Miopatías inflamatorias idiopáticas: una mirada actualizada al diagnóstico y el manejo / Idiopathic inflammatory myopathies: a review

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of acquired immune-mediated diseases, which typically involve the striated muscle with a variable involvement of the skin and other organs. Clinically, they are characterized by proximal muscle weakness, elevation of muscle enzymes, myopathic changes on electromyography and an abnormal muscle biopsy. The different IIM have been classified according to their distinctive histopathologic features in dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) and immune-mediated necrotizing myopathy (IMNM). Several myositis-specific antibodies are associated with the different phenotypes, as well as with different risk of neoplastic disease and systemic complications. The basis for the treatment of DM, PM, and IMNM is immunosuppression. For IBM there are only symptomatic treatments. Steroids, associated or not with other immunosuppressant drugs, are the first line of treatment. Biologic drugs will allow future individualized therapies. The 10-year survival of DM, PM and IMNM is 62 to 90%. The leading causes of death are neoplastic, lung and cardiac complications. IBM does not impair survival, although it affects the quality of life.

Compromiso neuropático y autonómico en Enfermedad de Fabry: presentación de casos clínicos / Neuropathy and Fabry's disease: report of five cases

Fabry's disease is an X-linked multisistemic lisosomal storage disorder caused by deficiency or absence in α-Galatosidase A. Symptoms develop early in childhood with small fiber neuropathy, autonomic disorders and skin lesions (angiokeratomas). More severe in males, patients develop over years heart disease (hypertrophic cardiomyopathy, bradycardia), proteinuria, renal failure, transient ischemic attacks and stroke, associated with decreased life expectancy. We report five patients with Fabry's disease aged between 21 to 56 years and with family history. Neuropathic symptoms are described and neurophysiological testing findings of nerve conduction studies, quantitative sensory testing, autonomic testing and sympathetic skin response are presented.

Caracterización de eventos de hipoglicemia en pacientes diabéticos y no diabéticos atendidos en un servicio de urgencia / Hypoglycemia in an emergency room: review of 251 cases

Background Hypoglycemia is the main limitation for the achievement of glycemic goals in the treatment of diabetes. Aim To assess the incidence of hypoglycemia in an emergency department. To characterize and identify which patients are at higher risk of having it. Material and Methods We reviewed the electronic records of patients discharged from an adult emergency room with the diagnosis of hypoglycemia between May 2011 and December 2014. Age, sex, diagnosis of diabetes (DM), antidiabetic therapy, glycosylated hemoglobin, creatinine, destination at time of discharge, blood glucose, impairment of conscience, treatment of the event and predictions were recorded. Results Of 175,244 attentions analyzed, 251 in patients aged 69 ± 17 years (54% women) consulted for hypoglycemia (0.14%). Eighty one percent had a type 2 diabetes, 6% a type 1 diabetes and 12% were non-diabetic. Mean blood glucose was 44.1 mg/dl. In diabetic patients, mean glycosylated hemoglobin was 6.5%. Ninety seven percent had impairment of conscience and 77% were admitted to the hospital. Among patients without diabetes, the main comorbidity was the history of a gastric bypass surgery. In type 2 diabetes, glibenclamide used alone or with other medications was involved in 59% of the events, 87% of patients were older than 65 years with a mean glycosylated hemoglobin of 6.3% and 32% had renal failure. Conclusions The incidence of hypoglycemia was low. There were a significant number of events in older patients with type 2 diabetes mellitus and renal failure, who were treated with glibenclamide. Most of these patients had a glycosylated hemoglobin below accepted recommendations.

Descripción electrofisiològica del síndrome de túnel carpiano según edad en pacientes adultos / Electrophysiological severity of carpal tunnel syndrome according to age in adult patients

Background: Carpal tunnel syndrome (CTS) represents 90% of entrapment neuropathies. Severity may be greater in older patients. Aim: To describe the electrophysiological findings in adult patients with CTS and determine if severity is related to age. Material and Methods: Descriptive and retrospective study of electrophysiological findings in patients over 18 years of age with clinical suspicion of CTS, studied between January 2011 and December 2015. Neurophysiological severity was classified in 3 grades, comparing them by age, gender and laterality. Results: Of 1156 patients subjected to electrophysiological studies due to a clinical suspicion of CTS, 690 (60%) had electrophysiological features of the disease. In 274 patients (24%) the compromise was mild, in 162 (14%) it was moderate and in 254 (22%) it was severe. There was a positive association between age and CTS severity (p < 0.01). Severity was significantly greater in males than females (p < 0.01). Bilateral CTS was present in 471 patients (68%), which was associated with increased age and severity (p < 0.01). Conclusions: Electrophysiological severity in CTS increases with age. Other factors associated with higher severity are male gender and bilateral disease.

Polirradiculoneuritis aguda asociada a infección por Virus Herpes Humano 7 en un paciente adulto inmunocompetente / Acute polyradiculoneuropathy associated with human Herpes Virus 7 in an immunocompetent patient: case report

Human herpes virus 7 (HHV-7) is a cause of encephalitis, meningitis and myeloradiculoneuropathy in adults who are immunocompetent or with immunosuppression. The involvement of the peripheral nervous system is always associated with myelitis. We report a case of acute polyradiculoneuropathy due to HHV-7, without involvement of central nervous system, in an immunocompetent patient. A 35-years-old man complained of lumbar pain radiating to both buttocks. On examination muscle strength and tendon reflexes were normal. He had asymmetric pinprick and light touch saddle hypoesthesia and also in the perineal region, dorsum and lateral aspect of the left foot. Magnetic resonance imaging showed mild thickening and contrast enhancement of cauda equina nerve roots. Polymerase chain reaction performed on cerebrospinal fluid was positive for HVV-7. Other inflammatory, infectious and neoplastic etiologies were ruled out. Lumbar pain and hypoesthesia improved progressively and neurological examination was normal after one month. He did not receive antiviral therapy.

