A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability

Background: The clinical features and epidemiological data about patients with phebolymphedema or lymphedema related to Chronic Venous Disease in Mexico is limited and has been understudied; at the same time, the relationships between its clinical features, physical activity level and disability remained unknown. Methods: This is a longitudinal cohort study based on the analysis of clinical data of 90 patients gathered between 2021 and 2022. The statistical analysis was carried out using the software SPSS version 25 and GrandhPad Prism 8; a descriptive analysis was developed using measures of central tendency for the variables of a quantitative nature and frequency distribution for those categorical variables. The behavior of the variables was revealed through the Shapiro-Wilk statistic. The mean difference analysis was carried out with the Student’s T for independent samples. To identify the effect of gender, age, and severity of the disease on the study variables, a three-way analysis of variance was obtained with a Sidak comparison analysis. For the associations between qualitative and dichotomous nature variables, the Chi-Square statistic was obtained along with the odds ratio to determine the intensity of the relationships found. Results: A total of 90 patients were included in the analysis; 71% (64) were female and 29% (26) were male; with a mean age of 62.7 years old (± 30.5). A mean BMI of 33.2, 79.9% (77) of patients reached overweight and obesity ranges. 50% (45) of patients reported disability to perform one or more daily life activities related to the disease’s condition (signs, symptoms, volume). Only 12% (10) of all patients performed at or above the minimum physical activity recommended for their population group, and 88% (80) of patients had no physical activity or performed under the proper population group’s recommendation of minimal physical activity. It was found that the practice of physical activity, the number of compromised segments, the stage of the pathology, and the presence of cardiological and metabolic antecedents provide a statistically significant association with disability. Notable statistical difference among sex as a risk factor was not found. Regarding the BMI, the only differences were observed in the level of severity of the disease, regardless of the presence of any disability (p=0.006), evidencing that the greater the severity, the higher the BMI in both men and women. About physical activity, it is observed that inactivity or minimal practice of physical activity is a risk factor for referred disability (p<0.05), since it is prolonged that the non-practice of physical activity increases by 230% the chances of referring a disability associated to the disease compared to those people who referred to practice minimal or above minimal physical activity; the presence of a cardiological and/or metabolic history is related to an increase of about 150% to 180% of presenting disability compared to patients who do not have these pathologies. Conclusion: This study shows clinical and epidemiological features of phlebolymphedema and their relationship with the level of physical activity and reported disability of 90 patients. Further studies are needed to improve and broaden the understanding of the clinical characteristics of phlebolymphedema and its correlations.

Cancer-Related Lymphedema: Clinical and Epidemiological Features in Mexico

Background? There is a lack of clinical and epidemiological knowledge about cancer-related lymphedema in Mexico. The objective of this study is to present a broad and deep report of cancer-related lymphedema’s clinical characteristics and epidemiological features based on the analysis of CRL patients’ data, collected from a specialized rehabilitation clinic in Mexico. Methods? This is a cohort study based on the analysis of clinical data gathered between 2015 and 2022. The study was developed in a private clinic that specializes in oncological patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering diverse clinical characteristics and demographic information, classified in a matrix, and statistically evaluated. Results? Among 307 lymphedema patients, gender distribution was represented by 87.9% (270) female and 12.1% (37) male; mean age of 54.5 years (± 32.5); 79.8% of the patients corresponded to breast cancer diagnosis, the rest of them were associated with other 19 different types of cancer. 90.2% of patients underwent some lymph node removal procedure, 68.1% of patients received fractioned radiotherapy sessions, and 87.7% received some chemotherapy scheme treatment. 64% of patients had a diagnosis of lymphedema and had onset symptoms of lymphedema in the first 5 years after oncological interventions and/or cancer diagnosis, most of them during the first 2 years. The general distribution of clinical staging was: 23.7% in stage 0; 20.1% in stage I; 44.6% in stage II, and in stage III 11.4%. Regarding body mass index, it was found a mean of 26.7 BMI. 61.2% of patients ranged between overweight and obesity. 43.3% of patients with CRL reported a disability to perform one or more activities due to lymphedema. 80% of patients had no physical activity or performed under the minimal physical activity recommended for the population group they belong. Conclusion? This study reports broad epidemiological and clinical features of a group of cancer-related lymphedema patients in Mexico, it was possible to identify diverse potential factors and relations that influence the clinical features of CRL; it is necessary to explore all factors and the interactions among them for a better understanding of CRL patients in the country.

