Estimated Loss of Productivity Attributed to Cardiovascular Diseases in South America. / Estimativa de Produtividade Perdida Atribuída a Doenças Cardiovasculares na América do Sul.

BACKGROUND: Cardiovascular diseases (CVD) have significant health and economic burdens. In South America, the loss of productivity related to these diseases has not yet been well explored. OBJECTIVE: Estimate the potentially productive years of life lost (PPYLL) and loss of productivity related to premature mortality associated with CVD in South America, in 2019. METHODS: Mortality data available from the 2019 Global Burden of Disease Study were used to estimate the burden of disease attributable to CVD. For monetary calculations of productivity loss, a proxy of the human capital approach was used. Data were stratified by sex, in working age groups. RESULTS: The total number of deaths due to CVD in South America in 2019 was 754,324, and the total number of PPYLL was 2,040,973. The total permanent loss of productivity was approximately US$ 3.7 billion and US$ 7.8 billion in purchasing power parity, equivalent to 0.11% of the gross domestic product. The cost per death was US$ 22,904, and the ratio between men and women for the cost per death was 1.45. The variation in scenarios indicates that the estimates are robust, even with important differences between countries. CONCLUSIONS: CVD impose a significant economic burden on countries in South America. The characterization of this burden can support governments in the allocation of resources for the planning and execution of health policies and interventions in promotion, prevention, and recovery.

FUNDAMENTO: As doenças cardiovasculares (DCV) têm ônus sanitário e econômico significativos. Na América do Sul (AS), a perda de produtividade relacionada a estas enfermidades ainda não foi bem explorada. OBJETIVO: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade relacionados a mortalidade prematura associada as DCV na AS, em 2019. MÉTODOS: Empregou-se dados de mortalidade disponíveis no Global Burden of Disease Study 2019 na estimativa da carga de doença atribuível a DCV. Para os cálculos monetários da perda da produtividade usou-se uma proxy da abordagem de capital humano. Estratificou-se por sexo, nas faixas etárias de trabalho. RESULTADOS: O número total de mortes por DCV na AS no ano de 2019 foi de 754.324 e os AVPP foram 2.040.973. A perda permanente de produtividade total foi de aproximadamente US$ 3,7 bilhões e US$ 7,8 bilhões em paridade do poder de compra, equivalente a 0,11% do produto interno bruto. O custo por morte foi de US$ 22.904, e a razão desse custo por óbito, entre homens e mulheres foi 1,45. A variação dos cenários aponta robustez nas estimativas, mesmo com diferenças importantes entre os países. CONCLUSÕES: As DCV impõem um ônus econômico significativo a este bloco de países. A caracterização deste fardo pode amparar os governos na alocação de recursos destinados ao planejamento e execução de políticas e intervenções sanitárias, sejam de promoção, prevenção ou recuperação.

Estimativa de Produtividade Perdida Atribuída a Doenças Cardiovasculares na América do Sul / Estimated Loss of Productivity Attributed to Cardiovascular Diseases in South America

Resumo Fundamento: As doenças cardiovasculares (DCV) têm ônus sanitário e econômico significativos. Na América do Sul (AS), a perda de produtividade relacionada a estas enfermidades ainda não foi bem explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade relacionados a mortalidade prematura associada as DCV na AS, em 2019. Métodos: Empregou-se dados de mortalidade disponíveis no Global Burden of Disease Study 2019 na estimativa da carga de doença atribuível a DCV. Para os cálculos monetários da perda da produtividade usou-se uma proxy da abordagem de capital humano. Estratificou-se por sexo, nas faixas etárias de trabalho. Resultados: O número total de mortes por DCV na AS no ano de 2019 foi de 754.324 e os AVPP foram 2.040.973. A perda permanente de produtividade total foi de aproximadamente US$ 3,7 bilhões e US$ 7,8 bilhões em paridade do poder de compra, equivalente a 0,11% do produto interno bruto. O custo por morte foi de US$ 22.904, e a razão desse custo por óbito, entre homens e mulheres foi 1,45. A variação dos cenários aponta robustez nas estimativas, mesmo com diferenças importantes entre os países. Conclusões: As DCV impõem um ônus econômico significativo a este bloco de países. A caracterização deste fardo pode amparar os governos na alocação de recursos destinados ao planejamento e execução de políticas e intervenções sanitárias, sejam de promoção, prevenção ou recuperação.

