TLR4 polymorphism and haplotype are associated with obesity and lipid profile in young population: a pilot study.

BACKGROUND: The single nucleotide polymorphisms in the TLR4 gene can decrease or increase the response to lipopolysaccharide, increasing the susceptibility to inflammatory diseases, affecting the expression or receptor function by inducing a low-grade chronic inflammatory response. PURPOSE: The objective of this study was to evaluate the association of SNPs - 2570 A > G (rs2737190), - 2081 G > A (rs10983755), 896 A > G (rs 4986790), and 1196 C > T (rs4986791) of the TLR4 gene with obesity and metabolic alterations in the young population. RESULTS: In this study, it was found that the carriers of the heterozygous genotype of the SNPs - 2081 G > A, 896 A > G, and 1196 C > T confer a higher risk of developing obesity (OR = 3.73, p = 0.018; OR = 5.66, p = 0.014, and OR = 8.95, p = 0.014, respectively). Also, with the lipid profile, the SNP - 2081 G > A was associated with total cholesterol (TC) ≥ 200 mg/dL (OR = 3.91, p = 0.020) and Kannel index > 3% (OR = 4.00, p = 0.008). The SNP 896 A > G was associated with LDL-c ≥ 100 mg/dL (OR = 3.64, p = 0.040) and Kannel index > 3% (OR = 4.33, p = 0.016), and the SNP 1196 C > T was associated with TC ≥ 200 mg/dL (OR = 4.37, p = 0.048), Castelli index > 4.5/> 5% (OR = 5.33, p = 0.016), and Kannel index > 3% (OR = 16.00, p = 0.001). Finally, the AGGT haplotype was associated with Castelli index > 4.5/> 5% (OR = 5.40, p = 0.015) and Kannel index > 3% (OR = 10.46, p < 0.001), and the AAAC haplotype was associated with obesity (OR = 3.56, p = 0.020), TC ≥ 200 mg/dL (OR = 4.04, p = 0.007), LDL-c ≥ 100 mg/dL (OR = 2.98, p = 0.030) and Kannel index > 3% (OR = 4.20, p = 0.002). CONCLUSION: The heterozygous genotype of the SNPs - 2081 G > A, 896 A > G and 1196 C > T of the TLR4 gene was associated with altered lipid profile and development of obesity in young university students of Guerrero State, Mexico.

Mitogen-activated protein kinase inhibitor-associated retinopathy (MEKAR). A clinical case.

Mitogen-activated protein kinase kinase (MEK) inhibitors have significantly improved the prognosis of various types of cancer such as metastatic melanoma. However, their use is usually associated with ocular side effects. A retinopathy associated with these agents (MEKAR) has been described, consisting of the development of neurosensory detachments, generally bilateral and multiple, similar to those that appear in the central serous chorioretinopathy (CSC). Generally, optical coherence tomography allows us to differentiate the two conditions. We present the case of a 55-year-old woman in treatment with a MEK inhibitor, who developed bilateral neurosensory detachments and blurred vision, which resolved with the discontinuance of the treatment due to tumour progression.

Retinopatía asociada a inhibidor de la proteinquinasa de activación mitogénica (MEKAR). A propósito de un caso / Mitogen-activated protein kinase inhibitor-associated retinopathy (MEKAR). A clinical case

Los inhibidores de la proteína quinasa de activación mitogénica (MEK) son fármacos utilizados para el tratamiento de neoplasias tales como el melanoma metastásico. Su introducción ha mejorado el pronóstico de estas enfermedades, pero su uso no está exento de complicaciones oculares. Se ha descrito una retinopatía asociada a estos fármacos (MEKAR) consistente en la aparición de desprendimientos neurosensoriales (DNS), generalmente bilaterales y múltiples similares a los que aparecen en la coriorretinopatía serosa central (CSC). En la mayoría de los casos la tomografía de coherencia óptica es suficiente para diferenciar esta entidad de una CSC. Presentamos el caso de una paciente de 55 años que, en este contexto, desarrolló DNS bilaterales que asociaron disminución de agudeza visual y que se resolvieron cuando se suspendió la terapia por progresión tumoral (AU)

