Características clínicas y epidemiológicas de las intoxicaciones en el Hospital General Docente Ambato de Ecuador, 2013 a 2014

RESUMEN Objetivos: determinar las características clínicas y epidemiológicas de las intoxicaciones en el Hospital General Docente Ambato de Ecuador desde septiembre del 2013 a agosto del 2014. Materiales y métodos: se realizó un estudio, observacional descriptivo de corte transversal sobre los casos de intoxicación registrados en el Hospital General Docente Ambato. Para la recolección de los datos se creó una planilla electrónica con las variables de interés. Los datos se expresan en proporciones, medidas de tendencia central y dispersión. Resultados: durante el periodo estudiado se registraron 58 casos, en el rango etario de 19 a 30 años se presentó 31,03% de los casos, correspondiendo a organofosforados en 25,86%, alcohol 22,41% y medicamentos 18,96%. Conclusión: se identificó que el porcentaje mayor de las intoxicaciones fueron ocasionadas por organofosforados, los pacientes son atendidos oportunamente y los intentos autolíticos constituyen la principal causa por la que acuden los pacientes intoxicados al Servicio de Emergencia del Hospital Ambato de Ecuador.

ABSTRACT Objectives: To determine the clinical and epidemiological characteristics of poisonings in the Hospital General Docente Ambato of Ecuador from September 2013 to August 2014. Materials and methods: A cross-sectional descriptive, observational study was conducted on intoxication cases registered at the Hospital General Docente Ambato. An electronic spreadsheet with the variables of interest was created for data collection. The data are expressed in proportions, measures of central tendency and dispersion. Results: During the studied period 58 cases were registered, there were 31.03% of the cases in the age range of 19 to 30 years, corresponding to organophosphorus in 25.86%, alcohol 22.41% and medicines 18.96%. Conclusion: It was identified that the highest percentage of poisonings were caused by organophosphates. Patients are treated promptly and autolytic attempts are the main cause of poisoned patients coming to the Emergency Service of the Hospital Ambato of Ecuador.

Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography

PURPOSE: Thrombosis of the portal vein, known as pylephlebitis, is a rare and fatal complication caused by intraperitoneal infections. The disease progression of superior mesenteric venous thrombosis (SMVT) is not severe. This study aimed to determine the clinical features, etiology, and prognosis of SMVT. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 41 patients with SMVT from March 2000 to February 2017. We obtained a list of 305 patients through the International Classification of Disease-9 code system and selected 41 patients with SMVT with computed tomography. Data from the medical records included patient demographics, comorbidities, review of system, laboratory results, clinical courses, and treatment modalities. RESULTS: The causes of SMVT were found to be intraperitoneal inflammation in 27 patients (65.9%), malignancy in 7 patients (17.1%), and unknown in 7 patients (17.1%). Among the patients with intraperitoneal inflammation, 14 presented with appendicitis (51.9%), 7 with diverticulitis (25.9%), and 2 with ileus (7.4%). When comparing patients with and without small bowel resection, the differences in symptom duration, bowel enhancement and blood culture were significant (P=0.010, P=0.039, and P=0.028, respectively). CONCLUSION: SMVT, caused by intraperitoneal inflammation, unlike portal vein thrombosis including pylephlebitis, shows mild prognosis. In addition, rapid symptom progression and positive blood culture can be the prognostic factors related to extensive bowel resection. Use of appropriate antibiotics and understanding of disease progression can help improve the outcomes of patients with SMVT.

