S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100001 La salud y el cambio climático Ávila-Agüero María Luisa , 03 2009 2009 51 04 06 Martin V Chevalier V Ceccato P Anyamba A De Simone L Lubroth J The impact of climate change on the epidemiology and control of Rift Valley fever Rev Sci Tech 2008 27 Ebi KL Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030 Global Health 2008 19 Shea KM Truckner RT Weber RW Peden DB Climate change and allergic disease J Allergy Clin Immunol 2008 122 Middleton J Environmental health, climate chaos and resilience Med Confl Surviv 2008 24 1 Wilkinson P Climate change & health:: the case for sustainable development Med Confl Surviv 2008 24 1 Bernardi M Global climate change--a feasibility perspective of its effect on human health at a local scale Geospat Health 2008 2 Tong S Mackenzie J Pitman AJ FitzGerald G Nicholls N Selvey L Global climate change: time to mainstream health risks and their prevention on the medical research and policy agenda Intern Med J 2008 38 Gill M Why should doctors be interested in climate change? BMJ 2008 336 Lupo AR Hagan JC 3a. Physicians and environmental change JAMA 2008 299 McMichael AJ Neira M Heymann DL World Health Assembly 2008: climate change and health Lancet 2008 371
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100002 Errores médicos Medical Errors Arrea-Baixench Carlos ,Academia Nacional de Medicina 03 2009 2009 51 07 09
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100003 Identificación de genes causales y de susceptibilidad para enfermedades de herencia Mendeliana y compleja Identification of Susceptibility and Causing Genes for Mendelian and Complex Diseases Rodríguez-Porras Luis Raventós-Vorst Henriette ,Universidad de Costa Rica Centro de Investigación en Biología Celular y Molecular 03 2009 2009 51 10 15

Los factores genéticos participan en la etiología de la mayoría de las enfermedades comunes en la población. Las enfermedades en las que participan factores genéticos pueden ser clasificadas en varias categorías y de acuerdo con las características que presenten, se pueden utilizar distintas estrategias metodológicas para identificar los genes participantes. En la mayoría de las enfermedades con un patrón de herencia mendeliana, se han podido identificar las mutaciones causales de la enfermedad. En las enfermedades complejas, esta búsqueda ha sido menos exitosa a pesar de ser las más frecuentes en la población. Encontrar genes de susceptibilidad es importante no solo para entender el mecanismo de acción de la enfermedad, sino que podría contribuir en el desarrollo de medicamentos más eficaces para el tratamiento, conocer los factores ambientales y desarrollar intervenciones preventivas y, en algunos casos, la aplicación de terapia génica.

Genetic factors are involved in the etiology of most common diseases and traits present in populations. Different methodological approaches can be utilized to determine genes involved according to their genetic features in diseases. In the majority of conditions that follow a simple Mendelian pattern culprit genetic mutations have been identified. Conversely complex traits that are most common in the population are also the most difficult to identify. Finding these genes is crutial no just to clarify the pathophysiology of these common diseases but also to identify environmental factors involved and to improve their treatment, including in some specific cases gene therapy.

 desequilibrio de ligamiento enfermedades multifactoriales herencia mendeliana heterogeneidad genética penetrancia tamizaje genómico linkage disequilibrium complex diseases mendelian inheritance genetic heterogeneity genetic penetrance genomic screening Kiberstis P Roberts L The puzzle of complex diseases Science 2002 296 Zlotogora J Recessive or dominant? Reclassification in the molecular age Clin Genet 1998 53 Lander E Schork N Genetic dissection of complex traits Science 1994 265 Zwick M Cutler D Chakravarti C Patterns of genetic variation in Mendelian and complex traits Annu Rev Genomics Hum Genet 2000 1 Spector T Mac Gregor A Snieder H Uses of twins in studying the genetics of complex traits Gene Screen 2000 1 Boomsma D Busjahn A Peltonen L Classical twin studies and beyond Nat Genet 2002 3 Prichard J Are rare variants responsible for susceptibility to complex diseases? Am J Hum Gent 2001 69 Conneally M The complexity of complex diseases Am J Hum Genet 2003 72 Reich D Schaffner S Daly M McVean G Mullikin J Higgins J Human genome sequence variation and the influence of gene history, mutation and recombination Nat Genet 2002 32 Clerget-Darpoux F Overview of strategies for complex genetic diseases Kidney Int 1998 53 Rao D Genetic dissection of complex traits: An overview. Genetic dissection of complex traits advances Adv Genet 2001 42 Kors E Van den Maagdenberg A Plomp J Frants R Ferrari M Calcium channel mutations and migraine Curr Opin Neurol 2002 15 May A Ophoff R Terwindt G Urban C Van Eijk R Haan J Familial hemiplegic migraine locus on 19p13 is involved in the common forms of migraine with and without aura Hum Genet 1995 96 Nyholt D Lea R Goadsby P Brimage P Griffiths L Familial typical migraine: linkage to chromosome 19p13 and evidence for genetic heterogeneity Neurology 1998 50 Hovatta I Kallela M Farkkila M Peltonen L Familial migraine: exclusion of the susceptibility gene from the reported locus of familial hemiplegic migraine on 19p Genomics 1994 23 Monari L Mochi M Valentino M Arnaldi C Cortelli P De Monte A Searching for migraine genes: exclusion of 290 cM out of the whole human genome Ital J Neurol Sci 1997 18 Kim J Yue Q Jen J Nelson S Baloh R Familial migraine with vertigo: no mutations found in CACNA1A Am J Med Genet 1998 79 Schrag D Kuntz K Garber J Weeks J Decision analysis--effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations N Engl J Med 1997 337 Healy B BRCA genes--bookmaking, fortunetelling, and medical care N Engl J Med 1997 336 Schliekelman P Slatkin M Multiplex relative risk and estimation of the number of loci underlying an inherited disease Am J of Hum Genet 2002 71 Altmuller J Palmer L Fischer G Scherb H Wjst M Genomewide scans of complex human diseases: true linkage is hard to find Am J Hum Genet 2001 69 Heutink P Oostra B Gene finding in genetically isolated populations Hum Molec Genet 2002 11 Fugazzola L Cerutti N Mannavola D Ghilardi G Alberti L Romoli R Multigenerational familial medullary thyroid cancer (FMTC): evidence for FMTC phenocopies and association with papillary thyroid cancer Clinical Endocrinology 2002 56 Honsho M Tamura S Shimozawa N Suzuki Y Kondo N Fujiki Y Mutation in PEX16 is causal in the peroxisome-deficient Zellweger Syndrome of complementation group D Am J Hum Genet 1998 63 Czarny-Ratajczak M Lohiniva J Rogala P Kozlowski K Carter L Spector T A Mutation in COL9A1 causes multiple epiphyseal dysplasia: further evidence for locus heterogeneity Am J Hum Genet 2001 69 Daw E Payami H Nemens E Nochlin D Bird T Schellenberg G The Number of trait loci in late-onset alzheimer disease Am J Hum Genet 2000 66 Risch N Merikangas K The future of genetic studies of complex human diseases Science 1996 273 Escamilla M Population isolates: their special value for locating genes for bipolar disorder Bipolar Disord 2001 3 Knapp M A note on power approximations for the transmissiondisequilibrium test Am J Hum Genet 1999 64 Schulze T McMahon F Genetic association mapping at the crossroads: which test and why? Overview and practical guidelines Am J Med Genet 2002 114 Pritchard J Przeworski M Linkage disequilibrium in humans: models and data Am J Hum Genet 2001 69 Service S Ophoff R Freimer N The genome-wide distribution of background linkage disequilibrium in a population isolate Hum Mol Genet 2001 10 Peltonen L Palotie A Lange K Use of population isolates for mapping complex traits Nat Rev Genet 2000 1 Carvajal-Carmona L Ophoff R Service S Hartiala J Molina J Leon P Genetic demography of Antioquia (Colombia) and the Central Valley of Costa Rica Hum Genet 2003 112 Mathews C Reus V Bejarano J Escamilla M Fournier E Herrera L Genetic studies of neuropsychiatric disorders in Costa Rica: a model for the use of isolated populations Psychiatr Genet 2004 14 Escamilla M Spesny M Reus V Gallegos A Molina J Use of linkage disequilibrium approches to map genes for bipolar disorder in the Costa Rican population Am J Med Genet 1996 67 Beaudet A Making genomic medicine a reality Am J Hum Genet 1999 64 Evans J Skrzynia C Burke W The complexities of predictive genetic testing BMJ 2001 322 Martin E Lai E Gilbert J Rogala A Afshari A Riley J SNPing away at Complex Diseases: Analysis of Single-Nucleotide Polymorphisms around APOE in Alzheimer Disease Am. J. Hum. Genet 2000 67
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100004 Errores médicos Medical Errors Alvarado-Guevara Ana Teresa Flores-Sandí Grettchen ,Poder Judicial Departamento de Medicina Legal 03 2009 2009 51 16 23

