Lepra: puesta al día. Definición, patogénesis, clasificación, diagnóstico y tratamiento / Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatmen

La lepra es una enfermedad granulomatosa crónica causada por una micobacteria (M. leprae) que presenta predisposición por la piel y los nervios periféricos. La lepra continúa siendo endémica en distintas regiones del mundo. La presentación clínica de la enfermedad depende del estado inmunológico del paciente al adquirirla y de la evolución de la misma. Es una infección que se asocia a discapacidad y marginación. El diagnóstico de lepra es clínico y se hace al tener uno o más de los signos cardinales establecidos por la OMS: máculas hipopigmentadas o eritematosas con disminución de la sensibilidad, engrosamiento de los nervios periféricos y la demostración de bacilos ácido alcohol resistentes en una baciloscopia o biopsia de piel, con pérdida de anexos en los sitios afectados. El tratamiento consta de tres fármacos: rifampicina, clofazimina y dapsona. Existen principalmente dos modalidades de tratamiento dependiendo de la presentación clínica del paciente: paucibacilar o multibacilar (AU)

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease (AU)

Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

Pseudoaneurisma gigante de fístula arteriovenosa humeral autóloga: reparación quirúrgica / Gigant pseudoaneurysm of an autologous arteriovenous fistula in the forearm: surgical repair

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Hemorragias vaginales repuberales. Un dilema diagnóstico de etiología múltiple y pronóstico variable / Prepubertal vaginal bleeding. A diagnostic dilema of multiple etiology and variable prognosis

Introducción y justificación. La hemorragia genital en la niña sin signos de desarrollo puberal, es motivo de alarma y consulta urgente, que plantea un dilema diagnóstico, dada la diversidad etiológica. Una casuística amplia, que incluye observaciones de menarquia prematura, seguida a lo largo plazo, nos permitirá valorar su frecuencia e importancia, los procedimientos diagnósticos, el tratamiento y el pronóstico final. Material y métodos. Abarca 143 observaciones de hemorragia vaginal en niñas sin otros signos de desarrollo sexual, de las cuales ocho presentaron menarquia prematura y hemorragia vaginal recidivante. En todas se realizó anamnesis, examen físico, que incluyó exploración ginecológica y vaginoscopia, estudio bacteriológico y citológico y ecografía abdominopelviana. En ausencia de etiología independiente de alteraciones hormonales, se practicaron, entre otras, determinaciones hormonales basales, test de LH-RH, secreción nocturna de gonadotropinas y RMN del área hipotálamo-hipofisaria. Resultados y conclusiones. La hemorragia vaginal en niñas sin signos de madurez tiene una diversidad etiológica, cuya causa más frecuente son las infecciones vulvovaginales, seguidas, en un número más limitado de traumatismos, cuerpos extraños y otros desórdenes. La menarquia precoz, seguida de hemorragia vaginal recurrente, es un proceso autolimitado posiblemente ocasionado por una activación transitoria e incompleta del eje hipotálamo-hipofisario (AU)

Introduction and justification. Genital bleeding in girls without signs of pubertal development is cause of alarm and prompt consultation, causing a diagnostic dilema given its high etiological diversity. A high casuistry, including the observation and long-term follow up of cases of premature menarche, will allow us to assess the frequency, relevance, diagnostic procedures, treatment and prognosis of this entity. Material and methods. It covers the observation of 143 cases of genital bleeding in girls without presented premature menarche and recurring vaginal bleeding. In all the cases we performed anamnesis and physical exam, including gynecological and vaginoscopy, citology, bacteriological study and pelvic and abdominal ultrasound. When non-hormone measurement levels, LHRH test, evaluation of gonadotropin secretion during sleep and NMR of the hypothalamus-hypophyseal area. Results and conclusions. Genital bleeding in girls with-out signs of pubertal development has a high etiological diversity. The most frequent causes are vulvovaginal infections, followed in a lower number of cases by traumatisms, foreign by recurring vaginal bleeding, is a self-limited process possibly originated in the transitory and incomplete activation of the hypothalamus-hypophysisasis (AU)

