COVID-19 en imagen tomográfica por energía dual

RESUMEN En diciembre de 2019 se informaron casos de una neumonía grave en la ciudad de Wuhan, China. En enero de 2020 fue identificado el nuevo virus, SARS-CoV-2, que producía esta enfermedad altamente contagiosa denominada COVID-19, y alcanzó nivel de epidemia en marzo de ese propio año. Existe un protocolo establecido para su diagnóstico, donde se encuentran los estudios de imagen, entre ellas la tomografía de tórax con técnica de energía dual. Las características de los hallazgos anatómicos pulmonares y vasculares en las imágenes tomográficas de pacientes con COVID-19, su distribución, y la relación con el tiempo transcurrido desde el inicio de los síntomas, juegan un papel importante en el control y tratamiento de esta enfermedad, lo que refleja el valor diagnóstico de esta técnica.

ABSTRACT In December 2019 some cases of a severe pneumonia were reported in the city of Wuhan, China. In January 2020, the new virus, SARS-CoV-2, which produced this highly contagious disease called COVID-19, was identified and it reached epidemic level in March 2020. There is an established protocol for its diagnosis, which includes imaging studies, including chest dual energy computed tomography. The characteristics of pulmonary and vascular anatomical findings in tomographic images of patients with COVID-19, their distribution, and their relationship with the time elapsed since the onset of symptoms, play an important role in the control and treatment of this disease, reflecting the diagnostic value of this technique.

La enfermedad diverticular hoy: revisión de la evidencia / Diverticular disease today: evidence review

Resumen La enfermedad diverticular es muy prevalente con gran repercusión económica y médica. A pesar de las múltiples guías para protocolizar el diagnóstico y tratamiento no existe unanimidad en su manejo. Hemos realizado una revisión actualizada con el objetivo de analizar los nuevos estudios de esta enfermedad, para manejarla adecuadamente y realizar el tratamiento más adecuado en cada momento. La enfermedad diverticular tiene un componente hereditario (40%) y presenta una relación directa con la dieta pobre en fibra, la obesidad, el consumo de carne roja, la inactividad, el alcohol y los AINEs. Por su clínica inespecífica, es difícil realizar un diagnóstico diferencial. La ecografía y el TC abdominal son métodos apropiados para el diagnóstico y se recomienda una colonoscopia de manera precoz (4ᵃ-8ᵃ semana) tras el cuadro agudo. La clasificación más seguida es la de Hinchey. En el tratamiento médico de la diverticulosis sintomática no se ha demostrado evidencia clara de ningún medicamento. La diverticulitis aguda no complicada se puede manejar ambulatoriamente y no es necesario el uso de antibióticos en pacientes sin factores de riesgo. En la diverticulitis complicada se tiende a un manejo conservador, aunque en el Hinchey III y IV el tratamiento es quirúrgico, recomendando la resección de la zona afecta y si es posible anastomosis con o sin estoma de protección. No se recomienda el lavado y drenaje en el Hinchey III. Hay que consensuar tratamiento de forma individualizada ya que no se recomienda tratamiento quirúrgico por el número de recurrencias ni por edad del paciente.

The diverticular disease is a prevalent condition with a great economic and medical repercussion. Despite the multiple guidelines available to protocolize diagnosis and treatment, there is not unanimity in its management. We have carried out an updated review with the aim of analyzing new studies of the disease, to manage it properly and to carry out the most appropriate treatment at each time. Diverticular disease has an inherited component (40%) and it is directly related to low fiber diet, obesity, consumption of red meat, inactivity, alcohol and NSAIDs. Due to its nonspecific symptoms, it is difficult to make a differential diagnosis. Ultrasound and abdominal CT are appropriate methods for diagnosis and early colonoscopy is recommended (4th-8th week) after acute symptoms. The most followed classification is the Hinchey Score. There is no clear evidence of the superiority of any drug in the treatment of symptomatic diverticulosis. Acute uncomplicated diverticulitis can be managed on an outpatient and the use of antibiotics is not necessary in patients without risk factors. Conservative management tends to be used in complicated diverticulitis, although in Hinchey III and IV the treatment is surgical, recommending resection of the affected area and, if possible, anastomosis with or without a protective stoma. Washing and draining is not recommended in the Hinchey III. Treatment must be agreed on an individual basis since surgical treatment is not recommended due to the number of recurrences or the age of the patient.