Abstract Background: Cardiovascular diseases (CVD) have significant health and economic burdens. In South America, the loss of productivity related to these diseases has not yet been well explored. Objective: Estimate the potentially productive years of life lost (PPYLL) and loss of productivity related to premature mortality associated with CVD in South America, in 2019. Methods: Mortality data available from the 2019 Global Burden of Disease Study were used to estimate the burden of disease attributable to CVD. For monetary calculations of productivity loss, a proxy of the human capital approach was used. Data were stratified by sex, in working age groups. Results: The total number of deaths due to CVD in South America in 2019 was 754,324, and the total number of PPYLL was 2,040,973. The total permanent loss of productivity was approximately US$ 3.7 billion and US$ 7.8 billion in purchasing power parity, equivalent to 0.11% of the gross domestic product. The cost per death was US$ 22,904, and the ratio between men and women for the cost per death was 1.45. The variation in scenarios indicates that the estimates are robust, even with important differences between countries. Conclusions: CVD impose a significant economic burden on countries in South America. The characterization of this burden can support governments in the allocation of resources for the planning and execution of health policies and interventions in promotion, prevention, and recovery.

Obesity: Perceived Self-Efficacy, Emotional Regulation and Stress / Obesidade: Autoeficácia Percebida, Regulação Emocional e Estresse / Obesidad: Autoeficacia Percibida, Regulación Emocional y Estrés

Abstract Obesity increases the risk of non-transmissible chronic illnesses decreasing the quality of life and life expectancy. This investigation aims to define a psychological profile for the treatment of the target population evaluating the levels of self-efficacy perceived, difficulty in emotional regulation and stress. Eighty-six adults participated, including 63 women and 23 men who pertained to OBEMOB in Temuco. The results indicate that the level of stress, trust in problem solving skills, as well as ability to solve problems and unexpected situations differs according to the type of obesity (p<0.05). In addition, there is a negative relation between general self-efficacy and difficulty of emotional regulation (rho=-0.419) while stress and BMI demonstrate a positive relation (rho=0,380).

Resumo A obesidade aumenta os riscos de doenças crônicas não-transmissíveis, diminuindo a qualidade e a expectativa de vida. Esta investigação busca delinear o perfil psicológico da população-alvo, avaliando os níveis percebidos de autoeficácia, dificuldade da regulação emocional e estresse. Participaram 86 pessoas adultas, 63 mulheres e 23 homens da cidade de Temuco. Os resultados mostraram que os níveis de estresse, confiança, habilidade para resolução de problemas e para lidar com situações inesperadas variam segundo o tipo de obesidade (p<0,05). Ainda, existe uma relação negativa entre autoeficácia geral e dificuldade de regulação emocional (rho=-0.419) e uma relação positiva entre estresse e IMC (rho=0,380).

Resumen La obesidad aumenta el riesgo de enfermedades crónicas no transmisibles, disminuye la expectativa y calidad de vida. Esta investigación busca establecer un perfil psicológico para el tratamiento de la población objetivo, realizar evaluaciones sobre los niveles de autoeficacia percibida, dificultad de la regulación emocional y estrés. Participaron 86 personas adultas, 63 mujeres y 23 hombres pertenecientes a OBEMOB de la ciudad de Temuco. Los resultados señalan que el nivel de estrés, confianza en la resolución de problemas, capacidad de resolución de problemas y resolución de situaciones inesperadas, difiere según el tipo de obesidad (p<0,05). Además, existe una relación negativa entre la autoeficacia general y la dificultad de la regulación emocional (rho=-0,419) y una relación positiva entre el estrés y el IMC (rho=0,380).