Pectus excavatum em uma ninhada de Buldogue Francês: relato de caso / Pectus excavatum in a French Bulldog Litter: case report

RESUMO O pectus excavatum é considerado uma patologia da parede torácica, onde há convexidade no aspecto ventral do esterno, o que gera complicações secundárias, como alongamento ventrodorsal do tórax e aumento da pressão intratorácica, entre outras. No presente caso, o corpo de um cachorro Buldogue Francês nasceu com sinais prévios de decaimento e baixo consumo de leito materno, além de uma avaliação médica forense. De acordo com a avaliação patológica, foi encontrada uma fenda no peito esternal relacionada às esternas caudais próximas à cartilagem xifóide, conteúdo espumoso na cartilagem epiglótica da laringe e sinais graves de enfisema nos lobos caudal, craniano e médio pulmonar. Na avaliação cardiológica, foi observada assimetria morfológica invaginante no septo interventricular na mesma área em que a fenda esternal ocorre, por sua vez, na avaliação radiográfica, evidencia uma depressão dorsal do terço caudal do esterno com alterações consideráveis na silhueta cardíaca. Na Colômbia não há relatos de ninhadas completas que apresentem esta alteração, portanto, pretende-se que este seja o primeiro relatório anatomopatológico e de imagem que descreva a patologia em caninos.

ABSTRACT Pectus excavatum is considered a pathology of the chest wall where there is convexity in the ventral aspect of the sternum, which generates secondary complications, such as ventrodorsal stretching of the chest and increased intrathoracic pressure, among others. In the present case, the body of a French bulldog dog was born with previous signs of decay and low consumption of maternal waste, in addition to a forensic medical evaluation. According to the pathological evaluation, a crack was found in the sternal chest related to the caudal sternum close to the xiphoid cartilage, frothy content in the laryngeal epiglottis cartilage and severe signs of emphysema in the caudal, cranial and middle lung lobes. In the cardiological evaluation, an invaginating morphological asymmetry was observed in the interventricular septum in the same area in which the sternal cleft occurs, in turn, in the radiographic evaluation, it shows a dorsal depression of the caudal third of the sternum with considerable changes in the cardiac silhouette. In Colombia there are no reports of complete litters that present this alteration, so it is intended that this is the first anatomopathological and imaging report that describes the pathology in canines.

Complicaciones intra y postquirúrgicas de exodoncias en un programa de atención comunitaria de la FOUBA en Junín de los Andes / Intra and postsurgical tooth extraction complications at a FOUBA community dentistry program in Junin de los Andes

El objetivo de este estudio fue analizar la incidencia de complicaciones intra y postquirúrgicas de extracciones simples en 5 días de atención comunitaria en Junín de los Andes, provincia de Neuquén, Argentina. Se realizaron 109 extracciones dentales en 74 de los pacientes que concurrieron al centro único de atención, entre el 27 y 31 de octubre de 2014, presentando piezas dentarias con indicación de extracción. Las complicaciones más frecuentemente encontradas fueron la fractura de la tabla ósea vestibular, la fractura de la corona de la pieza dentaria y el dolor posoperatorio. Complicaciones de frecuencia intermedia fueron el trismus, la alveolitis, la laceración de los tejidos blandos y la fractura de la raíz de la pieza dentaria. Se registró un caso de hemorragia primaria y una inyección accidental dentro de un vaso sanguíneo. Cuando se comparó estadísticamente la presencia de complicaciones pre y posquirúrgicas entre cirugías que duraron menos de 30 minutos y 30 minutos más, se encontró una asociación significativa; para ambas complicaciones, el porcentaje fue mayor en el segundo grupo. La práctica de extracciones simples ocasionalmente conlleva tener que manejar complicaciones. Es importante que el odontólogo general sea capaz de prevenirlas, diagnosticarlas y tratarlas. Reducir los tiempos operatorios parecería ser una medida clave para disminuir las probabilidades de aparición de complicaciones intra y posquirúrgicas.