El error médico es cualquier falla ocurrida durante la atención de salud que haya causado algún tipo de daño al paciente, y cuyo origen puede relacionarse con la organización e implementación del servicio, a través de múltiples y complejos mecanismos. Ninguna especialidad médica está exenta de él. Establecer la responsabilidad médica en casos de error diagnóstico es difícil, pues en muchas ocasiones resultan inevitables. No obstante, una vez analizadas sus causas, ya sean estos cognitivas, del sistema de salud o errores sin culpa, es posible instaurar estrategias que tiendan a su reducción. El punto medular en el enfoque del error médico y diagnóstico es que una vez cometido y más aún si se comprueba algún tipo de responsabilidad médica, este debe ser encarado con seriedad y transparencia.

A medical error is a fault that occurs during the delivery of health care that has caused damage to the patient. It could be related to the organization and implementation of the medical service, through multiple and complex mechanisms. None of the medical areas is exempt of them. The legal analysis of diagnostic errors is difficult because many times they are inevitable. However, as soon as their possible causes-cognitive errors, system errors and no fault errors-are analyzed, it is possible to establish strategies to minimize them. The most important approach to a medical or diagnostic error is to confront it with reliability and clarity.

 error médico error diagnóstico sistema de salud mala praxis medical error diagnostic error health system malpractice Medical Errors: The Scoop of the problem Medical Errors: The Scoop of the problem Febr ua ry Gálvez E Gálvez M Santiesteban M Morales L Criterio profesional acerca del error médico Rev Cubana Med Gen Integr 1998 14 Guia sobre erro médico - orientações ao consumidor Guia sobre erro médico - orientações ao consumidor 2006 IDEC Kohn LT Corrigan JM Donaldson MS To err is human: building a safer health system To err is human: building a safer health system 2000 ^eWashington, DC National Academy Press Ramos BN Calidad de la atención de salud. Error médico y seguridad el paciente Rev Cuba Salud Pública 2005 31 3 Wolf SH Kuzel AJ Dovey SM Phillips RL A String of mistakes: The importance of Cascade Analysis in Describing, Counting and Preventing Medical Errors Ann Fam Med 2004 2 Sanabria A Repercusiones del error médico Tribuna Médica 2003 103 Lee TH A Broader Concept of Medical Errors N Engl J Med 2002 347 Baker R Norton P Flintoft V Blais R Brown A Cox J The Canadian Adverse Events Study: The incidence of adverse events among Hospital patients in Canada CMAJ 2004 170 Zarbo RJ Meier FA Raab SS Error Detection in Anatomic Pathology Arch Pathol Lab Med 2005 129 Aranaz JM Aibar C Gea MT León MT Los efectos adversos en la asistencia hospitalaria. Una revisión crítica Med Clín (Barc) 2004 123 Croskerry P The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them Acad Med 2003 78 Rosser W Medical errors in primary care: Results of an international study of family practice Can Fam Physician 2005 51 Russo G Aspectos medicolegales referentes al diagnóstico Aspectos medicolegales referentes al diagnóstico Blanco MA Hernández O Bosch R Moreno M Errores cometidos por residentes de Medicina Interna en la entrevista medica bajo observación directa Rev Cuba Med Mil 2002 31 Carvalho M Vieira A Erro médico em pacientes hospitalizados J Pediatr (Rio J) 2002 78 Carvalho WB Erros médicos associados com a deprivação do sono em UCI Rev Assoc Med Bras 2005 51 4 Flores G Cómo disminuir los accidentes en la atención de salud mediante calidad total, uso de computadoras y otras medidas Rev Latinoam Derecho Médico y Medicina Legal 2003 8 Flores G Presentismo: potencialidad en accidentes de salud Acta Méd Costarric 2006 48 Flores G Laws MB Mayo SJ Zuckerman B Abreu M Medina L Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters Pediatrics 2003 111 Moreno MA Burunate M Oquendo D Ausencia de correlación clínico patológica en el diagnóstico de la bronconeumonía Rev Cubana Med 1996 35 3 Ferreres AR Gutiérrez VP Cirugía del lado equivocado: error quirúrgico e implicancias médico-legales Rev Argent Cir 2003 84 Jacobs S Errors and adverse events in family medicine: Developing and validating a Canadian taxonomy of errors Can Fam Physician 2007 53 Diccionario de la Lengua Española. Tomo I Diccionario de la Lengua Española. Tomo I 2001 Vigésimo segunda edición Madrid Espasa Calpe Abate A O erro médico. Erro do diagnóstico e Erro do procedimento Informativo Jurídico 2006 35 Cabrera MC Correlación entre los diagnósticos premortem y posmortem en pacientes quirúrgicos. Cirugía General y