Genetic diversity and population structure of Culex modestus across Europe: does recent appearance in the United Kingdom reveal a tendency for geographical spread?

In mainland Europe, the mosquito species Culex modestus Ficalbi (1890) is a bridge vector for West Nile virus (WNV) from its natural bird-mosquito cycle to mammals. The present study assessed the genetic diversity of Cx. modestus, as well as related Culex species, using the mitochondrial COI DNA barcoding region and compared this with the population structure across Europe. A haplotype network was mapped to determine genealogical relationships among specimens. The intraspecific genetic diversity within individual Culex species was below 2%, whereas the interspecific genetic divergence varied from 2.99% to 13.74%. In total, 76 haplotypes were identified among 198 sequences. A median-joining network determined from 198 COI sequences identified two major lineages that were separated by at least four mutation steps. A high level of intraspecific genetic diversity was not detected in Cx. modestus in samples submitted from different European populations, which indicates that morphologically identified specimens represent a single species and not a species complex. Therefore, it is deduced that different populations of Cx. modestus will show a similar potential to transmit WNV, lending support to concerns that the population present in southeast England represents a risk of transmission to humans.

How to optimize the percutaneous treatment of bifurcated lesions: dedicated stents vs. provisional stenting.

Although provisional T-stenting with stenting of the main branch and optional side branch stenting is nowadays the default strategy generally preferred for simple bifurcation lesions, percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains a difficult task to achieve also with modern second generation drug eluting stents. Treatment of complex bifurcational lesions is not only more time consuming but can lead to significantly higher rate of periprocedural myocardial infarction and late estenosis, stent thrombosis and target lesion revascularization. These clinical complications may be at least in part be due to the fact that current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and the bifurcation branches and often leave a significant number of malapposed struts. Struts left unapposed in the lumen are not efficient for drug delivery to the vessel wall, disturb blood flow and may increase the risk of restenosis and stent thrombosis. This article summarises the various techniques of bifurcation stenting, highlighting their relative merits and disadvantages. In addition, the role of newer dedicated bifurcation stent devices, as well as the role of imaging in guiding optimal stent deployment will be discussed.

Progressive multifocal leukoencephalopathy--incidental finding in the forensic neuropathological examination.

Progressive Multifocal Leukoencephalopathy (PML) is a fatal demyelinating disease of the central nervous system (CNS) caused by the human virus JC (JCV), a small DNA virus which belongs to the subfamily of polyomaviruses. JVC infection is widely extended in the human population in asymptomatic patients; however, in severely immunocompromised patients the virus is able to replicate itself and reach the brain causing PML. It is an extremely rare disease in patients with a competent immune system and few cases have been described in medical literature. We report the case of an elderly immunocompetent man, with no pathological antecedents, who died of sepsis 50 days after suffering extensive and severe flame burns. In the forensic autopsy, a PML was discovered as an incidental finding in the neuropathological examination that was not detected during his time in hospital. Diagnosis was confirmed by the detection of JCV in the brain by in situ hybridization. Possible pathophysiological mechanisms for the reactivation of the JCV and the rapid evolution to the fatal brain demyelinating lesions are discussed. One of the main clinical implications of this case is that immunocompetence should not be considered as an exclusion criterion for the diagnosis of PML.

Infarto cerebral hemorrágico por embolización de un trombo mural cardíaco / Hemorrhagic cerebral infarction due to embolization of a mural thrombus within the right ventricle

Las enfermedades cerebrovasculares son consecuenciade una alteración en la circulación cerebral. Suforma más distintiva de presentación es el ictus, entendidocomo un déficit neurológico focal de instauraciónbrusca y evolución rápida.Un infarto cerebral de origen oclusivo puede debersebien a una trombosis in situ o bien a una embolia procedentede un foco distante. En las embolias cerebrales lacausa principal son los trombos murales cardiacos y elárea encefálica afectada con mayor frecuencia es el territorioirrigado por la arteria cerebral media.Presentamos el caso de una mujer de 81 años, conantecedentes de Hepatitis C, cardiopatía hipertensiva yfibrilación auricular crónica, que sufrió una fractura decadera consecutiva a una caída accidental. Durante elingreso hospitalario comenzó un cuadro de deterioroneurológico progresivo que no llegó a ser filiado, falleciendo9 días después. En la autopsia médico-forense seencontró un infarto cerebral hemorrágico en el territoriode la arteria cerebral media izquierda. Dado que las arteriasdel Polígono de Willis eran permeables y ante la presenciade trombos vitales adheridos a la pared del ventrículoderecho, se estimó como causa más probable delaccidente vasculocerebral la embolización de uno dedichos trombos