Mitogen-activated protein kinase kinase (MEK) inhibitors have significantly improved the prognosis of various types of cancer such as metastatic melanoma. However, their use is usually associated with ocular side effects. A retinopathy associated with these agents (MEKAR) has been described, consisting of the development of neurosensory detachments, generally bilateral and multiple, similar to those that appear in the central serous chorioretinopathy (CSC). Generally, optical coherence tomography allows us to differentiate the two conditions. We present the case of a 55-year-old woman in treatment with a MEK inhibitor, who developed bilateral neurosensory detachments and blurred vision, which resolved with the discontinuance of the treatment due to tumour progression (AU)

Manejo médico de la miomatosis uterina: Revisión de la literatura

Objetivo: Proporcionar un enfoque basado en la mejor evidencia disponible de las diferentes opciones de tratamiento médico para los miomas uterinos. Método: Se realizó una búsqueda bibliográfica en las bases de datos, Med Line PubMed, Embase, Cochrane, Ovid-Hinari, Scielo, Bireme y Lilacs. Resultados: Se revisaron 212 artículos y se seleccionaron 58, los cuales estaban relacionados directamente con el tema. Hay múltiples tratamientos que han sido usados para el tratamiento de miomatosis. Los agonistas de la GnRH, son los únicos medicamentos aprobados por la Food and Drug Administration, para la disminución del volumen de los miomas, usados pre-quirúrgicamente, sin embargo presentan muchos efectos secundarios. El dispositivo liberador de levonogestrel se plantea como una opción para pacientes con miomas menores de 6 centímetros que no afecten la cavidad uterina. Los moduladores selectivos de receptores de progestágeno y los inhibidores de aromatasa se plantean como un manejo que puede ser útil, especialmente para pacientes en la perimenopausia. Conclusión: La literatura muestra que hay evidencia de varios medicamentos que pueden ser usados para el manejo de pacientes con miomatosis, especialmente para el manejo de los síntomas asociados para mejorar su calidad de vida y las pacientes que obtienen mayor beneficio son las que están cercanas a la menopausia. Finalmente hay otros fármacos que son objeto de investigación y pueden ser futuras opciones terapéuticas para su uso en conjunto tanto en la miomectomía y como uso exclusivo de tratamiento médico.

Objective: We offer an approach of scientific literature based on the best available evidence of the different medical treatment options for uterine fibroids. Method: A search of the literature in the databases in Med Line PubMed, Embase, Cochrane, Ovid-Hinari, Scielo, and Lilacs. Results: 212 articles were reviewed and 58 articles were selected, which were directly related to the topic. GnRH agonists are the only drugs approved by the Food and Drug Administration for reducing the volume of fibroids, used pre-surgically, but have many side effects. The levonorgestrel-releasing device is proposed as an option for patients with fibroids under 6 centimeters and without involvement the uterine cavity. Selective progestin receptor modulators and aromatase inhibitors arise as a management that can be useful, especially for patients in perimeno-pause. Conclusions: The literature shows that there is evidence of several drugs that can be used for the management of patients with fibroids especially for the management of associated symptoms to improve quality of life and benefit more patients are those closest to the menopause. Finally there are other drugs that are under investigation and may be future therapeutic options for use both together as myomectomy and exclusive use of medical treatment.

