Simultaneously in time we supported the interest to describe the conceptual aspects of consumption related to the prescription15 and no less problematic. The aim of this study was to assess the risk of recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve during surgery. Measurement of the degree of vocal cord paralysis was based on the number of nerves at risk.
Postoperatively, the recurrent laryngeal nerve recovered in most patients without documented nerve injury during surgery.
La identificación y disección de rutina de los NLR durante las tiroidectomías ha sido un tema de controversia durante muchos años.13 Sin embargo, esta técnica es realizada hoy por muchos cirujanos14-16. Wade3 declaró en 1995 que los nervios de NLR son muy sensibles y no deben diseccionarse ni tocarse. Mientras que Bergamaschi et al7, en sus investigaciones demostraron que los porcentajes de parálisis temporal o permanente de las CV no tienen significancia estadística como la.
Agarwal A, Mishra SK, Role of surgery in the management of Graves disease.J Indian Med Assoc 2001; 99:252-256
Parálisis del nervio laríngeo recurrente en cirugía tiroidea relacionada con operaciones y nervios de riesgo. La lesión del nervio laríngeo recurrente es una complicación frecuente de la cirugía de la glándula tiroides. La evaluación organizada de la práctica médica ofrece la posibilidad de intercambiar experiencias, conocer el trabajo de diferentes grupos y por supuesto en beneficio del paciente.
Desde entonces, con la mejora de la técnica, la frecuencia ha disminuido sin desaparecer por completo, actualmente en un mínimo del 0,5% al 5%, según las series.
Aunque muchos autores han descrito diferentes técnicas para minimizar la posibilidad de lesión del nervio recurrente, todos coinciden en la importancia de una técnica cuidadosa y estandarizada, así como la exposición completa del nervio. La tasa mundial de parálisis recurrente es del 6,14%, dentro del rango de publicaciones sobre el tema, aunque algo elevada según los últimos trabajos.
PROPOSAL OF GUIDELINE FOR CLINICAL TRIAL PROTOCOLS WITH HERBAL DRUGS
Maykel Pérez Machín MSc., Miriam Cid Ríos, Rayza Méndez Triana, Migdalia Rodríguez Rivas, Migdacelys Arboláez Estrada
Vicerrectorate of Investigations. Clinical Trials Center
Rev Electron Biomed / Electron J Biomed 2007;1:16-20
- An index to organize the content 2. A summary of the protocol
- Fifteen chapters including the fundamental aspects in the designing of an herbal drug clinical trial protocol
- basic data of the health problem itself and its context. This includes a brief description of the problem that requires a therapeutic solution, and
- justification of the proposed study, including the pre-clinical studies (toxicology and experimental pharmacology) carried out and the available clinical experience
- managing information,
- biological, pharmaceutical and chemical information and
- preclinical information about experimental pharmacology and toxicology including long term studies
- remaining stages of the 5 established by the Center for State Control of Drug Quality (CECMED) should be presented for a definitive registration of an herbal
- Complementary information of the product: An informative sheet containing all the necessary data about the use of the product will be presented as well as the format of the labels and containers with the provided information, listing in the label the active ingredient
In 1998, the editors of the New England Journal of Medicine declared, "It's time the scientific community stopped free-roaming alternative medicine"1. There are indications that the correct use of these products can contribute to improving the health of the population. The implementation of regulations that safeguard these principles in one of the objectives of the drug regulatory authorities5.
There is a critical step in the development process of a new drug involves a series of studies that must be completed before the product can be submitted for product registration. This does not mean that we should limit the assessment of a plant's safety and efficacy to folk wisdom. Regulatory agencies have the responsibility to establish and control the new drug investigation process; supervising the use of the correct methodology and the proper interpretation of the results and avoiding biased conclusions.
To facilitate the use of the guidelines and to arrive at a clear final protocol, the chapters also contain a corresponding subheading. It contains the synthesis of why, for what and how the study was conducted, including the objectives of the studies, the design (sample size, masking, randomisation, study and control group, duration of the study), the characteristics of the population which will be studied (disease or condition to be treated and most relevant aspects of the inclusion and exclusion criteria), ethical considerations, plan for statistical analysis, practical considerations and legal aspects. The guidelines contain the information researchers in this field need to validate the pharmacological activity of the natural products through clinical trials.
