RESUMO
BACKGROUND: Surgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAIs) can threaten these efforts. AIM: To analyse the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery programme. METHODS: Cohort study including children aged <12 years with CHD who underwent cardiovascular surgery between 2010 and 2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control programme databases. Impact of various preventive interventions was assessed using a Poisson model. P < 0.05 was considered statistically significant. FINDINGS: A total of 2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%), and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (P = 0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR: 0.56; 95% CI: 0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% of infections. No significant risk reduction was observed for other HAI with the implemented interventions. CONCLUSION: Preventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.
Assuntos
Infecção da Ferida Cirúrgica , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Masculino , Feminino , Pré-Escolar , Colômbia/epidemiologia , Lactente , Criança , Incidência , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estudos de Coortes , Controle de Infecções/métodos , Recém-Nascido , Antibioticoprofilaxia/métodosRESUMO
Introduction Cognitive impairment, usually associated with seizures and psychosis, is one of the main symptoms of autoimmune encephalitis. The objective of our study is to analyse cognitive impairment in patients with autoimmune encephalitis. Methods We conducted a descriptive cross-sectional study of clinical data from 39 patients older than 18 years diagnosed with autoimmune encephalitis. Twenty-two patients underwent neuropsychological assessment. Results All but one of the patients presented cognitive impairment. Memory was the most frequently affected domain (90.91%), followed by language (50%), attention (45.45%), executive function (40.91%), praxis (40.91%), and visuospatial skills (9.09%). No association was found with disease progression time, age, sex, or education level. Results from cerebrospinal fluid analysis, electroencephalography, and brain magnetic resonance imaging studies revealed alterations in 77.27%, 57.89%, and 55% of cases, respectively. Conclusions Memory is the most frequently affected cognitive domain; however, other cognitive domains were also altered in our patients. Neuropsychological assessment is crucial to determine which cognitive domains are impaired in patients with autoimmune encephalitis.
Introducción El deterioro cognitivo, habitualmente asociado a convulsiones y psicosis, es uno de los principales síntomas de la encefalitis autoinmune. El objetivo de nuestro estudio es analizar el deterioro cognitivo en pacientes con encefalitis autoinmune. Métodos Se realizó un estudio descriptivo de corte transversal de datos clínicos de 39 pacientes mayores de 18 años con diagnóstico de encefalitis autoinmune. A 22 pacientes se les realizó evaluación neuropsicológica. Resultados Todos los pacientes, excepto uno, presentaron deterioro cognitivo. La memoria fue el dominio más frecuentemente afectado (90,91%), seguido del lenguaje (50%), la atención (45,45%), la función ejecutiva (40,91%), la praxis (40,91%) y las habilidades visoespaciales (9,09%). No se encontró asociación con el tiempo de evolución de la enfermedad, la edad, el sexo o el nivel educativo. Los resultados de los estudios de análisis de líquido cefalorraquídeo, electroencefalografía y resonancia magnética cerebral revelaron alteraciones en el 77,27%, 57,89% y 55% de los casos, respectivamente. Conclusiones La memoria es el dominio cognitivo más frecuentemente afectado; sin embargo, otros dominios cognitivos también se vieron alterados en nuestros pacientes. La evaluación neuropsicológica es crucial para determinar qué dominios cognitivos están alterados en pacientes con encefalitis autoinmune.
Assuntos
Doenças Autoimunes do Sistema NervosoRESUMO
El sebaceoma es un tumor cutáneo poco frecuente que presenta diferenciación sebácea, y se localiza en piel de cabeza y cuello. Puede asociarse con la presencia de tumores malignos, asociación conocida como síndrome de Muir-Torre, por lo que ante su diagnóstico se deben descartar. Su localización en la piel del conducto auditivo externo es muy infrecuente. Presentamos nuestra experiencia en el manejo de esta patología en un varón de 78 años de edad que presentaba una lesión nodular sólida en el conducto auditivo externo izquierdo con pérdida de audición y otorrea como síntomas asociados. Se recomienda la exéresis completa de la lesión, como tratamiento de elección con fines tanto diagnósticos como terapéuticos.
Sebaceoma is a rare benign cutaneous tumor with sebaceous differentiation and it is typically located on the skin of the head and neck. This pathology made appear in association with malignant tumors (known as Muir-Torre syndrome) and must be ruled out. The location in the external auditory canal is very unusual. We present our experience in managing this pathology in a 78-year-old man who complains of hearing loss and otorrhea and presents a solid nodule in the left external auditory canal. Complete surgical removal was performed, as the choice treatment for diagnosis and therapeutic care.
Assuntos
Humanos , Masculino , Idoso , Neoplasias das Glândulas Sebáceas/patologia , Meato Acústico Externo/patologia , Carcinoma de Células Escamosas/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.
Assuntos
Síndrome de Guillain-BarréRESUMO
RESUMEN La vitamina D (VD), un esteroide pleiotrópico, ha sido relacionada con la función reproductiva masculina, pero aún no se ha estudiado la expresión de su receptor (RVD) en el desarrollo testicular. RVD regula la expresión de componentes del sistema histaminérgico, y la histamina (HA) modula la esteroidogénesis en células de Leydig (CL). Se ha relacionado a la deficiencia de VD con múltiples patologías, entre ellas cáncer. Los tumores de células de Leydig (TCL) son los más frecuentes del intersticio testicular, y al malignizar no responden a radio/quimioterapia. VD fue descripta como tratamiento para varios tumores, pero se desconoce su aplicación en TCL. Por lo expuesto, hemos estudiado la expresión de RVD en la ontogenia de testículo de rata, evaluando su correlación con los niveles de testosterona séricos (T) y el contenido de HA; y además evaluamos la expresión de RVD en testículo humano fetal, neonatal, prepuberal, TCL e hiperplasia de CL. En testículo de rata, se observó un aumento en la expresión de RVD en CL con la edad, en línea con el incremento de T, y en contraposición con la disminución del contenido de HA, lo cual fue consistente con la reducción en los niveles de la enzima que cataliza su síntesis, HDC. Esto sugiere que la VD podría ejercer una función en el desarrollo testicular normal, ya sea en forma directa sobre las CL o mediante la regulación de la expresión de componentes del sistema histaminérgico (HDC y/o receptores de HA). Por su parte, el TCL humano presentó sobreexpresión de RVD y HDC. Considerando que las hormonas esteroideas se encuentran aumentadas en esta patología y funcionan como factores de crecimiento, si el calcitriol pudiera modular la esteroidogénesis podría tener una aplicación terapéutica.