Incontinencia Urinaria en mujeres de Jaén: Estudio de prevalencia / Urinary incontinence in Jaén woman: Prevalence study

Objetivo: conocer la prevalencia de la incontinencia urinaria (IU) en mujeres de la ciudad de Jaén (España) y su distribución por edad e identificar el tipo de IU que padecen. Metodología: se diseñó un estudio descriptivo y transversal. Participaron 379 mujeres adscritas a los centros de salud de la ciudad de Jaén de entre 30 y 80 años de edad que acuden a consulta de Enfermería. Se estimó la prevalencia y el tipo de IU con el cuestionario de versión española del International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados: la prevalencia encontrada fue del 43,3%. El número de casos con pérdida de orina presenta una pendiente positiva con la edad. Respecto al tipo de incontinencia 12,2% (20) era de urgencias, un 60,4% (99) de esfuerzo, un 17,1% (28) mixta y otras IU un 10,4%. Conclusión principal: la prevalencia de la IU en mujeres de Jaén aumenta con la edad. El tipo de IU más frecuente es la IU de esfuerzo. Las mujeres con IU presentan mayor pérdida de calidad de vida

Objective: knowing the prevalence of urinary incontinence (UI) in women from the city of Jaen (Andalusia, Spain) and its distribution by age, in addition to identify the type of UI they sufferers. Methods: a descriptive cross-sectional study was designed, in which 379 women participated; all they assigned to Health Centers in the city of Jaen, with ages between 30 and 80; who attend nursing consultation. The prevalence and type of UI was estimated with the Spanish version of the questionnaire International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results: the prevalence found in the study was 43.3%; the number of cases with loss of urine has a positive slope with age. Regarding the type of incontinence 12.2% (20) was urge incontinence, 60.4% (99) was stress incontinence, 17.1% (28) UI mixed and other 10.4%. Conclusions: the prevalence of UI of women in Jaén increases with age. The most common type of IU is stress. Women with UI have greater loss of quality of life

[Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital]. / Gastrostomía endóscopica percutánea en esclerosis lateral amiotrófica; experiencia en un hospital de tercer nivel.

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians. OBJECTIVE: To analyse the characteristics of ALS patients at the moment of PEG placement and their progression. METHODS AND MATERIALS: Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15. RESULTS: 37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement. CONCLUSIONS: There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates.

Introducción: La Esclerosis Lateral Amiotrófica (ELA) es una enfermedad degenerativa neurológica con afectación de la vía piramidal, produciendo trastornos motores progresivos que evolucionan hasta la parálisis. Estos pacientes pueden asociar disfagia, precisando soporte nutricional a través de de sonda nasogástrica o Gastrostomía Endoscópica Percutánea (PEG). La PEG está asociada con aumento de la supervivencia, sin embargo la evidencia acerca del momento óptimo para su colocación es escasa. Objetivo: Analizar las características de los pacientes con ELA en el momento de colocación de la PEG y su evolución. Material y métodos: Estudio descriptivo retrospectivo. Se incluyeron pacientes con diagnóstico de ELA y PEG valorados durante los años 2005-2014 en nuestro hospital. Se analizaron parámetros nutricionales y respiratorios, y evolución de los pacientes. Los resultados se analizaron en el programa SPSS15. Resultados: 37 pacientes fueron incluidos (56,8% hombres, 43,2% mujeres) con una edad media al diagnóstico 60 años, y edad media de colocación de PEG de 63,1 años, el 48,6% debutó con afectación espinal y el 51,4%, con bulbar. El 43,2% de los pacientes recibieron suplementos previa colocación de PEG durante un promedio de 11,3 meses. La capacidad vital forzada (CVF) media al diagnóstico fue del 65,45±13,67%, evolucionando desfavorablemente hasta un 39,47±14,69% en el momento de colocación de la PEG. El 86,5% de los pacientes precisaron soporte respiratorio con ventilación mecánica no invasiva (VMNI). El 86,5% presentaron disfagia, el 64,9% pérdida de peso > 5-10% de su peso habitual, el 8,1% IMC bajo, el 27% parámetros bioquímicos de desnutrición y el 73% empeoramiento de función respiratoria, por tanto, el 100% cumplían criterios de colocación de PEG según nuestro protocolo. La duración de la nutrición enteral fue de 10,1 meses con una mortalidad del 50% en los primeros 6 meses de la colocación de la PEG. Conclusiones: Evidenciamos una demora de 3 años entre el diagnóstico y la colocación de la PEG, con una supervivencia del 50% a los 6 meses de la realización de la misma. Más estudios son necesarios para determinar si una colocación más precoz podría aumentar la supervivencia.