El Papel de la Dimensión Colectiva en el Estudio de la Felicidad / The Role of the Collective Dimension in the Study of Happiness / O Papel da Dimensão Coletiva no Estudo da Felicidade

Resumen Los estudios sobre felicidad incluyen diversas perpectivas, conceptualizaciones y factores asociados a este concepto; sin embargo, las investigaciones sobre felicidad con frecuencia se concentran en la dimensión individual de la misma. El presente trabajo hace énfasis en la concepción de la felicidad como un constructo multidimensional conformado por aspectos individuales y por aspectos colectivos. De manera que el propósito central del artículo es presentar un análisis sobre la dimensión colectiva de la felicidad, la cual ha sido poco estudiada en el contexto latinoamericano. En particular este artículo busca enfatizar el papel de las relaciones afectivas, la conducta prosocial y la inversión en los demás, en la comprensión de la felicidad. En las conclusiones se identifican temáticas relevantes asociadas a la dimensión colectiva que permitirán ampliar la investigación sobre la felicidad.

Abstract Studies of happiness include diverse perspectives, concepts and factors; however, research on happiness often focuses on its individual dimension. This work emphasizes the concept of happiness as a multidimensional construct of individual and collective aspects. The main purpose of the article is to present an analysis of the collective dimension of happiness, which has been little studied in the Latin American context. In particular, this article seeks to emphasize the role of relationships, prosocial behavior and investment in others in the understanding of happiness. The conclusions identify issues associated with the collective dimension that permit a broadening of the research on happiness.

Resumo Os estudos sobre felicidade incluem diversas perspectivas, conceituações e fatores associados a esse conceito; contu do, as pesquisas sobre felicidade com frequência concentram-se na dimensão individual dela. Este trabalho enfatiza a concepção da felicidade como um constructo multidimensional conformado por aspectos individuais e por aspectos coletivos. Assim, o propósito central deste artigo é apresentar uma análise sobre a dimensão coletiva da felicidade, a qual tem sido pouco estudada no contexto latino-americano. Em particular, neste texto, busca-se salientar o papel dos relacionamentos afetivos, do comportamento pró-social e do investimento nos demais, na compreensão da felicidade. Nas conclusões, identificam-se temáticas relevantes associadas à dimensão coletiva que permitirão ampliar a pesquisa sobre a felicidade.

Características epidemiológicas del síndrome de Guillain-Barré en población chilena: estudio hospitalario en un período de 7 años / Clinical features of Guillain-Barré syndrome in 41 patients admitted to a public hospital

Background: Guillain-Barré syndrome (GBS) is the commonest cause of acute flaccid paralysis worldwide, with an incidence of 0.6-4 per 100.000 inhabitants per year. It affects all age groups and carries an incapacity burden of up to 20%. Aim: To describe the features of GBS in adult Chilean patients admitted to a tertiary care hospital. Material and Methods: Review of medical records of 41 patients aged 17 to 81 years (30 males) admitted to a public hospital with the diagnosis of GBS between 2003 and 2009. According to clinical and electrophysiological criteria, the patients were classified into different varieties of GBS. Results: The incidence of GBS was higher in males (2.7:1) and the demyelinated GBS variety was found in 66% of cases. According to the Hughes’ disability score, patients treated with plasmapheresis, showed non-statistically significant better outcomes than those treated with intravenous immunoglobulin. Conclusions: In this group of patients the demyelinated variety of GBS was more common than the axonal type. Although not statistically significant, the better response to plasmapheresis is encouraging and should prompt a controlled study.

Atributos y estereotipos de género asociados al ciclo de la violencia contra la mujer / Gender Attributes and Stereotypes Associated with the Cycle of Violence Against Women

Se examinó la relación entre la construcción social de atributos y estereotipos de género, y la presencia de violencia doméstica contra la mujer. Participaron 1.200 sujetos de ambos sexos, mayores de 18 años, residentes en distintas localidades de España. Los participantes valoran positivamente los atributos de género que conforman la imagen femenina, sin embargo tienden a estereotiparse marcadamente por el género. En referencia a los atributos de género a infundir en la educación de los hijos, existen diferencias respecto al sexo del educador, siendo las madres más rígidas en la crianza de los hijos. Respecto a la valoración de atributos de género en la pareja, los sujetos tienden a preferir parejas marcadamente estereotipadas. En relación a la valoración a cerca de los prototipos de género que difunden los medios de comunicación, ambos sexos coinciden en el deseo de percibir figuras masculinas y femeninas más estereotipadas. Se encontró una asociación entre la violencia doméstica con los atributos de género masculinos, calificando a los hombres maltratadores como personas violentas y a las mujeres como pasivas, siendo la valentía la principal característica para salir del círculo de la violencia.

This study examined the relation between the social construction of gender attributes and stereotypes, and the presence of domestic violence against women. The participants were 1.200 subjects of both sexes, over 18 years of age, residing in different locations in Spain. Participants positively value the gender attributes that constitute the female image. However, they tend to markedly stereotype themselves according to gender. Regarding the transmission of gender attributes in the education of children, there are differences related to the sex of the educator, mothers being more rigid in their parenting. Concerning the assessment of gender attributes in romantic relationships, the subjects tend to prefer strongly stereotyped couples. In relation to the assessment of the gender prototypes broadcast by the media, both sexes agree on their desire to perceive more stereotyped male and female figures. An association between domestic violence and male gender attributes was found, as well as the description of abusive men as violent persons and of women as passive, and the notion of courage as the main characteristic needed to break the cycle of violence.