ABSTRACT Vitamin D (VD) is a steroid hormone traditionally related to bone health. However, several authors have associated VD with reproduction and steroidogenesis in males. The presence ofVD receptor (VDR) and the enzymes involved in its activation had been reported in several cell types of the testes. Until now, nobody has studied RVD expression during testicular development. In addition, VDR in association with its co-activators or co-repressors, regulates the expression of several genes, including those related to the histaminergic system. Previously, we demonstrated that histamine (HA) can modulate steroidogenesis in Leydig cells (LC) in a concentration-dependent manner. Also, we observed a decrease in the endogenous HA content, consistent with the previously described decrease of HDC (histidine decarboxylase, the enzyme responsible of HA synthesis) levels, during LC ontogeny. Epidemiologic studies strongly suggest that a relationship exists between VD deficiency and multiple pathologies, particularly cancer. Leydig cell tumors (LCT) are rare endocrine tumors ofunknown etiology, which originate in the testicular interstitium. The incidence worldwide is 1-3% in adults and 4% in prepubertal boys, but recent publications indicate that these figures have been increasing. While usually benign, approximately 10% of LCT in adults become malignant and do not respond to chemo or radiotherapy. It is imperative to deeply investigate the biology of LCT, to identify new therapeutic targets. The potential role of calcitriol (1a,25(OH)2-vitamin-D3) in cancer treatment has been described for several types of tumors, but it remains unexplored in LCT. Thus, as a first step, it is worth evaluating VDR expression in LCT.In view of the aforecited evidence, herein we studied VDR expression during the rat testicular ontogeny, evaluating a possible correlation withserum testosterone (T) levels in blood, endogenous levels of HA and the previously described HDC expression levels. We also analized VDR expression in human testes corresponding to three different stages of development (fetal, neonatal andjuvenile), in LCT and in LC hyperplasia. Methods: Rat testes of different ages (7, 21, 35, 90 y 240 days), human fetal, neonatal and pre pubertal testes, a human LCT and a human LC hyperplasia; were used for detection of VDR by immunohistochemistry. Results: In the rat testes, VDR expression increased with age in LC, in line with the increase in serum testosterone; and in contrast with the decrease in the endogenous content of HA and HDC levels. Likewise, we detected an increase in VDR expression with age in the human testes samples. LCT presentedVDR and HDC overexpression. We also detected VDR in LC hyperplasia. Conclusions: Given that VDR testicular expression increases with age in LC, as well as testosterone serum levels, it is reasonable to speculate thatVD may play a role in normal testicular development, either acting directly on LC or by regulating one of more components of the histaminergic system (HDC or HA receptors). Considering that VDR is overexpressed in LCT, and that steroids are increased in this pathology (and act like growth factors); if calcitriol could modulate steroidogenesis, it could have a therapeutic role.
RESUMO
Introduction: The diagnosis and treatment of depression in patients with Parkinson's disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD. Objective: To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD. Methods: This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA. Results: Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms. Conclusion: Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment.
Introducción: El diagnóstico y el tratamiento de la depresión en pacientes con enfermedad de Parkinson (EP) son inadecuados, lo que a menudo contribuye a una menor calidad de vida, una rápida progresión de la enfermedad, un mayor deterioro cognitivo y una mayor carga de cuidados para los familiares de los pacientes con EP. Objetivo: Determinar los factores asociados con la depresión en la EP y examinar la frecuencia de los síntomas depresivos entre los pacientes con EP. Métodos: Este estudio fue un estudio observacional, analítico y multicéntrico de una cohorte transversal, realizado entre julio de 2016 y mayo de 2017. Los pacientes con EP fueron reclutados en clínicas de neurología en Lima, Perú. Todos los análisis estadísticos se realizaron utilizando estadísticas descriptivas. Los análisis de regresión logística bivariada y multivariada se calcularon utilizando STATA. Resultados: De 124 pacientes (edad media: 68,7 años; 58% varones) incluidos en el estudio, el 60,5% (75/124) presentó síntomas de depresión; sólo el 20% (25/124) recibió antidepresivos. Los factores asociados a la depresión en la EP incluyeron: desempleo, caídas, congelamiento de la marcha, micrografía de movimientos involuntarios, postura encorvada, hiposmia, trastornos del movimiento durante el sueño, progresión rápida de la enfermedad y el uso de IMAO. Además, se encontraron diferencias estadísticamente significativas en la duración de la enfermedad, puntuaciones UPDRS y MMSE, estadio de Hoehn y Yahr (HY) y tiempo de toma de L-dopa entre pacientes con EP con y sin síntomas depresivos. Conclusión: Los factores asociados a los síntomas depresivos en pacientes con EP fueron la hiposmia, la progresión rápida de la enfermedad, el uso de L-dopa y el uso de IMAO. La frecuencia de síntomas depresivos en pacientes con EP es alta, por lo que se requiere un diagnóstico temprano y un tratamiento oportuno para mejorar su calidad de vida y el entorno familiar.