Deterioro funcional en ancianosingresados en un hospitalsin unidades geriátricas / Functional impairment in elderly inpatients in a hospital without geriatric units

Introducción: El aumento de la población de personasmayores de 65 años hace cada vez más frecuente su ingresoen los hospitales. La estancia hospitalaria en unidadesde hospitalización convencionales puede llevaraparejado el deterioro de la capacidad funcional en losancianos. Objetivos. Establecer el perfil del paciente ancianoatendido en las Unidades de Medicina Interna delComplejo Hospitalario de Jaén. Analizar los resultadosde la hospitalización en personas mayores en términosde variación de la capacidad funcional al alta respectodel ingreso. Identificar qué variables influyen en la variaciónde esa capacidad funcional de los ancianos hospitalizadosen un centro sin unidades geriátricas. Métodos.Estudio prospectivo observacional en tres unidadesde hospitalización de medicina interna de un hospitaluniversitario de la red pública de Andalucía. Se ha incluidouna muestra de 190 pacientes ancianos hospitalizados.Las variables recogidas fueron: demográficas, (..) (AU)

Introduction: Increased population of elderly people is becomingmore frequent admission to hospitals of people olderthan 65 years. Hospital stay in conventional units can leadto functional worsening in the elderly. Aim: To identify theprofile of elderly patients treated in the Internal MedicineHospital of Jaén. To analyze variation in functional abilityof elderly people following admission to inpatient units of apublic hospital. To identify variables that influence thechanges in the functional ability of elderly inpatients inhospitals without geriatric units. Methods: Prospective observationalstudy in 3 units of internal medicine units in ahospital belonging to the Andalusian Health Service. Asample of 190 hospitalized elderly patients has been included.Variables related to demographic, hospitalization andfunctional ability using Barthel Index, were reported.Results: Hospitalization in internal medicine units did nothelp to improve functional ability in older people; rather,they had a negative effect, promoting functional worsening (..) (AU)

Plantilla de enfermería y demanda de cuidados de ancianos hospitalizados, ¿son suficientes los recursos? / Nursing staff and care needs in hospitalized elders, are there enough resources?

Introducción: El aumento de la población de personas mayoresde 65 años hace cada vez más frecuente su ingreso enlos hospitales. El tiempo de estancia hospitalaria de los ancianossuele ser más prolongado que el del resto de pacientes.Objetivo: Analizar la capacidad de prestación de cuidadosde 3 unidades de hospitalización de un hospital público ycompararla con la demanda de cuidados de los ancianos.Métodos: Estudio prospectivo observacional en 3 unidadesde hospitalización de medicina interna de un hospital universitariode la red pública de Andalucía (España). Se ha incluidouna muestra de 190 pacientes ancianos hospitalizados.Las variables recogidas fueron: demográficas, relacionadascon la hospitalización, demanda de cuidados y capacidadde prestación de cuidados de la plantilla de enfermería. Losdatos se han obtenido del sistema de información del hospital,del conjunto mínimo básico de datos de pacientes y porobservación directa mediante el método de nivel de cuidados(MNC). Resultados: La edad media de los ancianos hospitalizadosfue de 77,4 años, con 21,1% de mayores de 85años. La estancia media fue de 15,68 días. La estimación dela capacidad de prestación de cuidados de la plantilla de en fermería fue de 2,8 horas/paciente/día (con un índice de enfermerastituladas del 60%). A partir de la medición de nivelesde dependencia, la demanda de cuidados media de losancianos fue de 4,9 horas/paciente/día. Esta diferencia suponeun déficit anual de 51 profesionales de enfermería en laplantilla de las 3 unidades de hospitalización. Los factoresque influyen en la demanda de cuidados de los ancianos sonla edad, días de estancia hospitalaria, el diagnóstico médico yel destino del paciente al alta. También se encuentra una relacióncon la presencia de un familiar acompañando al paciente(cuidador familiar). Los cuidados básicos representanun 65,7% del total de cuidados requeridos. Conclusiones:La proporción de ancianos frágiles ingresados en los hospitalesestá en aumento. La demanda de cuidados de los ancianoses mayor que la capacidad de provisión de la plantilla deenfermería del hospital, lo cual genera un déficit que tieneque ser asumido por los cuidadores familiares

