Delirium postoperatorio en mayores de 60 años. Hospital Nacional de Itauguá, Paraguay. Año 2016 / Postoperative delirium in patients over 60 years of age. National Hospital of Itauguá.2016

Introducción: El delirium postoperatorio (DPO) es una complicación frecuente asociada a cirugía cardíaca y no cardíaca, en especial en enfermos de la tercera edad. Parece existir correlación entre el DPO como complicación y una declinación en la calidad de vida y mayor mortalidad. Objetivo: Determinar la frecuencia de delirium en el postoperatorio inmediato, en pacientes mayores de 60 años. Métodos: Se realizó un estudio, observacional,descriptivo y transversal en pacientes mayores de 60 años llevados a cirugía en el Hospital Nacional de Itauguá en el año 2016 mediante la escala de CAMICU. Resultados: Se examinaron un total de 160 pacientes, el 55% fueron de sexo masculino y 45% sexo femenino. El 80% fueron cirugías programadas y 20% de urgencias. Se encontraron 20 pacientes con DPO. De los pacientes con DPO, el 45% habían sido sometidos a anestesia general, 20% a anestesia raquídea, 20% a anestesia peridural más anestesia general y el 15% a bloqueo regional más anestesia general. El 55% de los casos de DPO fueron cirugías de 3 o más horas, el 40% de cirugías de 2-3 hs y 5% a cirugías de 1 hora o menos de duración. Conclusiones: La frecuencia de DPO fue de un 12,5%. La mayor frecuencia se encontró en el grupo etario de 70 ­ 79 años, en cirugías de más de 3hs de duración y en anestesias generales. Palabras Claves: Delirium postoperatorio, anciano, anestesia.

Introduction: Postoperative delirium (DPO) is a frequent complication associated with cardiac and noncardiac surgery, especially in the elderly. There seems to be a correlation between DPO as a complication and a decline in quality of life and higher mortality. Objective: To determine the frequency of delirium in the immediate postoperative period, in patients older than 60 years. Methods: An observational, descriptive and crosssectional study was performed in patients older than 60 years of age who underwent surgery at the National Hospital of Itauguá in 2016 using the CAM-ICU scale. Results: A total of 160 patients were examined, 55% were male and 45% female. 80% were scheduled surgeries and 20% of emergencies. Twenty patients with DPO were found. Of the patients with DPO, 45% were submitted to general anesthesia, 20% to spinal anesthesia, 20% to epidural anesthesia plus general anesthesia and 15% to regional block plus general anesthesia. 55% of the cases of DPO were surgeries of 3 or more hours, 40% of surgeries of 2-3 hours and 5% of surgeries of 1 hour or less in duration. Conclusions: The frequency of DPO was 12.5%. The highest frequency was found in the age group of 70 - 79 years, in surgeries of more than 3 hours duration and in general anesthesia. Key words: postoperative deliriu, oldman, anesthesia.

Oral ulcers in HIV-positive Peruvian patients: an immunohistochemical and in situ hybridization study.

BACKGROUND: This study describes the histopathological, immunohistochemical (IHC) and in situ hybridization (ISH) data of 25 cases of oral ulcers in HIV-positive patients, with clinical and microscopical features similar to ulcers not otherwise specified (NOS)/necrotizing ulcerative stomatitis (NUS). METHODS: Sex, age and clinical history were obtained from the clinical records. Histological analysis for H&E, Gomori-Grocott and Ziehl-Neelsen stains, IHC analysis to detect infectious agents and to characterize inflammatory cellular infiltrate, and ISH for cytomegalovirus (CMV) and EBER1/2 were performed. RESULTS: Twenty-one patients were men and four were women (mean age of 34.6 years). The tongue was preferentially affected. Microscopically, the lesions showed extensive necrosis, leukocytoclasia, vasculitis with luminal fibrin clots and an intense inflammatory cellular infiltrate predominated by CD68(+) atypical large cells, normal-sized and crescent-shaped nuclei macrophages, interspersed by CD8(+) T lymphocytes. Mast cells were also observed in all samples studied. CD4(+) T lymphocytes, CD20(+) B lymphocytes and VS38c(+) plasma cells were practically absent. CMV and EBER1/2 were identified in scarce cells of 3 and 16 of 25 cases respectively. CONCLUSION: These results show that CD68(+) macrophages, followed by CD8(+) T lymphocytes, were the predominant inflammatory cells, indicating they are relevant to the pathogenesis of the ulcers, possibly reflecting an abnormal immune response in the oral mucosa. The clinicopathological and immunoprofile features of the present cases are similar to NOS ulcers/NUS in HIV-positive patients.

