Type A acute aortic dissection presenting as a stroke in a young male patient.

A male patient in his 40s with a history of nephrolithiasis and found in the desert after 10 days without oral intake was admitted to the hospital for severe dehydration, acute kidney injury and rhabdomyolysis. He had acute-onset loss of consciousness during hospitalisation with new left-sided hemiparesis and hemineglect. After haemorrhage was excluded, prompt thrombolysis was given. He later had chest pain and became hypotensive. An echocardiogram revealed pericardial effusion and dilation of the ascending aorta with suspected dissection. Magnetic resonance angiography of the brain and neck reported bilateral parieto-occipital areas of stroke in a watershed distribution and dissection of the right internal carotid artery. CT angiography showed type A aortic dissection from the ascending aorta extending into the bilateral common iliac arteries. Thrombolysis was reversed and the patient underwent ascending aorta replacement, resuspension of the aortic valve and aortic arch debranching at outside facility with complete recovery.

A Survey of Basic Daily Living Assistance in Dependency Units during the Morning First Period at Nursing Homes with a Healthcare Dysfunction.

(1) Background: It is important to evaluate the attention in the basic activities of daily life in the early hours of the day to evaluate the quality of care and to be able to increase the attention of human resources in case of observing an increase in dependency. The purpose was to improve healthcare quality in nursing homes, correctly identifying the work burden and incidents of daily planning, and completing the work plan by nursing assistant staffing. (2) Methods: The sample is based on 70 elderly people. The analysis used an observational trial every workday over a six-month period. An ad hoc sheet was prepared to collect socio-demographic data on each participant, and the Barthel Index was applied to the study subjects. A daily record of three basic activities of daily living (BADL), such as dressing, bathing, and eating, was kept. (3) Results: Our results showed a significant evolution in both units, but it was in the psychogeriatric unit in which higher compliance with the schedule and higher maintained stability was reached. (4) Conclusions: The use of some BADL registers helped us address situations of imbalance in terms of user assistance and establish an interdisciplinary communication with the nursing team as a way of achieving better organization and compliance with care protocols.

[The value of an occlusal adjustment: why?, how?, and when? case report]. / El valor de un ajuste oclusal: ¿por qué?, ¿cómo? y ¿cuándo? reporte de caso.

The aim of optimal dentistry is to stabilise the stomatognathic system (teeth, periodontium, muscles and temporomandibular joint). All of these must work in harmony, as together they provide optimal care from diagnosis through planning to treatment. However, many clinicians currently give little importance to the identification of premature contacts and/or interferences prior to any dental treatment, which should be taken into account to provide improved stability in mandibular closure, correct anterior and canine guidance in mandibular movements.This clinical case describes the treatment of a patient with a diagnosis of functional occlusal disorder due to premature contact, whose treatment consisted of an occlusal adjustment by selective wear, following the technique described by the author Klineberg, with the aim of preserving the dental structure as much as possible while maintaining control during the occlusal adjustment and returning the greatest number of symmetrical and pointed contacts.

Sporadic, classic-type renal angiomyolipoma with renal vein and inferior vena cava extension: an incidental case.

Renal angiomyolipomas (AMLs) were first described in the early 1900s by Gravitz, but it was not until 1951 that they were named renal AML. These kidney tumours are rare, occurring in 0.13%-0.44% of the population. These mesenchymal tumours are composed of smooth muscle-like, adipocyte-like and epithelioid cells. Depending on the predominant cell population, it can be further subclassified into classic, epithelioid and AML with epithelial cyst. A 32-year-old woman presented with mild, intermittent, epigastric and right upper quadrant abdominal pain. Abdominal ultrasound revealed an incidental lesion within the inferior vena cava (IVC). A CT scan showed a lesion within the left renal vein extending into the IVC with 40% narrowing and a fat-containing mass in the lower pole of the left kidney of 15 mm suggesting an AML. Thrombectomy was performed. The specimen resulted positive for classic variant renal AML. Initial diagnosis is centred on imagining studies, based in fatty tissue concentration. The AML expresses melanocytic markers. This helps differentiate from renal cell carcinoma. Although AML is considered a benign condition, there is evidence of malignant transformation. Active surveillance is recommended for lesions <4 cm. Nephron sparing surgery is the procedure of choice. Nephrectomy is recommended if there is a high probability of malignancy. Mammalian target of rapamycin (mTOR) inhibitors have been proposed to be an alternative treatment.

