RESUMO

Objetivo: Describir las características clínicas y demográficas de los pacientes internados con pie diabético complicada con infección en el servicio de clínica médica del Hospital Regional de Coronel Oviedo, Paraguay durante el año 2021. Materiales y métodos: Se realizó un estudio observacional descriptivo de corte transversal, con muestreo no probabilístico de casos consecutivos de pacientes mayores de 18 años diagnosticados con pie diabético internados en el servicio de clínica médica del Hospital Regional de Paraguay durante el año 2021, donde las variables fueron la edad, grado de Wagner, primer y segundo antibiótico dirigido y tipo de procedimiento quirúrgico. Resultados: Fueron incluidos 76 pacientes, el 57% fue del sexo masculino. De acuerdo con la clasificación de Wagner 36 pacientes (47%) tenían un grado de Wagner IV y 20 pacientes (26%) un grado de Wagner III. El tratamiento fue conservador en el 53% (n=41). El 30% (n=23) requirió amputación de las falanges y el 6% (n=5) requirió amputación infracondílea. Conclusión: En su mayoría fueron del sexo masculino, a su vez en su mayoría fueron los grados III y IV de Wagner. Entre los pacientes que necesitaron cirugía, las amputaciones de falanges fueron el procedimiento más común. En cuanto al tratamiento terapéutico predominó el uso de betalactámicos y medicamentos anaeróbicos.

Objective: To describe the clinical and demographic characteristics of patients hospitalized with diabetic foot complicated with infection in the medical clinic service of the Regional Hospital of Coronel Oviedo, Paraguay during the year 2021. Materials and methods: A cross-sectional descriptive observational study was carried out, with non-probabilistic sampling of consecutive cases of patients over 18 years of age diagnosed with diabetic foot admitted to the medical clinic service of the Regional Hospital of Paraguay during the year 2021, where the Variables were age, Wagner grade, first and second targeted antibiotic, and type of surgical procedure. Results: 76 patients were included, 57% were male. According to the Wagner classification, 36 patients (47%) had a Wagner grade IV and 20 patients (26%) had a Wagner grade III. Treatment was conservative in 53% (n=41). 30% (n=23) required phalangeal amputation and 6% (n=5) required infracondylar amputation. Conclusion: Most of them were male, in turn most of them were Wagner grades III and IV. Among patients who required surgery, phalangeal amputations were the most common procedure. Regarding therapeutic treatment, the use of beta-lactams and anaerobic medications predominated.

RESUMO

RESUMEN La ocurrencia de casos de cálculos urinarios considerados como gigantes ha disminuido sensiblemente en su frecuencia desde el advenimiento de los antibióticos y el control apropiado de las infecciones urinarias. El diagnóstico de los mismos se da por sintomatología y estudios de imágenes. Se presenta el caso clínico de un hombre de 59 años de edad con litiasis vesical gigante recurrente. El paciente fue diagnosticado de dos litiasis de origen vesical tras realización de una tomografía axial computarizada del aparato urinario y posteriormente se le realizó una cistolitotomía para extracción de los cálculos de hasta 1435 g. El análisis morfoconstitucional de los cálculos reveló a la Brushita, Carbapatita y Estruvita como componentes principales. La evaluación metabólica señaló presencia de hipocitraturia e hiperoxaluria. Es el primer reporte en el país acerca de una litiasis gigante en que la composición de los cálculos indicaría procesos infecciosos como posibles causas de formación.

ABSTRACT The occurrence of cases of urinary stones considered as giant has decreased significantly in its frequency since the advent of antibiotics and the appropriate control of urinary tract infections. The diagnosis of them is based on symptomatology and imaging studies. We present a case of a 59-year-old man with recurrent giant bladder stones. The patient was diagnosed with two vesical stones after performing a computerized axial tomography of the urinary system and later a cystolithotomy was performed to remove stones of up to 1,435 g. The morphoconstitutional analysis of the calculus revealed brushite, carbapatite and struvite as main components. The metabolic evaluation indicated the presence of hypocitraturia and hyperoxaluria.This is the first report in the country of a giant lithiasis in which the composition of the stones would indicate infectious processes as the possible causes of formation.

