Controversias sobre el rastreo de los niveles séricos de vitamina D y su suplementación / Controversies about serum vitamin D levels screening and its supplementation

Si bien los niveles bajos de vitamina D se han asociado con varios resultados de interés en salud, aún resulta motivo de controversia qué significa un nivel bajo, cual es la utilidad de su suplementación y cuales son sus potenciales efectos adversos. En ese contexto, se realizó en el Servicio de Medicina Familiar y Comunitaria del Hospital Italiano un taller de discusión denominado "Actividad ECCO" (Evidencia Científica en la Clínica Cotidiana) en la que fueron presentados los resulta-dos de estudios identificados que hubieran comparado el uso de vitamina D (con o sin suplementación de calcio) ver-sus placebo, con el objetivo de discutir cuál es la evidencia actual para el rastreo de deficiencia de vitamina D y para, eventualmente, recomendar o no su suplementación. Este artículo resume la evidencia identificada y las conclusiones consensuadas en dicha actividad. (AU)

Although low levels of vitamin D have been associated with several health outcomes, it is controversial what a low level means, the usefulness of its supplementation and its potential adverse effects. In this context, a workshop called "ECCO Activity" (Scientific Evidence in the Daily Clinic) was held in the Family and Community Medicine Division of Hospital Italiano de Buenos Aires, where the results of identified studies that compared the use of vitamin D (with or without calcium supplementation) versus placebo, with the aim of discussing what is the current evidence for screening of vitamin D deficiency and to, eventually, recommend or not its supplementation. This article summarizes the identified evidence and the agreed conclusions in that activity. (AU)

Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996.

BACKGROUND: A national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages. METHODS: A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage. RESULTS: The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision. CONCLUSION: Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilisation in the country.

Stromal tumors of the stomach. Review of our experience and reclassification of a series of patients.

OBJECTIVE: To retrospectively review a series of 12 patients operated on in our department for stromal tumor of the stomach. Clinical and morphological data, and the patients' postoperative course, were analyzed. METHODS: Medical records for 12 patients (mean age 63.3 years) were retrospectively reviewed to obtain data on clinical presentation, diagnosis and treatment. Surgical morbidity and mortality were analyzed. A pathologist reviewed the resected specimens to determine the morphological factors of prognostic value. The biological nature of the tumor was reclassified based exclusively on mitotic index, and all tumors were staged according to the TGM system. Recurrence and survival rates were also calculated. RESULTS: The most frequent clinical presentation was abdominal pain and gastrointestinal bleeding. The most sensitive diagnostic methods were computerized tomography and echographic endoscopy. Operability and resectability rates were 100% and 91.6% respectively. Local resection was done in 5 patients, partial gastrectomy in 5, and extended total gastrectomy in 1. Histologically, 6 cases were muscular tumors (2 leiomyomas, 3 low-grade leiomyosarcomas and 1 high-grade leiomyosarcoma), 2 were gastrointestinal autonomic nerve (GAN) tumors, and 4 were pure stomal tumors. The morbidity rate was 33.3% and the mortality rate was 8.3% (1 patient). All patients were followed up: 1 patient each died after 9 months and 4 years, 1 developed liver metastases after a disease-free interval of 14 months, and the other 9 patients were still alive and free of disease after intervals ranging from 4 months to 7 years. CONCLUSIONS: Stromal tumors include a group of tumors which may present muscular differentiation (the most frequent type), neural differentiation (GAN tumors) or no differentiation at all (pure stromal tumors). The mitotic index is the most valid parameter to determine biological nature, considering that classification as a benign tumor requires the total absence of mitoses. Treatment was mostly surgical, and local resection with adequate safety margins was effective. Prognosis was relatively good, but long-term follow-up is needed to assess the malignant potential of these tumors.

Tumores estromales gástricos. Revisión de nuestra experiencia y reclasificación de la serie / Stromal tumors of the stomach. Review of our experience and reclassification of a series of patients

OBJETIVO: el propósito del estudio es una revisión retrospectiva de una serie de 12 tumores estromales gástricos intervenidos en nuestro servicio, analizando tanto sus datos clínicos como sus características morfológicas y valorando el tratamiento quirúrgico y la evolución de los pacientes. PACIENTES Y MÉTODOS: se revisan las historias clínicas de todos los pacientes obteniendo datos de presentación clínica, diagnóstico y tratamiento; se analiza morbilidad y mortalidad. Paralelamente se revisan las piezas de anatomía patológica estudiando factores morfológicos de valor pronóstico y reclasificando el carácter biológico de los tumores en base exclusivamente al índice mitótico. Se estadifica la serie según el sistema TGM. Se analiza la tasa de recurrencia y supervivencia. RESULTADOS: la edad media de los pacientes fue de 63,3 años. La forma más frecuente de presentación clínica fue el dolor abdominal y la hemorragia digestiva. Los métodos diagnósticos más sensibles fueron CT y ecoendoscopia. La operabilidad fue del 100 por ciento y la resecabilidad del 91,6 por ciento, se realizó resección local en cinco pacientes, gastrectomía parcial en cinco casos y una gastrectomía total ampliada. Histológicamente seis casos fueron tumores musculares (dos leiomiomas, tres leiomiosarcomas de bajo grado y un leiomiosarcoma de alto grado), hubo dos tumores GAN y cuatro estromales puros. La morbilidad fue del 33,3 por ciento y la mortalidad del 8,3 por ciento (un caso). El seguimiento se llevó a cabo en el 100 por ciento de los casos: dos pacientes fallecieron (a los nueve meses y a los cuatro años respectivamente), un paciente desarrolló metástasis hepáticas (tras un intervalo libre de 14 meses) y el resto están vivos y libres de enfermedad con un rango entre cuatro meses y siete años. CONCLUSIONES: los tumores estromales incluyen un grupo de tumores que pueden presentar diferenciación muscular (los más frecuentes), diferenciación neural (tumores GAN) o ninguna diferenciación (tumores estromales puros). El índice mitótico es el criterio diferencial más válido para determinar su carácter biológico, considerándose que el criterio de benignidad exige la ausencia total de mitosis. El tratamiento se basa fundamentalmente en la cirugía, siendo suficiente la resección local con márgenes de seguridad. El pronóstico es relativamente bueno, siendo necesarios seguimientos a largo plazo para controlar la expresión de su potencia maligno (AU)

Central serous choroidopathy in pregnancy.

Central serous choroidopathy is a spontaneous serous detachment of the sensory retina, usually affecting adults between 20 to 50 years of age but is also found in patients older than 60 years of age. This disease usually affects males with a male to female ratio of 8-10 to 1. Many aetiological or associated factors have been described. Here we report a 39-year-old pregnant lady presented with left central serous chorioretinopathy preceded by an unusual emotional disturbance. She was not given any photocoagulative treatment to avoid possible photocoagulative complications. Post delivery, she presented with resolution of the CSC.

Computed tomography (CT) of orbital pseudotumour.

Orbital pseudotumour is a non-specific inflammatory disease. Its highly variable clinical and radiographic presentation makes specific diagnosis difficult. This study on 31 proven cases of pseudotumour shows that unilateral involvement, retroorbital fat infiltration and enlargement of multiple extraocular muscles with involvement of the tendinous insertions are key computed tomography CT features which help to establish the diagnosis of orbital pseudotumour.