Mortalidad por hipertensión arterial en personas mayores cubanas: Estudio de causas múltiples en 582494 casos

RESUMEN Introducción: La hipertensión arterial (HTA) constituye un problema de salud. Mediante la codificación de causas múltiples se puede estimar su papel como causa de muerte. Objetivos: Definir la ganancia cuantitativa de la HTA para determinar su aporte relativo real como causa de muerte en las personas mayores en Cuba, cuando se compara por la metodología de causas múltiples con la causa básica. Método: Se realizó un estudio observacional descriptivo de las 582 494 defunciones ocurridas en Cuba entre 2013 y 2019. Se evaluaron las Enfermedades Hipertensivas (I10-I15) como causa de defunción según la Clasificación Internacional de Enfermedades (CIE-10) y la frecuencia con que la HTA era informada como causa básica o no básica, y el total de menciones (causas múltiples). Resultados: Casi nueve de cada diez personas que fallecen con y por HTA en Cuba tienen 60 años y más, y el riesgo de morir por y con esta enfermedad evidencia un ascenso en los siete años analizados en este grupo poblacional. El análisis por causas múltiples muestra un aumento pronunciado de los casos de HTA. La razón entre causas múltiples y causa básica estuvo alrededor de 4; pero hubo un leve incremento del número absoluto de certificados de defunción donde se consideró la HTA como causa básica de muerte. La mortalidad proporcional por hipertensión, mediante el análisis de causas no básicas, fue tres veces mayor que por el análisis de causas básicas (diferencia absoluta promedio de 8,4%). Las enfermedades cerebrovasculares y del corazón son las causas básicas donde, con mayor frecuencia, aparece la enfermedad hipertensiva como padecimiento asociado. Conclusiones: La HTA, es una enfermedad de relativamente baja frecuencia como causa básica de muerte en las personas mayores en Cuba, pero muy frecuente como causa concurrente, lo que demuestra la importancia de su prevención y control en este grupo poblacional.

ABSTRACT Introduction: High blood pressure (HBP) constitutes a health problem. Its role as a cause of death can be estimated by multiple-cause coding. Objectives: To define the quantitative gain of high blood pressure to determine its real relative contribution as a cause of death in the elderly in Cuba when compared by the multiple-cause methodology with the underlying cause of death. Methods: We conducted a descriptive observational study of 582 494 deaths in Cuba between 2013 and 2019. Hypertensive Diseases (I10-I15) were evaluated as a cause of death according to the International Classification of Diseases (ICD-10), the frequency with which high blood pressure was reported as an underlying/contributory cause of death and the total number of times it was mentioned (multiple causes). Results: Almost nine out of every 10 persons who die with and due to high blood pressure in Cuba are 60 years of age and older, and the risk of dying with and due to this disease has increased in the seven years analyzed in this population group. The analysis by multiple causes shows a noticeable increase in the number of high blood pressure cases. The ratio between multiple causes and underlying cause of death was around 4; but there was a slight increase in the absolute number of death certificates where high blood pressure was considered the underlying cause of death. The proportional mortality due to high blood pressure, using the analysis of contributory causes, was three times higher than that of the analysis of underlying causes of death (average absolute difference of 8.4%). Cerebrovascular and heart disease are the underlying causes where hypertensive disease most frequently appears as an associated condition. Conclusions: High blood pressure is a disease of relatively low frequency as an underlying cause of death in the elderly in Cuba, but frequent as a concurrent or contributory cause, which demonstrates the importance of its prevention and control in this population group.

Estudio descriptivo transversal de los grupos terapéuticos más prescritos en el municipio de Teotitlán de Flores Magón, Oaxaca, México / A descriptive cross-sectional study of the most prescribed pharmacological groups in the municipality of Teotitlán de Flores Magón, Oaxaca, Mexico / Estudo transversal descritivo dos grupos terapêuticos mais prescritos no município de Teotitlán de Flores Magón, Oaxaca, México

RESUMEN Objetivo: Conocer cuáles son los grupos terapéuticos más prescritos, las principales formas farmacéuticas usadas y el porcentaje de polifarmacia que presentan las recetas que son proporcionadas a los pacientes en el municipio de Teotitlán de Flores Magón, Oaxaca, tanto del sector salud como privado. Metodología: Para lo cual se realizó un estudio de tipo cuantitativo observacional de tipo descriptivo transversal. Resultados: Existe una correlación entre la edad y la forma farmacéutica prescita, cabe decir que la forma farmacéutica más usada en las recetas corresponde a las tabletas. Así mismo, se puede evidenciar que las recetas que comúnmente reciben los pacientes presentan más de un principio activo, siendo los grupos terapéuticos más prescritos son los antiinflamatorios no esteroideos, antibióticos y vitaminas.