Glucogenosis tipo Ib / Type Ib glycogenosis

Las glucogenosis tipo Ib son enfermedades infrecuentes; representan solo el 10-20% de las glucogenosis I, cuya incidencia en Europa es de 1 caso por 100.000 recién nacidos. Presentamos el caso de un lactante afecto de glucogenosis Ib que debutó con cuadro séptico. Sometido a tratamiento diario con factor estimulante de las colonias de granulocitos y a tratamiento dietético, evoluciona con infecciones respiratorias de repetición, aceptable control metabólico y crecimiento y desarrollo psicomotor adecuados (AU)

The glycogen storage diseases type Ib are uncommon diseases; representing only 10-20% of glycogenosis I, whose incidence in Europe is 1 case per 100,000 newborns. We report the case of an infant with glycogenosis Ib who presented with a sepsis. Subjected to daily treatment with granulocyte colony-stimulating factor and dietary treatment evolves with recurrent respiratory infections, acceptable metabolic control and appropriate growth and psycho-motor development (AU)

La enfermería en salud pública: el caso de la Influenza / The public health nursing: the case of influenza

Ante un brote de una enfermedad infecto-contagiosa, el estudio de contactos limita la transmisión de esta. El objetivo de este trabajo fue identificar a los contactos de los posibles casos de influenza en trabajadores de la UNAM para establecer una comunicación y proporcionar educación para la salud sobre medidas higiénicas. Material y métodos: Se elaboró un cuestionario, se estableció contacto con los casos por vía telefónica y se llevó a cabo una visita domiciliaria. Se llevó a cabo un análisis descriptivo de los datos y una descripción de las experiencias y percepciones durante las visitas. Resultados: Se identificó que la mayoría de los contactos eran familiares directos de los casos, que no contaban con un esquema de vacunación completo, ni contra la influenza y la frecuencia de síntomas varió de 1 hasta 4. Comentarios finales: Ante una situación de este tipo (la Pandemia del Virus de la Influenza Humana A (H1N1)) el papel de la enfermera en salud pública es de suma importancia no solo en la búsqueda de los casos y sus contactos, sino también en la orientación y educación de la población en relación a las medidas preventivas.

In the view of an infectious and contagious disease epidemic, the identification of the contacts limits its transmission. The objective of this work was to identify the contacts of the possible cases of UNAM workers in order to establish communication and provide health education about hygiene measures. Material and methods: A questionnaire was prepared, telephone contact was established with the cases, and a home visit was arranged. A descriptive analysis of the data was carried out, as well as, a description of the experiences and perception during the home visit. Results: Most identified contacts were relatives of the cases, which did not have a complete vaccine scheme, no even against influenza, and the frequency of symptoms varied between 1 a 4. Final comments: In a situation like this (A(H1N1) human influenza virus pandemic) the public health nurse roll is of great importance, not just in the identification of the cases and its contacts, but also in the orientation and education of the population in relation to preventive measures.

[Memory loss: a reason for consultation]. / Pérdida de memoria como motivo de consulta.

INTRODUCTION: Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. METHODS: We studied 200 patients who came to general neurology consultation due to loss of memory. RESULTS: 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. CONCLUSIONS: Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

Pérdida de memoria como motivo de consulta / Memory loss: a reason for consultation

Introducción. La pérdida de memoria es motivo de consulta de frecuencia creciente en neurologia; el objetivo de este trabajo es conocer la frecuencia actual, asi como las características y patologías de los pacientes que acuden por este motivo. Métodos. Se estudian 200 pacientes que acuden a una consulta de neurología general por pérdida de memoria. Resultados. El 18,47 % de los pacientes que acuden por primera vez a una consulta de neurología general lo hacen por pérdida de memoria, siendo pérdida subjetiva de memoria (PSM) en el 39 % de los casos y pérdida referida de memoria (PRM) en el 61 %. Los grupos diagnósticos a los que pertenecen los pacientes son por orden decreciente los siguientes: demencia degenerativa primaria tipo enfermedad de Alzheimer, deterioro cognitivo leve, demencia mixta, demencia vascular pura, seudodemencia depresiva, demencia degenerativa primaria no tipo enfermedad de Alzheimer, atribuible a fármacos y tóxicos, secundaria a enfermedad sistémica, causas estructurales, amnesia global transitoria y epilepsia. En el 13 % de ellos no se encuentra ningún tipo de patología y suelen acudir por PSM. Conclusiones. La frecuencia de la pérdida de memoria como motivo de consulta continúa creciendo. Los pacientes estudiados por pérdida de memoria en los que no se encuentra patología suelen ser aquellos que presentan PSM, a pesar de lo cual la PSM es un buen predictor de deterioro cognitivo. Es importante realizar un abordaje sistematizado de todo paciente que consulte por pérdida de memoria e investigar el posible uso de fármacos o tóxicos que puedan alterar la memoria