It is very important to conduct investigations according to international requirements if we are trying to obtain natural products with efficacy, safety and quality, and the use of guidelines helps to achieve this goal. Regardless of how the drug is produced - synthesized in the laboratory, extracted from a medicinal plant or part of a plant.
MEDICAL HYPOTHESES
HISTOLOGICAL GLOMERULAR PATTERNS AS CHAOTIC ATTRACTORS
Musso C 1 , Bezic J 1 , Christiansen S 3 , Algranati L 1
1 Servicios de Nefrologia y 3 Anatomía Patológica. Hospital Italiano de Buenos Aires
Rev Electron Biomed / Electron J Biomed 2007;1:21-27 Versión en español
Ilia Prigogine, one of the founders of Chaos Theory, proposed that information that combats entropy is represented by the self-organization of matter and the acquisition of a complex internal order, as occurs in chaotic systems. In this sense, fractal objects that cannot be represented by Classical or Euclidean Geometry, (circles, squares, etc.) can be represented by repeating or repeating a basic (fractal) structure. Mandelbrot manages to explain the shape of many elements in nature, such as sea shores, mountains, clouds, etc.
In the human body, fractal structures have been described in the coronary arteries, cardionectary system, cardiac valves, vascular and bronchial tree. In the following, we will present a hypothesis elaborated by studying photographs of nephrons and glomeruli in particular, in healthy and diseased histological samples. In the present study we propose that the nephron follows a fractal shape, the main structure of which would be the sinusoidal (sine-cosine) mathematical function.
The repetition (iteration) of the sinusoidal mathematical function, with different variations for each nephronal region (Bowman's capsule, convoluted tubules, etc.) allows the construction of a complete nephron. We also noticed that some glomerular histological patterns, which are developed in the context of different diseases, may be variations of the same mathematical function. We conclude that from fractal geometry, sinusoidal function could explain not only the normal nephrological structure, but also that of the glomerular histopathological patterns.
Moreover, the authors have found that some pathological conditions are rather associated with a reduction in the diversity of possible sinusoidal configurations. They are characterized by their fractal dimension and represent a probability cloud which will be denser in the most frequently visited area.
HIPOTESIS MEDICA
PATRONES HISTOLOGICOS GLOMERULARES COMO ATRACTORES CAOTICOS
Rev Electron Biomed / Electron J Biomed 2007;1:28-34 English version
FRACTURA-LUXACIÓN DE ASTRÁGALO
A PROPÓSITO DE UN CASO
Alfredo Martín Acosta Inguanzo, Lázaro González Robaina, Manuel González Reina, Héctor Blanco Placencia
Ciudad de la Habana. Cuba
Rev Electron Biomed / Electron J Biomed 2007;1:35-41
ACUTE RENAL FAILURE WITH NORMAL PLASMA UREUM LEVEL SECONDARY TO ACUTE PYELONEPHITIS IN A SINGLE KIDNEY PATIENT.
ACUTE RENAL FAILURE WITH NORMAL PLASMA UREA LEVEL SECONDARY TO ACUTE PYELONEPHITIS IN A SINGLE KIDNEY PATIENT
1 Nephrology Department. Hospital Italiano de Buenos Aires
Urinalysis documented high leukocytes and pyocytes, decreased creatinine clearance (35 ml/minute), normal plasma urea (29 mg/dl) and increased plasma creatinine (2.1 mg/dl) and partial urea excretion (80% ) were discovered. The case was interpreted as acute renal failure resulting from acute pyelonephritis in a patient with a single kidney. In addition, since urea is also excreted in the S3 segment of the proximal tubules, this substance undergoes the process of intrarenal recycling, which contributes to the reduction of its excretion5-6.
The syndrome of acute renal failure usually occurs with an increased concentration of creatinine and urea in the plasma, as for both substances glomerular filtration plays an important role in their excretion1. However, there are cases of acute renal failure with increased plasma creatinine but normal urea concentration. In addition, acute pyelonephritis can alter the intrarenal process of urea recycling8 and also cause acute renal failure in a patient with a single kidney or chronic kidney disease.