SUMMARY Aim: To know the most prescribed pharmacological groups, the main pharmaceutical forms used, and the percentage ofpolypharmacy presented by the prescriptions that are provided to patients in the municipality of Teotitlán de Flores Magón, Oaxaca, both in the health sector as private. Methodology: For which a quantitative observational study of descriptive cross-sectional type was conducted. Results: There is a correlation between age and the pharmaceutical form prescribed, it can be said that the pharmaceutical form most used in oral recipes, tablets being the most common. Likewise, it can be evidenced that the prescriptions they require received the patients presented more than one active ingredient, the most prescribed pharmacological groups being non-steroidal anti-inflammatory drugs, antibiotics, and vitamins.

RESUMO Objetivo: Saber quais são os grupos terapêuticos mais prescritos, as principais formas farmacêuticas utilizadas e a porcentagem de polifarmácia apresentada pelas prescrições que são fornecidas aos pacientes do município de Teotitlán de Flores Magón, Oaxaca, tanto no setor saúde como no setor privado. Metodologia: Para a qual foi realizado um estudo transversal observacional descritivo quantitativo. Resultados: Há correlação entre a idade e a forma farmacêutica prescrita, cabe ressaltar que a forma farmacêutica mais utilizada nas prescrições corresponde aos comprimidos. Da mesma forma, pode-se comprovar que as prescrições que comumente os pacientes recebem possuem mais de um princípio ativo, sendo os grupos terapêuticos mais prescritos os antiinflamatórios não esteroidais, antibióticos e vitaminas.

Utilidad de las técnicas de deformación miocárdica (strain) para evaluar cardiotoxicidad en pacientes con enfermedades oncológicas y tratamiento quimioterápico / Usefulness of myocardial strain techniques to assess cardiotoxicity in patients with oncologic diseases undergoing chemotherapy

RESUMEN Introducción: La evaluación de la función miocárdica es fundamental para la toma de decisiones durante el seguimiento de pacientes con enfermedades oncológicas que reciben quimioterapia. Con las técnicas de speckle-tracking bidimensional se puede determinar el grado de deformación de la fibra miocárdica y obtener una medida más directa de la función sistólica que la que aporta la fracción de eyección del ventrículo izquierdo (FEVI). Objetivo: Evaluar la función miocárdica, mediante ecocardiografía, en pacientes con enfermedades oncológicas y tratamiento quimioterápico. Método: Se realizó un estudio descriptivo longitudinal prospectivo en 21 pacientes con diagnóstico de enfermedad oncoproliferativa e indicación de quimioterapia con trastuzumab, en el Hospital de Fuerteventura (España), entre enero de 2017 y mayo de 2020. A todos se les realizó ecocardiograma transtorácico con técnica de speckle-tracking (strain longitudinal global) antes del tratamiento y durante el seguimiento. Resultados: Predominaron las mujeres (95,2%) con diagnóstico de cáncer de mama (90,5%) y la edad promedio fue de 53,8 años (rango 38-75). La FEVI y el strain longitudinal global fueron normales (100%) antes del inicio de la quimioterapia. Fue necesario suspender el tratamiento en 3 pacientes (14,3%); pero solo en 2 de ellos (9,5%) por cardiotoxicidad detectada por ecocardiografía. Cinco pacientes (23,8%) presentaron síntomas de insuficiencia cardíaca, 1 (4,8%) tenía cardiotoxicidad y en los otros 4 (19,0%) se demostró ausencia de disfunción miocárdica, por lo que se pudo continuar el tratamiento con seguridad. Conclusiones: El ecocardiograma con técnica de speckle-tracking bidimensional fue de vital importancia para evaluar la función miocárdica y guiar el tratamiento quimioterápico en pacientes con enfermedades oncológicas.

ABSTRACT Introduction: Assessment of myocardial function is critical for decision making during the follow-up of patients with oncologic diseases undergoing chemotherapy. Two-dimensional speckle-tracking techniques help to determine the degree of myocardial fiber deformation and provide a more direct measure of systolic function than left ventricular ejection fraction (LVEF). Objective: To evaluate myocardial function by means of echocardiography in patients with oncological diseases undergoing chemotherapy. Methods: A prospective longitudinal descriptive study was performed in 21 patients diagnosed with cancer and with indication for chemotherapy with trastuzumab, in the Hospital of Fuerteventura (Spain), between January 2017 and May 2020. All underwent transthoracic echocardiography with speckle-tracking technique (global longitudinal strain) before treatment and during follow-up. Results: Women (95.2%) with a diagnosis of breast cancer (90.5%) predominated and the mean age was 53.8 years (range 38-75). Left ventricular ejection fraction and global longitudinal strain were normal (100%) before starting chemotherapy. It was necessary to suspend treatment in 3 patients (14.3%); but only in 2 of them (9.5%) due to cardiotoxicity detected by echocardiography. Five patients (23.8%) presented symptoms of heart failure, 1 (4.8%) had cardiotoxicity and in the other 4 (19.0%) the absence of myocardial dysfunction was demonstrated, so that treatment could be continued safely. Conclusions: Two-dimensional speckle-tracking echocardiography was of vital importance for assessing myocardial performance and guiding chemotherapy in patients with oncologic diseases.

