCETDT programs, were used to analyze the genotype data. RESULTS: The family based association study showed that for the genotype wise analysis, only D6S259 presented a significant p-value (0.03). Nevertheless no individual allele of this marker showed an evident preferential transmission from heterozygous parents to affected offspring. CONCLUSIONS: The results of the present study do not show a clear evidence that a candidate gene for NSCLP may be located within or near the analyzed chromosome region in our sample. Nevertheless, it must be emphasized that the genotype wise analysis shows a significant p-value for D6S259 marker.

Lupus miliar diseminado facial (LDMF) / Facial disseminated Miliar Lupus (FDML)

Se presenta un paciente con lupuis vulgar diseminado facial; se comentan algunos rasgos de esta patología y se plantean diagnósticos diferencxiales por su similitud clínica e histológica con otras entidades. Con respecto al tratamiento se utilizó prednisona a dosis decrecientes manteniendo dosis bajas por cuatro meses, obteniendo buenos resultados