Variation in predicted COVID-19 risk among lemurs and lorises

The novel coronavirus SARS-CoV-2, which in humans leads to the disease COVID-19, has caused global disruption and more than 1.5 million fatalities since it first emerged in late 2019. As we write, infection rates are currently at their highest point globally and are rising extremely rapidly in some areas due to more infectious variants. The primary viral target is the cellular receptor angiotensin-converting enzyme-2 (ACE2). Recent sequence analyses of the ACE2 gene predicts that many nonhuman primates are also likely to be highly susceptible to infection. However, the anticipated risk is not equal across the Order. Furthermore, some taxonomic groups show high ACE2 amino acid conservation, while others exhibit high variability at this locus. As an example of the latter, analyses of strepsirrhine primate ACE2 sequences to date indicate large variation among lemurs and lorises compared to other primate clades despite low sampling effort. Here, we report ACE2 gene and protein sequences for 71 individual strepsirrhines, spanning 51 species and 19 genera. Our study reinforces previous results and finds additional variability in other strepsirrhine species, and suggests several clades of lemurs have high potential susceptibility to SARS-CoV-2 infection. Troublingly, some species, including the rare and Endangered aye-aye (Daubentonia madagascariensis), as well as those in the genera Avahi and Propithecus, may be at high risk. Given that lemurs are endemic to Madagascar and among the primates at highest risk of extinction globally, further understanding of the potential threat of COVID-19 to their health should be a conservation priority. All feasible actions should be taken to limit their exposure to SARS-CoV-2.

Etiology and treatment of amyotrophic lateral sclerosis.

BACKGROUND: To date all researchers conclude that the etiology of Amyotrophic lateral sclerosis (ALS) is not known. On the contrary, since August 2009, we believe that disease is of ischemic origin in the anterior surface of the medulla oblongata. MATERIAL AND METHOD: We present our surgical experience into 45 patients with ALS (bulbar form in 36 cases and spinal form in 9). Preoperative MRI scans revealed microinfarcts in the medulla oblongata and/or cervical cord. During surgery we found: 1) poor quality of omentum in most cases; 2) degenerative changes in the cervical spine; 3) anatomical anomalies at the V4 segments of the vertebral arteries; 4) moderate to severe atherosclerosis at both V4 segments; 5) unilateral absence or stenosis in the anterior-ventral spinal arteries (AVSAs). All patients received omentum on the anterior, lateral and posterior surface of the medulla oblongata, and in 9 cases, an additional segment at the C5-C6 level. RESULTS: Neurological improvement was better during the first days or weeks after surgery than in the following months or years, in all patients. However, 13 patients suffered neurological impairment in about 4 months later, due to greater deterioration of the cervical spine, by contrast, 7 patients with mild ALS have experienced neurological improvement by 80 to 100% during a follow-up of 4 and 6 years. CONCLUSIONS: These results confirm that ALS is of ischemic origin in the intraparenchymal territory of the AVSAs and/or in anterior spinal artery caused by atherosclerosis and associated to anatomical variants in the V4 segments of the vertebral arteries. Because in contrast to this, its revascularization by means of omentum can cure (mild degree) or improve this disease.

How efficient are New Zealand's District Health Boards at producing life expectancy gains for Maori and Europeans?

OBJECTIVE: Use data envelopment analysis (DEA) to measure the efficiency of New Zealand's District Health Boards (DHBs) at achieving gains in Maori and European life expectancy (LE). METHODS: Using life tables for 2006 and 2013, a two-output DEA model established the production possibility frontier for Maori and European LE gain. Confidence limits were generated from a 10,000 replicate Monte Carlo simulation. RESULTS: Results support the use of LE change as an indicator of DHB efficiency. DHB mean income and education were related to initial LE but not to its rate of change. LE gains were unrelated to either the initial level of life expectancy or to the proportion of Maori in the population. DHB efficiency ranged from 79% to 100%. Efficiency was significantly correlated with DHB financial performance. CONCLUSION: Changes in LE did not depend on the social characteristics of the DHB. The statistically significant association between efficiency and financial performance supports its use as an indicator of managerial effectiveness. Implications for public health: Efficient health systems achieve better population health outcomes. DEA can be used to measure the relative efficiency of sub-national health authorities at achieving health gain and equity outcomes.