Digestiva Correlación entre los diagnósticos premortem y posmortem en pacientes quirúrgicos. Cirugía General y Digestiva 10/1 1/ 20 Schiff GD Kim S Abrams R Cosby K Lambert B Elstein A Diagnosing diagnosis errors: lessons from a multi-institutional collaborative project. Advances in patient safety: from research to implementation Diagnosing diagnosis errors: lessons from a multi-institutional collaborative project. Advances in patient safety: from research to implementation 2005 1-4 Rockville, MD Agency for Healthcare Research and Quality Shojania K Changes in Rates of Autopsy-Detected Diagnostic Errors Over Time JAMA 2003 289 Weingart SN Wilson RM Gibberd RW Epidemiology of medical error BMJ 2000 320 Santos Neto L O erro diagnóstico Brasília méd 1997 34 Frable WJ Surgical pathology--second reviews, institutional reviews, audits, and correlations: what’s out there? Error or diagnostic variation? Arch Pathol Lab Med 2006 130 Idalino CV Gomes EE Cury PM Estudo comparativo dos diagnósticos macro e microscópicos de autópsias: análise de dificuldades e possíveis causas de erro J Bras Patol Med Lab 2004 40 Guly HR Diagnostic error in an accident and emergency department Emerg Med J 2001 18 Menezes CA Do erro médico Revista de Direito Renovar 2003 27 Gallagher TH Waterman AD Ebers AG Fraser VJ Levinson W Patients’ and Physicians’ Attitudes Regarding the Disclosure of Medical Errors JAMA 2003 289 Tullio A Diccionario Medico Legal Diccionario Medico Legal 1999 Abeledo-Perrot Quagliato Jr R Grangeia TAG Massucio RAC De Capitani EM Rezende SM Balthazar AB Associação entre paracoccidioidomicose e tuberculose: realidade e erro diagnóstico J Bras Pneumol 2007 33 Graber M Gordon R Franklin N Reducing Diagnostic Errors in Medicine: What’s the goal? Acad Med 2002 77 López MA Implicaciones de los dictámenes periciales Revista Médico-Legal 2005 29 Graber ML Franklin N Gordon R Diagnostic error in internal medicine Arch Intern Med 2005 165 Bonet M Módol M Tor J Rego MJ Tudela P Vilaseca B Error diagnóstico en Urgencias: relación con el motivo de consulta, mecanismos y trascendencia clínica Medicina clínica 2005 25 Gandhi TK Kachalia A Thomas EJ Puopolo AL Yoon C Brennan TA Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims Ann Intern Med 2006 145 Guly HR Missed diagnoses in an accident and emergency department Injury 1984 15 Brandão P Reis AM Erro médico em imagiologia. Performance e sistemas de detecção computorizada Acta Med Port 2006 19 Méndez N Silva D Morejón LF Rodríguez A Manifestaciones psiquiátricas en enfermedades endocrinas Rev Cuba Med Mil 1996 25 1 Lorenzano C El diagnóstico médico El diagnóstico médico 2006 Cleopas A Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness Qual Saf. Health Care 2006 15 Elder N Classification of medical errors and preventable adverse events in primary care: A synthesis of the literature. Medical error; primary care physicians; family physicians J Fam Pract 2002 51 Hayward R Estimating Hospital Deaths to Medical Errors JAMA 2001 286 Hinckley CM Make no mistake-errors can be controlled Qual Saf Health Care 2003 12 Kostopoulou O Confidential reporting of patient safety events in primary care: results from a multilevel classification of cognitive and system factors Qual Saf Health Care 2007 16 Lamb R Open disclosure: the only approach to medical error Qual Saf Health Care 2004 13 Margo CE A pilot study in ophthalmology of inter-rater reliability in classifying diagnostic errors: an underinvestigated area of medical error Qual Saf Health Care 2003 12 Schwappach DL Koeck CM What makes an error unacceptable? A factorial survey on the disclosure of medical errors Int J Qual Health Care 2004 16 Singh H Understanding diagnostic errors in medicine: a lesson from aviation Qual Saf. Health Care 2006 15 Díaz J Gallego B León A El diagnóstico médico: bases y procedimientos Rev Cubana Med Gen Integr 2006 22 1 Holder AR Medical errors. Hematology Medical errors. Hematology 2005 Lu TC Preventable deaths in patients admitted from emergency department Emerg Med J 2006 23
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100005 Un espacio de aprendizaje para quien comienza a investigar Arguedas-Arguedas Olga , 03 2009 2009 51 24 25
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100006 Prevalencia de nefropatía diabética y sus factores de riesgo en un área urbano marginal de la meseta Central de Costa Rica Prevalence and Risk Factors of Diabetic Nephropathy in a Peripheral Urban Area of the Central Plateau of Costa Rica Laclé-Murray Adriana Valero F Juan Luis ,Universidad de Costa Rica Instituto de Investigaciones en Salud ,Universidad de Salamanca 03 2009 2009 51 26 33

