La universidad y su articulación con la sociedad en la búsqueda de entornos saludables en Yaguajay

RESUMEN: Analizar el papel del centro universitario en la articulación con la universidad médica en la búsqueda de entornos saludables y su contribución al desarrollo local en el municipio Yaguajay, constituye el propósito fundamental del presente trabajo, para el que se realizó una revisión documental de numerosos documentos y entrevistas a los principales líderes y a la población. El fomento de prácticas y estilos de vida sanos, la integración y capacitación de actores sociales, el desarrollo de la ciencia, la innovación tecnológica y del potencial científico productivo, junto a la sostenibilidad ambiental, fueron algunos de los resultados evidenciados. Se constató que la universidad en el territorio trabajó por incentivar una cultura saludable, por unificar esfuerzos, coordinar acciones, involucrar sectores, consolidar alianzas interinstitucionales dentro y fuera de la esfera sanitaria, con lo que se demostró la fortaleza de la promoción de salud dentro de los procesos de desarrollo local. [AU]

Assessment of the Allergeaze ® Patch Test compared to other conventional allergens / Valoración del Test Allergeaze® versus otros alergenos convencionales

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Síndrome confusional: échale la culpa a los opioides / Confusional syndrome: Blame the opioids...

Varón de 42 años con antecedentes de alcoholismo, abuso de cocaína y fractura de meseta tibial derecha de seis meses de evolución que se trató quirúrgicamente, inicialmente, y precisa de múltiples reintervenciones por infección de la herida quirúrgica y osteomielitis. El paciente presentaba ánimo depresivo y estaba polimedicado: antibióticos endovenosos y opioides, BZD, analgésicos y fármacos coadyuvantes v.o. (distraneurine, bromazepam, pregabalina, paracetamol, metamizol, tramadol, Enantyun® y morfina). El paciente presentaba sobre todo dolor de tipo neuropá- tico con un EVA de 8, por lo que se suspenden las BZD y se pauta analgesia por vía oral: pregabalina (150 mg-0-150 mg), amitriptilina (0-0-25 mg), Oxycontin® (10-0-10 mg) y paracetamol 1 g/8 h. Cuando se plantea la disminución de la dosis de opioide por buen control del dolor, debuta con un cuadro de estupor importante por la noche, sin responder a estímulos ni obedecer órdenes, que alterna con agitación psicomotriz importante, incoherencia en el lenguaje y desconexión con el medio. Este cuadro persiste. Los médicos habituales del paciente creían en una sobredosificación de opioide como origen del cuadro. En este caso tendríamos que hacer un diagnóstico diferencial con las principales causas de síndrome confusional con: septicemia, endocarditis, abscesos cerebrales, ortopédica (cadera y rodilla), delirio postoperatorio, toma de opioides o tricíclicos. La polimedicación era sospechada como causa principal del cuadro, si bien lo único que parece claro es que la agitación psicomotriz se debía a un síndrome de abstinencia a opioides, pero había que buscar otra causa para la disminución reiterada del nivel de consciencia. El delirio postoperatorio es muy factible en este paciente, aunque la literatura consultada no aporta mucha evidencia sobre que la medicación usada para las anestesias de este paciente sean las precipitantes de este cuadro. Una gran variedad de alteraciones del comportamiento se ven asociadas a infartos cerebrales en el territorio de la arteria cerebral media derecha. El síndrome confusional aparece en el 13-48 % de los pacientes en la fase aguda de un infarto cerebral. Un 12 % de los ACVA se dan en pacientes menores de 45 años, siendo el modo de presentación de muy diversas enfermedades sistémicas o locales, aun así, en el 40 % de los casos no se puede diagnosticar la etiología. El deliro es un cuadro infradiagnosticado. Los falsos mitos sobre los opioides, la opiofobia y el escaso conocimiento de esta medicación conllevan a un incumplimiento terapéutico por parte de los pacientes y/o del personal sanitario. El síndrome de abstinencia ha de tenerse siempre en cuenta cuando disminuimos la dosis de opioide que se toma de forma crónica. Es importante seguir un esquema de diagnóstico diferencial, ya que con ello nos aseguramos el diagnóstico certero de la patología subyacente (AU)