Peripheral vascular insufficiency impairs functional capacity in patients with heart failure / Insuficiência vascular periférica compromete a capacidade funcional no paciente com insuficiência cardíaca

INTRODUCTION: Heart failure (HF) is a complex syndrome in which effort limitation is associated with deterioration of peripheral musculature. Improving survival rates among these patients have led to the appearance of cases in which other pathologies are associated with HF, such as peripheral vascular insufficiency (PVI). The combination of these two pathologies is common, with significant repercussions for affected patients. OBJECTIVE: To compare functional limitations and quality of life between patients with HF in isolation or HF + PVI. METHOD: Twelve patients with HF+PVI were paired to 12 patients with HF in isolation. All had ejection fraction <40%. The following were conducted: 6 minute walk test (6MWT), chair test (CT), step test (ST), one repetition maximum test (1RM) and quality of life questionnaire. RESULTS: The results for the 6MWT (311±27 vs. 447±29), ST (49±3 vs. 81±10) and CT (17±1 vs. 21±1) were lower in the HF+PVI group than in the HF group (p<0.05). The HF+PVI group exhibited a reduction in the number of steps taken from the first to the second minute of the ST, in relation to the HF group. The HF group exhibited better HR recovery than the HF+PVI group (50±4 vs. 26±3; p<0.05). No differences were found in results for the Borg scale, the peripheral muscle strength test (1RM) or the questionnaires (p>0.05). CONCLUSIONS: The study participants who had mixed disease exhibited a greater degree of functional impairment than the group with HF, without reporting worsened quality of life...

INTRODUÇÃO: A insuficiência Cardíaca (IC) é uma síndrome complexa e a limitação ao esforço está associada à piora da musculatura periférica. Devido à melhora na sobrevida destes pacientes, observa-se o surgimento de patologias associadas à IC, como a insuficiência vascular periférica (IVP). A associação das duas patologias é comum e com grandes prejuízos aos pacientes acometidos. OBJETIVO: Comparar as limitações funcionais e a qualidade de vida em IC isolada e IC + IVP. MÉTODO: Doze pacientes com IC+IVP foram pareados a 12 pacientes com IC isolada. Todos possuíam fração de ejeção <40%. Foram realizados: teste da caminhada de seis minutos (TC6M), teste da cadeira (TCAD), teste do degrau (TD), teste de uma repetição máxima (1RM) e questionário de qualidade de vida. RESULTADOS: Os valores obtidos nos testes TC6M (311±27 vs. 447±29), TD (49±3 vs. 81±10) e TCAD (17±1 vs. 21±1) no grupo IC+IVP foram menores do que no grupo IC (p<0,05), respectivamente. O grupo IC+IVP obteve redução do número de degraus alcançados entre o primeiro e o segundo minuto do TD em relação ao grupo IC. O grupo IC apresentou melhor recuperação da FC em relação ao grupo IC+IVP (50±4 vs. 26±3; p<0,05). Não foi encontrada diferença na escala de Borg, na força muscular periférica (1RM) e nos questionários aplicados (p>0,05). CONCLUSÃO: No presente estudo, os participantes com doença mista apresentaram maior comprometimento funcional em relação ao grupo com IC, sem demonstrar piora na qualidade de vida...

The internet racing ahead of the scientific evidence: the case of "liberation treatment" for multiple sclerosis / A corrida da internet na frente da evidência científica: o caso do "tratamento de liberação" para esclerose múltipla

Multiple sclerosis (MS) is a chronic neurological disease that typically affects young adults. A recent publication suggested that MS might originate from insufficient blood drainage in certain areas of the central nervous system. The condition was named chronic cerebrospinal venous insufficiency (CCSVI). Other papers have not confirmed these findings and, therefore, the matter remains controversial. Nineteen months after the original publication on CCSVI and MS, another 22 papers have been published addressing the matter. No clinical trials have been carried out on the subject and there is no evidence-based indication to perform surgical vascular procedures in MS patients. However, over the same nineteen-month period, the internet discussion on the subject of CCSVI and MS has led to countless websites advertising treatment using vascular surgery for patients with MS all over the world. The treatment based on the CCSVI theory has appealingly been called "liberation treatment", thus making it difficult to explain to patients why a treatment that has been highly praised (on the internet) cannot be recommended based on partial medical results that await confirmation.