Inestabilidad externa de codo tras el tratamiento quirúrgico de la epicondilitis. A propósito de un caso / External stability of the elbow after surgical treatment of epicondylitis. Presentation of a case

La inestabilidad de codo es una enfermedad de diagnóstico difícil en determinados casos, y puede conllevar unos problemas limitantes para la funcionalidad diaria como los bloqueos articulares, los resaltes, la debilidad muscular y el dolor persistente. Presentamos el caso de un paciente con clínica de epicondilitis con antecedente previo de una caída sobre el brazo afecto. Tras efectuar los tratamientos convencionales no agresivos y no obtener mejoría, se realiza cirugía sobre la afectación tendinosa. El caso evoluciona hacia la persistencia del dolor, y a una clínica de inestabilidad articular que acaba por precisar cirugía reconstructiva ligamentaria sobre el complejo externo. En el control a los 6 meses de la última intervención ha desaparecido la clínica de inestabilidad, pero aún persisten las molestias en cara externa y un déficit a la extensión de 30°. Es importante tener en consideración ante un cuadro de epicondilitis con traumatismo previo, rebelde a los tratamientos conservadores, la posibilidad de que haya una inestabilidad de codo subyacente, descartándola con una correcta exploración física y con pruebas complementarias si se precisan (AU)

Elbow instability is a difficult to diagnose condition in certain cases, and could lead to some problems that limit daily functioning, such as joint blocks, bumps, projections, muscle weakness, and persistent pain. A case is presented of a patient with a clinical picture of epicondylitis, with a previous history of a fall on the affected arm. As there was no improvement after performing conventional non-aggressive treatment, surgery was performed on the affected tendon. The outcome of this was persistent pain and clinical instability of the elbow that ended up requiring surgery to reconstruct the ligament over the external complex. In follow-up 6 months after the operation, the clinical instability had disappeared, but there was still external discomfort and a 30° extension deficit. When faced with a picture of epicondylitis with a previous injury that does not respond to conventional therapies, it is important to take into account the possibility of an underlying elbow instability, ruling this out with a correct physical examination and, where necessary, with the appropriate complementary tests (AU)

[External stability of the elbow after surgical treatment of epicondylitis. Presentation of a case]. / Inestabilidad externa de codo tras el tratamiento quirúrgico de la epicondilitis. A propósito de un caso.

Elbow instability is a difficult to diagnose condition in certain cases, and could lead to some problems that limit daily functioning, such as joint blocks, bumps, projections, muscle weakness, and persistent pain. A case is presented of a patient with a clinical picture of epicondylitis, with a previous history of a fall on the affected arm. As there was no improvement after performing conventional non-aggressive treatment, surgery was performed on the affected tendon. The outcome of this was persistent pain and clinical instability of the elbow that ended up requiring surgery to reconstruct the ligament over the external complex. In follow-up 6 months after the operation, the clinical instability had disappeared, but there was still external discomfort and a 30° extension deficit. When faced with a picture of epicondylitis with a previous injury that does not respond to conventional therapies, it is important to take into account the possibility of an underlying elbow instability, ruling this out with a correct physical examination and, where necessary, with the appropriate complementary tests.

Caracterización del cáncer de próstata incidental / Characterization of incidental prostate cancer

Introducción: El Cáncer de Próstata (CaP) es uno de los principales problemas de salud en los países desarrollados. El CaP diagnosticado después de la cirugía prostática por patología benigna, se denomina incidental y oscila entre 4 por ciento y 15 por ciento. Corresponde al estadio T1a y T1b según clasificación TNM. Objetivos: Describir las características clínicas e histológicas y el manejo del Cáncer de próstata T1a y T1b diagnosticados en nuestro servicio. Material y Método: Análisis descriptivo retrospectivo de 2835 pacientes con adenoma prostático entre el año 2002 y 2012, cuyas biopsias post-cirugía fueron positivas para cáncer (63 pacientes). El análisis estadístico se realiza con test de Fisher, T-test y X2. Resultados: La edad promedio fue 72 años. PSA promedio fue 10,6 ng/dl, siendo el 50 por ciento de tamaño grado 3-4. En promedio el volumen prostático fue 79gr con un tamaño tumoral de 5,5gr y compromiso tumoral del 40 por ciento (T1a 7 por ciento y T1b 93 por ciento). 75 por ciento presento Gleason 5-7. El número de focos (+) fue mayoritariamente 1 o 2 (89 por ciento). Presentó márgenes (+) un 23 por ciento. El tratamiento posterior fue principalmente hormonoterapia (39 por ciento). Al comparar PSA, Gleason y tacto rectal entre sí y con las otras variables no se encontraron diferencias estadísticas significativas. Conclusiones: Los tumores T1a-T1b en nuestro servicio equivalen al 2,2 por ciento, menor a otras series publicadas. El no existir asociación estadística entre las variables lo atribuimos a un bajo “n” muestral. El cáncer incidental de próstata no es frecuente y la adecuada selección de los pacientes sometidos a biopsias, disminuye su incidencia.