Introduction: The increase in the elders’ population makesmore and more frequent its admittance in hospitals. Thehospital stay of the elder patients is usually longer than therest of patients. Aim: To analyze the care delivery capacityin 3 units of the hospital and to compare it with the needsfor care of the elders. Methods: Observational and prospectivestudy in 3 Internal medicine units in an universityhospital belonging to the Andalusian Health Service(Spain). A sample of 190 hospitalized elders has been included.Variables reported were: demographics, hospitalization-related, needs for care and care delivery capacity of thenursing staff. Data were extracted by the Hospital informationsystem, the minimum basic set of data and by directobservation applying the method of level of care. Results:The median age of the elders was 77.4 years, a21.1% of the patients were older than 85 years. The hospitalstay was 15.68 days as average. The nursing staf has acare delivery capacity of 2.8 hours/patient/day (with askill-mix of RN 60%). According to the dependence level,the need for care of the elders was 4.9 hours/patient/day, asaverage. This gap means a lack of 51 nurses each year, among the 3 units. Factors influencing the needs for care ofelders were: age, hospital stay, medical diagnosis and dischargedestination. There is a relation also with the presenceof a relative accompanying to the patient (family caregiver).The proportion of basic care was a 65.7% of the totalamount of care. Conclusions: The rate of frail elders inthe hospitals is increasing. The needs for care of the eldersare higher than capacity for care delivery of nursing staff,so a shortage is created that can be taken up by family caregivers (AU)

Impacto de una vía clínica para pacientes intervenidos con resección transuretral en próstata y vejiga / Impact of a clinical pathway in cases of transurethral resection of the prostate and bladder

Objetivo. Conocer, desde una triple perspectiva, clínica, económica y centrada en el paciente, la efectividad de una vía clínica. Método. Para ello, se diseñó un estudio experimental, en el que participaron 122 pacientes intervenidos de hiperplasia benigna de próstata o carcinoma vesical mediante resección transuretral (RTU), divididos en 2 grupos, experimental y control. La aleatorización se realizó sobre los listados de espera y, al ser hospitalizados, se controló que el ingreso no se produjera en la misma habitación que otro paciente incluido en distinto grupo, para mantener el simple ciego. Resultados. La comparación de ambos grupos detectó diferencias respecto a los días de estancia (desviación estándar [DE]): 3,59 (1,54) frente a 2,92 (1,18), p = 0,008. Los pacientes del grupo control, en promedio, estaban 0,67 días de más hospitalizados (intervalo de confianza [IC] del 95%, 0,18-1,17) que los del grupo al que se le aplicó la vía clínica. No se detectaron diferencias estadísticamente significativas en cuanto a presentación de complicaciones (el 3,6 frente al 1,8%; p = 0,55), ni en la satisfacción (el 90,9 frente al 94,5%; p = 0,46). Conclusiones. Las vías clínicas producen una reducción de la estancia, si bien el mecanismo por el que lo hacen efectivo no está claro