Serum repressor element-1 silencing transcription factor levels in alzheimer's patients from a national institute of health in mexico city, elderly and young controls

ABSTRACT Background: Decreased levels of repressor element-1 silencing transcription (REST) factor in the brain, plasma, and neuron-derived exosomes are associated with Alzheimer’s disease (AD). Objective: The objective of the study was to test the viability of serum REST as a possible blood-based biomarker for AD, comparing serum REST levels in AD patients from a National Institute of Health in Mexico City (with different levels of severity and comorbidities), with elderly controls (EC) and young controls (YC). Methods: We used an enzyme-linked immunosorbent assay to determine serum REST levels in AD patients (n = 28), EC (n = 19), and YC (n = 24); the AD patients were classified by dementia severity and comorbidities (depression and microangiopathy) using clinimetric tests and magnetic resonance imaging. Results: Mean serum REST levels did not differ between AD patients, EC, and YC. The severity of AD and the presence of depression or microangiopathy were not associated with serum REST levels. Conclusion: Our results differ from previously published patterns found for plasma and cerebral REST levels. Free serum REST levels may not be a viable AD blood-based biomarker. (REV INVEST CLIN. 2021;73(1):17-22)

Use of infrared thermography in Quarter Horse submitted to team roping / Uso da termografia infravermelha em equinos da raça Quarto de Milha submetidos à prova de laço em dupla

This study aimed to verify whether the body and local temperatures change after high-intensity, short-duration exercise (team roping) and whether different pieces of training influence these changes. To this end, twelve animals, males and females, aged 3-6 years, with an average weight of 450 kg, were used. The horses were divided into two groups: regular training (RTG) and sporadic training (STG). The surface temperatures were assessed using a specific thermal camera. Temperatures of the ocular, thoracolumbar, distal tendon (thoracic and pelvic limbs) and croup regions were measured 30 min before, immediately after, and one, two, six and 24 hours after competition simulation. In the RTG, there was an increase in surface eye temperature two hours after exercise, returning to baseline level 24 hours later. In the STG, increase in eye temperature occurred immediately after exercise and returned to baseline level two hours later. Temperature of the pelvic limb tendons and croup (right side) rose immediately after exercise and did not return to baseline level 24 hours later. Team roping exercise increased the surface temperature of the distolateral thoracic and pelvic limb, croup and thoracolumbar regions in both groups and the eye temperature in the STG. Training frequency influenced the surface temperature profile in the distolateral pelvic limb, croup and thoracolumbar regions.(AU)

Os objetivos do presente estudo foram verificar se as temperaturas corpóreas e locais se alteram após exercício de alta intensidade e curta duração (prova de laço em dupla) e se treinamentos distintos podem influenciar nestas alterações. Foram utilizados 12 animais, machos e fêmeas, com idade entre 3 e 6 anos e peso médio de 450kg. Os animais foram divididos em dois grupos: treino regular (GTR) e treino esporádico (GTE). As aferições da temperatura por meio de termografia infravermelha foram feitas por uma câmera termal específica. As medições das temperaturas das regiões ocular, toracolombar, tendíneas distais (membros torácicos e pélvicos) e garupa foram realizadas 30 minutos antes, imediatamente depois, uma, duas, seis e 24 horas após a simulação de competição. No GTR houve aumento de temperatura ocular duas horas após o exercício, retornando ao basal apenas 24 horas depois. No GTE o aumento ocorreu imediatamente após o exercício e retornando ao basal duas horas depois. As temperaturas da região dos tendões dos membros pélvicos e garupa (lado direito) elevaram-se imediatamente após o exercício e não retornaram ao basal após 24 horas. O exercício de laço em dupla aumentou as temperaturas superficiais nas regiões distolateral de membros torácicos e pélvicos, garupa e região toracolombar de ambos os grupos e da temperatura ocular do GTE. A frequência de treinamento influenciou o perfil de temperatura superficial na região distal de membros pélvicos, garupa e toracolombar.(AU)