Introduction: Prostate cancer (PCa) is a major health problem in developed countries. The PCa diagnosed after surgery for benign prostate, called incidental and ranges between 4 percent and 15 percent. Corresponds to stage T1a and T1b as TNM classification. Objectives: To describe the clinical and histological features and management of prostate cancer diagnosed in T1a and T1b our service. Methods: retrospective analysis of 2835 patients with prostatic adenoma between 2002 and 2012, whose post-surgery biopsies were positive for cancer (63 patients). Statistical analysis was performed with Fisher test, T-test and X2.Results: Mean age was 72 years. Average PSA was 10.6 ng / dl, with 50 percent grade 3-4. On average prostate volume was 79gr with a tumor size of 5.5 g and 40 percent tumor involvement (T1a 7 percent and T1b 93 percent). 75 percent showed Gleason 5-7. The number of foci (+) was mostly 1 or 2 (89 percent). Presented margins (+) 23 percent. The subsequent treatment was primarily hormonotherapy (39 percent). Comparing PSA, Gleason and DRE among themselves and with the other variables were not statistically different. Conclusions: T1a-T1b tumors in our service equal to 2.2 percent, lower than other published series. The absence of statistical association between the variables we attribute to a low “n” sample. Incidental prostate cancer is not a common and appropriate selection of patients undergoing biopsy, reduces its incidence.

Estudio comparativo de SCORE de gleason en biopsia por punción y prostatectomía radical, análisis en Hospital Barros Luco Trudeau (HBLT) período 2002-2012 / Comparative study on gleason score by needle biopsy and radical prostatectomy at Hospital Barros Luco Trudeau (HBLT): analysis of the 2002-2012 period

INTRODUCCIÓN: El cáncer de próstata es la segunda neoplasia más frecuente en el hombre y la biopsia prostática transrectal es el procedimiento diagnóstico confirmatorio. El objetivo de este trabajo es comparar la relación del Score de Gleason (S.G.) por biopsia y el obtenido por Prostatectomía Radical, en pacientes del HBLT. MATERIALES Y MÉTODO: Estudio observacional retrospectivo de corte transversal. Se seleccionaron biopsias de Prostatectomía Radical realizadas entre abril de 2002 y abril de 2012, con diagnóstico previo de cáncer de próstata en biopsias por punción transrectal. Se consideró concordante a muestras que presentaran igual S.G. y proporción de patrón histológico. Se confeccionaron tablas de contingencia, analizándose en programa estadístico SPSS v.17.0, RESULTADOS: 248 casos en total. Concordancia de diagnóstico anatomo-patológico: 49.4 por ciento, subgraduación: 33,6 por ciento, sobregraduación: 17 popr ciento. En biopsias por punción los S.G. predominantes fueron: 6(3+3) (60 por ciento) y 7(3+4) (8.5 por ciento). En pieza quirúrgica los S.G. fueron: 6(3+3) (49.4 por ciento) y 7(3+4) (17.8 por ciento). Concordancia con pieza quirúrgica en S.G. menor a 8: 56,8 por ciento, concordancia en S.G. mayor a 8: 12,2 por ciento (p<0,05). De las muestras subgraduadas en que la pieza quirúrgica informó S.G. 9 o 10 (n=12). CONCLUSIONES: Esta serie reporta 49,4 por ciento de concordancia exacta de S.G. y patrón histológico. La frecuencia de patrones predominantes en biopsia por punción y pieza quirúrgica fueron similares. Existe diferencia estadísticamente significativa entre la concordancia post cirugía en S.G. bajo 8 y sobre 8. Los resultados son concordantes con las series publicadas.

