ABSTRACT
Resumen Las alteraciones congénitas de las arterias coronarias, son un grupo de anomalías poco frecuentes, por lo general no son diagnosticadas y se presentan en menos del 1% de la población general. Se caracterizan por un espectro clínico amplio, que abarca desde la ausencia de síntomas hasta la presencia de angina, el síncope, la falla cardiaca, las arritmias ventriculares, el infarto agudo del miocardio y/o la muerte súbita. Generalmente, su diagnóstico es incidental, durante la realización de una arteriografía coronaria por sospecha de síndrome coronario agudo o durante la práctica de autopsias. El surgimiento de nuevas técnicas diagnósticas ha permitido una apropiada clasificación de estas anomalías y una mejor aproximación clínica y terapéutica. Presentamos Se presenta el caso de un paciente de género masculino de 44 años de edad, que consulta a la unidad de urgencias por presentar dolor torácico. Durante su proceso diagnóstico, se documenta mediante la tomografía axial computarizada con reconstrucción de los vasos coronarios el origen anómalo de la arteria coronaria derecha, que nace del seno coronario izquierdo y sigue un trayecto interarterial. Se realiza un tratamiento quirúrgico.
Abstrac Congenital alterations of coronary arteries are a group infrequent abnormalities and generally not diagnosed, present in 1% of the general population. They are characterised by a broad clinical spectrum, ranging from the absence of symptoms to the presence of angina, syncope, heart failure, ventricular arrhythmias, acute myocardial infarction and/or sudden death. Generally, their diagnosis is incidental, during the process of a coronary angiography because of the suspicion of acute coronary syndrome or during autopsies. The surge of new diagnostic techniques has allowed for a proper classification of these abnormalities and a better clinical and therapeutic approach. The case of a male 44-year old patient, consulting the ER for chest pain, is presented. During the diagnostic process, the computerised axial tomography with reconstruction of the coronary arteries revealed the anomalous origin of the right coronary artery that arises from the left coronary sinus and follows an interarterial course. Surgical treatment is conducted.
Subject(s)
Humans , Male , Adult , Chest Pain , Coronary Vessels , Tomography , Heart Defects, CongenitalABSTRACT
The diagnosis of diabetes mellitus type 2 (DM2) is based either on increased plasma glucose or Glycated hemoglobin levels. Since these measures are the only means for diagnosis of DM2, they must be well adapted to each population according to their metabolic characteristics, given that these may vary in each population. The World Health Organization (WHO) determined the cut-points of plasma glucose levels for the diagnosis of DM2 by associating hyperglycemia with the risk of a specific microvascular complication-retinopathy. Cardiovascular diseases are however the principal causes of mortality in patients with DM2 and we reported that in the Colombo-Ecuadorian population impaired fasting glucose and impaired glucose tolerance are both risk markers for myocardial infarction. We propose that the current cut-points accepted by the WHO need to be revaluated in populations such as Latin America and that there should be lower cut points for glycaemia in this population, to reduce the prevalence of cardiovascular complications associated with DM2.
ABSTRACT
BACKGROUND: Hand-foot syndrome (HFS), also known as palmar-plantar Erythrodysesthesia (PPE), acral erythema or Burgdorf reaction, is a dermatologic toxic reaction to certain chemotherapies, including sorafenib. A high incidence of adverse events is already described in dermatological clinical trials of this drug, but its use in medical practice, common in the patient with metastatic thyroid carcinoma has not yet been reported. Sorafenib (BAY 43-9006) is an orally administered multi-level kinase inhibitor, approved for treatment of solid tumors such as renal cell carcinoma, hepatocellular carcinoma and recently for metastatic thyroid carcinoma. CASE PRESENTATION: We report a case of a 29 year old Latin woman diagnosed with papillary thyroid carcinoma, who was initially given a total thyroidectomy, central and bilateral neck lymph node removal followed by a radioiodine therapy. Subsequent evaluation indicated locoregional progressive disease and metastatic involvement in both lungs. Following this, the patient was prescribed 200 mg of sorafenib administered every 12 hours, but after four days, she presented with a skin reaction compatible with hand-foot syndrome. After discontinuation of the therapy, this reaction ceased. CONCLUSION: Sorafenib as a new therapeutic option for patients with radioactive iodine (RAI)-resistant metastatic differentiated thyroid cancer, it is important that clinicians are fully aware of the potential adverse effects. All patients on Sorafenib therapy should be educated to recognize the first symptoms to obtaining the maximal benefit from this anti-neoplastic rescue therapy.
ABSTRACT
Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.