Objective. To determine the effectiveness of a clinical pathway from a triple perspective: clinical, economic, and patient-centered. Methods. We designed an experimental study. A total of 122 patients undergoing surgery for benign prostatic hyperplasia or cancer of the bladder through transurethral resection were divided into 2 groups: experimental and control. Patients on the waiting list for surgery were randomized to one of the two groups. To guarantee simple blinding, admitted patients were not assigned to the same ward as another patient in the other group. Results. Comparison of the two groups revealed differences in the length of hospital stay (SD): 3.66 (1.42) versus 2.98 (1.42), p = 0.015. On average, length of hospital stay was 0.68 days (95% CI, 0.13-1.21) longer in the control group than in patients in whom the clinical pathway was applied. No significant differences were detected in the complication rate (3.6% versus 1.8%, p = 0.55) or in patient satisfaction (94.5% versus 90.9%, P = 0.46). Conclusions. Clinical pathways reduce the length of hospital stay, although the mechanism through which this reduction is achieved is not entirely clear

Exostosis múltiple hereditaria y síndrome de Down / Multiple hereditary exostoses and Down's syndrome

Introducción. La exostosis múltiple hereditaria es un trastorno autosómico dominante caracterizada por excrecencias cartilaginosas múltiples, fundamentalmente, en huesos de las extremidades, y en la que se han descrito como asociados el síndrome de Langer Giedion, la leucemia mieloide aguda y la espondilitis anquilosante. Objetivo: describir el caso de un niño de 10 años de edad en el cual coexisten la exostosis múltiple hereditaria y síndrome de Down. Caso clínico. Paciente masculino de 10 años, con edad aparente mayor a la real, braquicefalia, fisuras palpebrales oblicuas, epicanto, puente nasal aplanado, retardo mental, con presencia de tumoraciones de 3 x 2 cm aproximados, localizadas en extremidades, cintura escapular y pélvica, con marcha claudicante y complemento cromosómico de 47, XY, +21. Conclusión. Parece tratarse del primer caso en donde coexisten el síndrome de Down y la exostosis múltiple.

Introduction. Multiple hereditary exostoses is an autosomal dominant disorder characterized by multiple osteochondromas, fundamentally in bones of the extremities, and in which they have been described like the associates the syndrome of Langer Giedion, the acute myeloid leukemia and the ankylosing spondylitis. Objective: to describe the case of 10-year-old boy in which coexist multiple hereditary exostoses and Down's syndrome. Case report. Male patient with greater apparent age to the real one, brachycephaly, up slanting palpebral fissures, low nasal bridge, mental deficiency, and tumors presence of approximate 3 x 2 cm, located in extremities waist scapular and pelvic, with failing march and complement chromosomal of 47, XY, + 21. Conclusion. We report appears to be the first case of Down's syndrome with the coexistence of multiple exostoses.

Síndrome de Pfeiffer tipo 2 con expresividad variable

Introducción. Objetivo: presentar un caso clínico de síndrome de Pfeiffer, de 5 años de edad, con cráneo en trébol, proptosis ocular severa, y aparentemente sin retardo mental Caso clínico. Niño de 5 años de edad, producto de segunda gesta, embarazo normoevolutivo de término; padres de 19 años de edad al momento de nacer el propositus, sin antecedentes teratogénicos, ni consanguinidad o de otro padecimiento similar en miembros de la familia. A la exploración física: cráneo en trébol, frente amplia y prominente, proptosis ocular (antecedente de salida del globo ocular derecho en dos ocasiones), aplanamiento medio facial, pabellones auriculares con hélix de configuraciones en cruz horizontal, primer dedo de manos y pies anchos de su falange distal, sindactilia parcial en manos y pies. El cariotipo en linfocitos de sangre periférica mostró un complemento cromosómico normal 46, XY. Radiológicamente se observó cráneo en trébol, con múltiples impresiones digitales. Conclusión. El caso presentado aquí corresponde clínica y radiológicamente a un síndrome de Pfeiffer tipo 2, sin complicaciones viscerales y con desarrollo neurológico de acuerdo a su edad cronológica.

