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Se describe el caso de un varón de 68 años con antecedente de hipertensión arterial no tratada, diagnosticada un año antes, que ingresó con un cuadro de anasarca, debilidad muscular y disnea al reposo. Los primeros exámenes realizados mostraron hipopotasemia severa, alcalosis metabólica, litiasis renal y vesical y enfermedad renal crónica. La tomografía abdominal reveló una tumoración suprarrenal derecha, hidronefrosis bilateral y litiasis renal y vesical. Con la sospecha de hiperaldosteronismo primario se completó el estudio, con la determinación de relación aldosterona/concentración de renina directa, que resultó alta. El estudio metabólico arrojó hipercalciuria e hiperuricosuria y la gradiente transtubular de potasio mayor de 7. El paciente fue sometido a tratamiento quirúrgico con nefrectomía derecha, sin embargo, falleció en el postoperatorio inmediato, por shock hipovolémico e insuficiencia respiratoria.

SUMMARY We report the case of a 68-year-old male with a history of non-treated arterial hypertension diagnosed the previous year that was admitted with anasarca, muscle weakness and dyspnea at rest. The first laboratory exams showed severe hypopotassemia, metabolic alkalosis, renal and gallbladder lithiasis and chronic renal disease. The abdominal tomography revealed a right suprarenal tumor, bilateral hydronephrosis and renal and gallbladder lithiasis. Under the suspicion of primary hyperaldosteronism, the diagnosis was confirmed with the determination of the relationship between aldosterone/direct renin concentration, which was high. The metabolic study showed hypercalciuria and hyperuricosuria and the potassium trans tubular gradient was above 7. The patient underwent right nephrectomy, nonetheless, died at the immediate post-operatory period due to a hypovolemic shock and respiratory failure.

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To assess the effects of exposure to extremely low-frequency magnetic fields (ELF-MFs) on MDCK cell lines, experiments were performed in a chamber under controlled conditions (temperature, humidity and CO2). Therefore, the measured physicochemical and electrical changes in the cells are due solely to the magnetic field exposure and not to external factors. A developed sinusoidal magnetic field generator produced the ELF-MFs with a uniform magnetic field and adjustable intensity and frequency. Three experimental indicators were used: (i) transepithelial electrical impedance (TEEI); (ii) cell migration and proliferation; and (iii) expression of the proteins of the tight junctions, and changes in the area and shape of the cell nuclei. No significant effects on TEEI values were observed when 10 and 50 G 60 Hz magnetic fields were applied to confluent cell monolayers. There were no significant differences in migration and proliferation of the cell monolayer exposed to 60 Hz magnetic fields10 and 50 G , but a contact inhibition factor was observed. The expression of the CLDN-1 protein decreased by 90% compared with the control, while ZO-1 protein expression increased by 120%. No significant effects were observed in the area and shape of the cell nuclei. Experimentation in a controlled environment, under physiological conditions, ensures that the observed effects were strictly due to exposure to magnetic fields. Different exposure conditions are necessary to determine the impact on TEEI and cell migration-proliferation indicators.

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Resumen ANTECEDENTES: Los tumores vaginales benignos son excepcionales: papilomas, hemangiomas, pólipos y leiomiomas. Estos últimos son los más raros (4-5% de todas las neoplasias vaginales) pues solo se han reportado alrededor de 300 casos. CASO CLÍNICO: Paciente de 47 años, acudió a la consulta ginecológica con una tumoración vaginal de dos meses de evolución, sin manifestaciones clínicas adicionales. En la exploración física se observó una tumoración elástica, en la cara posterolateral derecha de la vagina. La ecografía transvaginal no mostró la alteración. Después del tratamiento expectante inicial, en la siguiente revisión se comprobó el rápido crecimiento de la lesión y la manifestación de los síntomas vaginales. Se decidió la extirpación quirúrgica de la lesión. El estudio anatomopatológico reportó un leiomioma vaginal, con células con núcleos atípicos. Durante el seguimiento la paciente permaneció asintomática, sin signos de recidiva local. CONCLUSIÓN: Si bien los leiomiomas son los tumores benignos más frecuentes en mujeres en edad reproductiva, su manifestación vaginal es excepcional. El diagnóstico definitivo se establece en el estudio anatomopatológico y el tratamiento de elección es la extirpación quirúrgica completa. Los tumores con elevada celularidad, alta concentración de células atípicas y actividad mitótica incrementada pueden tener un comportamiento benigno. Las recidivas también son excepcionales.