Assuntos

RESUMO

El mundo, actualmente se enfrenta a una doble carga de malnutrición que incluye la desnutrición y la alimentación excesiva. A ello se suman las parasitosis intestinales que es una enfermedad frecuente con importante morbimortalidad en la población infantil, ligadas a la pobreza y malas condiciones higiénico-sanitarias. El objetivo de este trabajo fue describir el estado nutricional-hematológico y parasitológico de niños escolares de cuatro comunidades rurales de Paraguay. Estudio observacional descriptivo de corte transverso en el que participaron 102 niños de ambos sexos de 5 a 12 años de edad. Se realizó medición de peso y talla, utilizando balanza calibrada, y un altímetro fijado a la pared. Toma de muestra sanguínea por punción venosa para determinación de parámetros hematológicos, procesados en contador hematológico por impedancia. Muestras de heces de una sola toma fueron recogidas en frascos apropiados con formol al 10%, utilizándose 4 métodos: directo, flotación de Willis, Graham y de concentración. En relación al estado nutricional-hematológico se encontró que el 3,9% de los niños estaba con desnutrición moderada y el 9,8% presentó riesgo de desnutrición; anemia se observó en el 38,2% de los niños. En relación a la parasitosis, el estudio diagnóstico se realizó a 94 niños y se encontró que el 72,2% estaba parasitado, siendo Blastocystis hominis el más frecuente. Tanto la frecuencia de anemia como de parasitosis es alta en esta población, sin embargo no se pudo establecer una relación entre ellas(AU)

Assuntos

RESUMO

UNLABELLED: The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. AIM: To determine the lithogenic risk profile in patients with urolithiasis. MATERIAL AND METHODS: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. RESULTS: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. CONCLUSIONS: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Assuntos

RESUMO

Los menores de cinco años de edad se afectan por la falta de alimentos adecuados mucho más rápido que a edades superiores por las demandas del crecimiento. El objetivo fue evaluar la situación nutricional de niños menores de cinco años de comunidades rurales, indígenas y no indígenas. Previo consentimiento informado de los padres o tutores, fueron evaluados 226 niños menores de cinco años de ambos sexos, 117 indígenas y 109 no indígenas según indicadores antropométricos de malnutrición por defecto y por exceso. Se aplicó una encuesta para obtener información de las características sociodemográficas y hábitos alimentarios. En niños indígenas y no indígenas la prevalencia de desnutrición global fue de 2,4 % y 2,6 %, riesgo de desnutrición 22% y 5,1%, desnutrición crónica 35,9% y 12,8%, sobrepeso 28,9% y 12,9%, respectivamente. Se observó un consumo frecuente de frutas en ambas poblaciones, seguida del consumo de proteína vegetal en población indígena y de proteína animal en los no indígenas. El 69,2% de los niños indígenas y el 3,7% de los niños no indígenas vivían en la pobreza extrema. Los principales problemas nutricionales encontrados fueron la desnutrición crónica, el riesgo de desnutrición y el sobrepeso. Los niños más fuertemente afectados son los indígenas, que sobreviven en difíciles condiciones socioeconómicas.

Children under five years of age are affected by the lack of adequate food faster thanolder individuals due to growth demands. The objective was to evaluate the nutritional situation of indigenous and non-indigenous children under five years living in rural communities. After obtaining the informed consent of their parents, 226 boys and girls under five years, 117 indigenous and 109 non-indigenous children, were evaluated using nutritional indicators of malnutrition by defect and excess. A questionnaire was applied toobtain information about social-demographic characteristics and dietary habits. Inindigenous and non-indigenous children, the prevalences of global malnutrition were 2.4% and 2.6%, malnutrition risk 22% and 5.1%, chronic malnutrition 35.9% and 12.8%,overweight 28.9% and 12.9%. Frequent consumption of fruits was observed in both populations, followed by consumption of vegetable protein in indigenous population and animal protein in non-indigenous. 69.2% of indigenous children and 3.7% of non-indigenous children living in extreme poverty. The main nutritional problems found were chronic malnutrition, malnutrition risk and overweight. The most strongly affected children were theindigenous, who survive in difficult socio-economic conditions.

Assuntos

RESUMO

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Assuntos

RESUMO

Background: Official figures of mortality in children under five years of age in the Americas, report that infectious and parasitic diseases caused most of the deaths. Objective: To evaluate the frequency of intestinal parasites in vulnerable children, indigenous and non-indigenous, and their socio-environmental characteristics. Patients and Methods: We evaluated 247 children under five years of age, of both sexes. Descriptive study with an analytical component, transverse cutting. Copro-parasitological examinations were carried out and semi-structured interviews to collect socio-demographic data were conducted. Results: The frequency of intestinal parasitic diseases was 56.1% and 35.5% in indigenous and non-indigenous children, respectively. In both populations, the most common pathogens were Blastocystis hominis and Giardia lamblia. Conclusion: We found a high frequency of parasitism in indigenous children at the expense of protozoa. Non-indigenous children still present the same parasitic species found in previous studies, suggesting the need to implement more control and prevention. The poor conditions in which they live favor the development of these diseases.