Introduction. Since 1964, about 30 cases of Pfeiffer syndrome type 2 have been informed; this variant is characterized by cloverleaf skull, prominent forehead, severe ocular proptosis, severe central nervous system damage, elbow synostosis, and early death. Case report. A 5 years old male withouth antecedents of consanguinity, teratogenic exposure of his parents (of 19 years of age at the time of the bird of patient), or familial malformation, was admitted. On physical examination a cloverleaf skull, wide forehead, ocular proptosis (in 2 previous occasions the right eye exited), mid facial flattening, horizontal cross configuration of ear helix, widening of the first finger of hand and feet, and partial syndactyly of hands and feet were observed. A normal 46 XY cariotype, and a normal neural development were found. Discussion. We present a case of Pfeiffer syndrome type 2 without visceral complications and normal neurologic development.

Enfermedad de lafora: una forma poco frecuente de epilepsia mioclónica: aspectos clínicos, histológicos, inmunohistoquímicos y ultraestructurales de un caso: revisión de la literatura / Lafora's disease: an form little frequent of myclonus epilepsies: aspect clinic histological inmunohistochemical and ultrastructural: revision of a case and of the literature

Los cuerpos de poliglucosán (CPG), se encuentran en diversas entidades patológicas e incluso en condiciones normales. Su hallazgo en biopsia, cerebrales de pacientes con epilepsia mioclónica progresiva es diagnóstico de enfermedad de Lafora, siendo también encontrados en hígado, músculo esquelético, músculo cardíaco y piel. Presentamos los hallazgos clínicos, gistoquímicos, inmunohistoquímicos y ultraestructurales de la biopsia cerebral de un paciente masculino de 18 años de edad, en el que clínicamente se sospechó la enfermedad

Neurotuberculosis: lesiones expansivas del sistema nervioso central / Neurotuberculosis: expansives injuries of the central nervous system

La tuberculosis (TBC) del sistema nervioso central (SNC), rara vez se manifiesta como una lesión ocupante del espacio (LOE), siendo los tuberculomas más frecuentes que los abscesos tuberculosos. Presentamos los hallazgos clínicos, imagenológicos e histopatológicos de tres tuberculomas y un absceso tuberculoso. En todos los casos se realizaron coloraciones para bacterias, hongos y bacilos ácido alcohol resistentes (BAAR). Todos los pacientes presentaron manifestaciones clínicas e imagenológicas de LOE. El diagnóstico de neurotuberculosis fue establecido por estudios histopatológicos. Las LOE por TBC en el SNC pueden presentar problemas en el diagnóstico diferencial, por lo que es necesario correlacionar la información clínica y los hallazgos anatomopatológicos, para establecer un diagnóstico y tratamiento temprano

Cambios clinicos y hematologicos en becerros infectados con Anaplasma marginale / Clinical and hematological change in calves infected with Anaplasma marginale

Clinical and hematological changes of six Anaplasma marginale(isolated Zulia) inoculated calves (experimental group) and four healthy calves (control group) were studied during twenty and eighty days before and after infection, respectively. The behavior of the four calves used as control group was stable and no significant changes in the parameters analyzed was observed. The experimental group developed the three typical phases of illness. During the prepatent phase, which lasted a mean of 21.2 + /- 2.56 days, the animals were asymptomatic and no significant changes in the hematological values occurred, but a remarkable transitory decrease in number of lymphocytes from 6.5 x 10(6) to 3.3 x 10(6) cells/ml. The infection during the acute phase produced a highly severe effect in two animals, a severe effect in three animals and a mild effect in one. The effects observed were the following: 1) a fast decrease in haematocrite, ranging from 6 to 10 percent; 2) values of parasitaemia varied from 15 to 48 percent 3) a greater body temperature than the control animals (40.5 vs. 38.5 degrees C); 4) a elevated heart frequency, from 60 to 110 beats/min; 5) an increase in the concentration of neotrophiles from 10 x 10(6) to 13 x 10(6) cells/ml; 6) The number of monocytes also augmented from 3 x 10(6) to 6 x 10(6) cells/ml; and 7) an important decrease of weight gain. The natural course of infection was interrupted with oxytetracycline when the haematocrite of the animal lowered to values less or equal to 10 percent. Then, the animals showed a rapid recovery with an undetectable parasitaemia and concomitant return to basal line of the rest of the parameters