A 42-year-old male with precedents of alcoholism, abuse of cocaine and fracture of right tibial plateau of six months of evolution that was treated surgically, at a first time, and required multiple reinterventions for infection of the surgical wound and osteomielitis. The patient presented depressive sindrome and was polymedicated with endovenous antibiotics and opioids, and oral formulations of benzodiazepines, analgesics and rescue medicaments (distraneurine, bromazepam, pregabalina, paracetamol, metamizol, tramadol, Enantyun® and morphine). The patient was presenting especially pain of neuropathic type with a VAS of 8, so benzodiazepines were suspended and analgesia is changed by oral route: Pregabalina (150 mg-0-150 mg), amitriptilina (0-0-25 mg), Oxycontin® (10-0-10 mg) and paracetamol 1 g/8 h. When the decrease of opioids dose was possible for good pain control, the patient presents an important stupor in the night, without answering to stimuli and obey orders, which it alternates with important psychomotor agitation, incoherence in language and disconnection with the environment. This syntomatology persists. The habitual doctors of the patient were believing in an overdosage of opioids as origin of the syntomatology. In this case we would have to make a differential diagnosis with the principal reasons of confusional syndrome with: Blood poisoning, endocarditis, cerebral abscesses or stroke, orthopaedic (hip and knee), postoperatory delirium, drugs (opioids or triciclics). The polymedication was suspected as main cause of the syntomatology, though the only thing that seems to be clear is that the psychomotor agitation was due to an abstinence syndrome to opioids, but it was necessary to look for another reason for the repeated decrease of the level of conscience. The postoperatory delirium is very feasible in this patient, though the consulted literature does not give great evidence on which medication used for the anesthesias could caused the confusional syndrome. A great number of alterations of the behavior are associated with cerebral strokes in the territory of the cerebral artery right average. A confucional syndrome in 13-48 % of the patients in the acute phase of a cerebral stroke. A 12 % of the cerebral strokes occurs in patients younger of 45-year-old, being the way of presentation of very diverse systemic or local diseases, nonetheless, in 40 % of the cases are unnoticed. The confusional syndrome is underdiagnosed. The false myths on the opioids, the opiofobia and the low knowledge of this medication carry to a therapeutic breach by the patients and/or sanitary personnel. The syndrome of abstinence has to be counted when we diminish dose of opiods taken chronically. It is important to follow a scheme of differential diagnosis to assure ourselves the accurate diagnosis of the underlying pathology (AU)

Genetic disorders of pediatric MEN2A patients in the south of Spain

INTRODUCTION: Medullary thyroid carcinoma (MTC) is observed in nearly 100 % of patients with multiple endocrine neoplasia type 2A (MEN2A). The gene responsible for MEN2A is the RET proto-oncogene and about 95 % of MEN2A patients have germline mutations in five specific cysteine codons (609, 611, 618, 620 and 634). MATERIALS AND METHODS: A retrospective study of children from families with MEN2A in our geographic area was performed. Variables analyzed included demographic data, kinship relations, age at genetic screening, age at prophylactic thyroidectomy, genetic mutation subtype and histological findings. The genetic study consisted in direct molecular analysis by automatic sequencing of RET mutated exon in the studied family. RESULTS: We performed 13 prophylactic total thyroidectomies from 1997 to 2013, 8 females and 5 males. The mean age at genetic diagnosis was 3.8 years (range 2-5.9). All children belonged to four interconnected families living in the same geographic area and presenting C634Y mutation in all the cases. The mean age at prophylactic thyroidectomy was 5.6 years (range 4-8.5). Histopathological findings demonstrated seven cases of C-cells nodular hyperplasia, one lymphocytic thyroiditis, two without evidence of disease, two micro-carcinomas and one multicentric carcinoma. CONCLUSION: The mutation found in the RET proto-oncogene responsible for MEN2A in pediatric patients in the south of Spain is the C635Y. It is considered a high-risk mutation, associated with an earlier malignant transformation and development of MTC (AU)

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Allergic contact hobby dermatitis from turpentine

Introduction: Turpentine is an oleoresin obtained from various species of pine. It contains a volatile oil (oil of turpentine) which is responsible for its properties and this is the form generally used. Opportunity for contact with turpentine is widespread. It is universally used as a solvent to dissolve and thin lacquers, varnishes and paints. It is also an ingredient in many liniments and cold remedies. Turpentine is regarded as both a local irritant and a sensitizer. Cases of allergic contact dermatitis in painters, mechanics, shoe repairers and home decorators have been reported. Case report: We report a case of a non-professional painter who developed a contact allergic dermatitis due to his exposure to turpentine while doing oil-painting as a hobby. Discussion: Dermatitis is one of the biggest dangers of working with art materials and occupational contact dermatitis is often detected on the hands of the painters. Solvents are indispensable and turpentine is the most important and the traditional one used in oil-painting. Contact allergy to oil of turpentine was reported to have become rare in Europe but over the last few years, increased rates of turpentine sensitization have been reported

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