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Introduction Decompressive craniectomy (DC) is a valuable treatment for reducing early lethality in malignant intracranial hypertension (IH); however, it has been shown that the decision to implement DC in patients with extensive ischemic stroke should not be based solely on the detection of IH with the use of intracranial pressure (ICP) devices. Objective To establish the usefulness of DC in patients with extensive ischemic stroke who came to the emergency room during the period between May 2018 and March 2019. Methods This was an analytical, prospective, and longitudinal study whose population corresponded to all patients with a diagnosis of extensive ischemic stroke. Results The sample consisted of 5 patients, of which 3 were female and 2 males, the average age was 62.2 years old (minimum 49 years old, maximum 77 years old). Of all the patients who underwent DC, it was found that 80% of the patients did not present an increase in intracranial pressure. Decompressive craniectomy was not performed in a case that responded adequately to medical treatment. The mean values of ICP were 25 mmHg with a minimum value of 20 mmHg and a maximum value of 25 mmHg; in patients with a moderate value, the ICP averages were < 20 mmHg. The mortality was of 40% (RANKIN of 6 points). Conclusions Decompressive craniectomy is useful in extensive ischemic stroke. The decision to implement DC in patients with extensive stroke rests on clinicoradiological parameters. The monitoring of the IPC was not particularly useful in the early detection of the neurological deterioration of the patients studied.
Fundamento A craniectomia descompressiva (CD) é um tratamento valioso para reduzir a letalidade precoce na hipertensão intracraniana (HI) maligna; no entanto, foi demonstrado que a decisão de implementar a CD em pacientes com acidente vascular cerebral (AVC) isquêmico extenso não deve ser baseada apenas na detecção de HI com o uso de dispositivos de pressão intracraniana (PIC). Objetivo Estabelecer a utilidade da CD em pacientes com AVC isquêmico extenso que chegaram ao pronto-socorro no período entre maio de 2018 e março de 2019. Métodos Foi realizado um estudo analítico, prospectivo e longitudinal cuja população correspondeu a todos os pacientes com diagnóstico de AVC isquêmico extenso. Resultados A amostra foi composta por 5 pacientes, sendo 3 do sexo feminino e 2 do sexo masculino, com média de idade de 62,2 anos (mínimo 49 anos, máximo 77 anos). De todos os pacientes que realizaram CD, verificou-se que 80% dos pacientes não apresentaram aumento da pressão intracraniana. Não foi realizada uma CD que tenha respondido adequadamente ao tratamento médico. Os valores médios de pressão intracraniana foram de 25 mmHg, com o valor mínimo de 20 mmHg e o valor máximo de 25 mmHg; em pacientes com escala moderada, as médias de PIC foram < 20 mm Hg. A mortalidade foi de 40% (RANKIN de 6 pontos). Conclusões A DC é útil no AVC isquêmico extenso. A decisão de implementar uma CD em pacientes com AVC extenso depende de parâmetros clínico-radiológicos. O monitoramento do PCI não foi muito útil na detecção precoce da deterioração neurológica dos pacientes estudados.
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Objetivo Determinar el Riesgo de diabetes mellitus según FINDRISC en indígenas Warao de Barrancas del Orinoco, Monagas, Venezuela. Metodología Se realizó un estudio observacional, descriptivo y de corte transversal en diciembre del 2015. El universo estuvo conformado por 213 indígenas y la muestra por 103 individuos. Se incluyeron pacientes sin diagnóstico de diabetes y mayores de 12 años. Se aplicó la encuesta FINDRISC. Los datos fueron agrupados y procesados por medio del programa estadístico SPSS, en el cual se aplicó la prueba estadística de chi-cuadrado de homogeneidad que arrojó un valor estadísticamente significativo de p<0,05. Resultados De 103 pacientes incluidos en el estudio, 57 eran del sexo femenino y 46 del masculino. Por sexo, el riesgo de diabetes con puntaje menor a 7 (leve) fue más frecuente en el masculino (63,0%) y el puntaje de 12-14 (riesgo moderado) fue similar en ambos sexos, sin diferencias estadísticamente significativas (p=0,37). La frecuencia de pacientes con 50 años y más con riesgo alto fue de 11,1%, seguido de los de 30-39 años, con 7,7%. El riesgo moderado (12-14 puntos) fue más frecuente en los pacientes con edades de 40-49 años, con un 44,4% y diferencias estadísticamente significativas por edad (p<0,00001). En general, los indígenas de la etnia Warao obtuvieron un riesgo alto de diabetes en el 3,9%, el riesgo moderado fue de 10,7% y más de la mitad obtuvo resultados de bajo riesgo, con 54,4%. Conclusión Los indígenas de la etnia Warao tienen un bajo riesgo de diabetes.