Cerebrovascular diseases are due to a disturbance incerebral blood flow. The most frequent way ofpresentation is stroke, defined as a sudden and focalneurological impairment with rapid evolution.Cerebral infarction of occlusive origin can besecondary to in situ thrombosis or to embolism from adistal focus. Mural thrombi are the main cause of brainembolism and the middle cerebral artery territory is themost likely affected brain area.We report the case of an 81 year-old woman, withantecedents of Hepatitis C, hypertensive cardiopathy andchronic atrial fibrillation, who suffered a hip fracture due toan accidental fall. A progressive neurological impairment ofunknown aetiology appeared during her hospitalization,and she died 9 days after her admission. Forensic autopsyfound a hemorrhagic cerebral infarction in the territory ofthe left middle cerebral artery. As the arteries of thepolygon of Willis were patent and there were vital thrombiadhered to the free wall of the right ventricle,thromboembolism was considered the most probablecause of the cerebrovascular event

Estudio médico-legal del homicidio en la provincia de Sevilla (2004-2007). Especial referencia a los homicidios de mujeres en el contexto de violencia de género / Medico-legal study of the homicide in the province of Seville (2004-07). Special reference to the female victims inside the gender violence

Este estudio retrospectivo analiza los 57 homicidiosocurridos en la provincia de Sevilla durante unperiodo de cuatro años (2004-2007).Se han estudiado diversas variables relacionadascon los mismos obteniéndose los siguientes resultados: latasa media de homicidios ha sido de 0.77 por 100.000habitantes; el arma blanca es el método más utilizadoseguido por el arma de fuego, contusiones y asfixia mecánica;las víctimas son en su mayoría varones (relaciónhombre/mujer 2:1) con una edad media de 46 ± 21.2años; el mayor número de casos se registra en fines desemana (sábado y domingo) y durante el mes de octubre.El análisis toxicológico de las víctimas detectó etanol enel 47.4%, benzodiacepinas en el 14%, cocaína en el 12.3%,opiáceos en el 10.5% y tetrahidrocannabinol en el 8.8%.Se ha hecho una valoración más detallada de loscasos de homicidio dentro del contexto de violencia degénero dada su alta incidencia en nuestro país. En 18 de19 casos, las mujeres murieron a manos de su pareja,ex-pareja o familiar en primer grado.Los resultados han sido comparados con estudiossimilares realizados tanto en el ámbito nacional comointernacional

This retrospective study analyzes the 57 homicidesoccurred in the province of Seville in a period of fouryears (2004-2007).Some variables related with the homicides havebeen studied with the following results: the meanhomicide rate was 0.77 per 100.000 inhabitants; sharpinjury was the most frequent mechanism followed by shotgun, contusions and mechanical asphyxia; victims are inmajor part of cases males (male/female ratio 2:1) with amean age of 46 ± 21.2 years; homicides are morefrequents in weekend (Saturday and Sunday) and duringOctober. Toxicological analysis of the victims showedethanol in 47.4%, benzodiazepines in 14%, cocaine in12.3%, opium derivatives in 10.5% andtetrahydrocannabinol in 8.8%.A detailed analyses was also carried out in the casesof homicides occurred in the setting of gender violencedue to its high prevalence in our country. In 18 out of 19cases, women died in the hands of her couple, ex-couple,or first-degree relative.Results have been compared with similar nationaland international studies

Muerte súbita por disección de aorta torácica secundaria a coartación de aorta / Sudden death due to thoracic aorta dissection associated with aortic coarctation