Assuntos
Doença de ParkinsonRESUMO
La ginecomastia es el agrandamiento benigno del tejido mamario en el varón. Es una causa frecuente de consulta que produce ansiedad e incomodidad y puede ser la expresión clínica de una enfermedad relevante. Objetivos: 1) Evaluar las características de presentación de la ginecomastia y el perfil bioquímico; 2) Evaluar la etiología de la ginecomastia en la población estudiada. Material y Métodos: Estudio retrospectivo, multicéntrico. Se evaluaron las historias clínicas de 220 varones (18-85 años) con diagnóstico clínico y por imágenes de ginecomastia, con evaluación bioquímica completa. Resultados: Se observó mayor prevalencia entre 21-30 años de edad (n = 66; 30 %). La mayoría consultó en forma espontánea (77,7 %); el resto fue derivado por otras especialidades. Principales motivos de consulta: razones estéticas (70,4 %) y dolor (27,3 %). El 23,2 % tenía antecedente de ginecomastia puberal. El tiempo de evolución previo a la consulta fue muy variable: 1 mes a 40 años. Examen físico: 122 pacientes (55,4 %) presentaron ginecomastia bilateral y 98 (44,6 %) unilateral (54,1 % izquierda y 45,9 % derecha). El 44,8 % presentó sobrepeso y 22,4 % obesidad. En 29,1 % se constató dolor mamario al examen. Un paciente (con macroprolactinoma) presentó secreción mamaria espontánea y 3 pacientes secreción mamaria provocada. Etiología: la ginecomastia idiopática fue la más frecuente (49,1 %) y de las causas secundarias, el consumo de anabólicos. Se constató un 10 % de pacientes con hipoandrogenismo, 16,4 % con hiperprolactinemia y 10,5 % con hiperestrogenemia. En 6 casos coexistieron 2 causas (total 226 causas). No se hallaron marcadores oncológicos elevados. En los < 40 años las causas más frecuentes fueron uso de anabólicos y ginecomastia puberal persistente; y en los > 40 años fueron hipogonadismo y consumo de fármacos. Los pacientes con ginecomastia bilateral tuvieron mayor tiempo de evolución, mayor IMC y menores niveles de TT versus ginecomastia ...
Gynecomastia is a benign enlargement of breast tissue in men. It occurs physiologically in three stages of life: newborns, pubescent boys and older adults. It is a frequent reason for consulting and -though generally benign- it produces anxiety and discomfort. It is important to differentiate between the asymptomatic presence of palpable breast tissue, which is of little clinical relevance, and a recent onset breast enlargement usually associated with pain and swelling, which can be a sign of illness or pharmacological impact. Aims: To evaluate the presenting features (symptoms, duration, laterality, etc.) and biochemical profile of gynecomastia; to assess the etiology of gynecomastia in the study population. Methods: Retrospective, multicenter study. We evaluated the medical records of 220 men aged 18-85 years (average age 33 years: median 39.5 ± 19.6 years) with imaging and clinical diagnosis of gynecomastia who had undergone biochemical assessment. The consultation period was from May 2002 to June 2013. The following data was assessed: breast pain, duration of gynecomastia, sexual function, galactorrhea, weight change, habits (alcohol, drug addiction, anabolic steroids), history of pubertal gynecomastia, use of medication and family history of gynecomastia. Physical examination: weight, height, body mass index (BMI), breast and gonadal examination. Laboratory: total testosterone (TT), bioavailable testosterone (Bio-T), estradiol (E2), luteinizing hormone, follicle stimulating hormone, prolactin, thyrotropin, alpha fetoprotein, β subunit of human chorionic gonadotropin and carcinoembryonic antigen. For hormonal abnormalities, each site’s reference values were considered. In all patients, gynecomastia was confirmed by ultrasound and / or mammography. Results: A higher prevalence of gynecomastia is observed in the age range between 21 and 30 years (n = 66; 30 %). Most patients presented spontaneously (77.7 %); the rest were referred from other specialties. The most frequent reasons for consultation were aesthetic reasons (70.4 %) and breast pain (27.3 %). Twenty-three point two percent of subjects had a history of pubertal gynecomastia. Evolution time prior to consultation was highly variable (1 month to 40 years). On physical examination, 122 patients (55.4 %) had bilateral and 98 patients (44.6 %) had unilateral gynecomastia (54.1 % left and 45.9 % right); 44.8 % were overweight and 22.4 % were obese. BMI: 27.2 ± 4.3 kg/m2. In 29.1 % of patients breast pain was identified on medical examination. One patient (with macroprolactinoma) had spontaneous galactorrhea and in 3 patients mammary secretion was found on physical examination. Gonadal examination was performed in 147 patients, 126 had normal testicular volume, 10 had bilateral hypotrophy, 7 had unilateral hypotrophy and 4 unilateral absence of the testis. Idiopathic gynecomastia was the most common etiology (47.8 %). The most relevant secondary cause of gynecomastia was anabolic steroids consumption (14.1 %). In 6 cases two causes coexisted (total: 226 causes). Elevated cancer markers were not found in any of the cases. If we divide the population into patients younger and older than 40, in the former the most common secondary causes were the use of anabolic steroids and persistent pubertal gynecomastia, while in patients older than 40, they were hypogonadism and medical drug use. Patients with bilateral gynecomastia had a longer history of gynecomastia: 3.4 ± 5.7 versus 1.4 ± 1.9 years (p = 0.0004); higher BMI: 28.4 ± 4.4 versus 25.5 ± 3.5 kg/m2 (p < 0.0001) and lower TT levels: 4.7 ± 2.0 versus 5.4 ± 1.9 ng/ml (p=0.019) than patients with unilateral gynecomastia, respectively. A negative correlation between BMI and TT was found (r= -0.38, p< 0.0001). No correlation between BMI and E2 and between BMI and bio-T was found. Ultrasound was used in 83.2 % of patients and mammography in 43.6 % (both 28.2 %). Conclusions: Patients with gynecomastia consulted more often for aesthetic reasons and secondarily for breast pain. Detection of galactorrhea was rare. Gonadal examination was normal in most patients and 66.7 % were overweight or obese. Just over half of the patients presented with bilateral gynecomastia and compared with cases of unilateral gynecomastia, they had a longer history of disease, higher BMI and lower TT levels. The most common cause of gynecomastia was idiopathic in all age groups. Persistent pubertal gynecomastia and anabolic steroids consumption were frequent in patients younger than 40 years, and medical drug use and hypogonadism in patients over 40. The presence of gynecomastia may be the expression of an underlying and clinically relevant disease. This highlights the need for an adequate and complete clinical, biochemical and imaging assessment in these patients. Rev Argent Endocrinol Metab 52:22-28, 2015 No financial conflicts of interest exist.