Evidence of congenital transmission of Trypanosoma cruzi in a vector-free area of Bolivia.

A seroprevalence survey of Trypanosoma cruzi was carried out in two areas of South Bolivia. Triatoma infestans, the main vector of Tryp. cruzi, was abundant in the first area, but absent in the second one. Titration of Tryp. cruzi antibodies was carried out in children aged 6-24 months and their mothers. The seroprevalence of Chagas' disease was significantly higher in the area with the vector, but also high in the second area. Chagas' infection in children under 2 years old could be linked to congenital transmission of parasites during pregnancy and/or delivery, despite active vector control in both areas.

Microalbuminuria en pacientes con diabetes tipo 2 / Microalbuminuria in patients with type 2 diabetes

La diabetes constituye una afección común en el Paraguay, donde unas 300.000 personas la padecen y aproximadamente otras 500.000 personas presentan un estado previo a la enfermedad. La nefropatía es una de las complicaciones mas graves, que sobreviene por la falta de control de la enfermedad. En la actualidad, el acceso al tratamiento sustitutivo, hemodiálisis y transplante renal ha desplazado a la insuficiencia renal al tercer puesto como causa de muerte del paciente diabético, después de la cardiopatía isquémica y del accidente cerebro vascular. La presencia de microalbuminuria en orina es un claro marcador de riesgo hacia la progresión de las complicaciones de la enfermedad, especialmente las nefropatías. En este estudio la prevalencia de microalbuminuria hallada en los pacientes diabéticos tipo 2, fue de 34.7%, porcentaje elevado con respeto a la referencia que oscila alrededor del 20 al 40% en la Diabetes tipo 2. Existen factores de riesgo que predisponen al desarrollo de la microalbuminuria y su progresión, como son la duración de la diabetes, la falta de control de la glicemia, la hipertensión arterial, una mala alimentación y el tabaquismo. Con el control de dichos factores se vería reducido el riesgo de avance de la enfermedad. Se observó que a medida que aumenta el tiempo de evolución de la enfermedad aumenta la proporción de pacientes diabéticos con microalbuminuria, acompañados por un progresivo aumento de la presión arterial.

Diabetes constitutes a common affection in Paraguay, where approximately 300,000 people are affected and approximately other 500,000 people present a disease­previous condition. Nephropathy is one of the most serious complications caused by the lack of control of the disease. At present, the access to the substitutive treatment, hemodialysis and renal transplant has displaced renal insufficiency to the third position as death causes of diabetic patients after ischemic cardiopathy and cerebrovascular accident. The presence of microalbuminuria is a clear risk marker of progression towards the complications of the disease, especially nephropathies. In this study, the prevalence of microalbuminuria found in the type 2 diabetic patients was 34.7 %, a high percentage in relation to the reference that ranges around 20 to 40 % in type 2 diabetes. There are risk factors predisposing to the development of microalbuminuria and its progression such as the duration of the diabetes, lack of control of glycemia, blood hypertension, malnutrition and smoking. The control of the above mentioned factors would reduce the risk of advance of the disease. It was observed that as the time of evolution of the disease increases, the proportion of diabetic patients with microalbuminuria also increases accompanied by a progressive increase of blood pressure.

Use of short tandem repeats loci to study the genetic structure of several populations from Zulia State, Venezuela.