La disección aórtica es un cuadro catastróficocaracterizado porque la sangre penetra y separa los planoslaminares de la media, formando un nuevo conductolleno de sangre dentro de la pared de la aorta (hematomadisecante intramural), que suele romperse y produciruna hemorragia masiva. Presentamos el caso de un jovende 22 años, con antecedentes de hipertensión arterial sintratamiento, que fallece súbitamente como consecuenciade una rotura-disección de aorta torácica asociado acoartación aórtica y a válvula bicúspide diagnosticadosdurante la autopsia

Aortic dissection is a catastrophic illness characterizedby blood going right through and separating the medialayers, that causes a new canal full of blood within the aortic wall (dissecting intramural haematoma) which uses to tear and cause massive haemorrhage. We present the case of a 22-year-old man, with antecedents of hypertensión without treatment, who dies suddenly as a consequence of a rupture-dissection of the thoracic aorta asociated with aortic coarctation and bicuspid valve, both diagnosed at the autopsy

Lipomatosis cardiaca y muerte súbita. Diagnóstico diferencial con la miocardiopatía arritmogénica del ventrículo derecho y la metaplasia grasa del infarto de miocardio antiguo / Cardiac lipomatosis and sudden death. Differential diagnosis with arrhythmogenic right ventricular cardiomyopathy and lipomatous metaplasia in old myocardial infarction

La presencia de tejido adiposo en el miocardio es un hallazgo de autopsia relativamente frecuente, no siendo un criterio diagnóstico suficiente, por sí mismo, para identificar una miocardiopatía concreta. Presentamos el caso de un anciano, sin antecedentes patológicos conocidos, que falleció súbitamente y la autopsia puso de manifiesto, como único hallazgo relevante, una cardiomegalia leve-moderada e infiltración grasa en el miocardio de ambos ventrículos. Las arterias coronarias presentaban ateromatosis leve con estenosis luminal no superior al 25%. El estudio microscópico confirmó el diagnóstico de infiltración grasa en el miocardio (lipomatosis cardiaca). Se realiza el diagnóstico diferencial entre tres entidades nosológicas con similitudes en su presentación macroscópica pero con claras diferencias clínicas y, principalmente, histopatológicas: Lipomatosis Cardiaca, Miocardiopatía Arritmogénica del Ventrículo Derecho/displasia (MAVD/D) y Metaplasia Grasa en el infarto de miocardio antiguo (AU)

The presence of adipose tissue within the myocardium is a relatively common autopsy finding, without being, by itself, enough diagnostic criterion of a particular myocardial disease We present the case of an elderly man, with unknown pathological antecedents, who died suddenly and the autopsy showed, as unique relevant finding, a light moderate cardiomegaly and fatty infiltration in right and left ventricular myocardium. The coronary arteries had slight atheromatosis with luminal stenosis not superior to 25%. The microscopical study confirmed the diagnosis of myocardial fatty infiltration (cardiac lipomatosis). We analyse the differential diagnosis between three diseases with similar macroscopic features but with both evident clinic and, mainly, histopathological differences: Fatty infiltration of myocardium, arrhythmiogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and lipomatous metaplasia in old myocardial Infarction (AU)

Suicidio por ingesta masiva de ácido clorhídrico / Suicide by hydrochloric acid massive ingestion

Se presenta el caso de un suicidio por ingesta masiva de ácido clorhídrico (Salfuman). La intensa causticación del estómago permitió el vertido del líquido a las cavidades torácica y abdominal, lo que originó mediastinitis y peritonitis químicas con extensa necrosis de coagulación que afectó prácticamente a la totalidad de las vísceras en ambas cavidades (AU)

We present a case of suicide by hydrochloric acid (Salfuman) massive ingestión. The intense caustic injury to the stomach allowed the pouring of the liquid into both thoracic and abdominal cavities, which caused chemical mediastinitis and peritonitis with extensive coagulating necrosis that practically affected all visceras (AU)