Objective To determine the risk of diabetes mellitus according to FINDRISC in Warao indigenous of Barrancas del Orinoco, Monagas, Venezuela. Methodology An observational, descriptive and cross-sectional study was carried out in December 2015. Universe was conformed by 213 natives and sample conformed by 103 individuals. Patients without diagnosis of diabetes and older than 12 years were included. The FINDRISC survey was applied. The data were grouped and processed by means of the statistical program SPSS, the statistical test of chi-square of homogeneity was applied and a value of p<0.05 was considered as statistically significant. Results Of 103 patients included in the study, 57 were female and 46 were male. By sex, the risk of diabetes with a score lower than 7 (mild) was more frequent in men (63.0%), the score of 12-14 (moderate risk) was similar in both sexes, with no statistically significant differences (p=0.37). The frequency of patients who were 50 years old and more at high risk was 11.1% followed by those aged 30-39 years with 7.7%. The moderate risk (12-14 points) was more frequent in patients aged 40-49 years old with 44.4%, with statistically significant differences being found by age (p<0.00001). In general, the indigenous people of the Warao ethnic group had a high risk of diabetes in 3.88%, the moderate risk was 10.7%, and more than half obtained low risk results with 54.4%. Conclusion The indigenous people of the Warao ethnic group have a low risk of diabetes.
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Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected,with 5 cases, followed by the parietal lobe,with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias Encefálicas/cirurgia , Monitorização Intraoperatória/métodos , Ultrassonografia , Neuronavegação/métodos , Glioma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Epidemiologia Descritiva , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Glioma/fisiopatologia , Glioma/diagnóstico por imagemRESUMO
RESUMEN La espondilitis tuberculosa (enfermedad de Pott) representa del 1-5% de los casos de tuberculosis. Se presenta un caso clínico de una paciente femenina de 14 años de edad con esta patología complicada con fractura de cuerpos vertebrales T4, T7, T8 y T9; a quien se le realizó un abordaje por vía posterior, consistente en laminectomía completa bilateral de T3, T4, T7, T8, T9 preservando las articulaciones facetarias, mas artrodesis instrumentada con ganchos sublaminares en T1-T2, colocación de alambres sublaminares T5 y T6, tornillos transpediculares en T11 y dos barras de titanio. Con excelentes resultados postoperatorios. Además, se discuten las diferentes vías de abordaje quirúrgico de esta patología.
ABSTRACT Tuberculous spondylitis (Pott's disease) represent 1-5% of tuberculosis cases. We present a clinical case of a female patient of 14 years of age with tuberculous spondylitis (Pott's disease) complicated with vertebral body fracture T4, T7, T8 and T9, who underwent a posterior approach, bilateral complete laminectomy of T3, T4, T7, T8, T9 preserving the facet joints, more arthrodesis instrumented with sublaminar hooks in T1-T2 placement of sublaminar wires T5 and T6 placement of transpedicular screws in T11, and two titanium bars. With excellent postoperative results. In addition, the different surgical approaches to this pathology are discussed.
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Resumen Introducción. El aborto se ha convertido en un problema de salud pública. Una las causas que podría estar influyendo para su aumento es la falta de información sobre el control prenatal, por lo anterior, este es un tema que no escapa de la realidad y de la práctica médica. Objetivo. Caracterizar clínica y epidemiológicamente el aborto. Materiales y Métodos. Estudio observacional, descriptivo, retrospectivo, realizado en el Hospital "Gervasio Vera Custodio" Upata-Estado Bolívar, Venezuela, durante el periodo comprendido de enero a diciembre de 2013. Se recolecto datos de 207 historias clínicas de mujeres con diagnóstico de aborto. En el análisis estadístico se aplicó la prueba chi2 de Pearson. Resultados. Se encontró que la edad prevalente de aborto fue de 21 a 30 años con 42%. La edad gestacional más frecuente de las pacientes fue de 1 a 8 semanas con 50%. De estas 93,5% no cumplieron control prenatal. El tipo de aborto más frecuente fue espontáneo con 98,5%. Se realizó legrado uterino a 97%, de las cuales, 8,5% presentaron complicaciones. Se encontraron diferencias estadísticamente significativas al relacionar la edad materna con la edad gestacional. Conclusiones. Existió alta prevalencia de aborto espontáneo en el grupo de 21 a 30 años de edad, presentados entre las semanas 1 a 8 de gestación. La técnica más segura fue el legrado uterino. Finalmente, se encontró bajo cumplimiento del control prenatal.