BACKGROUND: Prostate cancer is the second most common cancer in men and transrectal prostate biopsy is the confirmatory procedure. The aim of this study is to compare the relationship of Gleason score (G.S.) and biopsy obtained by radical prostatectomy in patients at HBLT. MATERIALS AND METHODS: Observational retrospective cross-sectional study. Biopsies were selected after radical prostatectomy performed between April 2002 and April 2012, with a previous diagnosis of prostate cancer at transrectal ultrasound guided prostate biopsy. Samples were considered consistent to submit the same G.S. histologic pattern and proportion. Contingency tables were compiled, analyzed in SPSS v.17.0, RESULTS: n=248. Concordance in pathological diagnosis: 49.4 percent, low G.S. graduation: 33.6 percent, high G.S. graduation: 17 percent. In the G.S. needle biopsies were predominant: 6 (3 +3) (60 percent) and 7 (3 +4) (8.5 percent. In the surgical specimen G.S. were: 6 (3 +3) (49.4 percent) and 7 (3 +4) (17.8 percent). Surgical specimen concordante with G.S less than 8: 56.8 percent concordance; G.S. over 8: 12.2 percent (p <0.05). low G.S. graduation samples in which the surgical specimen reported G.S. 9 or 10 = 12. CONCLUSIONS: This series reports 49.4 percent G.S concordance considering histological pattern. The predominant G.S. patterns in needle biopsy and surgical specimen were similar. There is statistically significant difference between the correlation of G.S. post-surgery under 8 and 8. The results are consistent with the published series.

[Endemic corridors: a useful tool for the epidemiological surveillance of influenza]. / Corredores endémicos: una herramienta útil para la vigilancia epidemiológica de la influenza.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004, the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.

Corredores endémicos: Una herramienta útil para la vigilancia epidemiológica de la influenza / Endemic corridors: a useful tool for the epidemiological surveillance of influenza

La vigilancia epidemiológica provee información actualizada y oportuna sobre los problemas de salud y sus condicionantes, lo que permite definir acciones de prevención y control. Para la detección de epidemias es útil disponer de corredores endémicos, que indican el número de casos esperados para un cuadro infeccioso en un momento determinado. Con datos de la sección Microbiología del Hospital de Niños "Dr. Pedro de Elizalde" acerca de pacientes internados con diagnóstico de infección respiratoria aguda baja (IRAB) entre el 1/1/96 y el 31/12/2002 se confeccionaron los corredores para influenza A (IA) por semanas epidemiológicas, correspondientes a un período de siete años. En ese período se internaron 10.473 niños con diagnóstico de IRAB y se identificó IA en 411 aspirados nasofaríngeos. Se calcularon la media y el intervalo de confianza de 95% para los límites superior e inferior de incidencia en períodos semanales, y se encontró que el pico estacional ocurre entre las semanas 25 y 32. Al analizar los datos del año 2003, se observó que el pico se produjo antes, entre las semanas 19 y 25, y con valores muy por encima de los esperados para esas semanas. En 2004 aparecen 2 picos, el primero en la semana 20 y sin superar los valores de fluctuación de la parte central de la curva, y el segundo en la semana 26.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004 , the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.

Aphasia management considered in the context of the World Health Organization model of disablements.

Approaches to the management of individuals with aphasia are numerous, heterogeneous, and individualized. Treatment varies with the unique constellation of symptoms, goals, and residual abilities of each patient. This article considers aphasia management within the context of the World Health Organization model of disablements.

Ethnic conflict and the psychology of liberation in Guatemala, Peru, and Puerto Rico.

