Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus / Pathophysiologic factors and perioperative therapeutic goals that affect reconstructive surgical procedures with flaps in patients with Diabetes Mellitus

RESUMEN Introducción: la diabetes mellitus es considerada un factor de riesgo para complicaciones locales y fracaso quirúrgico en cirugías reconstructivas mediante el uso de colgajos debido a las alteraciones en el proceso de cicatrización propias de esta patología. Objetivo: hacer una revisión de la literatura disponible sobre los factores fisiopatológicos que influyen en los resultados posquirúrgicos a corto, mediano y largo plazo en la población diabética, así como de las metas terapéuticas perioperatorias asociadas a mayores tasas de éxito. Metodología de Búsqueda: se realizó búsqueda en las bases de datos PUBMED, MEDLINE Y SCIELO, mediante el gestor de búsqueda utilizando los términos: "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obteniendo un total de 160 artículos de revistas en línea, de los cuales se seleccionaron 50. Resultados: la realización de colgajos en pacientes con diabetes mellitus se asocia a mayor riesgo de fracaso y complicaciones, las cuales disminuyen considerablemente si se realiza un estricto manejo perioperatorio enfocado en metas. Conclusiones: la diabetes mellitus causa alteraciones en la respuesta inflamatoria, disfunción microvascular y mayor estrés oxidativo, lo cual se ve reflejado en un proceso de cicatrizacion anormal, generando mayores tasas de infeccion y perdidas de colgajos; un estricto manejo peri operatorio guiado por metas logra disminuir las complicaciones y aumentar el exito quirurgico. MÉD.UIS. 2017;30(1):35-43.

ABSTRACT Introduction: diabetes mellitus is considered a risk factor for local complications and surgical failure in reconstructive surgeries, mainly in flaps due to the fact that it causes alterations in the cicatrization process. Objective: to review the available literature on the pathophysiological factors that influence the short-, medium- and long-term results in the diabetic population, the perioperative therapeutic goals associated with higher success rates, and to establish a baseline protocol for the perioperative management of these patients. Searching methodology: we searched the PUBMED, MEDLINE and SCIELO databases using the search terms "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obtaining a total of 160 online journal articles, of which 50 were selected. Results: the performance of flaps in patients with diabetes mellitus is associated with an increased risk of failure and complications, which decrease considerably when a strict goal-directed perioperative management is performed. Conclusions: diabetes mellitus causes alterations in the inflammatory response, microvascular dysfunction and increases oxidative stress, which is reflected in an abnormal healing process, generating higher infection rates and graft loss, but if glycemic management goals are achieved in the perioperative period it is possible to reduce the complications and to increase the surgical success. MÉD.UIS. 2017;30(1):35-43.

TRH injected into the nucleus accumbens shell releases dopamine and reduces feeding motivation in rats.

The thyrotropin-releasing hormone (TRH), an anorexigenic factor that reduces food intake in food-restricted animals, may be involved in motivation for food. Injected centrally, TRH impairs acquisition of food-rewarded behavior. Through the TRH-R1 receptors, TRH injected in the nucleus accumbens increases dopamine content-perhaps the mechanism by which the peptide modulates food motivation. This, however, is still to be demonstrated. We sought to evaluate dopamine release by microdialysis after a TRH injection into the nucleus accumbens shell in free-moving fasted rats. In addition, we assessed dopamine content and turnover by HPLC and the relationship with the motivation for food by analyzing the performance of rats during a progressive-ratio (PR) operant-conditioning test. Finally, we determined serum leptin and triiodothyronine (T3) levels in order to evaluate the animals' metabolic response to food restriction and the impact of intra-accumbal TRH administration on circulating hormones. Intra-accumbal injections of TRH reduced food intake in food-restricted rats-compared to counterparts treated with saline-, without further decreasing T3 or leptin levels, which dropped due to their dietary regime. TRH-injected rats had lower breaking points on the PR schedule, which indicated lower motivation to eat. Accordingly, compared to saline-treated animals, dopamine release and turnover increased in the nucleus accumbens of TRH-injected rats, a finding that suggests a relationship between motivation for food and TRH-induced release of dopamine.

Intermediate cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis successfully treated with fluconazole.

