[Etiology and risk factors for a first episode of cerebral isquemia in young adults]. / Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes.

INTRODUCTION: To determinate the etiology and risk factors for a first episode of cerebral ischemia in young adults at three hospitals of Lima and Callao-Peru. METHODS: Multicentric study carried out at three national hospitals in Lima. The sample included 30 patients with a first episode of stroke and 60 controls matched by age and sex 2:1 with the patients. Serum biochemistry studies, EKGs and echocardiograms were done. Etiologies were classified based on the classification of Baltimore-Washington Cooperative Young Stroke Study. RESULTS: The most frequent etiologies were cardiac embolism and atherosclerotic valvular heart disease, which were 30% of the cases (9 patients) each one. Hypertriglyceridemia (p=0.014), valvular heart disease (p=0.001) and hormonal contraception/replacement therapy (p=0.002) were independent risk factors for a first episode of cerebral ischemia in peruvian young adults. Motor deficiency was the most frequent presentation (50.0%). Intracraneal hypertension and urinary tract infection were the most frequent complications during acute ischemia and mortality was raised up to 10%. CONCLUSIONS: The hypertriglyceridemia, valvular heart disease and the use of oral contraceptives are independent risk factors for a first episode of ischemia in young adults from three hospitals of Lima and Callao. The most frequent etiologies were cardiac embolism and atheroesclerotic valvular heart disease.

Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes / Etiology and risk factors for a first episode of cerebral isquemia in young adults

Introducción: Determinar la etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes de tres hospitales de Lima y Callao-Perú. Métodos.Estudio de casos y controles, multicéntrico realizado en el Hospital Nacional Dos de Mayo, Hospital Nacional Daniel Alcides Carrión y Hospital EsSalud Alberto Sabogal Sologuren. La muestra estuvo constituida por 30 pacientes con un primer episodio de enfermedad cerebrovascular y 60 controles pareados por edad y sexo 2:1 con los pacientes. A todos se les realizó estudios de bioquímica sérica y evaluación cardiovascular (electrocardiograma y ecocardiografía). Las etiologías fueron clasificadas de acuerdo a la clasificación de Baltimore-Washington Cooperative Young Stroke Study. Resultados: Las etiologías más frecuentes fueron el cardioembolismo y la vasculopatía aterosclerótica con un 30% de casos (9 pacientes) cada uno. Los factores de riesgo independientes para un primer episodio de isquemia cerebral fueron la hipertrigliceridemia (p=0,014), la enfermedad valvular cardiaca (p=0,001) y la anticoncepción/reemplazo hormonal (p=0,002). El déficit motor fue la forma de presentación más frecuente (50,0%); la hipertensión endocraneana y la infección del tracto urinario fueron las principales complicaciones durante el episodio agudo y la mortalidad fue del 10%.Conclusiones: La hipertrigliceridemia, enfermedad valvular cardiaca y el uso de anticonceptivos/reemplazo hormonal constituyen factores de riesgo independientes para un primer episodio de isquemia en adultos jóvenes de tres hospitales de Lima y Callao, siendo las etiologías más frecuentes el cardioembolismo y la vasculopatía aterosclerótica (AU)

Introduction: To determinate the etiology and risk factors for a first episode of cerebral ischemia in young adults at three hospitals of Lima and Callao-Peru.Methods: Multicentric study carried out at three national hospitals in Lima. The sample included 30 patients with a first episode of stroke and 60 controls matched by age and sex 2:1 with the patients. Serum biochemistry studies, EKGs and echocardiograms were done. Etiologies were classified based on the classification of Baltimore-Washington Cooperative Young Stroke Study. Results: The most frequent etiologies were cardiac embolism and atherosclerotic valvular heart disease, which were 30% of the cases (9 patients) each one. Hypertriglyceridemia (p=0.014), valvular heart disease (p=0.001) and hormonal contraception/replacement therapy (p=0.002) were independent risk factors for a first episode of cerebral ischemia in peruvian young adults. Motor deficiency was the most frequent presentation (50.0%). Intracraneal hypertension and urinary tract infection were the most frequent complications during acute ischemia and mortality was raised up to 10%. Conclusions: The hypertriglyceridemia, valvular heart disease and the use of oral contraceptives are independent risk factors for a first episode of ischemia in young adults from three hospitals of Lima and Callao. The most frequent etiologies were cardiac embolism and atheroesclerotic valvular heart disease (AU)

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district.

BACKGROUND: Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. OBJECTIVE: To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). METHODS: An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. RESULTS: In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. CONCLUSION: Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Pénfigo foliáceo endémic en Ucayalí, Perú: Reporte de 16 caso / Pemphigus foliaceous in Ucayali, Peru: Report of 16 cases

Se reporta 16 casos de pénfigo foliáceo endémico en el departamento de Ucayali, en su mayoría procedentes de la provincia de Coronel Portillo (94 por ciento); el 50 por ciento corresponde al distrito de Campo Verde. El 80 por ciento de los pacientes provenían de un área rural y el 56 por ciento de los casos fueron de sexo femenino. Afecta a la población pediátrica en un 44 por ciento (7 casos); y el compromiso de las lesiones cutáneas fue generalizado en un 100 por ciento de los casos; sin compromiso de mucosas. El signo de Nikolsky estuvo presente en el 50 por ciento. En todos los casos se encontró acantólisis subcórnea y sólo el 40 por ciento tuvo inmunofluorescencia positiva para pénfigo.