Justificación objetivo: La nefropatía diabética afecta alrededor del 40% de los pacientes diabéticos tipo 2 y es la primera causa de enfermedad renal en pacientes que inician tratamiento renal sustitutivo. El conocer su prevalencia como sus factores asociados es fundamental para planificar los servicios de salud y evaluar su calidad. El presente estudio tuvo como objetivo conocer la prevalencia de la nefropatía diabética y de sus factores de riesgo en una cohorte de diabéticos tipo 2 de una comunidad urbano marginal de la meseta central de Costa Rica. Metodología: Se caracterizó una cohorte de 572 diabéticos del Área 3 de Desamparados en el año 2000 (sociodemográficos, control metabólico, comorbilidad y complicaciones microvasculares). Se determinó la prevalencia de la nefropatía diabética y de sus factores asociados con un análisis de regresión logística. Resultados: La cohorte se caracterizó por ser predominantemente mujeres (63.8%), con una edad media de 58.5%, de baja escolaridad y de ingresos medio y bajo. Se presentó una alta prevalencia de hipertensión arterial (53.2%), obesidad (78.5%,) y dislipidemia (41.5%). El 61% había iniciado su DM antes de los 60 años y tenía como promedio 8 años de evolución. La prevalencia de sus complicaciones fueron altas: retinopatía (19.6%), neuropatía (30.6%) y nefropatía en un 33.6%: microproteinuria (24,8%), macroproteinuria (7%), síndrome nefrótico (1.4%) e Insuficiencia renal crónica (7,1%), sin diferencia estadística por sexo. Los factores asociados de la nefropatía diabética fueron la retinopatía diabética (4.6 IC: 2.5-8), los años de evolución (1.8 IC: 1.2-2.6), la HTA (2.3 IC: 1.4-3.8), la hemoglobina glicosilada elevada> 8% (2.4 IC: 1.3-4-6), el HDL-col bajo (1.7 IC 1.02-2.7) y el antecedente de infarto de miocardio (6.1 (2.4-15.3). Conclusión: En Costa Rica no existen datos de prevalencia de la nefropatía diabética a nivel comunitario. Este estudio es un primer esfuerzo para estimar en un área de salud la prevalencia y los factores asociados de esta patología. Los métodos diagnósticos para valorar la microalbuminuria deberían estar a la disposición a nivel de atención primaria, para poder afinar este indicador en el contexto de la vigilancia de la DM a nivel nacional.

Background and aim: Diabetic nephropathy affects approximately 40% of type 2 diabetic patients and is the leading cause of kidney disease in patients starting renal replacement therapy in developed countries. The same seems to be true in Costa Rica. Knowing its prevalence and associated factors is fundamental to plan and to evaluate health services for the diabetic population. The main objective of this study was to determine the prevalence of diabetic nephropathy and its risk factors in type 2 diabetic patients from a poor marginal urban community of the central plateau of Costa Rica. Methodology: Five hundred and seventy two type 2 diabetics from the Health Area 3 of Desamparados, were identified in 2000, sociodemographic data, metabolic control, comorbidities and microvascular diabetic complications variables were studied. The prevalence of diabetic nephropathy and its associated factors were determined using a multivariate logistic regression analysis for the latter. Results: The cohort had an average age of 58.5 years low education and low income and consisted predominantly of women (63.8%). The group had a high prevalence of hypertension (53.2%), obesity (78.5%), and dyslipidemia (41.5%). Sixty-one percent had the diagnosis of diabetes before age 60 and an average of 8 years with the disease. The prevalence of microvascular complications was high: retinopathy (19.6%), neuropathy (30.6%), nephropathy (33.6%), microproteinuria (24.8%), macroproteinuria (7%), nephrotic syndrome (1.4%) and chronic renal insufficiency (7.1%) without sex differences. Associated risk factors and odds ratio found for diabetic nephropathy were: diabetic retinopathy (4,6 IC:2.5-8), years of evolution (1,8 IC:1.2- 2,6), HTA (2,3 IC: 1.4-3.8), high level of HbA1c > 8% (2,4 IC:1.3-4-6), low HDL-col (1,7 IC1.02-2.7) and the history of a myocardial infarction (6,1 (2.4-15.3). Conclusion: In Costa Rica there is no known prevalence data of diabetic nephropathy at the community level. This study is a first effort to find the prevalence and associated factors of this entity in a poor urban Health Area. Diagnostic methods to evaluate microalbuminuria should be made available at primary health care facilities in order to increase the sensitivity of this indicator in the context of surveillance of diabetes nationwide.