Miocarditis aguda y muerte súbita en jóvenes. Presentación de un caso / Acute myocarditis and sudden death in the young. Case report

La miocarditis puede ser definida simplemente como una inflamación del miocardio. Actualmente se considera una miocardiopatía adquirida producida por una amplia variedad de agentes infecciosos, habitualmente virus, así como toxinas y drogas. La presentación clínica de la enfermedad varía desde síntomas sistémicos inespecíficos hasta muerte súbita. Diversas series autópsicas han diagnosticado una miocarditis aguda como causa de muerte súbita en niños y adultos jóvenes entre el 4-12%. Por otra parte, la miocarditis se ha identificado como causa de miocardiopatía dilatada hasta en el 9% de los casos. La miocarditis en una de los diagnósticos que más a menudo pasa desapercibido macroscópicamente ya que en la mayor parte de los casos el corazón es absolutamente normal por lo que el diagnóstico requiere siempre el examen microscópico siguiendo los criterios de Dallas. Es aconsejable la caracterización del virus mediante Reacción en Cadena de la Polimerasa. Presentamos el caso de una joven que presentó una muerte súbita debida a una miocarditis aguda linfocitaria

Myocarditis could be defined simply as an inflammation of the myocardium. Nowadays it is considered an acquired cardiomyopathy produced by a wide variety of infectious agents, mainly viruses, as well as toxins and drugs. The clinical presentation of the disease varies from unspecific systemic symptoms to sudden death. Some post-mortem series have diagnosed an acute myocarditis as the cause of sudden death in children and young adults between 4-12% of cases. On the other hand, myocarditis has been identified as the cause of dilated cardiomyopathy in 9% of cases. Myocarditis is a diagnostic challenge in the autopsy room because in the great majority of cases the heart is completely normal on gross examination. For that reason, microscopical diagnosis according to the Dallas criteria is always mandatory. The characterization of the virus trough Polimerase Chain Reaction is recommended. We present the case of a young girl dying suddenly due to acute lymphocytic myocarditis

Suicidio por arma de fuego con un proyectil del calibre 6.35 mm / Suicide by shotgun with a bullet calibre 6.35 mm

Se expone el caso de un suicidio por disparo de arma de fuego en la cabeza con entrada y salida. El disparo se realizó a contacto con una pistola del calibre 6.35 mm y debido al pequeño calibre del proyectil se pudo observar con nitidez la cavidad lineal dejada en el encéfalo

In this paper we present a case of suicide by shotgun in the head with entrance and exit. The shot was made at contact range with a pistol calibre 6.35 mm and due to the small calibre of the bullet the lineal cavity left in the brain could be observed with clarity

Miocardiopatía hipertrófica como causa de muerte súbita en una mujer joven / Hypertrophic cardiomyopathy presenting as sudden death in a young woman

La miocardiopatía hipertrófica (MCH) es una enfermedad genética muy heterogénea, con múltiples loci, identificándose para cada gen múltiples mutaciones. Está considerada en Estados Unidos la causa más frecuente de muerte súbita (MS) en jóvenes, fundamentalmente atletas, siendo en ocasiones la primera manifestación de la enfermedad. La MCH se caracteriza morfológicamente por una hipertrofia asimétrica del ventrículo izquierdo y/o derecho con un patrón histopatológico caracterizado por desestructuración (“disarray”) de los miocardiocitos en una matriz de tejido conectivo prominente así como hipertrofia de la íntima de las arterias coronarias intramurales. Se expone el caso de una mujer joven, de 25 años, diagnosticada clínicamente y con antecedentes familiares de MS por MCH en su madre, que presentó una MS mientras dormía

Hypertrophic cardiomyopathy (HCM) is a genetic and very heterogeneous disease with multiple loci, and with several mutations identified for every gene. In USA, it is regarded as the most common cause of sudden death (SD) in young people (mainly athletes), and occasionally SD is the initial presentation of the disease. HCM is morphologically characterized by an asymmetric hypertrophy of left and/or right ventricle with a histopathological pattern of cardiac myocytes dearrangement in a prominent connective tissue matrix, as well as intimal hypertrophy of intramural coronary arteries. In this paper, we present the case of a 25 year-old woman, clinically diagnosed with HCM, and with family history of HCM in her mother, who experienced a SD while sleeping

[Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients]. / Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios.