Introducción: Cifras oficiales de mortalidad en niños bajo 5 años de edad, en las Américas, refieren que la mayor parte de las defunciones fueron causadas por enfermedades infecciosas incluyendo las parasitarias. Objetivo: Evaluar la frecuencia de enteroparasitosis en población infantil vulnerable, indígenas y no indígenas, y sus características socio-ambientales. Pacientes y Métodos: Se evaluaron 247 niños bajo 5 años de edad, de ambos sexos. Estudio descriptivo con componente analítico, de corte transverso. Se realizaron exámenes copro-parasitológicos y se aplicaron encuestas semi-estructuradas para recoger datos socio-demográficos. Resultados: la frecuencia de enteroparasitosis en los niños indígenas fue de 56,1% y en los niños no indígenas de 35,5%. En ambas poblaciones los patógenos más frecuentes fueron Gardia lamblia y Blastocystis hominis. Conclusión: Encontramos una elevada frecuencia de parasitosis en la población infantil indígena, a expensas de los protozoarios. Los niños no indígenas siguen portando las mismas especies parasitarias encontradas en estudios anteriores, sugiriendo la necesidad de implementar un mayor control y prevención. Existen escasos estudios en nuestro país sobre parasitosis en edades tempranas y no se cuentan con datos en la niñez indígena. Las pobres condiciones en las que viven favorecen el desarrollo de estas enfermedades.

Assuntos

RESUMO

BACKGROUND: Official figures of mortality in children under five years of age in the Americas, report that infectious and parasitic diseases caused most of the deaths. OBJECTIVE: To evaluate the frequency of intestinal parasites in vulnerable children, indigenous and non-indigenous, and their socio-environmental characteristics. PATIENTS AND METHODS: We evaluated 247 children under five years of age, of both sexes. Descriptive study with an analytical component, transverse cutting. Copro-parasitological examinations were carried out and semi-structured interviews to collect socio-demographic data were conducted. RESULTS: The frequency of intestinal parasitic diseases was 56.1% and 35.5% in indigenous and non-indigenous children, respectively. In both populations, the most common pathogens were Blastocystis hominis and Giardia lamblia. CONCLUSION: We found a high frequency of parasitism in indigenous children at the expense of protozoa. Non-indigenous children still present the same parasitic species found in previous studies, suggesting the need to implement more control and prevention. The poor conditions in which they live favor the development of these diseases.

Assuntos

RESUMO

BACKGROUND: The prevalence of spondyloarthritis (SpA) varies across populations. In Mexicans, the prevalence of SpA is still unknown. OBJECTIVE: The objective of this study was to determine the prevalence of SpA in the community as well as that of inflammatory back pain (IBP) and ankylosing spondylitis (AS). METHODS: We identified individuals older than 18 years with nontraumatic back pain (BP) in a door-to-door nurse survey using the Community Oriented Program for the Control of Rheumatic Diseases. Then, general physicians and rheumatology fellows selected those likely to have IBP (Berlin criteria). Finally, 2 expert rheumatologists assessed IBP individuals according to clinical data and classification criteria and requested HLA-B27 and radiographic studies to determine the clinical condition of the individual and SpA (European SpA Study Group) classification. RESULTS: The prevalence of BP among 4059 individuals was 14.6% (95% confidence interval [CI], 13.6-15.8). The prevalence of IBP and SpA was 1.3% (95% CI, 1.0-1.7) and 0.6% (95% CI, 0.4-0.9), respectively. Ankylosing spondylitis prevalence was 0.1% (95% CI, 0.02-0.2). Inflammatory back pain and SpA percentage of males and females was similar. The percentage of individuals with IBP according to the 2 experts was lower than that determined by general physicians and rheumatology fellows, but all cases with HLA-B27, radiographic sacroiliitis, SpA, and AS had previous IBP confirmation by the expert. CONCLUSIONS: The prevalence and sex distribution of patients classified with SpA in this community study--as well as that of patients diagnosed with AS--are consistent with those found in recent studies. Expert assessment of individuals with positive responses to questionnaires is relevant for the classification of IBP and SpA.

Assuntos

RESUMO

OBJECTIVE: Back pain (BP) is frequent in the community; its prevalence in México is 6%. Our objective was to determine the prevalence of BP in Mexican communities and determine its most important characteristics. METHODS: A cross-sectional study of individuals aged > 18 years was conducted in Mexico City and in urban communities in the state of Nuevo León. Sampling in Mexico City was based on community census and in Nuevo León, on stratified, balanced, and random sampling. Procedures included a door-to-door survey, using the Community Oriented Program for the Control of Rheumatic Diseases, to identify individuals with BP > 1 on a visual analog scale in the last 7 days. General practitioners/rheumatology fellows confirmed and characterized BP symptoms. RESULTS: In all, 8159 individuals (mean age 43.7 yrs, two-thirds female) were surveyed and 1219 had BP. The prevalence of nontraumatic BP in the last 7 days was 8.0% (95% CI 7.5-8.7). The mean age of these individuals was 42.7 years, and 61.9% were female. Thirty-seven percent had inflammatory BP [prevalence of 3.0% (95% CI 2.7-3.4)]. Compared with the state of Nuevo Léon, the characteristics and consequences of BP in Mexico City were more severe. In logistic regression analysis, living in Mexico City, having a paid job, any kind of musculoskeletal pain, high pain intensity, and obesity among other variables were associated with BP. CONCLUSION: The prevalence of nontraumatic BP in the last 7 days in urban communities in México is 8.0%. However, clinical features and consequences differed among the communities studied, suggesting a role for local factors in BP.