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La ginecomastia es el agrandamiento benigno del tejido mamario en el varón. Es una causa frecuente de consulta que produce ansiedad e incomodidad y puede ser la expresión clínica de una enfermedad relevante. Objetivos: 1) Evaluar las características de presentación de la ginecomastia y el perfil bioquímico; 2) Evaluar la etiología de la ginecomastia en la población estudiada. Material y Métodos: Estudio retrospectivo, multicéntrico. Se evaluaron las historias clínicas de 220 varones (18-85 años) con diagnóstico clínico y por imágenes de ginecomastia, con evaluación bioquímica completa. Resultados: Se observó mayor prevalencia entre 21-30 años de edad (n = 66; 30 %). La mayoría consultó en forma espontánea (77,7 %); el resto fue derivado por otras especialidades. Principales motivos de consulta: razones estéticas (70,4 %) y dolor (27,3 %). El 23,2 % tenía antecedente de ginecomastia puberal. El tiempo de evolución previo a la consulta fue muy variable: 1 mes a 40 años. Examen físico: 122 pacientes (55,4 %) presentaron ginecomastia bilateral y 98 (44,6 %) unilateral (54,1 % izquierda y 45,9 % derecha). El 44,8 % presentó sobrepeso y 22,4 % obesidad. En 29,1 % se constató dolor mamario al examen. Un paciente (con macroprolactinoma) presentó secreción mamaria espontánea y 3 pacientes secreción mamaria provocada. Etiología: la ginecomastia idiopática fue la más frecuente (49,1 %) y de las causas secundarias, el consumo de anabólicos. Se constató un 10 % de pacientes con hipoandrogenismo, 16,4 % con hiperprolactinemia y 10,5 % con hiperestrogenemia. En 6 casos coexistieron 2 causas (total 226 causas). No se hallaron marcadores oncológicos elevados. En los < 40 años las causas más frecuentes fueron uso de anabólicos y ginecomastia puberal persistente; y en los > 40 años fueron hipogonadismo y consumo de fármacos. Los pacientes con ginecomastia bilateral tuvieron mayor tiempo de evolución, mayor IMC y menores niveles de TT versus ginecomastia ...(AU)
Gynecomastia is a benign enlargement of breast tissue in men. It occurs physiologically in three stages of life: newborns, pubescent boys and older adults. It is a frequent reason for consulting and -though generally benign- it produces anxiety and discomfort. It is important to differentiate between the asymptomatic presence of palpable breast tissue, which is of little clinical relevance, and a recent onset breast enlargement usually associated with pain and swelling, which can be a sign of illness or pharmacological impact. Aims: To evaluate the presenting features (symptoms, duration, laterality, etc.) and biochemical profile of gynecomastia; to assess the etiology of gynecomastia in the study population. Methods: Retrospective, multicenter study. We evaluated the medical records of 220 men aged 18-85 years (average age 33 years: median 39.5 ± 19.6 years) with imaging and clinical diagnosis of gynecomastia who had undergone biochemical assessment. The consultation period was from May 2002 to June 2013. The following data was assessed: breast pain, duration of gynecomastia, sexual function, galactorrhea, weight change, habits (alcohol, drug addiction, anabolic steroids), history of pubertal gynecomastia, use of medication and family history of gynecomastia. Physical examination: weight, height, body mass index (BMI), breast and gonadal examination. Laboratory: total testosterone (TT), bioavailable testosterone (Bio-T), estradiol (E2), luteinizing hormone, follicle stimulating hormone, prolactin, thyrotropin, alpha fetoprotein, β subunit of human chorionic gonadotropin and carcinoembryonic antigen. For hormonal abnormalities, each site’s reference values were considered. In all patients, gynecomastia was confirmed by ultrasound and / or mammography. Results: A higher prevalence of gynecomastia is observed in the age range between 21 and 30 years (n = 66; 30 %). Most patients presented spontaneously (77.7 %); the rest were referred from other specialties. The most frequent reasons for consultation were aesthetic reasons (70.4 %) and breast pain (27.3 %). Twenty-three point two percent of subjects had a history of pubertal gynecomastia. Evolution time prior to consultation was highly variable (1 month to 40 years). On physical examination, 122 patients (55.4 %) had bilateral and 98 patients (44.6 %) had unilateral gynecomastia (54.1 % left and 45.9 % right); 44.8 % were overweight and 22.4 % were obese. BMI: 27.2 ± 4.3 kg/m2. In 29.1 % of patients breast pain was identified on medical examination. One patient (with macroprolactinoma) had spontaneous galactorrhea and in 3 patients mammary secretion was found on physical examination. Gonadal examination was performed in 147 patients, 126 had normal testicular volume, 10 had bilateral hypotrophy, 7 had unilateral hypotrophy and 4 unilateral absence of the testis. Idiopathic gynecomastia was the most common etiology (47.8 %). The most relevant secondary cause of gynecomastia was anabolic steroids consumption (14.1 %). In 6 cases two causes coexisted (total: 226 causes). Elevated cancer markers were not found in any of the cases. If we divide the population into patients younger and older than 40, in the former the most common second¡ary causes were the use of anabolic steroids and persistent pubertal gynecomastia, while in patients older than 40, they were hypogonadism and medical drug use. Patients with bilateral