Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

La diabetes mellitus tipo 2 es una de las epidemias del siglo XXI, tanto por su creciente magnitud como por su impacto negativo en la enfermedad cardiovascular. Es un síndrome heterogéneo, endocrino-metabólico complejo, de etiología multifactorial. Entre sus causas intervienen factores de riesgo genéticos y ambientales, lo que ha sido demostrado por varios investigadores. La siguiente revisión bibliográfica tiene como objetivo abordar las causas genéticas y ambientales que llevan al debut de la diabetes mellitus tipo 2 y destacar la interacción genoma-ambiente en este contexto como causa fundamental en la aparición de la enfermedad. Tener en cuenta los factores de riesgos genéticos y ambientales permite mejorar las acciones de prevención llevadas a cabo por la salud pública al enfocar la atención en la individualidad genética, así como en los factores ambientales, que son realmente los únicos susceptibles de ser modificados.

Se trata de una paciente de 47 años de edad, de raza blanca, con antecedentes de ser sordo-muda y de retraso mental así como de padecer diabetes mellitus tipo 2 e hipertensión arterial esencial, para lo que lleva tratamiento. En esta ocasión acudió a su área de salud por sangramiento vaginal de seis meses de evolución; le realizaron examen físico y ultrasonido ginecológico y le diagnosticaron un fibroma uterino, por lo que fue remitida al Hospital Ginecoobstétrico “Mariana Grajales” para ser intervenida quirúrgicamente. En el acto quirúrgico la maniobra de extracción del cuello uterino fue difícil; fue recibido en varios fragmentos. El estudio anatomopatológico informó la presencia en el cuello uterino de un tumor de células epitelioides perivascular (PEComa). Los PEComas son una familia de tumores de origen mesenquimal con características citomorfológicas e inmunohistoquímicas similares dadas por la presencia de células epiteliodes y fusocelulares con citoplasma eosinófilo o claro que tienen íntima relación con la vasculatura y característicamente co-expresan marcadores melanocíticos y mioides. Son tumores extremadamente raros que, debido a su disposición perivascular, pueden ubicarse en cualquier parte del cuerpo (en la literatura se describen en diversas partes), así como afectar a cualquier edad o sexo; aunque llama la atención su mayor predisposición hacia el sexo femenino.

Introduction: the National Program of cochlear implant established in Cuba has benefited freely 216 children with severe and deep hearing loss. Objective: to compare the results obtained in children older than six years with deep prelingual hearing loss who have cochlear implant with a group of the same characteristics using another type of programmable digital prosthetic attachment. Methods: a prospective, descriptive and quasi-experimental study was realized at "José Luis Miranda" Hospital from October 2012 to September 2015. It was used a non-probabilistic sampling and the sample was 15 patients older than six years of age who underwent a cochlear implant (Group 1) and 25 of the same age who used a programmable digital hearing attachment (Group 2). A questionnaire was designed that included the variables: sex, age, age of implant, etiology, language, auditory performance and stage of rehabilitation. The Kolmogorov-Smirnov test and the Mann-Whitney test were used. Results: all patients with cochlear implants passed the detection-discrimination stage, seven reached the identification-recognition stage (46.7%) and four reached the stages of discrimination-identification and recognition-comprehension, respectively (26.7%). Patients with digital prostheses failed to advance to higher levels of rehabilitation (80%). Conclusions: Patients older than six years old who received a cochlear implant achieved higher auditory performance, higher levels in the rehabilitation stages and achieved better communication than users of digital prostheses.

It is a 53 years old female patient, white, with a personal history of bronchial asthma, high blood pressure, diabetes mellitus type 2, alcoholism, alcoholic polyneuropathy, alcoholic liver disease, tuberculosis contact, multiple admissions for dematological lesions and respiratory sepsis, pathological hip fracture and disseminated osteolytic lesions. She was admitted with diagnosis of deep venous thrombosis, she evolved unfavorably with sepsis at various levels and progressive deterioration and died due to failure and multiple organ damage. The anatomopathological findings showed a systemic miliary tuberculosis that caused multiorgan damage and failure. Mycobacterium tuberculosis is responsible for most of the cases of tuberculosis, several risk factors favor this disease, most of the patients with the human immunodeficiency virus suffer from it. Granuloma is the histological finding that distinguishes it.

In the open fracture type III B of the distal third of the leg, it can be performed the soft tissue coverage with fasciocutaneous flap of distal base. It is presented a patient in which the above procedure was performed in combination with an external fixator RALCA, with good result. A comparison was made with other reconstructive methods and the advantages presented by this type of flap were considered. It was recommended to extend its use in the Orthopedic Specialty in the province for the variety of injuries in which it is indicated.

The symptomatic arteriovenous malformation in the head and neck in the adult is an infrequent and potentially fatal disease. The surgical management is described and outcome in a patient diagnosed with cervical arteriovenous malformation who entered at Neurosurgery Ward of “Arnaldo Milán Castro” Hospital. The patient attended the institution because of bilateral cervicobrachial and right lumbosciatic pain for four years that was accompanied by acroparesthesia and marked and progressive weakness of both lower limbs. A nuclear magnetic resonance reported an extramedullary intracranial occupational process at the level of the cervical segment C-6 and C-7, so surgical treatment was decided (a laminectomy and a total exceresis of the lesion were performed). A biopsy sample was taken that reported cervical arteriovenous malformation. Postoperative evolution was satisfactory and continued with follow-up.

Se trata de una paciente de 68 años con historia de sangrado vaginal postmenopáusico de ocho meses de evolución que se acompañaba de dolor en bajo vientre; al examen físico se le constató útero ligeramente aumentado de tamaño. Se le realizó un legrado diagnóstico que informó la presencia de un tumor mesenquimatoso en el útero y se decidió realizar histerectomía. En el estudio histopatológico se diagnosticó un adenosarcoma uterino con sobrecrecimento del componente sarcomatoso. Los adenosarcomas son tumores raros que tienen un componente epitelial glandular benigno y uno mesenquimal maligno. Los adenosarcomas mullerianos con sobrecrecimiento del componente sarcomatoso se comportan de modo agresivo y están frecuentemente asociados con recurrencia postoperatoria o metástasis.

Introduction: septic shock is a common cause of death in children worldwide, it is the first cause of admission to the units of non-coronary intensive care and it is an emerging disease. Objective: to describe the results of therapy with fluid in patients with septic shock at “José Luis Miranda” Hospital in one year of study. Method: a descriptive, longitudinal, prospective study between January and December 2012 with patients admitted to the Intensive Care Unit of the hospital was realized. Data were recorded in the statistical professional program SPSS version 15.0, the information was showed in tables and graphs and inferential statistics tests were applied. Results: the most affected age group was that of one month to one year, of male sex; severe acute respiratory infections were the most frequent etiologies; the administration of intravenous fluids contributed to the recovery of clinical parameters related to perfusion at six hours; with the administration of 60ml/kg of intravenous fluids there was a recovery of blood pressure in most children. Conclusions: aggressive and early administration of intravenous fluids contributes to the recovery of clinical parameters related to perfusion at six hours and reducing mortality in children with septic shock.