Genetic relationships between populations can be studied by comparing genotypic and allelic similarities. This investigation aims to demonstrate that selected autosomal microsatellite markers could be used to study the genetic structures of different populations living in northwest Venezuela, in Zulia State. Seven autosomal systems (CSF1PO, TPOX, TH01, vWA, D7S820, D13S317, and D5S818) were tested by PCR in a multiplex format on 688 different chromosomes from unrelated individuals living in Maracaibo, "Isla de Toas," and "San José de Heras," and from two Amerindian populations from the "Sierra de Perijá," Barí' and Yukpa. Allele frequencies, Hardy-Weinberg equilibria, genetic distances, phylogenetic trees, and ethnic admixtures were estimated. The study shows the existence of a clear genetic difference among these populations in accordance with their historic evolution. The populations of Maracaibo and "Isla de Toas" showed a triracial origin, with a large European contribution, followed by an Amerindian component and a small African component. The indigenous groups, Barí' and Yukpa, showed exclusively an Amerindian component, and "San José de Heras" showed only an African component. These results indicate that microsatellite markers are useful for molecular anthropology in a regional and worldwide context and provide important genetic information about contemporary populations of Venezuela.

[Characterization of neuronal ceroid lipofuscinosis in Venezuelan children]. / Caracterización de la ceroidolipofuscinosis en niños venezolanos.

INTRODUCTION: Neuronal ceroid lipofuscinosis (NCL), represents a group of inherited neurodegenerative disorders. Based on the age of the patient at onset, clinical course and ultrastructural morphology it has been identified three clinical types for the pediatric group: 1) Infantile NCL (INCL); 2) Late infantile NCL (LINCL); and 3) Juvenile NCL (JNCL). Other variants or atypical forms represent around 20% of the NCL in different populations. Genetic advances have made possible a better characterization, diagnostic and classification of these disorders. CASE REPORTS: We present the clinical, neurophysiological, neuroradiological, and morphological data from 6 patients with NCL, who were assessed at the pediatric neurology department of the Hospital Universitario de Maracaibo during a ten years period (1993 2003). All 6 cases corresponded with the late infantile form. Age of onset ranged form 2 to 5 years. For most of the patients initial symptoms included seizures, psychomotor delay, accompanied by macular degeneration and optic atrophy. The EEG was characterized by high voltage spikes elicited by low frequency photic stimulation, in 5 cases. Neuroimaging findings were characteristic of the late infantile form of the NCL. In three patients a decreased intensity of signal was seen in the thalami and putamen on T2-weighted images. The ultrastructural examination of the samples obtained through a biopsy showed curvilinear bodies in all patients. CONCLUSION: There is not epidemiological data of the NCL in Venezuela; it is presumed the presence of clinical forms and variants in the pediatric group. This first study could contribute to the knowledge and a better research of this group of disorders in our population.

Caracterización de la ceroidolipofuscinosis en niños venezolanos / Characterization of neuronal ceroid-lipofuscinosis in venezuelan children

Introducción. La ceroidolipofuscinois neuronal (CLN) representa un grupo de trastornos neurodegenerativos de origen genético. En función de la edad de comienzo, el curso clínico y la morfología ultraestructural, se reconocen tres formas clínicas en la edad pediátrica: 1) CLN infantil (INCL); 2) CLN infantil tardía (LINCL), y 3) CLN juvenil (JNCL). Otras variantes o formas atípicas representan alrededor de un 20 por ciento de las CLN en diferentes poblaciones. Los avances en genética han permitido una mejor caracterización, diagnóstico y clasificación de estos trastornos. Casos clínicos. Se presentan los datos clínicos, neurofisiológicos, neurorradiológicos y morfológicos de seis pacientes con CLN evaluados en el Servicio de Neuropediatría del Hospital Universitario de Maracaibo, durante 10 años (1993-2003). Todos los casos correspondieron a la forma infantil tardía. La edad de comienzo varió entre los 2 y los 5 años. En la mayoría de los pacientes los síntomas iniciales fueron convulsiones y retardo psicomotor, acompañados de degeneración macular y atrofia óptica. El EEG practicado con fotoestimulación en frecuencias bajas evidenció, en cinco casos, puntas occipitales de amplitud elevada. Los hallazgos en la neuroimagen fueron característicos de la forma LINCL. En tres pacientes se objetivaron lesiones hipointensas en regiones talámicas en las imágenes ponderadas en T2. El examen ultraestructural del material obtenido mediante biopsia mostró cuerpos curvilíneos en todos los pacientes estudiados. Conclusión. No existen datos epidemiológicos de CLN en Venezuela. Se presume la existencia de formas clínicas y variantes en edad pediátrica. Este primer estudio puede contribuir al conocimiento y mejor investigación de este grupo de trastornos en nuestra población (AU)