Transplante de epiplón para la enfermedad de Parkinson: Reporte de 3 casos / Omentum tranplant for Parkinson´s disease: Report of 3 cases

Introducción: Desde 1990, hemos postulado que la causa primaria de la enfermedad de Parkinson (EP) es de origen isquémico iniciado en el tegmento mesencefálico. Sin embargo, hasta la fecha, casi todos los investigadores consideran que la etiología es desconocida. Objetivo: Demostrar que la EP puede ser mejorada por medio de un transplante de epiplón. Material y Método: Presentamos 3 pacientes con EP avanzado. A través de una craneotomía temporal localizamos la bifurcación carotídea y el espacio perforado anterior (EPA). Aquí encontramos:1) aterosclerosis en las carótidas supraclinoideas, 2) ausencia de la arteria coroidea anterior o de la comunicante posterior, 3) varias arterias perforantes anteriores y posteriores exsangües y 4) aterosclerosis en la bifurcación basilar. El epiplón fue colocado sobre el EPA y fosa interpeduncular. Resultados: La mejoría neurológica fue observada después del tercer día y evidente en las primeras semanas del postoperatorio. Actualmente, 10 y 23 meses después de la cirugía, dos pacientes requieren medicación antiparkinsoniana a dosis reducidas y además, reciben aspirina y clonazepan. Todos los pacientes realizan actividades cotidianas sin asistencia familiar. Conclusiones: Nuestros resultados indican que la EP es causada por isquemia progresiva en el territorio de las arterias perforantes posteriores; porque, en contraste a esto, su revascularización por medio del omento produjo mejoría neurológica. Así mismo, creemos que el uso regular de aspirina y clonazepan puede ayudar a esta enfermedad.

Introduction: Since 1990, we have postulated that the primary cause of Parkinson´s disease (PD) is of ischemic origin initiated in the mesencephalic tegmentum. However, up to date, almost all researchers consider that the etiology is unknown. Objetive.To demonstrates that PD can be improved by means of omental transplantation. Material and Method: We present 3 patients with advanced PD. Through a temporal craniotomy we located the carotid bifurcation and anterior perforated space (APS). Here we found: 1) atherosclerosis at the supraclinoid carotids; 2) absence of anterior choroidal or posterior communicating arteries; 3) several exsanguine anterior and posterior perforating arteries,and 4) atherosclerosis at the basilar bifurcation. The omentum was placed on the APS and interpeduncular fossa. Results: Neurological improvement was observed after the third day and evident in the first weeks postoperatively. At present, 10 and 23 months after surgery, two patients require incomplete antiparkinsonian medication and besides, they receive aspirin and clonazepan. All of them carry out daily activity without assistance familiar. Conclusions: Our results indicate that PD is caused by progressive ischemia in the intraparenchymal territory of the posterior perforating arteries; because, in contrast to this, its revascularization by means of omentum produced neurological improvement .Likewise we believe that the regular use of aspirin and clonazepan may help to this disease.

Esclerosis Lateral Amiotrófica. Experiencia quirúrgica en 13 pacientes / Amyotrophic Lateral Sclerosis. Surgical experience in 13 patients