INTRODUCTION: The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). METHODS: We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. RESULTS: The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). CONCLUSIONS: MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity.

Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios / Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients

Introducción. El síndrome metabólico (SM) es una asociación de factores de riesgo cardiovascular con un nexo fisiopatológico común: la resistencia insulínica. Analizamos su prevalencia y su impacto para la presencia de cardiopatía isquémica (CI). Métodos. Se registraron los datos de 1.000 pacientes consecutivos que acudieron por primera vez a la consulta externa de un Servicio de Cardiología de un hospital terciario. El diagnóstico del SM se realizó según los criterios del Adult Treatment Pannel (ATP-III). Resultados. La prevalencia global de SM fue del 27,3% (IC al 95%: 25,6-29,0) y aumentó de forma paralela a la edad. La mayor prevalencia se encontró entre los pacientes con diabetes mellitus o intolerancia hidrocarbonada (70,1%) seguidos de los que tienen obesidad (58,6%) o hipertensión (48,3%). El SM confirió mayor riesgo de CI (odds ratio [OR]: 5,5) que la diabetes (OR: 3,8). La mitad de los pacientes con CI presentaron síndrome metabólico y el 90% de los diabéticos con CI. El SM confiere el mayor riesgo de tener CI en los pacientes con obesidad (OR: 8,6), hipertrigliceridemia (OR: 6,5), antecedentes familiares de CI (OR: 5,6), sobrepeso (OR: 5,5) o hipertensión arterial (OR: 4,6). Conclusiones. El SM es altamente prevalente en los pacientes atendidos en una consulta de Cardiología y es un importante factor de riesgo para la CI, especialmente en los pacientes que tienen obesidad

Introduction. The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). Methods. We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. Results. The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). Conclusions. MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity

Nuevas estrategias en prevención cardiovascular / New strategies in cardiovascular prevention

Las enfermedades cardiovasculares son la principal causa de mortalidaden España y en los países occidentales, especialmente la cardiopatíaisquémica. La prevención de las complicaciones se basa enla estratificación del riesgo cardiovascular, que se basa en la presenciade los factores de riesgo clásicos. Existen diferentes escalas quepermiten estratificar el riesgo cardiovascular de un sujeto como bajo,intermedio o alto. Pese a que el impacto y tratamiento de los factoresde riesgo es bien conocido, el control de los mismos es bastantepobre. Además, la obesidad, la diabetes y la hipertensión parecenestar aumentando debido a los cambios en los estilos de vida yalimentación que están experimentando nuestras comunidades.En las últimas décadas se han identificado nuevos factores de riesgocardiovascular, o emergentes, que pueden mejorar la estratificacióndel riesgo cardiovascular y son principalmente la proteína C-reactiva,la homocisteína y la lipoproteína a. El síndrome metabólico es unaasociación de factores de riesgo cardiovascular que tienden a aparecerde forma conjunta por tener un nexo fisiopatológico común: laresistencia insulínica. Su presencia se asocia con la mayoría de losfactores de riesgo cardiovascular, tanto clásicos o emergentes, especialmentela obesidad, hipertensión arterial y la proteína C-reactiva.Por otra parte, la detección de formas subclínicas o incipientes deaterosclerosis, especialmente mediante la medición del grosor de laíntima-media carotídea, aporta información indirecta pero estrechamenterelacionada con la aterosclerosis coronaria que mejora laestratificación en sujetos de riesgo intermedio