Abstract Introduction. The abortion has become a public health problem may be due to the lack of information about prenatal care, so that this is an issue which does not escape reality and everyday medical practice. Objective. Characterize the abortion clinic and epidemiologically. Materials and Methods. An observational, descriptive, retrospective study at the Hospital "Gervasio Vera Custodio" Upata-Ciudad Bolivar, Venezuela was performed from January to December 2013. Data from 207 women with diagnosed a diagnosis of abortion were collected from medical records. Pearson chi-square test was applied for the statistical analysis. Results. It was found that abortion was prevalent among 21-30 years old with a 42%. The most common gestational age of abortion was 1 to 8 weeks in the 50% and 93.5% of them did not meet prenatal care. The most frequent abortion was spontaneous in 98.5% ot the patients. Curettage was performed in 97%, of which 8.5% had complications. Statistically significant differences were found to maternal age related to gestational age. Conclusion. There was high prevalence of abortion in the group of 21-30 years of age with 1 to 8 weeks of gestation. The safest practice was the uterine curettage. Finally, the mayority of the cases had no prenatal care.
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Objetivo: Determinar el riesgo de Diabetes Mellitus tipo 2, en la comunidad rural de Apostadero, Municipio Sotillo. Estado Monagas. Venezuela. Materiales y métodos: Se realizó un estudio observacional, descriptivo y de corte transversal en Enero de 2013. Universo conformado por 163 personas mayores de 18 años. Se tomaron medidas antropométricas (peso, talla, índice de masa corporal [IMC], y circunferencia abdominal), glicemia capilar, tensión arterial y se aplicó la encuesta FINDRISC para estimar riesgo de diabetes en 10 años. Resultados: De una muestra de 41 voluntarios, 25 (61%) eran de género femenino y 16 (39%) de masculino. El promedio de IMC fue 28,08±5,69, la prevalencia de sobrepeso fue de 24,4% y de obesidad de 36,6%. El género femenino fue más afectado con IMC promedio de 29,52±6,04 vs masculino 25,84±4,37 (p<0,05). La prevalencia de pre-hipertensión fue de 31,7% y la de hipertensión arterial fue de 53,7%. La glicemia capilar media fue de 93,63±12,18 mg/dL y en cuanto al género no hubo diferencias significativas (p=0,17), la prevalencia de alteración de glicemia en ayunas fue de 24,4% y de Diabetes mellitus tipo 2 de 4,9%. El 21,95% de los encuestados estaban en alto riesgo de desarrollar diabetes mellitus tipo 2, siendo las mujeres las más afectadas significativamente (p=0,047). Conclusión: La población tiene un elevado riesgo de desarrollar diabetes tipo 2 en 10 años, siendo las féminas las más vulnerables.
Objective: To determine the risk of type 2 diabetes in the rural community of Apostadero, Sotillo Municipality. Monagas State. Venezuela. Methods: An observational, descriptive, cross-sectional study in January 2013 was performed. The universe was composed of 163 people over 18 years. Anthropometric measurements (weight, height, body mass index [BMI] and waist circumference), capillary glucose and blood pressure were taken. The FINDRISC survey was used to estimate the risk of diabetes in 10 years. Results: From a sample of 41 volunteers, 25 (61%) were female and 16 (39%) male. The mean BMI was 28.08 ± 5.69, the prevalence of overweight was 24.4% and obesity was 36.6%. Female gender was more affected with an average BMI of 29.52 ± 6.04 vs 25.84 ± 4.37 in men (p <0.05). The prevalence of prehypertension was 31.7% and that of hypertension was 53.7%. The mean capillary blood glucose level was 93.63 ± 12.18 mg/dL without gender differences; the prevalence of impaired fasting glucose was 24.4% and type 2 diabetes mellitus of 4.9%. High risk of developing type 2 diabetes mellitus was observed in 21.95% of the participants, women being the most affected (p=0.047). Conclusion: The population has a high risk of developing type 2 diabetes within 10 years, being women the most vulnerable.