Assuntos

RESUMO

BACKGROUND: The management of type 2 diabetes mellitus is complicated by the presence of risk factors related to overweight and obesity, particularly visceral adiposity. However, weight loss and weight maintenance are difficult for patients with diabetes, and the benefits of dietary modifications are typically modest. Sibutramine is a serotonin- and norepinephrine-reuptake inhibitor that reduces food intake by inducing early satiety and attenuates the decrease in basal energy expenditure associated with weight loss. Previous trials of sibutramine in overweight and obese patients with type 2 diabetes have shown significant weight loss accompanied by better glycemic control. OBJECTIVE: The goal of this study was to assess the effect on body weight and glycemic control of sibutramine in combination with glibenclamide in obese Hispanic patients with type 2 diabetes. METHODS: This was a 12-month, randomized, double-blind, placebo-controlled clinical trial conducted at the Endocrinology Service, General Hospital of Mexico, Mexico City. Included were overweight or obese (body mass index [BMI] >27 kg/M2) patients with type 2 diabetes between the ages of 24 and 65 years who had been receiving glibenclamide monotherapy for at least 2 weeks and whose glucose concentrations were stable. Patients were randomized to receive sibutramine 10 mg or placebo once daily. The primary efficacy measures were change in body weight, waist circumference, and glycosylated hemoglobin (HbA1c). Anthropometrics and fasting glucose concentrations were measured monthly. HbA1c was determined at baseline and at 6 and 12 months. Laboratory parameters were measured at baseline and at the end of the study. RESULTS: Forty-four patients were randomized to receive sibutramine (28 women, 16 men; mean [SD] age, 47.6 [9.0] years), and 42 were randomized to receive placebo (31 women, 11 men; mean age, 45.8 [8.1] years). Twenty-four patients in the sibutramine group and 23 in the placebo group completed the trial. In the sibutramine group, body weight was reduced from a mean (SD) of 73.9 (10.3) kg at baseline to 69.8 (10.6) kg at month 12; BMI decreased from 29.9 (2.6) to 28.2 (2.9) kg/M2; waist circumference was reduced from 94.9 (8.4) to 90.8 (8.4) cm; the plasma fasting glucose concentration decreased from 140.4 (29.4) to 114.2 (32.0) mg/dL; and the HbA1c value was reduced from 8.9% (1.2) to 8.3% (1.2) (all, P < 0.001). In the placebo group, the corresponding changes were from 74.5 (10.3) kg at baseline to 73.1 (11.2) kg at month 12; from 30.1 (2.5) to 29.5 (2.9) kg/M2; from 94.4 (7.3) to 93.1 (8.3) cm (P < 0.05); from 140.7 (25.2) to 123.9 (38.3) mg/dL (P < 0.05); and from 9.0% (1.2) to 9.1% (1.3). In the sibutramine group, weight loss continued for up to 12 months. CONCLUSION: In this population of obese Hispanic patients with type 2 diabetes, sibutramine combined with glibenclamide therapy achieved weight loss for up to 12 months and was associated with better glycemic control than placebo.

Assuntos

RESUMO

Se hace un estudio de 100 pacientes de 0 a 14 años a quienes se les realizaron investigaciones endoscópicas en el Instituto de Gastroenterología. Nuestro objetivo fue seleccionar un anestésico de corta duración, que al metabolizarse no dañara el hígado en los niños con enfermedades hepáticas y demostrar que la ketamina es el anestésico de elección en las endoscopias digestivas en la infancia. Los resultados obtenidos en 100 niños a los que se les realizó laparoscopia con biopsia hepática o sin ésta, gastroscopia y duodenoscopia, y colonoscopia, demostraron gran efectividad del medicamento, cuya acción se logró entre los 20 y 40 s de su administración. Los efectos secundarios (rash cutáneo, sialorrea, excitación, vómitos, etcétera) se presentaron solo en el 9% de los casos; el estado emocional previo a la endoscopia influye al valorar los efectos secundarios, por lo que se utilizó una premedicación con diazepan por vía endovenosa

Assuntos