Cardiovascular diseases, especially coronary heart disease, are theleading cause of mortality in Spain and western countries. The preventionof complications is based on a cardiovascular risk stratificationthat is based on the presence of classical cardiovascular riskfactors. There are many scales for cardiovascular risk stratificationthat classify subjects into low, intermediate or high risk. Despite thefact that the impact and treatment of risk factors are well known, theircontrol remains poor. Obesity, diabetes, and hypertension seems alsoseem to be increasing trends due to the changes in lifestyles andnutritional habits of our communities.In recent decades some new, or emerging, cardiovascular risk factorshave been identified that can improve the stratification of cardiovascularrisk: C-reactive protein, homocysteine, and lipoprotein a. Themetabolic syndrome is an association of cardiovascular risk factorsthat cluster in the same subject because they share a physiopathologiclink: insulin resistance. Its presence is related to most cardiovascularrisk factors, classical or emerging, especially obesity, hypertension,and C-reactive protein. On the other hand, detection of subclinicalor incipient atherosclerosis, especially with the measurementof intima-media thickness, offers indirect information closely relatedto coronary atherosclerosis that improves the stratification of subjectsat intermediate risk

Patología cerebro-vascular hemorrágica en adultos asociada al consumo de cocaína / Cerebral haemorrhage in adults associated with the use of cocaine

La cocaína es la segunda droga de comercio ilegal más consumida en España después del cannabis. El número de pacientes atendidos en los servicios de urgencias tras consumir cocaína y los casos de muerte secundarios al consumo de la misma han ido aumentando hasta multiplicarse por seis en los últimos años. El consumo de este alcaloide ocasiona efectos nocivos, constatados sobre diferentes órganos y sistemas corporales, e incluso la muerte. A nivel del SNC destaca, por su gravedad e incidencia, la patología cerebro-vascular hemorrágica (PCVH). Este tipo de cuadro se halla asociado al consumo de drogas ilícitas entre el 9,5% y el 34% de los accidentes vasculares en menores de 45 años, siendo la cocaína la más frecuentemente implicada en su presentación. Por otro lado, la rotura de un aneurisma o malformación arteriovenosa se ha detectado hasta en el 50% de los pacientes con PCVH secundarios al consumo de cocaína. Presentamos tres casos de muerte súbita en adultos por patología cerebro-vascular hemorrágica asociada al consumo de cocaína

Cocaine is the second most frequent illegal drug consumed in Spain after cannabis. A significant increase has occurred in the number of individuals treated in emergency departments after cocaine use just as in the number of cocaine-related deaths. These rates have been actually multiplied by six in the latest years. Cocaine causes injury in different organ systems, even death. In the CNS the use of cocaine is frequently associated with cerebral haemorrhage. Stroke in young adults below 45 years is usually related to drug use between 9,5% and 34% of cases, and cocaine is the most frequently mentioned drug. Otherwise, even 50% of cocainerelated stroke is the result of rupture of saccular aneurysms involving the arteries at the base of the brain and vascular malformation. In this paper, we present three cases of sudden death in adults due to cerebral haemorrhage associated with cocaine use

Embolia grasa como complicación de politraumatismo por precipitación autolítica / Fat embolism as complication of polytraumatism by suicide jumping

El síndrome de embolia grasa (SEG) es un cuadro clínico debido a la oclusión de los vasos sanguíneos por glóbulos de grasa. Se asocia fundamentalmente a fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. Aunque las primeras descripciones se realizaron a finales del siglo XIX en la actualidad sigue siendo un desafío para el clínico por lo que, en ocasiones, el diagnóstico inicial se realiza en la autopsia. Presentamos un caso de SEG en una mujer de 19 años que fallece en el hospital doce días después de precipitarse desde un puente con finalidad suicida sufriendo politraumatismo con fractura de huesos largos. El SEG fue sospechado clínicamente y se diagnosticó en la autopsia macroscópica siendo posteriormente confirmado por los estudios histopatológicos. Así mismo se revisan las características clinico-patológicas del SEG

Fat embolism syndrome (FES) is a clinical entity which consists in the occlusion of blood vessels by fat droplets. It is commonly associated to long bone fractures and it's an important source of morbidity and mortality in polytraumatized patients. Although the first descriptions were made in the nineteenth century, nowadays it continues to be an important clinical challenge determining that, sometimes, the first diagnostic is made at autopsy. In this paper, we present a case of FES in a woman 19 years old who died in hospital twelve days after jumping from a bridge suffering polytraumatism with long bone fracture. FES was suspected clinically and diagnosed in the gross autopsy being confirmed microscopically. The clinic-pathological characteristics of this syndrome are also reviewed