Introduction. Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. Methods. We studied 200 patients who carne to general neurology consultation due to loss of memory. Results. 18.47 % of the patients who carne for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39 % of the cases and referred loss of memory (RLM) in 61 % of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13 % of them, and the generally carne due to SLM. Conclusions. Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are gene rally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory

[Stereotactic target identification for neurosurgery of Parkinson disease]. / Identificación de las dianas estereotáxicas en la cirugía de la enfermedad de Parkinson.

INTRODUCTION: The use of applied neurophysiological methods to improve the stereotactic localization of devices in the deep human brain is a high and systematic technology in Parkinson's neurosurgery today. The available standard equipment for clinical neurophysiology practice may constitute the basic set for high tech functional neurosurgery. Free run and event related multiunit recording, naturalistic and electrical evoked potentials, and deep brain microstimulation responses are the basic methodological set to neurophysiological target localization. DEVELOPMENT AND CONCLUSIONS: This article is concerned with the topic: set out a high technology using low cost equipment. So our 41 cases experienced in pallidal and thalamic nucleolisis and thalamus and subthalamus DBS results suggest that the proposed equipment and methods are the required to assure accuracy and safety for target location.

Functional sexual dimorphism of the nucleolar organizer regions in the tuberomamillary nucleus.

The tuberomamillary nucleus (TM) is a cluster of magnocellular neurons that are located close to the mamillary recess or basal surface of the mamillary body (MBs) and is the only known source of histamine (HA). The nucleolar organizer regions (NORs) of the nervous cells of the subnuclei E1, E2 and E3 of the TM are quantified in this paper to discern the existence of possible sexual differences in the overall neuronal protein synthesis between male and female rats in two phases of the oestrous cycle (oestrous-dioestrous). We have used the argentic impregnation technique of the NORs (AgNORs) in both bilateral nuclei of the TM and found functional bilateral symmetry in its AgNORs. Furthermore, we demonstrate the existence of significant differences (P < 0.001) between sexes and between two phases of the oestrous cycle studied (oestrous-dioestrous) in the parameter of number of AgNORs per neuron. Hormonal manipulation of the TM in the rat during the two periods, postnatal or adult, shows the importance of the activational effect of the hormones on the activity of cellular protein synthesis.

[Evaluation of topical calcipotriol in psoriasis]. / Evaluación de calcipotriol tópico en psoriasis.

Calcipotriol is an analogue of vitamin D3 with effect on epidermal keratinization, cellular division and modulation of immune response. An evaluation of its therapeutic effect when given in twenty-five psoriatic patient with less than 25% of their body surface affected was done. The medication was applied twice daily during six weeks on involved areas. The evolution was evaluated by the psoriatic area and severity index (PASI) analysis. The evaluation of initial and terminal PASI analysis revealed a decrease in the psoriatic activity that fluctuated from 25% to 100%, with a 61% average. A reactivation in the psoriatic lesion was noticed two weeks after the medication was halted; thereafter, the calcipotriol was restarted for an additional four weeks and a decrease in their PASI with a 74% average was achieved. There were no important side effects reported. Calcipotriol is effective in the treatment of psoriasis and it is an important addition to the therapeutic medications available to treat psoriasis. It is important to give the treatment for longer periods of time for evaluating the possibility to induce prolonged remissions.

Functional sexual differences in rat mammillary bodies: a quantitative Ag-NOR study.

The mammillary bodies of the posterior hypothalamus are one of the CNS structures in which structural sexual dimorphism has already been described. This study quantifies the argyrophilic nucleolar organizer regions (NORs) of the neurons from this region in the male and female rats, the latter during two major phases of the estrous cycle (estrus-diestrus). The number and relative area of these NORs stained with a silver nitrate technique are considered as an index of the global protein synthesis of the neurons in the different nuclei from the mammillary bodies. Our results show the existence of statistically significant differences between sexes and estrous cycle phases. These findings suggest a significant influence of gender and the hormonal state on the neural activity of the MB.