 Diabetes mellitus tipo 2 nefropatía diabética prevalencia factores de riesgo Diabetes mellitus type 2 diabetic nephropathy prevalence risk factors Raptis AE Viberti G Pathogenesis of diabetic nephropathy Exp Clin Endocrinol Diabetes 2001 109 Cooper ME Pathogenesis, prevention, and treatment of diabetic nephropathy Lancet 1998 352 Marshall SM Recent advances in diabetic nephropathy Postgrad Med J 2004 80 Nephropathy in Diabetes Diabetes Care 2004 27 Valmadrid CT Klein R Gross JL de Azevedo MJ Silveiro SP Canan LH Diabetic nephropathy: diagnosis, prevention, and treatment Diabetes Care 2005 28 Adler AL Stevens RJ Manley SE Bilous RW Cull CA Holman RR Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64) Kidney Int 2003 63 Murussi M Baglio P Gross JL Silveiro SP Risk factors for microalbuminuria and macroalbuminuria in type 2 diabetic patients: a 9-year follow-up study Diabetes Care 2002 25 Gall MA Hougaard P Borch-Johnsen K Parving HH Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study BMJ 1997 314 Keane WF Brenner BM Zeeuw D Grufeld JP Mcgill J Mitch WE The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL Study Kidney Int 2003 63 Control clínico y metabólico de la DM2. Guías ALAD 2000 para el diagnóstico y manejo de la Diabetes mellitus tipo 2 con medicina basada en evidencia Control clínico y metabólico de la DM2. Guías ALAD 2000 para el diagnóstico y manejo de la Diabetes mellitus tipo 2 con medicina basada en evidencia 2001 Laclé A Tamizaje de Diabetes Mellitus tipo 2 en atención primaria Acta Med Costarric 2006 48 King H Aubert RE Herman WH Global burden of diabetes, 1995- 2025: prevalence, numerical estimates, and projections Diabetes Care 1998 21 prevention of diabetes mellitus. Technical Report prevention of diabetes mellitus. Technical Report 1994 844 Geneva WHO Wild S Roglic G Green A Sicree R King H Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 Diabetes Care 2004 27 Bo S Gentile L Cavallo-Perin P Vineis P Ghia V Sex-and BMI related differences in risk factors for coronary artery disease in patients with type 2 Diabetes mellitus Acta Diabetol 1999 36 Laclé A Perfil del paciente diabético Tipo 2 de 55 y más años de una Clínica Periférica de la C.C.S.S Acta Med Costarric 1999 41 Jiménez MF Ruíz L Niveles de glicemia y de hemoglobina glicosilada en un grupo de diabéticos Nicoyanos Acta Med Costarric 2001 43 ^s1 Saydah SH Fradkin J Cowie CC Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes JAMA 2004 291 Grant RW Buse JB Meigs JB Quality of diabetes care in U.S. academic medical centers. University Health System Consortium (UHC), Diabetes Benchmarking Project Team Diabetes Care 2005 28 Eid M Mafuzy M Faridah AR Non-achievement of clinical targets in patients with type 2 diabetes mellitus Med J Malaysia 2004 59 Gomes MB Gianella D Faria M Tambascia M Fonseca RM Réa R Prevalence of Type 2 diabetic patients within the targets of care guidelines in daily clinical practice: a multi-center study in Brazil Rev Diabet Stud 2006 3 Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes Lancet 1998 352 Effect of intensive blood glucose control policy with metformin on complications in type 2 diabetes patients (UKPDS 34) Lancet 1998 352 Piehlmeier W Renner R Schramm W Kimmerling T Garbe S Proetzsch et al Screening of diabetic patients for microalbuminuria in primary cares, The PROSIT- Project. Proteinuria Screening and Intervention Exp Clin Endocrinol Diabetes 1999 107 Leza O Briones E González MA De la Cruz M del C Ramos E Microalbuminuria in patients with type 2 diabetes Rev Med Inst Mex Seguro Soc 2005 43 Durruty P Díaz J Zanetti L de la Varas MA García de los Ríos M Microalbuminuria, lipid changes and coronary heart disease in noninsulin- dependent diabetics Rev Med Chil 1998 126 Gomes MB Lucchetti MR Gazzola H Dimetz T Gonçalves MF Neves R Matos H Microalbuminuria and associated clinical features among Brazilians with insulin dependent diabetes mellitus Diabetes Res Clin Pract 1997 35 Kong NC Chia YC Khalid BA Juwita S Samiah Yasmin AK Yap LY Microalbuminuria prevalence study in hypertensive type 2 diabetic patients in Malaysia Med J Malaysia 2006 61 Buranakitjaroen P Deerochanawong C Bunnag J Microalbuminuria prevalence study in hypertensive type 2 diabetic patients in Thailand Microalbuminuria prevalence study in hypertensive type 2 diabetic patients in Thailand 2005 88 Wu AY Kong NC de Leon FA Pan CY Tai TY Yeung VT Yoo SJ Rouillon A Weir MR An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the Microalbuminuria Prevalence (MAP) Study Diabetologia 2005 48 Cueto AM Cortes L Martinez HR Rojas E Barragan G Alfaro G Detection of early nephropathy in Mexican patients with type 2 diabetes mellitus Kidney Int Suppl 2005 97 Martins D Tareen N Zadshir A Pan D Vargas R Nissenson A Norris K The association of poverty with the prevalence of albuminuria: data from the Third National Health and Nutrition Examination Survey (NHANES. III) Am J Kidney Dis 2006 47 Valmadrid CT Klein R Moss SE Klein BE The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus Arch Intern 2000 160 Murussi M Baglio P Gross JL Silveiro SP Risk factors for microalbuminuria and macroalbuminuria in type 2 diabetic patients: a 9-year follow-up study Diabetes Care 2002 25 Gall MA Hougaard P Borch-Johnsen K Parving HH Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study BMJ 1997 314 Sacks DB Bruns DE Goldstein DE Maclaren NK McDonald JM Parrott M Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus Clin Chem 2002 48 Zelmanovitz T Gross JL Oliveira J de Azevedo MJ Proteinuria is still useful for the screening and diagnosis of overt diabetic nephropathy Diabetes Care 1998 21 Mogensen C Vviberti GC Petrein E Kuter D Hasslacher Ch Hoffman W Muticenter Evaluation of the Micra-TestII. Test Strip and immunologic Rapid Test for the Detection of Microalbuminuria Diabetes Care 1997 20
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100007 Comportamiento epidemiológico del dengue clásico en el distrito de Pavas, San José, Costa Rica, 2003-2007 Epidemiology of Classic Dengue Fever in the District of Pavas, Costa Rica, 2003-2007 Ramírez-Salas Alcira Montero-Chinchilla Guiselle Sanabria-Varela Luis ,Clínica de Pavas 03 2009 2009 51 34 38

Justificación y objetivo: Desde su reaparición en el país al inicio de la década del noventa, el dengue constituye un problema de Salud Pública que con el pasar del tiempo, ha venido adquiriendo mayor relevancia. La expansión de la enfermedad a localidades del Valle Central se convierte en una amenaza para la población y requiere un importante esfuerzo de los servicios de salud para su prevención y control. Este estudio tiene por objetivo describir el comportamiento epidemiológico del dengue en el Distrito de Pavas del cantón central de San José, en el período comprendido entre el año 2003 y el 2007. Métodos: Estudio observacional descriptivo del total de casos confirmados como dengue clásico en el Área de Salud de Pavas, durante el período 2003-2007. Resultados: Pavas constituye una zona de transmisión local del virus del dengue, el grupo etario económicamente productivo fue el más afectado, no hubo diferencia en la incidencia de la enfermedad según sexo, por otra parte, sí se evidenció una clara estacionalidad de la enfermedad en concordancia con el patrón climático del lugar y concentración de la enfermedad en localidades definidas. Conclusión: El predominio de casos autóctonos a partir del año 2004 evidencia que Pavas es un área con transmisión local del virus lo cual sumado a los serotipos circulantes (1 y 2) y a la cantidad de susceptibles para dengue hemorrágico, la que se incrementó a lo largo del período de estudio, constituyen un riesgo real no sólo para su población sino para la del área metropolitana.

Justification and aim: Since the reappearance of dengue in Costa Rica during the early nineties, it has certainly become a relevant public health problem. The spread of this disease to different localities of the Central Valley, becomes a threat for the population, which in turn requires an important effort from health services to work on its prevention and control. This study describes the epidemiological behavior of dengue in Pavas between the 2003 and 2007. Methods: Descriptive study of all the cases confirmed as classic dengue in the Area of Health of Pavas, during the period 2003-2007. Results: Pavas constitutes a local transmission zone of the dengue virus. The most affected age group by the disease is the economically productive one. There was no difference in the incidence of disease related to sex; on the other hand, there was a clear seasonality of the infection closely related to the climate pattern of the place and the concentration of the disease in particular localities. Conclusion: The predominance of native cases of dengue from 2004 makes evident that Pavas is an area with local transmission of the virus. This fact together with the circulating serotypes (1 and 2) and the amount of susceptible people for hemorrhagic dengue, that increased throughout the period of this study, constitutes a real risk not only for the Pavas’ population but also for the Metropolitan area’s population.