Abstract BACKGROUND: Benign vaginal tumors are a very rare entity which includes papillomas, hemangiomas, polyps and leiomyomas. Leiomyomas are especially infrequent, constituting only 4-5% of all vaginal tumors. In literature, about 300 cases have been reported. CLINICAL CASE: 47-year-old patient, who attended a gynecological consultation with a vaginal tumor of two months evolution, without additional clinical manifestations. Physical examination refers to an elastic tumor on the right posterolateral aspect of the vagina. The transvaginal ultrasound did not show the alteration. After the initial expected treatment, in the following review the rapid growth of the lesion was observed, in addition to the manifestation of vaginal symptoms. Surgical removal of the lesion will be applied. The anatomopathological study reported a vaginal leiomyoma, and cells with bizarre nuclei. During the follow-up, the asymptomatic patient was observed, without signs of local recurrence. CONCLUSION: Although leiomyomas represent the most frequent benign tumors in women of reproductive age, their vaginal manifestation is exceptional. The gold treatment is complete surgical extirpation and the definitive diagnosis is established by anatomopathological study. Tumors with high cellularity, high concentration of bizarre cells and increased mitotic activity appear to have a benign behavior. Although it is rare, there are cases of recurrence.

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La Medicina Basada en la Evidencia (MBE) promovida desde hace 25 años, como un enfoque de la práctica clínica que integre la ciencia a traves del uso juicioso de la mejor evidencia disponible con la pericia clínica y el respeto de valores y preferencias de los pacientes para la toma de decisiones. En su evolución promovió la corriente de toma de decisiones compartidas, la que buscó el involucramiento y empoderamiento de las personas en lo concerniente al cuidado de su salud, pero denotando que la sóla decisión informada no es suficiente, sino que se necesita de la complicidad con el médico para que esta decisión sea realmente compartida. Esto, ha permitido entender lo que implica el trabajo de ser paciente y como el cuidado de de la salud, depende del equilibrio entre la carga y la capacidad para sobrellevar ese trabajo y que sólo, a traves de la conversación empática, se podrá dirigir exitosamente el curso de la salud, estableciendo una medicina mínimamente intrusiva, proceso que entraña una profunda humanidad y convierte a la MBE en expresión humana de una práctica médica científica cuidadosa y afectuosa

Evidence-based medicine (EBM), has been into practice for the last 25 years, being an approach for clinical practice integrating science with the use of the best available evidence alongside clinical ability and also respecting patient's values and preferences for decision making. During its progress, EBM incorporated shared decision making, aiming to involve and empower persons with respect to their healthcare, but noting that isolated informed decision making is not enough; instead, a deep collaboration between patients and physicians is needed, so that decision making may really be a shared act. This has led to understanding what is the meaning of being a patient and how healthcare depends upon an equilibrium between the workload and the ability to manage it, and that only through an empathetic conversation we may successfully manage patients care, establishing a 'minimally intrusive medicine', a process that implies plenty of humanity and turns EBM into 'a human expression of a careful and caring scientific medical practice'

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Objetivo: La diabetes es una enfermedad no transmisible con prevalencia creciente que provoca alta carga de enfermedad por su tardío diagnóstico, complicaciones discapacitantes y elevada mortalidad. Para homogeneizar la atención el Ministerio de Salud peruano publicó la 'Guía de práctica clínica para el diagnóstico, tratamiento y control de la diabetes mellitus tipo 2 en el primer nivel de atención' (GPC). Materiales y métodos: Se elaboró una encuesta para evaluar el equipamiento, así como el conocimiento y uso de GPC en los 32 establecimientos de salud de los 3 distritos de la Dirección de Redes Integrales de Salud de Lima Norte. Resultados: Se evaluó la aplicación de la GPC, el conocimiento de los médicos y el equipamiento en 32 centros de los distritos del Rímac, San Martín de Porres y Los Olivos. Veintisiete médicos (84%) conocían la GPC, diez (28%) han recibido capacitación, 21 (71%) refirieron usarla, 17 (53%) manejaban los conceptos contenidos en la GPC. Solo 4/30 centros disponían de metfomina, ninguno de los centros realizaba hemoglobina glicosilada ni albuminuria y en solo 9 había disponibilidad de glucómetros de manera permanente. Conclusiones: La GPC no ha sido implementada y sólo parcialmente difundida, lo que limita su aplicación, afecta de manera significativa la calidad de atención de pacientes portadores de diabetes mellitus tipo 2 y hace que el esfuerzo y costos invertidos en su elaboración constituyan un dispendio de recursos

Background: Diabetes is a non-communicable disease with increasing prevalence that causes high burden of disease due to its late diagnosis, disabling complications, and high mortality. Aiming to standardize care, the Peruvian Ministry of Health published the 'Clinical practice guideline for diagnosis, treatment and control of type 2 diabetes mellitus at primary care level' (CPG). Materials and methods: A survey was prepared, aiming to assess the equipment as well as knowledge and use of CPG by physicians in 32 healthcare facilities in three districts from the Northern Lima Health Region. Results: The use of CPG, as well as knowledge from physicians and the equipment in 32 healthcare facilities in Rimac, San Martin de Porres, and Los Olivos districts were assessed. Twenty-seven physicians (84%) knew the CPG, 10 (28%) had received training, 21 (71%) declared they use the CPG, and 17 (53%) were familiarized with the concepts delivered by the CPG. Only 4/30 of the facilities had metformin available. None of them had the capability for measuring glycated hemoglobin or albuminuria, and only 9 have permanent availability of blood glucose meters. Conclusions: The GPC has not been implemented and it has been only partially disseminated, which limits its application, this significantly affects the quality of care of patients with type 2 diabetes mellitus; therefore, all effort and costs spent in its elaboration constitute resource waste