Introduction. Neuronal ceroid-lipofuscinosis (NCL), represents a group of inherited neurodegenerative disorders. Based on the age of the patient at onset, clinical course and ultraestructural morphology it has been identified three clinical types for the pediatric group: 1) Infantile NCL (INCL); 2) Late infantile NCL (LINCL); and 3) Juvenile NCL (JNCL). Other variants or atypical forms represent around 20% of the NCL in different populations. Genetic advances have made possible a better characterization, diagnostic and classification of these disorders. Case reports. We present the clinical, neurophysiological, neuroradiological, and morphological data from 6 patients with NCL, who were assessed at the pediatric neurology department of the Hospital Universitario de Maracaibo during a ten years period (1993-2003). All 6 cases corresponded with the late infantile form. Age of onset ranged form 2 to 5 years. For most of the patients initial symptoms included seizures, psychomotor delay, accompanied by macular degeneration and optic atrophy. The EEG was characterized by high voltage spikes elicited by low frequency photic stimulation, in 5 cases. Neuroimaging findings were characteristic of the late infantile form of the NCL. In three patients a decreased intensity of signal was seen in the thalami and putamine on T2-weighted images. The ultraestructural examination of the samples obtained thru a biopsy showed curvilinear bodies in all patients. Conclusion. There is not epidemiological data of the NCL in Venezuela; it is presumed the presence of clinical forms and variants in the pediatric group. This first study could contribute to the knowledge and a better research of this group of disorders in our population (AU)

Data for nine autosomal STRs markers (CSF1PO, D13S31, D16S539, D7S820, F13A01, FESFPS, TH01, vWA, TPOX) from Venezuela.

Allele frequencies for nine autosomal STRs loci were obtained from individuals from a sample of unrelated individuals born in Venezuela.

Solid-phase microextraction with on-fibre derivatisation applied to the analysis of volatile carbonyl compounds.

We have used a fast, sensitive and efficient method for the analysis of volatile carbonyl compounds (saturated aliphatic and unsaturated aldehydes) based on solid-phase microextraction with on-fibre derivatisation. Pentafluorophenylhydrazine was absorbed onto a poly(dimethylsiloxane)/divinylbenzene-coated fibre and exposed to the vapours of aldehyde-containing matrices. The hydrazones formed on the fibre were desorbed into the gas chromatograph injection port and quantified by means of electron-capture detection with high sensitivity (10-90 fmol) and good reproducibility (RSD<10%). The method was applied to the headspace-sampling of volatile carbonyl compounds released during the thermally-induced degradation of sunflower oil.

CFTR mutations in three Latin American countries.