gynecomastia had a longer history of gynecomastia: 3.4 ± 5.7 versus 1.4 ± 1.9 years (p = 0.0004); higher BMI: 28.4 ± 4.4 versus 25.5 ± 3.5 kg/m2 (p < 0.0001) and lower TT levels: 4.7 ± 2.0 versus 5.4 ± 1.9 ng/ml (p=0.019) than patients with unilateral gynecomastia, respectively. A negative correlation between BMI and TT was found (r= -0.38, p< 0.0001). No correlation between BMI and E2 and between BMI and bio-T was found. Ultrasound was used in 83.2 % of patients and mammography in 43.6 % (both 28.2 %). Conclusions: Patients with gynecomastia consulted more often for aesthetic reasons and secondarily for breast pain. Detection of galactorrhea was rare. Gonadal examination was normal in most patients and 66.7 % were overweight or obese. Just over half of the patients presented with bilateral gynecomastia and compared with cases of unilateral gynecomastia, they had a longer history of disease, higher BMI and lower TT levels. The most common cause of gynecomastia was idiopathic in all age groups. Persistent pubertal gynecomastia and anabolic steroids consumption were frequent in patients younger than 40 years, and medical drug use and hypogonadism in patients over 40. The presence of gynecomastia may be the expression of an underlying and clinically relevant disease. This highlights the need for an adequate and complete clinical, biochemical and imaging assessment in these patients. Rev Argent Endocrinol Metab 52:22-28, 2015 No financial conflicts of interest exist.(AU)
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Men with type 2 diabetes mellitus (DM2) have lower testosterone levels and a higher prevalence of hypogonadism. It still remains unclear the mechanism by which there is a relationship between hypogonadism and DM2. The objective was to evaluate the hypothalamic-pituitary-gonadal axis at different levels in eugonadal patients with DM2. Fourteen patients with DM2 (DM2 group) and 15 subjects without DM2 (normal glucose tolerance test) as control group (CG) were included. We assessed: (i) fasting glucose, insulin, Homeostasis Model Assessment (HOMA); (ii) luteinizing hormone (LH) pulsatility through blood collections every 10 min for 4 h; (iii) gonadotropin-releasing hormone (GnRH) test: basal LH and 30, 60 and 90 min after 100 µg of i.v. GnRH; (iv) human chorionic gonadotropin (hCG) test: basal total testosterone (TT), bioavailable testosterone (BT), free testosterone (FT), estradiol (E2), bioavailable E2 (BE2) and sex hormone-binding globulin (SHBG) and 72 h post 5000 IU of i.m. hCG. There were no differences in age, body mass index and waist circumference between groups. Glucose was higher in the DM2 group vs. CG: 131.1 ± 25.5 vs. 99.1 ± 13.6 mg/dL, p = 0.0005. There were no difference in basal insulin, HOMA, TT, BT, FT, E2, BE2, SHBG and LH levels between groups. The DM2 group had lower LH pulse frequency vs. CG: 0.8 ± 0.8 vs. 1.5 ± 0.5 pulses, p = 0.009. Differences in LH pulse amplitude were not found. A negative correlation was found between the number of LH pulses and glucose, r: -0.39, p = 0.03. There were no differences in the response of LH to GnRH between groups nor in the response of sexual steroids and SHBG to hCG. Patients with DM2 showed lower hypothalamic pulse frequency without changes in the pituitary response to GnRH nor testicular response to hCG. Glucose levels negatively correlated with the number of LH pulses which suggests a negative effect of hyperglycaemia in the hypothalamic secretion of GnRH.
Assuntos
Diabetes Mellitus Tipo 2/sangue , Hipogonadismo/sangue , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Glicemia , Gonadotropina Coriônica/sangue , Estradiol/sangue , Hormônio Liberador de Gonadotropina/sangue , Humanos , Insulina/sangue , Hormônio Luteinizante/sangue , Masculino , Homens , Pessoa de Meia-Idade , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangueRESUMO
Agricultural application of wastewater sludge has become the most widespread method of disposal, but the environmental effects on soil, air, and crops must be considered. The effect of wastewater sludge or urea on sunflower's (Helianthus annuus L.) growth and yield, the soil properties, and the resulting CO(2) and N(2)O emissions are still unknown. The objectives of this study were to investigate: i) the effect on soil properties of organic or inorganic fertilizer added to agricultural soil cultivated with sunflower, ii) how urea or wastewater sludge increases CO(2) and N(2)O emissions from agricultural soil over short time periods, and iii) the effect on plant characteristics and yield of urea or wastewater sludge added to agricultural soil cultivated with sunflower. The sunflower was fertilized with wastewater sludge or urea or grown in unamended soil under greenhouse conditions while plant and soil characteristics, yield, and greenhouse gas emissions were monitored. Sludge and urea modified some soil characteristics at the onset of the experiment and during the first two months but not thereafter. Some plant characteristics were improved by sludge. Urea and sludge treatments increased the yield at similar rates, while sludge-amended soil significantly increased N(2)O emissions but not CO(2) emissions compared to the other amended or unamended soils. This implies that wastewater sludge increased the biomass and/or the yield; however, from a holistic point of view, using wastewater sludge as fertilizer should be viewed with concern.