This increase in the fractional excretion of urea may explain the normal plasma urea levels found in our patient despite his reduced glomerular filtration. Acute pyelonephritis in a single kidney patient may present as a pattern of acute renal failure with normal plasma urea levels. Acute renal failure with normal plasma urea levels: a marker of proximal tubular dysfunction with diabetes insipidus.
A study of the intrarenal recycling of urea in the rat with chronic experimental pyelonephritis. Clin Invest. This case is described in a simple style and it notices a picture that is found more frequently every day in patients suffering from acute renal failure, especially if they are old or malnourished.
EN PACIENTE MONO-RENO SECUNDARIA A PIELONEFRITIS AGUDA
1 Servicio de Nefrología. Hospital Italiano de Buenos Aires
En el siguiente reporte presentamos el caso de un paciente monorrenal que desarrolló insuficiencia renal aguda con uremia normal secundaria a pielonefritis aguda. El paciente normonatremico y levemente hiperglucémico: 130 mg/dl, presentó insuficiencia renal con poliuria acuosa: volumen urinario 3000 cc y osmolalidad urinaria 176 mOsm/l. El caso se interpretó como insuficiencia renal aguda en un paciente monorreno por pielonefritis aguda.
La insuficiencia renal suele presentarse con un aumento de los niveles séricos de urea y creatinina, ya que la filtración glomerular juega un papel central en la excreción de ambas sustancias 1. Sin embargo, existen situaciones clínicas en las que la insuficiencia renal aguda puede presentarse con niveles elevados de creatinina pero con niveles normales de uremia . En cuanto a la pielonefritis aguda, esta infección puede inducir diabetes insípida nefrogénica al generar inflamación en el intersticio renal con la consiguiente alteración de la tonicidad medular 7.
Por otra parte, la pielonefritis aguda también puede interrumpir el proceso de recirculación intrarrenal de la urea 8 así como desencadenar una insuficiencia renal aguda en pacientes monorrenales o con enfermedad renal crónica2. Los mecanismos mencionados podrían explicar el aumento de la excreción fraccionada de urea, que permite al paciente mantener una uremia normal a pesar de una disminución de la tasa de filtración glomerular. La pielonefritis aguda en pacientes con un riñón único puede presentarse como insuficiencia renal aguda con uremia normal.
Es una triste realidad que en ocasiones no se piensa en la presencia de insuficiencia renal hasta que aparece la anuria o un aumento de la uremia del paciente. Este informe, así como el informe sobre el "síndrome intermedio" (Electron J Biomed) enfatizan que los cuadros clínicos en los ancianos deben ser interpretados desde su propia perspectiva, diferente a la que se aplica al cuidado de los jóvenes.
Letters to the Editor / Cartas al Editor
CARACTERÍSTICAS MICROBIOLOGICAS Y CLINICAS DE LOS DERMATOFITOS
Rev Electron Biomed / Electron J Biomed 2007;1:48-49
Todos los cultivos en los que se detectó un crecimiento compatible con dermatofitos se microcultivaron o se cultivaron en un agar de 4 cuadrados bajo un cubreobjetos para observar el crecimiento del micelio fúngico en un solo plano; estos se mantienen a temperatura ambiente durante 10 o 15 días, luego de lo cual se retira la tapa y se coloca en un portaobjetos con una gota de azul de lactofenol; estas preparaciones se observan luego al microscopio óptico con un objetivo de 40 aumentos. La identificación de los tres géneros se basa en criterios macroscópicos (textura de la colonia, color del micelio, color de fondo...), microscópicos (aspecto de macro y microconidios, forma de hifas...), tiempo de crecimiento, bioquímica. pruebas, etc Las muestras más frecuentes tomadas en los laboratorios hospitalarios son: escamas de cuero cabelludo, escamas interdigitales de manos y pies, raspados de uñas de manos y pies y escamas de piel (tronco, extremidades...).
Prevalence and risk factors for tinea unguium and tinea pedis in the general population in Spain.
SÍNDROME DE SWEET EN PACIENTE CON SÍNDROME MIELODISPLÁSICO
Servicios de Hematología-Hemoterapia y Medicina Interna del Complejo Asistencial de Burgos