 dengue Pavas comportamiento incidencia acumulada dengue Pavas behavior accumulated incidence Dengue and Dengue Haemorrhagic Fever Dengue and Dengue Haemorrhagic Fever Bonilla Roger Distribución Espacio-Temporal de la Fiebre Dengue en Costa Rica Población y Salud en Mesoamérica 2006 3 2 Clima en Costa Rica Clima en Costa Rica Análisis del Comportamiento del Dengue en el año 2007 Análisis del Comportamiento del Dengue en el año 2007 Normas técnicas para el control del dengue y dengue Hemorrágico Normas técnicas para el control del dengue y dengue Hemorrágico 2000 1ª San José Ministerio de Salud Greenberg R Flanders W Eley J Daniels S Boring J Epidemiología médica Epidemiología médica 2002 3ª Editorial Manual Moderno Dengue y Dengue Hemorrágico en las Américas: guías para su prevención y control Dengue y Dengue Hemorrágico en las Américas: guías para su prevención y control 1995 548 ^eWashington, D.C OPS Siquiera J Turchi C Coelho G Dengue and Dengue Hemorrhagic fever, Brazil. 1981-2002 Emer Infecc Dis 2005 11 Navas L Badilla X Wong R Trece años de Dengue en Costa Rica Acta médic costarric 2006 48 ^s1 Iturrino- Monge R Ávila-Agüero ML Ávila-Aguero CR Moya- Moya T Cañas-Coto A Camacho-Badilla K Seroprevalence of dengue virus antibodies in asymptomatic Costa Rican children, 2002- 2003: a pilot study Rev Panam Salud Pública 2006 20 1 Wong Mc Clure R Suarez M Badilla X Estudio de la estacionalidad del dengue en la costa pacifica de Costa Rica (1998-2004) Acta Médic Costarric 2007 49 1 Perez R Dengue surveillance, United States, 1986- 1992 MMWR CDC Surveill Sum 1994 J ul 43 Sáenz E Maranda L Piza J González L Achoy R Evaluación del sistema de vigilancia epidemiológico del dengue utilizando como indicador la aplicación de la definición de caso sospechoso, Costa Rica 1998 Rev Costarric Cienc Méd 2001 22 3-4 Sáenz E Maranda L Gonzalez L Adecuación de la definición de casos sospechosos de dengue, basado en la asociación de síntomas y signos según los registros médicos, Costa Rica, 1998 Rev Costarric Cienc Méd 2001 22 3-4 González L Sáenz E La Confirmación del Dengue por Laboratorio en Costa Rica. 1993-2006. Resultados y consideraciones generales Boletín Instituto Costarricense de Investigación y Enseñanza y en Nutrición y Salud 2007 19 1 Sánchez L Pérez D Alfonso L Castro M Sánchez LM Estrategia de educación popular para promover la participación comunitaria en la prevención del dengue en Cuba Rev Panam Salud Pública 2008 24 1
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100008 Anemia materna en el tercer trimestre de embarazo como factor de riesgo para parto pretérmino Maternal Anemia During the Third Trimester of Pregnancy as a Risk Factor for Preterm Labor Giacomin-Carmiol Loretta Leal-Mateos Manrique Moya-Sibaja Rafael Ángel ,Hospital Dr. Rafael Ángel Calderón Guardia Servicio de Obstetricia 03 2009 2009 51 39 43

Objetivos: Analizar la relación entre la anemia y el parto pretérmino en el Servicio de Obstetricia del Hospital "Dr. Rafael Ángel Calderón Guardia", durante 2006. Materiales y métodos: Estudio de 110 pacientes y 220 controles. Se utilizó el registro estadístico de la sala de partos del Servicio de Obstetricia para la identificación de la muestra. Los criterios de inclusión para el grupo de casos fueron: edad materna mayor o igual a 18 años, edad materna menor de 35 años, primigesta, embarazo mayor de 32 semanas, embarazo único, y recién nacido vivo al momento del parto. Los criterios de exclusión fueron: embarazo complicado por enfermedades médicas crónicas o inducidas por este, antecedente en la historia clínica de sangrado transvaginal durante el primer o segundo trimestre, antecedente en la historia clínica de síntomas que sugirieran infección del tracto urinario o de otro sistema, antecedente en la historia clínica del uso de tabaco, alcohol u otra sustancia ilícita, productos con algún tipo de malformación diagnosticada previo a la labor del parto o durante el nacimiento, parto inducido o cesárea electiva, parto atendido de forma extrahospitalaria, ausencia o registro incompleto de alguna variable de interés. Las pacientes del grupo de control fueron aquellas internadas durante el mismo periodo. Los dos controles para cada caso fueron seleccionados de forma aleatoria, pareados por grupo quinquenal de edad y fecha de la atención del parto. Los criterios de inclusión y exclusión fueron los mismos aplicados al grupo de casos. Se definió como anemia una hemoglobina menor a 11 g/dl. La magnitud de la asociación entre la anemia y el parto pretérmino se evaluó mediante la razón de probabilidades (Odds Ratio) Resultados: La hemoglobina promedio de los casos fue de 12,3 g/dl (DS+ 1,2) y la de los controles de 12,9 g/dl (DS+ 1,1; p < 0,001). El hematocrito promedio de los casos fue de 36,2 %(DS+ 3,6) y la de los controles de 38,2 (DS+ 3,1; p < 0,001). El porcentaje de pacientes con anemia en el grupo de casos fue del 10,9% (n=12) y en el grupo control del 4,1% (n=9); (p=0,016). La razón de probabilidades mostró una asociación positiva entre la presencia de anemia y un parto pretérmino de 2,87 (IC 95% 1.08-7,69). Conclusiones: Se demostró una asociación entre la anemia en el tercer trimestre y parto de pretérmino.

Objective: To explore the relationship between anemia and preterm birth at the Obstetrics Service of the Rafael Angel Calderón Guardia Hospital during the year 2006. Methods: A Case and Control study was made obtaining the sample from the statistical base of the Labor and Delivery Ward. There were 110 cases and 220 controls.Inclusion criteria were: age between 18 and 35 years, first pregnancy, pregnancy of more than 32 weeks, single pregnancy and live born. Exclusion criteria were: pregnancy complicated by a chronic medical illness or acquired during pregnancy, history of vaginal bleeding during pregnancy, history of urinary tract infection or of other system, alcohol or drug abuse, presence of fetal malformation, induced delivery or elective cesarean section, extrahospitalary delivery and absence or incomplete information. The patients from the control group were admitted to the hospital in the same period of time. Two controls were selected randomly, pared by quinquenal group of age and delivery date. The inclusion and exclusion criteria were the same as in the case group. Anemia was defined as hemoglobin less than 11 g/dl. The magnitude of the association between anemia and preterm birth was evaluated by the odds ratio. Results: The mean hemoglobin value of the cases was 12.3 g/dl (DS + 1.2) versus 12.9 g/dl (DS + 1.1) in the control group. The mean hematocrit of the cases was 36.2% (DS + 3.6) and 38.2% (DS + 3.1) (p < 0.001) in the control group. The percentage of patients with anemia in the control group was 10.9% (n=12) and 4.1% (n=9) in the control group (p< 0.016). The odds ratio showed a positive association between anemia and preterm birth (2.87; CI 95% 1.08-7.69). Conclusion: The present study demonstrated an association between anemia and preterm birth during the third trimester.