We analyzed 192 cystic fibrosis (CF) alleles in three Latin American countries: Mexico, Colombia, and Venezuela. Mutation screening was performed by polymerase chain reaction (PCR) and a reverse dot blot detection kit that enables determination of 16 of the most common CF mutations worldwide. Mutations were detected in 47.9% of the screened CF alleles. The most prevalent CF allele was DeltaF508 (39. 6%). The remaining 16 non-DeltaF508 detectable mutations represented 8.3% of the CF alleles. Among them, the G542X, N1303K, and 3849+10kb C>T were the most common. Although the frequency of DeltaF508 described here is lower than that reported for Caucasian populations, including in Spain, it is remarkable that mutation prevalences found in this study resemble those observed in Spain. Two of these mutations, G542X and 3849+10kb C>T, that were relevant in this analysis, have a particularly high incidence in Spanish communities. The low frequency of DeltaF508 described here may be explained by the Amerindian, Caucasian, and Black admixture that occurred in Latin America after the discovery of the New World, and also by the probable occurrence of mutations contributed by the original natives, which were undetectable in this analysis.

[Analysis of Bcl I polymorphism of factor VIII gene in the molecular diagnosis of female hemophilia A carriers in families from northwestern Venezuela]. / Análisis del polimorfismo Bcl I del gen del factor VIII en el diagnóstico molecular de portadoras de Hemofilia A en familias del noroccidente de Venezuela.

PURPOSE: To identify carrier females in segregant families of haemophilia A from Zulia state-Venezuela. PATIENTS AND METHODS: The polymorphisms' analysis linked to the gene, independently of the mutation nature is the most suitable method to identify carriers, because it permits to track the mutated gene. This study is comprised of 139 ADN samples distributed in 20 families affected by haemophilia A. The diagnosis of carrier was made by polymerase chain reaction (PCR), a fragment of 142 pb corresponding to intron 18 of the factor VIII gene, which shows a restriction polymorphism for the Bcl I enzyme. RESULTS: The frequency of the Bcl I alleles in the 43 unrelated individuals was 0.35 and 0.65 for the 142 pb and 99 + 43 pb, respectively. In the 35 women that required diagnosis, we were able to establish the carrier status for 11, and 4 were excluded to be. CONCLUSIONS: The Bcl I polymorphism at the FVIII gene was useful in the 43% (15/35) of the women that required diagnosis. It's possible to identify carriers for haemophilia A in most of the families from Zulia state-Venezuela employing several polymorphisms at the Factor VIII gene.

[Oral mycoses in the AIDS era]. / Las micosis orales en la era del sida.

The present advancement and generalization of oral mycosis is probably due to different factors associated to the progress and development of the countries and the presence of medically compromised patients and immunosupressor therapies. From all these mycoses, oral candidosis is the commonest, but histoplasmosis and paracoccidioidomycosis are also important. The main clinicopathologic and therapeutic features of those oral diseases are reviewed in this paper.

Amyloid deposits in labial salivary glands identified by electron microscopy.

Abnormal proteinaceous deposits identified by light microscopy as amyloid in labial salivary gland biopsies were studied by transmission electron microscopy in order to establish their ultrastructural characteristics. Results showed fine fibrils approximately 10 nm in diameter located in close relation to the basal lamina of the secretory end-pieces and ducts as well as in the interstitial connective tissue stroma of labial salivary glands; these are the typical features of amyloid. Thus, the present study confirms the light microscopy diagnosis of amyloid deposits in labial salivary gland biopsies, supporting the use of lip biopsy as a readily accessible method for the diagnosis of secondary amyloidosis.

[Leigh's encephalopathy (subacute necrotizing encephalopathy). Documentation of its evolution through neuroimaging]. / Encefalopatía de Leigh (encefalopatía necrotizante subaguda). Documentación de su evolución por neuroimagen.

A 30 months-old boy developed bilateral nistagmus, tremor, gait disturbance, hypotonia and disartria. The diagnose of Leigh encephalopathy was suggested on the basis of clinical, neuroimaging and laboratory findings. Computed tomography and magnetic resonance imaging (MRI) at an early stage revealed bilateral and symmetric lesions in the putamen, appearing as hyperintense signal on T2-weighted images. Twelve months later a relatively large hypertense area in the posterior brainstem was observed. At this stage, the patient exhibited marked deterioration, dystonic manifestations, rigidity and respiratory disturbances. He died 6 months later for respiratory arrest during bronconeumonic infection. We believe MRI is a valuable means to allow assessment of the evolution of the disease.