The objective of this study was to analyze the incidence of intra and postoperative complications of simple extractions in 5 days of community care in Junín de los Andes, province of Neuquén, Argentina. A total of 109 dental extractions were performed in 74 patients who attended the single care center between October 27 and 31, 2014, presenting teeth with indication of extraction. The most frequent complications were the fracture of the buccal bone table, the fracture of the crown of the tooth and the postoperative pain. Complications of intermediate frequency were trismus, alveolitis, laceration of the soft tissues and fracture of the root of the tooth. There was a case of primary haemorrhage and an accidental injection into a blood vessel. When statistically comparing the presence of pre and postsurgical complications between surgeries that lasted less than 30 minutes and 30 minutes more, a significant association was found; for both complications, the percentage was higher in the second group. The practice of simple extractions occasionally entails having to handle complications. It is important that the general dentist be able to prevent, diagnose and treat them. Reducing operative times seems to be a key measure to decrease the chances of intraoperative and postoperative complications.

(De)construyendo la esfera pública: juventud y (la otra) cultura política / (De) constructing the public sphere: youth and (the other) political culture

Ser joven se constituye hoy en un ámbito de indecibilidad. Lo anterior coloca laconstrucción de los proyectos identitarios directamente en el centro del campo político. El estudio deello requiere considerar una serie de interrogantes, que son las que dan cuerpo a esta intervención:¿cómo se tematiza la relación entre la juventud y la esfera pública en la Zona Metropolitana deGuadalajara, Jalisco, México? ¿Cuáles son las imágenes culturales que dotan de visibilidad a losjóvenes y a las jóvenes en dicha zona y cómo éstas funcionan cual mecanismos de control por partedel Estado? ¿Qué tácticas despliegan los sujetos jóvenes tapatíos frente a ello?

Factores asociados a niveles de parathormona intacta (PTHi): en 136 pacientes en hemodiálisis crónica / Associated factors of levels intact parathormone (PTHi): at 136 patients of chronic hemodialysis

El hiperparatiroidismo secundario (HPT2) es una complicación de alta prevalencia en pacientes en hemodiálisis crónica (HD) (1,2,3). El objetivo de este estudio fue conocer la correlación existente entre factores demográficos, nutricionales y bioquímicos, con la severidad del HPT2 medido a través de los niveles plasmáticos de parathormona intacta (PTHi). La población estudiada fue de 136 pacientes en HD trisemanal (84 hombres, 52 mujeres y 28 diabéticos en el grupo total). Edad promedio de 53,9 años (DS 19,6), PTHi promedio de 326 pg/dl (DS 591). Se calculó los promedios diarios de ingesta calórica, proteica y de fosfatos a partir de recordatorio de ingesta en 24 hrs. La ingesta calórica fue de 1.735 kcal, la proteica de 55,9 g y la de fosfatos de 875 mg en 24 horas respectivamente.Los pacientes diabéticos presentaron niveles menores de PTHi (179 pg/dl), con relación a los no diabéticos cuyos valores de PTHi (456,7 pg/dl) fueron significativamente mayores.Se encontró una correlación directa entre la ingesta de fosfatos con la ingesta calórica y la proteica. Los niveles de PTHi se correlacionaron directamente con el tiempo de permanencia en HD medido en meses (mHD) y tuvieron correlación inversa con la edad, ingesta calórica, ingesta de fosfatos y fosfatemia

Epidemiología molecular de cánceres de alta incidencia en México / Molecular epidemiology of high incidence cancers in Mexico

En este trabajo presentamos la situación epidemiológica molecular actual en México con respecto a la presencia de secuencias de ADN de virus de papiloma humano (VPH) en pacientes afectadas por cáncer cérvicouterino (CaCu) y en mujeres asintomáticas clínicamente normales. Encontramos, por PCR, que en un 82-85 por ciento de las neoplasias cervicales y en el 31 por ciento de las mujeres normales están presentes dichas secuencias. En cuanto a leucemias, otro cáncer de muy alta incidencia en México, investigamos la frecuencia de los rearreglos brc-abl y e2a-pbxl en pacientes con Leucemia Linfoblástica Aguda (LLA) y Leucemia Granulocítica Crónica (LGC) mediante la tecnología de RT-PCR. Encontramos que un 66 por ciento de los niños con pre B-LLA presentan el rearreglo e2a-pbxl, un 46 por ciento de los adultos con LLA CALLA(+) presentan el rearreglo bcr-abl y el 100 por ciento de los pacientes con LGC tuvieron el rearreglo bor-abl. Esta tecnología y los resultados presentados permiten un mejor diagnóstico, pronóstico y terapia de las mencionadas neoplasias

