Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica / Wernicke´s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery

La cirugía bariátrica es un tratamiento que garantiza una pérdida de peso sustancial y duradera, y beneficios tangibles respecto a condiciones médicas asociadas a la obesidad. El aumento del número de cirugías bariátricas ha llevado también a un aumento de las complicaciones relacionadas con ella, incluyendo la encefalopatía de Wernicke y la polineuropatía por deficiencia de vitaminas del complejo B. En este artículo se reporta un caso de encefalopatía de Wernicke siete semanas después de la cirugía, enfatizando en la importancia de reconocer el espectro de la sintomatología para hacer un diagnóstico temprano, que permita intervenir en la fase reversible de esta enfermedad potencialmente letal.

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Enfermedad de Marburg como variante de esclerosis múltiple: presentación de un caso atípico / Marburg's variant of multiple sclerosis: report of an atypical case

Se presenta el caso de una paciente de 58 años con esclerosis múltiple diagnosticada en el 2007 tratada con inter-ferón y metilprednisolona; con pobre respuesta en el último año, durante el cual presentó múltiples episodios de exacerbación. Consultó por deterioro neurológico rapidamente progresivo, de una semana de evolución, con un puntaje en la escala de Glasgow de 4/15 (apertura ocular: 2, respuesta verbal: 1, respuesta motora: 1). El caso fue evaluado en junta médica y se consideró como un cuadro atípico de la variante Marburg de esclerosis múltiple. La paciente fue manejada con inmunoglobulina y mitoxantrona, sin mejoría clínica; posteriormente presentó choque distributivo y falleció.

We present a 58 years old woman with multiple sclerosis diagnosed in 2007, she was treated with interferon and methylprednisolone with a stable disease until last year. Recently she had had multiple episodes of exacerbations. Patient was admitted for a rapidly progressive neurological deterioration. When evaluated the patient had a Glasgow scale of 4/15 (Best eye response: 2, Best verbal response: 1, Best motor response: 1). Case was evaluated in a medical board, and was considered an atypical Marburg variant of multiple sclerosis. She was treated with immunoglobulin and mitoxantrone without clinical improvement. Later she developed a distributive shock leading to death.

Factores de riesgo asociados con la prevalencia de hipertensión arterial en adultos de Bucaramanga, Colombia / Risk factors associated with the prevalence of arterial hypertension in adults in Bucaramanga, Colombia

OBJECTIVE: To assess the prevalence of high blood pressure (PHBP) and its association with age, sex, socioeconomic status (SES), and body mass index (BMI = kg/m2). MATERIAL AND METHODS: A cross-sectional survey was carried out in 1996, in a random sample of 356 adults aged 20 and older, residents of Bucaramanga, Colombia. Weight, height, and blood pressure readings were obtained, plus data on age and gender. Robust linear and log-binomial regression was used to estimate the independent effect of different risk factors on systolic (SBP) and diastolic (DBP) blood pressure and HBP. RESULTS: Mean SBP and DBP were significantly higher in men (122.5 and 88.1 mmHg) than in women (117.2 and 75.4 mmHg). The adjusted SBP increased with age, more in men than in women; DBP did not change with age. For each unit increase in BMI, SBP and DBP increased 0.76 and 0.69 mmHg, respectively. SBP was 6.8 and DBP was 9.8 mmHg higher in low-SES than in high-SES subjects. The adjusted PHBP increased with age and was higher in subjects > or = 50 years than in those 20-30 years old. Sex had no significant effect on PHBP (p = 0.795). For each unit increase in BMI the PHBP increased 3, and low-SES subjects had a PHBP 1.84 times higher than high-SES subjects. CONCLUSIONS: A high PHBP was found. There is a great potential for prevention by weight control. Further studies are needed to confirm the increasing PHBP in low-SES subjects and to identify its causes.