[Epidemiology of congenital malformations at the Hospital Pedro García Clara, Ciudad Ojeda, Venezuela]. / Epidemiología de malformaciones congénitas en el Hospital Pedro García Clara. Ciudad Ojeda, Venezuela.

Results from an epidemiological study of congenital malformations (CM) realized at Pedro Garcia Clara Hospital from march 1989 to december 1992 are presented. Malformation was defined as all external or internal morphological defects that could be clinically diagnosed at birth. In all births, incidence and type of CM, birth condition, sex, weight, number of pregnancies and maternal ages were analyzed. Moreover, in live births from march 1989 to august 1991, were analyzed: the type of childbirth presentation, maternal residence place, paternal age, maternal and paternal occupation and school education, parental consaguinity, previous spontaneous abortions, other malformed in the family and exposition to physical agents, medicaments, vaccines, acute and chronical diseases and vaginal bleeding in the first trimester of pregnancy. The control group were children born during the same day and sex matched as the malformed children. The incidence of CM was 23.4 per 1000 total births. Most frequent malformations were principally minor or feasible of satisfactory treatment. Major malformations were Central Nervous System anomalies, specially, neural tube deffects and Down syndrome. Only maternal age, type of childbirth, other malformed members in the family and medicaments exposition were statistically significant. Our results confirm the importance and utility of CM epidemiology monitoring.

Self-reported childhood and adolescent sexual abuse among adult homosexual bisexual men.

From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending sexually transmitted disease clinics were interviewed regarding potentially abusive sexual contacts during childhood and adolescence. Thirty-seven percent of participants reported they had been encouraged or forced to have sexual contact before age 19 with an older or more powerful partner; 94% occurred with men. Median age of the participant at first contact was 10; median age difference between partners was 11 years. Fifty-one percent involved use of force; 33% involved anal sex. Black and Hispanic men were more likely than white men to report such sexual contact. Using developmentally-based criteria to define sexual abuse, 93% of participants reporting sexual contact with an older or more powerful partner were classified as sexually abused. Our data suggest the risk of sexual abuse may be high among some male youth and increased attention should be devoted to prevention as well as early identification and treatment.

A highly sensitive method for diagnosis of secondary amyloidosis by labial salivary gland biopsy.

Both labial salivary gland and gingival biopsies were taken from 19 patients with clinical findings suggestive of secondary amyloidosis. Amyloid deposits were present in all salivary gland biopsies (19/19) while amyloid deposits in gingiva were observed only in three cases (16%). No amyloid was found in similar biopsies from 11 control patients. Periductal amyloid involvement was found along the basement membrane in all salivary gland samples; additionally, 16 cases had periacinar infiltration (84%), 13 had perivascular (68%) and 7 (37%) showed interstitial deposits. Amyloid in gingiva was seen along the epithelial basement membrane, as in salivary glands, although in isolated areas and scattered at the top of some dermal papillae and small blood vessels. In secondary amyloidosis it therefore appears that amyloid is deposited along the epithelial basement membrane before perivascular deposition occurs. This study presents a new highly sensitive and reliable method for the diagnosis of secondary amyloidosis, a method which is technically simple, free from complications and well-accepted by the patients.

Proposición de un método de evaluación de los exámenes basados en preguntas de desarrollo / Proposition of an evaluation method based on developmental questions

Se realizó un trabajo pedagógico que tiene como objetivos la proposición de un método evaluativo de los exámenes con preguntas de desarrollo y el estudio del comportamiento de los índices de dificultad y discriminación de la prueba final ordinaria de las asignaturas de Fisiología II. Se presentan los resultados obtenidos aplicando el método propuesto. Se concluye, que el método resulta confiable y que es comparable con el utilizado para pruebas de selección múltiple. También se expresan las consideraciones pertinentes sobre los autores Valorati por propuestas en la literatura consultada, y se tienen en cuenta los distintos estudios realizados con anterioridad(AU)