Introducción: En agosto del 2009 operamos el primer paciente con esclerosis lateral amiotrófica (ELA). Sin embargo, hasta la fecha, todo los investigadores informan que no hay cura para esta enfermedad. Objetivo: Demostrar que la ELA puede ser detenida y mejorada mediante un transplante de epiplón. Material y Método: Presentamos a 13 pacientes con formas bulbar y espinal de ELA. Durante la cirugía encontramos: 1) variantes anatómicas del segmento V4 de las arterias vertebrales, 2) aterosclerosis moderada o severa en ambos segmentos V4, 3) algunas arterias circunflejas originadas desde las arterias espinales anteroventrales (AEAVs) exsangües, 4) hipotrofia de raicillas nerviosas en la hilera de los nervios IX, X y XI, 5) en algunos casos, hipotrofia de la superficie anterior de las pirámides e 6) hipotrofia de raíces anteriores en C5 - C6.Todos ellos recibieron transplante de epiplón a la superficie anterior, lateral y posterior de la medula oblongada y en 5 pacientes, un transplante adicional a nivel C5-C6. Resultados: La mejoría neurológica fue observada desde el primer día de la operación y fue mayor durante los primeros días o semanas de la cirugía que en los siguientes meses. Actualmente, 2 pacientes con 8 y 12 meses de evolución postoperatoria han mejorado en un 90% los síntomas de la forma bulbar de ELA. Conclusión: Estos resultados indican que la forma bulbar de ELA es originada por isquemia progresiva en el territorio intraparenquimatoso de las AEAVs y la forma espinal por isquemia en la arteria espinal anterior, pero a nivel C5 a T1. Eso explicaría porque su revascularización por medio del epiplón produjo mejoría neurológica.

Introduction: In August 2009 we performed surgery for the first time in a patient with amyotrophic lateral sclerosis (ALE). However, every published report about ALE mentions there is no cure for this condition. Objective: To prove that the progression of ALE may be stopped and the condition may be improved using an epiplon transplant. Material and Method: This report presents our experience with 13 ALE patients, affected by the bulbar and spinal forms of the disease. During the surgical procedures, we made the following findings: 1) anatomical variants in the V4 segment of vertebral arteries, 2) moderate or severe atherosclerosis in both V4 segments, 3) some circumflex blood vessels originating from the low-flow anterior and ventral spinal arteries, 4) hypothrophy of small nerve roots in the pathway of IX, X, and XI cranial nerves, 5) in some cases, hypothrophy of the anterior surface of the pyramids, and 6) hypothrophy of the anterior roots in C5 - C6. Every patient underwent an epiplon transplant upon the anterior, lateral, and posterior aspects of the medulla oblongata, and 5 patients underwent an additional transplant performed upon the C5-C6 territory. Results: Neurological improvement was seen from the first postoperative day, and it reached its maximum level during the first few days or weeks after surgery. Nowadays, 2 patients after eight and twelve months after surgery have had a 90% symptomatic improvement of the bulbar form of ALE. Conclusion: These results indicate that the bulbar form of ALE is caused by progressive ischemia in the parenchymal territory irrigated by the anterior and ventral spinal arteries, and that the spinal form is caused by ischemia in the anterior spinal artery, affecting the area between C5 and T1. This may explain why this revascularization procedure using epiplon tissue led to neurological improvement.

Documento técnico para la creación del observatorio de la particiapción comunitaria en salud en Bolivia / Es

Crear mecanismos de participación comunitaria para mejorar la administración de los servicios de salud; fortalecer los mecanismos de relaciones institucionales para un trabajo conjunto con organismos interesados en la salud de la comunidad

Representacion religiosa del Patrono San Cristobal

Contiene: Marco Teórico metodológico - El espacio territorial de estudio - El sistema religioso del pueblo San Cristobal - El traslado de la población de San Cristobal - La refundación del pueblo de San Cristobal - Conclusiones generales

Unidad de rehidratacion oral propuesta y experiencia. / Oral rehydration unit - proposal and experience

Se relata la experiencia hecha en el Hospital de Ninos de Santa Fe, en una Unidad creada al efecto para el desarrollo de la tecnica. Se preconiza que con un minimo de espacio, elementos y control, puede hacerse en Centros de menor complejidad, lugares destinados al efecto. Se enumeran los casos tratados, caracteristicas, asi como los resultados obtenidos

Unidad de rehidratacion oral propuesta y experiencia. / Oral rehydration unit - proposal and experience

Se relata la experiencia hecha en el Hospital de Ninos de Santa Fe, en una Unidad creada al efecto para el desarrollo de la tecnica. Se preconiza que con un minimo de espacio, elementos y control, puede hacerse en Centros de menor complejidad, lugares destinados al efecto. Se enumeran los casos tratados, caracteristicas, asi como los resultados obtenidos