Ethnic identity and conflict in Guatemala, Peru, and Puerto Rico are complexly embedded within dynamic systems of class- and race-based geopolitics. Whereas overt violence and terror have permeated both Guatemalan and Peruvian societies, overt conflict has undermined Puerto Rican nationhood. Despite similarities among these 3 countries of Hispano-America, there are important particularities that inform psychological theory and practice. This article explores selected contributions of a psychology of liberation informed by indigenous psychologies and reflexive praxis. The challenges these conflicts and their consequences pose to psychologists seeking to work with populations most deeply affected by these social inequalities are analyzed. It concludes with suggestions of how psychology can move toward the development of community-based responses to psychosocial oppression that foster enhanced individual and collective development in a context of social change.

[Meningococcal meningitis:descriptive study of 76 cases in a pediatric hospital]. / Meningitis meningocócica: estudio descriptivo de 76 casos en un hospital pediátrico.

BACKGROUND: One of the principal causes of bacterial meningitis (BM) in children older than one month is Neisseria meningitidis (Nm). A quick diagnosis and an immediate treatment are considered essential for a good outcome. We propose this study with the purpose of evaluating the clinical and epidemiological characteristics of the patients with BM caused by Nm and analyzing the effect on the presentation and incidence of sequelae and/or complications of the time elapsed since the starting of symptoms and the beginning of the treatment. METHODS: We performed a retrospective analysis of the clinical registers of 76 patients diagnosed as BM caused by Nm entered in the Hospital de Pediatria Pedro de Elizalde, Buenos Aires, Argentina, during the years 1992 and 1993. We investigated age, sex, date of entrance, first symptoms, biochemistry of cerebrospinal fluid (CSF), nutritional status, convulsions and/or complications, length of internation and conditions at discharge. Processing was done with Epi-info 5.0. Differences between qualitative variables were analyzed with chi 2 and differences between means with z-test. RESULTS: Boys were majority; fever was the most frequent initial symptom; petechiae were less frequently found, specially among infants. 79% of the patients had CSF of purulent characteristics; 32.9% of the patients had complications during their evolution; its incidence raised up to 48% in infants. Lethality was 1.3%, 6.5% of the children had sequelae at the moment of discharge. The average time of internment was 13 days. There were no significant differences when different groups were compared according to their prior evolution time. CONCLUSIONS: 1) Petechiae and vomits were significantly less frequent in infants; 2) the incidence of complications was significantly higher in this last group; 3) no greater incidence of complications or sequelae was observed in patients whose previous period of evolution was longer than 48 hours; 4) in all groups of age we found insidious forms of starting, and 5) there were patients with CSF of normal biochemical characteristics in all groups considered independently of the time of evolution elapsed.

Use of a prospectively measured incidence rate of nosocomial diarrhea in an infant/toddler ward as a meaningful quality assessment tool.

OBJECTIVE: To determine the incidence of nosocomial diarrhea as a quality assessment tool, to compare such a rate with a standard rate based on results reported in the literature, and to estimate the hospital cost of narrowing the gap between both. METHODS: This was a prospective hospital-based surveillance study of patients in a 16-cradle ward of a 316-bed public-owned children's hospital in Buenos Aires, Argentina. One hundred six pediatric patients were enrolled during the 3-month surveillance period. Data were collected by a non-attending physician under the usual conditions of care. The clinical staff members were blinded to the objectives of the investigation. RESULTS: The detected incidence rate was 22.6 episodes of nosocomial diarrhea per 100 admissions. This was 6.4-fold higher than the standard rate. Each day of nosocomial diarrhea lengthened the duration of hospitalization and thereby increased the total hospital bill of each patient. The potential savings from narrowing the gap between both rates was as much as $302,400 per year. CONCLUSIONS: Nosocomial diarrhea stands out as a relevant target both for quality improvement opportunity assessment and for cost-containment-oriented efforts.