Esclerose múltipla (EM) é uma doença neurológica crônica que tipicamente afeta adultos jovens. Uma recente publicação sugeriu que EM poderia se originar por insuficiência da drenagem sanguínea em certas áreas do sistema nervoso central. Esta condição foi denominada insuficiência venosa cerebroespinal crônica (CCSVI). Outros artigos não confirmaram estes achados e, portanto, o tema continua controverso. Dezenove meses após a publicação original sobre CCSVI e EM, outros 22 trabalhos foram publicados sobre este tema. Nenhum estudo clínico foi feito e não existe evidência para a realização de procedimentos cirúrgicos vasculares em pacientes com EM. No entanto, neste mesmo período de dezenove meses, a discussão na internet sobre o assunto CCSVI e EM levou a uma quantidade incontável de websites anunciando tratamento por cirurgia vascular para pacientes com EM no mundo todo. O tratamento baseado na teoria de CCSVI tem sido chamado de "tratamento de liberação", tornando difícil explicar aos pacientes porque um tratamento tão elogiado (na internet) não pode ser recomendado com base nos resultados médicos parciais que ainda aguardam confirmação.

Artificial magnetic field in treatment of cerebro-vascular insufficiency

51 patients with cerebro-vascular insufficiency were treated at 108 Military Hospital from June to December 2002. These patients were divided into 2 groups: 43 patients in group 1 were treated by alternating magnetic field; 8 patients in group 2 were treated by placebo. Alternating magnetic field with 45mT intensity had improved the symptoms of cerebro-vascular insufficiency such as: the relief of headache, vertigo, decrease in psychological and neuro-vegetative disorder, the decrease of stress making the sleep better and improving intellectuality. Results: 95.35% of patients in group 1 had more relief; 4.65% little relief, the moderate days of treatment were 14.484.79. A negative getting in the placebo group had demonstrated an objectiveness of the results. The intensity of magnetic field using in this study was suitable and almost without side effect during treatment

A Clinical Study of Serous Retinal Detachment in Pregnancy-induced Hypertension

PURPOSE: This study was designed to determine the clinical progression of serous retinal detachment(RD) due to hypertensive choroidopathy in toxemia of pregnancy. METHODS: We diagnosed 437 preeclampsia and eclampsia patients in 9, 689 consecutive deliveries at the Chunchon Sacred Heart Hospital from January 1996 to December 2000, and found 35 cases of serous RD among them. We retrospectively studied the incidence, clinical characteristics of the patients, location, and shape of retinal pigment epithelium (RPE) lesions. RESULTS: Among the 9, 689 pregnant women, there were 429 cases (4.4%) of preeclampsia and 8 (0.08%) of eclampsia. Serous RD occurred in 32 cases of preeclampsia (7.5%), and 3 of eclampsia (38%). In the preeclampsia cases, there were 26 cases (81%) of severe type, and 6 (19%) of mild type. The mean age of serous RD patients was 29.53yrs. Twenty-two cases (63%) in the 35 cases of serous RD were primipara patients, and 13 (37%) were multipara. Twenty-two cases (63%) in 35 the serous RD patients featured binocular involvement. Reattachment of retina was attained in all cases of serous RD, with a mean recovery interval of 18 days. CONCLUSIONS: Serous retinal detachment induced by toxemia of pregnancy can occur in mild preeclampsia patients. Reattachment of retina was attained in all serous RD cases. These study results will provide assurance for the treatment of serous retinal detachment patients.

Moyamoya Disease with Characteristic Funds Findings of Retinal Vascular Insufficiency

Moyamoya disease is characterized by progressive stenosis of internal carotid artery and shows unique angioraphic findings. Its etiology is still unknown, and theories of immunophysiologic and inflammatory mechanisms remain unproven. These patients show various neurologic symptons by cerebral ischemia, infarction and gemorrhage. and they also show various ophthalmologic symptoms. We experienced that a 21-year-old female who was diagnosed to have moyamoya disease presented with a suddenly developed occipital headache and neurologic deficit. The etiology of her characteristic fundus findings was thought to be retinal vascular insufficiency.