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Dióxido de Carbono/análise , Fertilizantes/análise , Helianthus/crescimento & desenvolvimento , Óxido Nitroso/análise , Solo/química , Produtos Agrícolas/crescimento & desenvolvimento , Condutividade Elétrica , Concentração de Íons de Hidrogênio , Análise de Componente Principal , Esgotos/análise , Solo/análise , Ureia/análiseRESUMO
Objetivo. Evaluar la eficiencia de la respuesta superovulatoria del ganado Brahman al protocolo P-24. Materiales y métodos. Se utilizaron doce vacas Brahman donadoras con más de 60 días postparto, a las cuales se les realizó un total de 21 tratamientos superovulatorios con base en el protocolo P-24. Se realizó la colecta de los embriones a través del método convencional y los embriones fueron clasificados (IETS). Resultados. Se obtuvo un promedio de 9.1 estructuras, 4.4 embriones transferibles, 3.7 embriones congelables y 3.2 embriones degenerados recuperados por colecta. Los estadíos de desarrollo que predominaron fueron mórula (32.6%), blastocisto temprano (38%) y blastocisto (18.5%). Se presentó efecto (p<0.05) del número de superovulaciones sucesivas sobre la producción de embriones congelables. Sin embargo, no hubo efecto (p>0.05) sobre las demás variables estudiadas. Se presentó efecto (p<0.05) de la producción promedio de estructuras recuperadas, embriones transferibles y congelables entre las donadoras con una producción mayor o igual a 5, y menor a 5 embriones transferibles. Por el contrario, no hubo efecto (p>0.05) de la producción promedio de embriones degenerados y ovocitos sin fecundar entre ambos grupos. No obstante, la proporción de éstos fue mayor en las donadoras con una menor producción de embriones transferibles (50 y 22.4%) vs. las donadoras con mayor producción (39.3 y 14%) para embriones degenerados y ovocitos sin fecundar respectivamente. Conclusiones. El ganado Brahman tuvo una respuesta superovulatoria eficiente al protocolo P-24 para transferencia de embriones a tiempo fijo.
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Bovinos , Animais , Animais Domésticos , Transferência Embrionária , SuperovulaçãoRESUMO
La osteoporosis (OP) es una enfermedad subdiagnosticada y subtratada en la mayoría de los hombres. Un tercio de las fracturas de cadera ocurren en la población masculina, con más complicaciones secundarias que en la población femenina y una tasa de mortalidad de 37,5 % dentro del año posterior a la fractura. Un gran número de fracturas ocurren en hombres cuya densidad mineral ósea (DMO) no está en rango osteoporótico, esto resalta la importancia de evaluar factores distintos a la DMO en la determinación del riesgo de fractura. Objetivos: establecer la prevalencia de causas secundarias de OP en hombres mayores de 50 años y analizar las posibles asociaciones entre los valores de DMO y distintos parámetros bioquímicos. Se evaluaron retrospectivamente 918 historias clínicas de varones mayores de 50 años, cuyo motivo de admisión fuese OP, osteopenia o fracturas óseas en cualquier localización. Criterios de inclusión: medición de parámetros plasmáticos y urinarios de metabolismo fosfocálcico, testosterona total y DMO de raquis lumbar, cuello femoral y trocánter. Resultados: 113 pacientes, de 70,6 ± 9,8 años, cumplieron los criterios de inclusión, el 75,2 % tenían diagnóstico de OP en al menos una localización y el 24,8 % osteopenia. En el 85,8 % de los pacientes se encontraron causas secundarias de OP, siendo las más frecuentes: hipovitaminosis D, hipogonadismo, corticoterapia crónica e hipercalciuria. El 22 % de los pacientes padeció alguna fractura sin sospecha previa de baja masa ósea. Conclusiones: en un alto porcentaje de hombres con OP se observaron causas secundarias. El diagnóstico de OP en el varón es tardío ya que el 22 % había padecido alguna fractura sin sospecha previa de baja masa ósea. Esto resalta la importancia de este problema y la necesidad de realizar un diagnóstico y tratamiento temprano en la población masculina.
Male osteoporosis (OP) is an underdiagnosed and undertreated disease in the majority of men. One third of hip fractures occur in men, who present more secondary complications than women, with a mortality rate of 37.5 % within one year of facture. The observation that most fractures occur in men, whose bone mineral density is not in the osteoporotic range, highlights the importance of different factors others than bone densitometry to evaluate the risk of fracture. Aims: to establish the prevalence of secondary factors OP in men older than 50 years and to analyze the possible associations between bone mineral density and biochemical parameters. Retrospective analysis of 918 medical records of men over 50 years old, admitted because of OP, osteopenia or bone fractures in any location. Inclusion criteria: measurements of plasma and urinary bone metabolism parameters, total testosterone, lumbar spine, femoral neck and trochanter bone mineral density. Results: 113 patients met the inclusion criteria, the mean age was 70.6 ± 9.8 years, of which 85 (75.2 %) had OP diagnosis in one location and 28 (24.8 %) osteopenia. Of 113 patients assessed, 97 (85.8 %) had secondary OP causes, such as hypovitaminosis D, hypogonadism, chronic corticotherapy and hypercalciuria. Twenty two per cent of the patients had suffered a fracture without previous suspicion of low bone mass. Conclusions: A high proportion of men with OP present secondary factors. Most of these factors are diagnosed by history taking and biochemical study. The diagnosis of male OP is delayed as 22 % had suffered a fracture without previous suspicion of low bone mass. This indicates the importance of this issue and its early diagnosis and treatment in the male population.