 Anemia parto pretérmino Hospital Calderón Guardia Anemia preterm birth Rafael Angel Calderón Guardia Hospital Informe anual del Sistema Nacional de Análisis de la Mortalidad Infantil en Costa Rica Informe anual del Sistema Nacional de Análisis de la Mortalidad Infantil en Costa Rica 2003 San José Ministerio de Salud Blanco J Clinical problems of preterm labor Clin Obstet Gynecol 2000 43 Berkowitz GS An epidemiology study of preterm deleviry Am J Epidemiol 1981 113 Goldenberg RL Iams JD Mercer BM Meis PJ Moawad AH Cooper RL The preterm prediction study: The value of new vs standard risk factors in predicting early and all spontaneous preterm birth Am J Public Health 1998 88 Pschirrer ER Munga M Risk factors for preterm labor Clin Obstet Gynecol 2000 43 Lieberman E Ryan K Monson R Shoenbaum S Association of maternal hematocrit with premature labor Am J Obstet Gynecol 1988 159 Klebanoff MA Shiono PH Selby JV Trachtenberg AI Graubard MA Anemia and spontaneous preterm birth Am J Obstet Gynecol 1991 164 Scholl TO Hediger ML Fisher RL Shearer J Anemia vs iron deficiency: Increased risk of preterm delivery in a prospective study Am J Clin Nutr 1992 55 Klebanoff MA Shiono PH Berendes HW Rhoads G Facts and artifacts about anemia and preterm delivery JAMA 1989 262 Scholl T Reilly T Anemia, iron and pregnancy outcome J Nutr 2000 130 CDC Criteria for anemia in children and childbearing-aged women MMWR 1989 38 La anemia como centro de atención: Hacia un enfoque integrado para el control eficaz de la anemia. Declaración conjunta de la Organización Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia La anemia como centro de atención: Hacia un enfoque integrado para el control eficaz de la anemia. Declaración conjunta de la Organización Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia 2004 Ginebra OMS Mora JO Mora OL Mora JO Mora OL Anemia ferropriva Deficiencia de micronutrientes en América Latina y el Caribe Deficiencia de micronutrientes en América Latina y el Caribe 1999 ^eWahington, D.C OPS, OMS, USAID, Roche, OMNI Encuesta Nacional de Nutrición: Micronutrientes Encuesta Nacional de Nutrición: Micronutrientes 1996 San José Ministerio de Salud Scholl TO Hediger ML Anemia and iron deficiency anemia: Compilation of data on pregnancy outcome Am J Clin Nutr 1994 59 Weck R Paulose T Flaws JA Environmental factors and poverty on pregnancy outcome Clin Obstet Gynecol 2008 51
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100009 Creatinina sérica elevada en el paciente hipotiroideo: miopatía o verdadera nefropatía? Propuesta de clasificación Elevated Serum Creatinine in Hypothyroidism: Myopathy or Real Nephropathy ? Classification Proposal Guerrero-Lobo Carmen Lidia ,Universidad de Costa Rica Facultad de Medicina Escuela de Medicina 03 2009 2009 51 44 48

Justificación: En el paciente hipotiroideo la creatinina sérica puede aumentar no solo por fallo renal, sino también por miopatía en presencia de función renal normal. Se reportan 2 pacientes representativos de sendos tipos de la clasificación aquí propuesta sobre la asociación disfunción tiroidea / creatinina sérica. El primer enfermo presenta aumento de la creatinina sérica secundario a miopatía hipotiroidea con función renal normal (tipo 1), esta se puede complicar con rabdomiolisis y causar insuficiencia renal aguda en hipotiroideos no diagnosticada. El otro paciente con creatina sérica alta mejoró su función renal al tratarse su hipotiroidismo (tipo 2). Ocasionalmente, este ha permanecido oculto y al ser diagnosticado y tratado, se mejora la función renal. El hipotiroidismo cursa con hipercolesterolemia y si no se valora la función tiroidea y se administran estatinas, se empeora el daño muscular del paciente. Lo mismo ha sucedido con el uso de gemfibrozil en condiciones similares. El tercer tipo de daño renal relacionado con hipotiroidismo es la proteinuria en rango de síndrome nefrótico, vinculada con suspensión de la levotiroxina. Las biopsias muestran lesiones histológicas de diversas glomerulopatías, que mejoran con la administración de levotiroxina. En pacientes con tiroiditis de Hashimoto aparecen otras glomerulopatías que responden a los glucocorticoides. Conclusión: 1) La hormona estimulante de la tiroides (TSH por sus siglas en inglés) debe cuantificarse en pacientes con creatina sérica aumentada, en aquellos con colesterol elevado sin una causa evidente y en los que tienen polimiositis o rabdomiolisis con creatina fosfocinasa elevada e insuficiencia renal aguda. 2) Se debe solicitar creatina sérica a los pacientes hipotiroideos que usan amiodarona y a quienes suspenden el tratamiento con levotiroxina, pues pueden presentar disminución de su función renal. 3) Un paciente hipotiroideo que descontinuó la levotiroxina puede desarrollar un síndrome nefrótico que puede responder al tratamiento con glucocorticoides o levotiroxina, si su origen es inmunológico o no.

Background: In patients with hypothyroidism is possible to find an increased serum creatinine not only due to renal failure but to myopathy in presence of normal renal function. Two patients, each representing 1 type of a proposed classification regarding thyroid dysfunction and abnormal creatinine are presented, in order to communicate this relationship, until now based on isolated reports. The first individual had an increased serum creatinine with normal renal function due to hypothyroid myopathy (type 1). Rhabdomyolysis related to this myopathy is pointed as a cause of acute renal failure. The 2nd patient had an increased serum creatinine with abnormal kidney function (type 2), which improved when he became euthyroid after levothyroxine administration. The diagnosis of hypothyroidism is often missed in patients with altered renal function, if it becomes evident and is properly treated the renal function will improve. As is known hypothyroidism causes hypercholesterolemia, if such patient unknowingly receives statins or gemfibrozil, severe rhabdomyolysis and renal falilure may occur, as reported in the literature. The 3d category of the classification is the occurrence of nephrotic syndrome in hypothyroid patients who discontinue T4 treatment due to thyroid cancer for further studies or by patient non adherence, developing significant proteinuria few months later. Kidney biopsy lesions vary from membranous glomerulopathy to membranoproliferative glomerulonephritis. These findings will resolve with the administration of levothiroxine, without glucocorticoids. However patients with nephrotic syndrome related to Hashimoto thyroiditis will improve with glucocorticoids. Conclusion: 1. TSH must be requested when: a) There is an increased serum creatinine or hypercholesterolemia without a clear cause. b) In patients with rabdomyolysis or acute renal failure with increased CK since it may be secondary to hypothyroid myopathy. 2. Serum creatinine should be requested in hypothyroid patients who discontinue levothyroxine for any reason or are using amiodarone. 3) Proteinuria within the nephrotic range in a hypothyroid patient who has discontinued levothiroxine will have a different response to treatment depending of the cause (if it is autoimmune it will respond to glucorticoids and if is not, will respond to levothyroxine.