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Se presentó una gestante de 26 años de edad, mestiza, con antecedente de salud aparente evaluada en consulta de asesoramiento genético comunitaria con riesgo incrementado por exposición a teratógenos y mutágenos, que en la ecografía fetal del segundo trimestre se identificaron alteraciones cardiovasculares que pudieron estar relacionadas con anomalía de Ebstein. Este diagnóstico fue confirmado en el Centro Provincial de Genética Médica de Guantánamo y, posteriormente, en Santiago de Cuba. A pesar de ser una cardiopatía congénita poco frecuente, se consideraron: la intensificación de las acciones en la atención prenatal precoz de las gestantes en la comunidad, la realización y cumplimiento de los programas prenatales existentes en nuestro país, principalmente los ultrasonidos prenatales que continúan siendo el examen complementario de elección y ofrecer el asesoramiento genético específico en las familias afectadas(AU)

A 26-year-old mixed-race pregnant woman with a history of apparent health evaluated in a community genetic counseling clinic with increased risk due to exposure to teratogens and mutagens was presented. Fetal echography of the second trimester identified cardiovascular alterations that may have been related to Ebstein's anomaly. Diagnosis that was confirmed in the Provincial Center of Medical Genetics of Guantanamo later was confirmed in Santiago de Cuba. Despite being a rare congenital heart disease, the following were considered: the intensification of the actions in the prenatal care of pregnant women in the community, the realization and fulfillment of the prenatal programs existing in our country, mainly the prenatal ultrasounds that continue being the complementary examination of choice and offer specific genetic counseling in affected families(AU)

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AIM: To evaluate alterations in tight junction (TJ) proteins and glucose transporters in rat peritoneal mesothelial cells (RPMC) from diabetic rats and after treatment with peritoneal dialysis solutions (PDS) in vitro. METHODS: Diabetes was induced in female Wistar rats by streptozotocin (STZ)-injection. Twenty-one days after STZ-injection, peritoneal thickness and mesothelial cell morphology were studied by light microscopy and microvilli length and density by atomic force microscopy. RPMC were obtained from healthy and diabetic rats. Mesothelial phenotype, evaluated by cytokeratin and pan-cadherin, epithelial to mesenchymal transition (EMT), evaluated by alpha-smooth muscle action (α-SMA) and vimentin, TJ proteins, claudins-1 and -2, and occludin, and glucose transporters, sodium and glucose co-transporters (SGLT) -1 and -2 and facilitative glucose transporters (GLUT) -1 and -2 were analyzed. Also, transepithelial electrical resistance (TER) was measured. Oxidative stress was estimated by measuring reactive oxygen species production, and protein carbonylation, receptor for advanced glycation end products (RAGE), nuclear factor erythroid related factor-2 (Nrf-2), and expression of antioxidant enzymes. KEY FINDINGS: Peritoneal damage was present 21days after STZ-injection. Diabetes induced changes in TJ and glucose transporters in RPMC together with decreased TER. RPMC from diabetic rats showed oxidative stress, which was enhanced by exposure to PDS. In addition, RPMC from diabetic rats showed early EMT. SIGNIFICANCE: To our knowledge, this is the first study that shows changes in TJ proteins and glucose transporters of RPMC from diabetic rats. All these alterations might explain the increased peritoneal permeability observed in diabetic patients undergoing peritoneal dialysis.

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Hace más de 20 años se publicó la primera definición de sepsis basado en el concepto de Respuesta Inflamatoria Sistémica (SIRS), definición que utilizamos hasta la actualidad. Recientemente, el Grupo de Trabajo de las Definiciones de Sepsis (Sepsis Definitions Task Force) ha publicado un consenso con las definiciones actualizadas de sepsis y shock séptico (SEPSIS-3) que utiliza un nuevo concepto de sepsis como disfunción orgánica potencialmentemortal causada por una respuesta disregulada del huésped a la infección, utilizando el sistema de puntuación SOFA (Sequential Organ Failure Assessment), y propugna se abandonen los antiguos criterios. Realizamos una revisión de los antecedentes de esta nueva propuesta de definición, las definiciones planteadas por este nuevo consenso, comparando estas nuevas definiciones con las antiguas, limitaciones y evaluamos su aplicabilidad en la práctica clínica

More than 20 years ago, the first definition of sepsis based on the concept of systemic inflammatory response syndrome (SIRS), was published, and this is the definition we have been currently using until now. Recently, the Sepsis Definitions Task Force has published a consensus statement with the updated definitions of sepsis and septic shock (sepsis-3), and introducing a new concept of sepsis as a life-threatening organ dysfunction caused by adysregulated host response to infection, using the SOFA scoring system (Sequential Organ Failure Assessment), and calls for abandoning the old criteria. We review the background for this new proposed definition, the definitions proposed by this new consensus, and we compare the new definitions with respect to the old ones, aiming at determining their limitations and evaluating their applicability in clinical practice

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