Lactancia en tiempos del sida / Lactancia in the days of the AIDS

Expone que en 1982 se reportaron los primeros casos de SIDA pediátrico, desde entonces el número de casos ha aumentado en forma sostenida en todas las regiones del mundo. Este incremento se atribuye al creciente número de mujeres infectadas que están transmitiendo VIH a sus bebés. Esta transmisión puede ocurrir: a)durante el embarazo, b)durante el nacimiento o c)a través del amamantamiento. Los invalorables beneficios de la lactancia materna están siendo opacados por la posibilidad de la transmisión del VIH de la madre infectada a su niño. Por este motivo en varios países se considera a la infección por VIH como factor determinante para la contraindicación de la lactancia. Estudios recientes demuestran que este criterio no es válido en aquellos países en que el índice de mortalidad infantil ocasionada por enfermedades infecciosas y desnutrición es elevado...

Eritropoietina y transfusiones en la anemia del insuficiente renal crónico: visión actualizada / Erytropoietin and tranfusions in anemia of chronic renal failure: update view

Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9ñ25 and 57ñ13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4ñ25.6 and 36.8ñ31.8 months respectively), dialysis hours (3.19ñ0.6 and 3.33ñ0.39 h respectively) and proportion of diabetics (6.6 and 20.8 percent respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22 percent) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4ñ1.46 vs 8.78ñ1.97 g/dl). Epo was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18 percent of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs

¿Qué es indispensable para la vigilancia y control de una diálisis crónica adecuada? / What is indispensable for the surveillance and control of adequate chronic dialysis

Se estudiaron prospectivamente 2 poblaciones de pacientes en diálisis crónica controlados con dos modalidades diferentes de programas de exámenes. La mayor parte del tiempo el agua de diálisis fue tratada con deionizador/osmosis reversa. El grupo A con 44 pacientes, edad promedio de 58 +/- 15.4 años, tiempo en dialisis de x 31.9 +/-22.5 meses fue controlada con un programa restringido el que incluía medición mensual de hemoglobina, trimestral de calcemia, fosfemia, calemia y fosfatasas alcalinas; anual de paratohormona y radiografía de manos y de marcadores virales cada 6 meses. El grupo B con 31 pacientes, edad promedio 56.9 +/- 13.8 años, tiempo en díalisis de promedio 33.8 +/- 30.5 meses fue controlado con un programa amplio y frecuente de exámenes. El porcentaje de diabéticos fue similar en ambos grupos. No hubo diferencia significativa en la mortalidad (18.1 por ciento para el A y 29 por ciento para el B, NS) hospitalizaciones (064/pacientes/año para el A y 1.5 para el B, NS), transfusiones (1.1 transfusiones/pacientes/año para el A y 1.5 para el B, NS) y administración de eritropoietina (9 por ciento de los pacientes del grupo A y 9.6 por ciento del B, NS). Un paciente de cada grupo desarrolla síndrome urémico por causas evidentes y específicas. En el grupo B se comprobó una mayor incidencia de hipercalemia asintomática como consecuencia de la medición mensual de este parámetro. Concluímos que disponiendo de un adecuado tratamiento del agua de díalisis y conociendo los marcadores virales de los pacientes a su ingreso es posible el control adecuado del tratamiento mediante un programa muy reducido de exámenes lo que disminuye costos y racionaliza su solicitud. Al esquema propuesto debe agregarse la medición frecuente de la potasemia por su valor en el diagnóstico de hipercalemia asintomática

Medicina Nuclear / Nuclear Medicine

Da a conocer la estructura del átomo para ingresar en la radiación nuclear, sus formas de desintegración, propiedades de las radiaciones y formas de medición. Además, plantea los efectos biológicos de las radiaciones, cómo protegerse y cuáles serían las cosecuencias de la exposición. Trata acerca del empleo de los radioisótopos...