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Klebsiella pneumoniae as a producer of extended spectrum beta-lactamase (ESBL) has played an important role as a cause of infection in the neonatal high risk unit (NHRU) of the Autonomous Hospital Institute of the Universidad de Los Andes (AHIULA). In this paper an outbreak caused by this bacterial specie that affected neonates hospitalized in this unit during February 2007 is described. Besides, the environment and the personnel were studied as possible sources of this organism. The strains of K. pneumonia isolated from the outbreak had the same resistance phenotype, produced ESBL type TEM and SHV and belonged to the same genotype as the isolated strains from the hands and the soapy solutions, possible sources of infection. This indicates that it was the same clone. The outbreak was resolved using two important measurements: reinforcing hand washing and with the opportune treatment of neonates with imipenem.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae , Sepse/epidemiologia , beta-Lactamases/biossíntese , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Farmacorresistência Bacteriana Múltipla , Genótipo , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Fenótipo , Fatores de Risco , Sepse/microbiologia , Venezuela/epidemiologiaRESUMO
The objective of the research was to learn the characteristics of Uruguayan workers' feeding, their health situations and the context and considerations that their companies offer to the consumption of food. The descriptive and cross-sectional type of the study allowed to collect data, through a telephone survey (n=295), on relevant aspects of eating behavior. Almost all the workers had a meal time in hours of work and lunch was the meal that prevailed. Half of them chose red meat-based food followed by cooked vegetables as a second choice. Around 40 percent of workers said they had diet-related pathologies. Only 8 percent used the time recommended by the WHO for food consumption at work. Some companies do not respect the regulations of the Uruguayan government on the necessary conditions for the feeding of their employees. The implementation ofpolicies that consider the feeding of the workers as a fundamental right is necessary.
El objetivo de la investigación fue conocer las características de la alimentación de los trabajadores/as uruguayos, su situación de salud y las condiciones ofrecidas por empleadores para el consumo de comidas. Este estudio descriptivo de corte transversal, permitió recabar mediante una encuesta telefónica (n=295), datos relevantes del comportamiento alimentario. Casi el total de trabajadores, realizaban alguna comida en horario laboral, predominando el almuerzo. La mitad de ellos seleccionaban preparaciones con carnes rojas, le seguían los vegetales cocidos. Aproximadamente, el 40 por ciento de los trabajadores declaró presentar patologías relacionadas con la dieta. Únicamente el 8 por ciento destinaba el tiempo recomendado por la OMS para el consumo de alimentos en el trabajo. Algunas empresas incumplen las normativas del Gobierno Uruguayo sobre las condiciones necesarias para la alimentación de sus empleados. Continuar investigando en la temática implica hacer camino en la instauración de políticas que contemplen la alimentación de los trabajadores como un derecho fundamental.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Comportamento Alimentar , Saúde Ocupacional/estatística & dados numéricos , Categorias de Trabalhadores , Fenômenos Fisiológicos da NutriçãoRESUMO
Klebsiella pneumoniae productora de β-lactamasa de espectro expandido (BLEE) ha jugado un papel importante como causa de infecciones en la unidad de alto riesgo neonatal (UARN) del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA). En el presente trabajo se describe un brote ocasionado por esta bacteria en los neonatos hospitalizados en dicha unidad durante el mes de febrero 2007, así como también, cepas aisladas en los meses siguientes al brote y además, se estudia el ambiente y el personal, como posible fuente de esta bacteria. Las cepas de K. pneumoniae aisladas del brote eran del mismo fenotipo de resistencia, productoras de (3LEE tipo TEM y SHV y pertenecían al mismo genotipo que las cepas aisladas de las manos y de las soluciones jabonosas, posible fuente de infección, lo cual indica que se trataba del mismo clon. El brote se resolvió usando dos importantes medidas: reforzando el lavado de manos y con la indicación oportuna de imipenem a los neonatos afectados.
Klebsiella pneumoniae as a producer of extended spectrum beta-lactamase (ESBL) has played an important role as a cause of infection in the neonatal high risk unit (NHRU) of the Autonomous Hospital Institute of the Universidad de Los Andes (AHIULA). In this paper an outbreak caused by this bacterial specie that affected neonates hospitalized in this unit during February 2007 is described. Besides, the environment and the personnel were studied as possible sources of this organism. The strains of K. pneumonia isolated from the outbreak had the same resistance phenotype, produced ESBL type TEM and SHV and belonged to the same genotype as the isolated strains from the hands and the soapy solutions, possible sources of infection. This indicates that it was the same clone. The outbreak was resolved using two important measurements: reinforcing hand washing and with the opportune treatment of neonates with imipenem.
Assuntos
Humanos , Recém-Nascido , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae , Sepse/epidemiologia , beta-Lactamases/biossíntese , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Farmacorresistência Bacteriana Múltipla , Genótipo , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Fenótipo , Fatores de Risco , Sepse/microbiologia , Venezuela/epidemiologiaRESUMO
STUDY DESIGN: This work is an experimental and prospective study in adult, female, Long-Evans rats. OBJECTIVES: The aim of this study was to probe the effect of metabolic inhibition after an acute traumatic spinal cord injury (TSCI) using a standardized contusion model (NYU impactor) to know whether the metabolic inhibition is a 'secondary mechanism of injury' or a mechanism of protection. SETTING: All experimental procedures were carried out in the Mexico City. METHODS: Animals were divided into five groups: one sham and four with TSCI, including no treatment, rotenone (inhibitor of mitochondrial complex I), sodium azide (inhibitor of mitochondrial complex IV) and pyrophosphate of thiamine or non-degradable cocarboxylase as a metabolic reactivator. RESULTS: After TSCI, the metabolic inhibition with sodium azide treatment diminished the lipid peroxidation process (malondialdehyde levels by spectrophotometric procedures) and the damage to the spinal cord tissue (morphometric analysis), and increased the activity of creatine kinase and lactate dehydrogenase enzymes (P<0.05) (measured by spectrophotometric procedures 24 h after TSCI as well as after the functional recovery of the hind limb (evaluated weekly for 2 months by the BBB (Basso, Beattie and Bresnahan) scale)) when compared with the TSCI group without treatment. CONCLUSION: The results show that the partial and transitory inhibition of the aerobic metabolism after an acute TSCI could be a self-protection mechanism instead of being a 'secondary mechanism of injury'.