Estudio epidemiológico del suicidio en Sevilla en 2004 / Epidemiological study of suicide in Seville in 2004

En este artículo se realiza un estudio epidemiológico descriptivo de las muertes de etiología suicida ocurridas en Sevilla en el año 2004 y los datos obtenidos se comparan con otros estudios previos realizados en la misma zona. La tasa de suicidio fue de 8,36 por 100.000 habitantes con una relación hombre/mujer de 2,6:1. La edad media global ha sido de 54,3 años (52,7 años en varones y 58,7 años en mujeres). El mayor número de suicidios (58,5%) se producen en el segundo y tercer trimestre del año (primavera y verano). En cuanto al estado civil, la mayor frecuencia se produce en personas casadas (31,2%). Solo en el 9,5% de los suicidas existían antecedentes de intentos autolíticos previos. La ahorcadura ha sido el mecanismo más empleado en los varones (50,9%) mientras que en las mujeres el mecanismo más frecuente ha sido la precipitación (41,5%). Un 57,1% de los sujetos tenía antecedentes psiquiátricos siendo los trastornos más frecuentes la depresión o los síntomas depresivos (65,5%) y la esquizofrenia (15,5%). Se efectuaron análisis químico-toxicológicos en el 78,2% de los casos de los cuales fueron positivos el 69,6%. El alcohol etílico fue la sustancia más detectada (24,3%), seguido de las benzodiazepinas (18,3%) y los antidepresivos (11,3%). Se observa una cierta estabilización en la tasa de suicidios en Sevilla desde mediados del siglo XX hasta la actualidad

In this paper, we present an epidemiological descriptive study of the suicides occurred in Seville in 2004 and the results are compared with data obtained in previous studies in the same area. Suicide rate was 8,36 per 100.000 inhabitants with a male/female ratio of 2,6:1. The medium age has been 54,3 years (52,7 years in males and 58,7 years in females). Suicides predominate in the second and third trimester of the year (spring and summer). Taking into account the civil status, the mayor frequency appears in married (31,2%). Only 9,5% of the cases had antecedents of previous autolysis intents. Hanging was the most frequent mechanism to commit suicide in men (50.9%) while in women was jumping (41,5%). In 57,1% of cases there were antecedents of mental disorder mainly depression of depressive symptoms (65,5%) followed by schizophrenia (15,5%). Toxicological analyses were performed in 78,2% of cases with positive results in 69,6%. Ethanol was the toxic most detected (24,3%) followed by benzodiazepines (18,3%) and antidepressants (11,3%). According to the results of the study, we observe a certain stabilization of the suicide rates in Seville from the middle of the XXth century up to now

[New strategies in cardiovascular prevention]. / Nuevas estrategias en prevención cardiovascular.

Cardiovascular diseases, especially coronary heart disease, are the leading cause of mortality in Spain and western countries. The prevention of complications is based on a cardiovascular risk stratification that is based on the presence of classical cardiovascular risk factors. There are many scales for cardiovascular risk stratification that classify subjects into low, intermediate or high risk. Despite the fact that the impact and treatment of risk factors are well known, their control remains poor. Obesity, diabetes, and hypertension seems also seem to be increasing trends due to the changes in lifestyles and nutritional habits of our communities. In recent decades some new, or emerging, cardiovascular risk factors have been identified that can improve the stratification of cardiovascular risk: C-reactive protein, homocysteine, and lipoprotein a. The metabolic syndrome is an association of cardiovascular risk factors that cluster in the same subject because they share a physiopathologic link: insulin resistance. Its presence is related to most cardiovascular risk factors, classical or emerging, especially obesity, hypertension, and C-reactive protein. On the other hand, detection of subclinical or incipient atherosclerosis, especially with the measurement of intima-media thickness, offers indirect information closely related to coronary atherosclerosis that improves the stratification of subjects at intermediate risk.