viernes, 21 de julio de 2017

Hipotiroidismo / Hypothyroidism

Julio 21, 2017. No. 2756





Hipotiroidismo subclínico y su asociación con el aumento de la mortalidad cardiovascular: Llamado a la acción.
Sub-Clinical Hypothyroidism and Its Association With Increased Cardiovascular Mortality: Call for Action.
Cardiol Res. 2017 Apr;8(2):31-35. doi: 10.14740/cr524w. Epub 2017 May 3.
Abstract
Thyroid hormones play an important role in regulating different functions regarding metabolism and performance in multiple organs. Any change in the thyroid hormones axis can lead to profound effect on the vital organ stability especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. Currently, there exists a paucity of evidence on the beneficial effects of thyroxine hormone replacement on cardiovascular mortality outcomes in subclinical hypothyroidism. Also, the clinical relevance of measuring and treating supra-normal thyroid-stimulating hormone levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. Here we review the current evidence regarding the prognostic significance of sub-clinical hypothyroidism in patients with heart failure with preserved ejection fraction.
KEYWORDS: Cardiovascular mortality; Heart failure with preserved ejection fraction; Sub-clinical hypothyroidism

Deficiencia de iodo. Manifestaciones clínicas
Iodine deficiency: Clinical implications.
Cleve Clin J Med. 2017 Mar;84(3):236-244. doi: 10.3949/ccjm.84a.15053.
Abstract
Iodine is crucial for thyroid hormone synthesis and fetal neurodevelopment. Major dietary sources of iodine in the United States are dairy products and iodized salt. Potential consequences of iodine deficiency are goiter, hypothyroidism, cretinism, and impaired cognitive development. Although iodine status in the United States is considered sufficient at the population level, intake varies widely across the population, and the percentage of women of childbearing age with iodine deficiency is increasing. Physicians should be aware of the risks of iodine deficiency and the indications for iodine supplementation, especially in women who are pregnant or lactating.
Avances recientes en enfermedades autoinmunes de la tiroides
Recent Advances in Autoimmune Thyroid Diseases.
Endocrinol Metab (Seoul). 2016 Sep;31(3):379-385. doi: 10.3803/EnM.2016.31.3.379. Epub 2016 Aug 26.
Abstract
Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs.
Manejo de enfermedades endocrinológicas. Hiponatremia asociada a hipotiroidismo: mecanismos, implicaciones y manejo
MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment.
Eur J Endocrinol. 2017 Jan;176(1):R15-R20. Epub 2016 Aug 2.
Abstract
SUMMARY: The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. CONCLUSIONS: Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly.

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
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miércoles, 19 de julio de 2017

Riesgo de lesión del nervio supraescapular y axilar en la artroplastia total reversa del hombro: Un estudio anatómico


The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: An anatomic study.

Fuente
Este artículo es originalmente publicado en:
De:

Injury.


2017 Jun 28. pii: S0020-1383(17)30417-5. doi: 10.1016/j.injury.2017.06.024. [Epub ahead of print]
Todos los derechos reservados para:
Copyright © 2017 Elsevier Ltd. All rights reserved.AbstractPURPOSE:
Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure.

CONCLUSIONS:
Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11mm and to the suprascapular notch of 19mm.
Copyright © 2017 Elsevier Ltd. All rights reserved.
KEYWORDS:
Axillary nerve; Complication; Glenoid baseplate; Iatrogenic nerve injuries; Reverse total shoulder arthroplasty; Suprascapular nerve; Surgical exposure



Resumen

PROPÓSITO:
La implantación de una artroplastia total reversa del hombro (rTSA) pone en riesgo los nervios axilar y suprascapular. El objetivo de este estudio anatómico fue analizar digitalmente la localización de estos nervios en relación a puntos óseos para predecir su trayectoria y así ayudar a reducir el riesgo de complicaciones neurológicas durante el procedimiento.
CONCLUSIONES:
La implantación de componentes de rTSA pone en peligro el nervio axilar debido a su proximidad a la metáfisis humeral y al borde glenoideo inferior. La perforación posterior y superior y la colocación del tornillo extraóseo durante la implantación de la placa base glenoidea en rTSA colocan el nervio suprascapular en riesgo, con zonas seguras al nervio pasando la muesca espinoglenoide de 11mm y la muesca suprascapular de 19mm.

Copyright © 2017 Elsevier Ltd. Todos los derechos reservados.

PALABRAS CLAVE:
Nervio axilar; Complicación; Placa base glenoide; Lesiones nerviosas iatrogénicas; Artroplastia total del hombro invertida; Nervio suprascapular; Exposición quirúrgica
PMID:   28711169   DOI:  10.1016/j.injury.2017.06.024

martes, 18 de julio de 2017

Enfermedades cardiovasculares y diabetes / Cardiovascular disease and diabetes

Julio 15, 2017. No. 2750






Enfermedades cardiovasculares y diabetes. ¡Dos caras de la misma moneda!
Cardiovascular Disease and Diabetes: Two Sides of the Same Coin!
Sayeeda Rahman, Md. Anwarul Azim Majumder, Russell Kabir, Mainul Haque, Subir Gupta, Sana Mohammad Yasir Arafat, Nkemcho Ojeh and Prasad Dalvi
Recent Trends in Cardiovascular Risks
Abstract
Cardiovascular disease (CVD) and type 2 diabetes (T2DM) are rapidly rising around the globe. Empirical researches demonstrated rapid increase in mortality and morbidity related to CVD and T2DM. Much of the diabetes-associated morbidity and mortality predominantly reflects its deleterious effect on macrovascular and microvascular diseases. The microvascular complications of T2DM include retinopathy, neuropathy and nephropathy and the macrovascular complications include ischemic heart disease, cerebrovascular disease and peripheral vascular diseases. Research indicates that coronary heart disease (CHD) is the major cause of mortality in people with T2DM. Herein, this chapter reviews relationship between CVD and T2DM, associated complications and effectiveness of relevant treatment modalities to treat/prevent diabetic macrovasculopthy. Macrovascular disease occur due to underlying obstructive atherosclerotic changes of major arteries which cause functional and structural abnormalities of blood vessels. The long-term complications can be controlled and prevented by controlling glycemia, maintaining normal lipid profiles, adopting a healthy lifestyle and using pharmacological interventions. Clinical trials have shown that lifestyle interventions help in prevention and reduction of CVD risk, but evidence for long-term CVD outcomes is lacking. A multidisciplinary approach involving patients, health professionals and researchers and governments should be undertaken to reduce the incidence and prevalence of diabetesrelated cardiovascular complications. Keywords: cardiovascular diseases, type 2 diabetes, vasculopathy, macrovascular diseases, atherosclerosis, pathophysiology, pathogenesis

Refinación de la predicción a largo plazo del riesgo cardiovascular en la diabetes - La puntuación de VILDIA.
Refining Long-Term Prediction of Cardiovascular Risk in Diabetes - The VILDIA Score.
Sci Rep. 2017 Jul 5;7(1):4700. doi: 10.1038/s41598-017-04935-8.
Abstract
Cardiovascular risk assessment in patients with diabetes relies on traditional risk factors. However, numerous novel biomarkers have been found to be independent predictors of cardiovascular disease, which might significantly improve risk prediction in diabetic patients. .... The VILDIA score based on traditional cardiovascular risk factors and reinforced with novel biomarkers outperforms previous risk algorithms.

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
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