American cutaneous leishmaniasis is an endemic anthropozoonosis that exhibits a broad spectrum of clinical presentations. Intermediate/borderline disseminated cutaneous leishmaniasis is a distinct clinical condition that comprises cutaneous disease of a chronic nature, usually occurring as multiple lesions with or without mucosal involvement. The disease is usually caused by parasites of the subgenus Viannia, frequently occurs in context of an underlying disease, and is often resistant to standard antileishmanial therapy. We report a case that was refractory to standard therapy and other second-line drugs, but resolved after treatment with fluconazole, and review the use of fluconazole as a second-line drug in children.

Diffuse (anergic) cutaneous leishmaniasis responding to amphotericin B.

American cutaneous leishmaniasis is an important endemic zoonotic disease in the New World that comprises a spectrum of clinical manifestations. Diffuse cutaneous leishmaniasis (DCL) is a rare form of the disease characterized by antigen-specific immunodeficiency that often presents with multiple disfiguring non-ulcerated confluent nodules or plaques that involve large areas of the skin, resembling lepromatous leprosy. Relapse is invariable in advanced stages, despite aggressive chemotherapy, and a plethora of drugs has been tested with unchanging results. We report on a severe an exceptional case that resolved after treatment with amphotericin B, a drug considered only mildly effective, and discuss the therapeutic approach to this disease.

Extensive chromoblastomycosis caused by Fonsecaea pedrosoi successfully treated with a combination of amphotericin B and itraconazole.

Chromoblastomycosis is a chronic infection caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, and is characterized by a wide variety of clinical and dermatological features including papillomatous, verrucous and vegetating lesions. Although it has been described world-wide, most cases originate in tropical and sub-tropical areas. In general, present treatments of the disease are unsatisfactory as one of the most common etiologic agents, Fonsecaea pedrosoi is difficult to manage from a therapeutic point of view. We report a case of extensive chromoblastomycosis of 22 years duration caused by F. pedrosoi and review the clinical course, diagnosis and management of this disease.

Análisis de factores biopsicosociales de pacientes portadores de VIH atendidos en la Clínica Reina Sofía y la Fundación Eudes / Analysis of biopsychosocial aspects of carryng patients of VIH taken care of in the Reina Sofía Clinics and the Fundación Eudes

Este studio buscó evaluar los factores biopsicosociales (Laboral, Sexual, Personal, Familiar y social) de los portadores del VIH, asociados con las afecciones emocionales tanto del propio individuo como de su entorno. Para esto se utilizó un diseño no experimental, de tipo descriptivo-correccional, y se tomaron 43 sujetos voluntarios que asistían a programas de ayuda en la fundación EUDES y la Clínica Reina Sofía. Para efectos de la investigación se aplicó un instrumento realizado por las evaluadoras y validado por jueces expertos en el tema; Constaba de 27 ítems que medían diferentes áreas de ajuste del individuo. Se realizó un análisis descriptivo, seguidamente se evaluaron las diferencias mediante las pruebas de Mc Nemar,U. de Mann-whitney, Análisis de viranza de Kuskal-Wallis y Wilcoxon; finalmente se evaluó la relación de riesgo, con el fin de identificar las correccionales más significativas entre las áreas familiar, social y sexual, las cuales arrojaron los datos más relevantes. En lo que se refiere a la salud, el presente estudio muestra que el VIH no solamente puede ser tomado en el aspecto físico sino que los factores psicosociales son claves, mostrando que en la salud, el comportamiento juega un papel importante al tener un gran efecto en el bienestar físico y emocional del individuo.

Pioderma granulomatoso superficial recalcitrante y embarazo: presentación de un caso y revisión de la literatura / Recalcitrant superficial granulomatous pyoderm and pregnancy: presentation of a case and literature review

El pioderma granulomatoso superficial es una variante del pioderma gangrenoso, caracterizada por la aparición de úlceras superficiales y vegetantes, con hallazgos granulomatosos en su histologías. Se asocia infrecuentemente a enfermedad sistémica. Se presenta un caso de aparición durante la gestación, con múltiples úlceras localizadas en miembros inferiores, que progresan rápidamente, sin alguna enfermedad subyacente. Se trata con prednisona 50 mg/día y posterior a la culminación del embarazo se asoció talidomina, clofazimina, daptona y terapia tópica oclusiva con bota de Unna y apósitos húmedos hidrocoloides, con cicatrización de las lesiones y sin recurrencias