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Metabolismo Energético/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/metabolismo , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Animais , Creatina Quinase/efeitos dos fármacos , Creatina Quinase/metabolismo , Modelos Animais de Doenças , Complexo de Proteínas da Cadeia de Transporte de Elétrons/efeitos dos fármacos , Complexo de Proteínas da Cadeia de Transporte de Elétrons/metabolismo , Metabolismo Energético/fisiologia , Inibidores Enzimáticos/farmacologia , Feminino , L-Lactato Desidrogenase/efeitos dos fármacos , L-Lactato Desidrogenase/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Peroxidação de Lipídeos/fisiologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/fisiologia , Estudos Prospectivos , Ratos , Ratos Long-Evans , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Rotenona/farmacologia , Azida Sódica/farmacologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Tiamina Pirofosfato/farmacologia , Resultado do Tratamento , Desacopladores/farmacologia , Complexo Vitamínico B/farmacologiaRESUMO
It has been described that febrile seizures during infancy increase risk of subsequent non-febrile seizures during the adulthood. However, latency period between febrile seizure and the onset of the first spontaneous seizure has not been evaluated. The present study was designed to investigate the susceptibility to subsequent seizures in immature rats that had experienced early-life hyperthermic seizures and before they achieved the adult age. The results were compared with those induced by hyperthermia alone. Pentylenetetrazol (PTZ) was applied 24h or 20 days after hyperthermic seizures or hyperthermia were induced in 10-day-old rats by a regulated stream of moderately heated air. One day after hyperthermic seizures or hyperthermia, animals demonstrated enhanced latency to the PTZ-induced myoclonic (88% and 53%, respectively), clonic (60% and 60%, respectively) and tonic seizures (233% and 659%, respectively). The incidence of myoclonic and clonic seizures was similar to that in control group (100%). However, hyperthermic seizures reduced (50%) the incidence of tonic seizures. Twenty days after hyperthermic seizures there was an augmented latency to tonic seizures (123%) and reduced incidence for all the PTZ-induced seizures (71% myoclonic; 71% clonic seizures; 57% tonic seizures) when compared with control group (100%). In contrast, hyperthermia enhanced only the latency to myoclonic (133%) and clonic seizures (659%). Our data indicate that hyperthermic seizures or hyperthermia induces a protective effect against PTZ-induced seizures during a latency period. A possible involvement of gamma-aminobutyric acid (GABA) system is discussed.
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Febre/fisiopatologia , Convulsões/induzido quimicamente , Animais , Animais Recém-Nascidos , Convulsivantes/farmacologia , Modelos Animais de Doenças , Feminino , Masculino , Pentilenotetrazol/farmacologia , Gravidez , Ratos , Ratos Sprague-Dawley , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Convulsões/classificação , Fatores de TempoRESUMO
La realización de mamografía anual ha demostrado impacto en la disminución de la mortalidad por cáncer de mama. La mamografía digital presenta beneficios técnicos con respecto a la mamografía convencional, presentando un aumento significativo en la tasa de detección de cáncer en los estudios más recientes.
The annual mammography screening has demonstrated an impact in the reduction of breast cancer mortality. The digital mammography has more technical benefits than the conventional mammography, increasing the cancer detection rate showed in the recent studies.
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Humanos , Idoso de 80 Anos ou mais , Feminino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Mamografia/métodos , Neoplasias da Mama , Programas de Rastreamento/instrumentaçãoRESUMO
Workers in the health area are constantly exponed to occupational risk factors that can lead to labourable accidents. The aim of this work is to name the accidents within the Clinical Hospital of the Universidad de Chile and other centers dependent on this, during the period between the years 2003 and 2008. In the year 2005,a descriptive study was made, which showed a higher rate of incidence in laboural accidents (8,48 x 100). Female accidents presented a higher rate of incidence and the highest rate of accidents was among the ages 31 to 40 years old. The most frequent type of accidents corresponds to cutting and stabbing injuries. On the other hand, the hit with an object was the most frequent kind of attack in the accidents with 24.8 percent. The technician group accidents corresponded to 52.2 percent. The results obtained are partially similar to other hospital Centers. It would be important to consider a risk prevention program especially oriented to the technician group as more than the half of the labour accidents belong to this labour group.
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Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Acidentes de Trabalho/estatística & dados numéricos , Pessoal de Saúde , Distribuição por Idade e Sexo , Chile/epidemiologia , Incidência , Licença MédicaRESUMO
INTRODUCTION: The dual pathology consisting of hippocampal sclerosis plus focal cortical dysplasia (FCD) is often reported in patients with medication-resistant medial temporal lobe epilepsy (MTLE). AIMS: To determine the histopathological changes that take place in the neocortex of patients with medication-resistant MTLE submitted to surgery and to evaluate the relation between the histopathological changes, pathological background and the clinical course of patients who had received surgical treatment. MATERIALS AND METHODS: Tissue obtained by en bloc resection from the neocortex of 18 patients with MTLE refractory to medical treatment was processed histologically and a tailored temporal lobectomy was performed with electrocorticography. RESULTS: Dual pathology was diagnosed in 13 patients (72.2%). Imaging studies confirmed the existence of mesial sclerosis of the temporal in 100% of cases and there was no evidence of neocortical lesions. Histologically, 46.15% and 38.46% of the patients were diagnosed as belonging to FCD type 1a and FCD type 1b, respectively. Only one patient presented FCD type 2a. A statistically significant relation was found between the presence of dual pathology and the existence of an early precipitating injury (p = 0.04). One year after surgery, 72.7% (8/11) patients with dual pathology were classified as belonging to Engel class I. CONCLUSIONS: In patients with MTLE there are microscopic FCD-type alterations in the neocortex. There is an association between these alterations and the existence of an initial precipitating injury. Complete resection of the epileptogenic area, which is guaranteed by the lobectomy tailored by electrocorticography, allows patients to enjoy a favourable post-surgical progression one year after surgery.