 creatinina sérica función renal glomerulopatía hipotiroidismo polimiositis rabdomiolisis serum creatinin renal function glomerulopathy hypothyroidism polymyositis rabdomyolysis Karanikas G Schutz M Becherer A Wiesner K Dudczak P Isotopic renal function in severe hypothyroidism and after thyroid hormone replacement therapy Am J Nephrol 2004 24 Del-Rio G Tapia L Picazo B Ruiz JA Hortas ML Romero J Renal failure and acquired hypothyroidism Pediatric Nephrol 2003 18 Yeter E Keles T Durmaz T Bozkurt E Rabdomyolysis due to additive effect of statin therapy and hypothyroidism: a case report J Med Case Reports 2007 1 Barquero J Rodríguez C Arrobas I Gemfibrozil induced rhabdomyolysis in a patient with undiscovered hypothyrodism An Med Interna 2006 23 Paydas S Gokel Y Different renal pathologies associated with hypothyroidism Ren. Failure 2002 24 Jameson JL Weetman AP Jameson J Larry Md Trastornos de la glándula tiroides. Efectos de la Amiodarona sobre la función tiroidea Harrison Endocrinología Harrison Endocrinología 2006 Madrid McGraw-Hill. Interamericana Iervasi G Clerico A Bonini R Manfredi C Acute effects of amiodarone administration on thyroid function in patients with cardiac arrthythmia J Clin Endocrinol Metab 1997 82 Kreisman S.H Hennessey J.V Consistent reversible elevations of serum creatinine levels in severe hypothyroidism Arch Intern Med 1999 159 Moses MA Scheinman SJ Braverman LE Utiger RD The kidney and electrolyte metabolism in hypoth yroidism Werner and Ingbar’s The Thyroid Werner and Ingbar’s The Thyroid 1996 7th Philadelphia Pa. Lippincott-Raven Press Lafayette RA Costa ME King AL Increased serum creatinine in the absence of renal failure in profound hypothyroidism Am J Med 1994 96 Khaleeli AA Edwards RTH Effect of treatment on skeletal muscle dysfunction in hypothyroidism Clin Sci 1984 66 Cabili S Pines A Kaplinski N Frankl O Hypothyroidism masquerading as polymyositis Postgrad Med 1982 58 Plotz PH Not myositis: A series of chance encounters JAMA 1992 268 Birewar S Oppenheimer M Zawada ETJr Hypothyroid acute renal failure S J D Med 2004 57 Jain S Bhargava K Sawlane KK Daga MK Myoglobinuria and transient acute renal failure in a patient revealing hypothyroidism J Assoc Physicians India 1999 47 Melli G Chaudhry V Cornblath DR Rabdomyolysis: and evaluation of 475 hospitalized patients Medicine (Baltimore) 2005 84 Kar PM Hirani A Allen MJ Acute renal failure in a hypothyroid patient with rhabdomyolysis Clin Nephrol 2003 60 Preuss HG Organic cationic drugs and renal creatinine secretion Renal Physiol 1983 6 Urakami Y Kimura N Okuda M Inui K Creatinine transport by basolateral organic cation transporter hOCT2 in the human kidney Pharm Res 2004 21 Levey AS Perrone RD Madias NE Serum creatinine and renal function Ann. Rev. Med 1988 39 Montenegro J González O Saracho R Changes in renal function in primary hypothyroidism Am J Kidney Dis 1987 253 Nakahama H Sakaguchi K Horita WW Treatment of severe hypothyroidism reduced serum creatinine levels in two chronic renal failure patients Nephron 2001 88 Den Hollander JG Wulkan RW Mantel MJ Berghout A Correlation between severity of thyroid dysfunction and renal function Clin Endocrinol (Oxf) 2005 62 Mooraki A Broumand B Reversible acute renal failure associated with hypothyroidism: Report of four cases with a brief review of literature Nephrology 8 Lim VS Thyroid function in patients with chronic renal failure Am J Kidney Dis 2001 38 Makino Y Fujii T Kuroda S Inenaga T Exacerbation of renal failure due to hypothyroidism in a patient with ischemic nephropathy Nephron 2000 84 Chen SS Wu TE Jap TS Wang Hl Subclinical hypthyroidism is a risk factor for nephropathy and cardiovascular diseases in type 2 diabetic patients Diabet Med 2007 24 Bernet VJ Reversible renal insuficiency attributable to thyroid withdrawl in a patient witn type 2 Diabetes mellitus Endocr Pract 2004 10 Lo JC Chertow GM Go AS Hsu CY Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease Kidney Int 2005 67 Thomas MC Mathew TH Russ GR Changes in thyroxin requirements in patients with hypothyroidism undergoing renal transplantation Am J Kidney Dis 2002 39 Lebkowska U Nalysko J Nysliwiec N Thyroid function and morphology in kidney transplant recipients, hemollized and peritoneally dialysed patient Transplant Proc 2003 35 Asami T Uchiyama M Elevated serum creatinine level in infants with congenital hypothyroidism: reflection of decreased renal function? Acta Paediatr 2000 88: Bald M Hauffa BP Wingen AM Hythyroidism mimicking chronic renal failure in reflux nephropathy Arch Dis Child 2000 83 Matoo TK Hypothyroidism in infants with nephrotic syndrome Pediatric Nephrol 1994 8 Hall C Batch J Jones C Increased serum creatinine associated with severe primary hypothyroidism J Pediatr Child Care 1996 32 Al-Fifi S Girardin C Sharma A Rodd C Moderate renal failure in association with prolonged acquired hypothyroidism in children Acta Paediatr 1999 88 Ogata S Yorika N Tangi A Two cases of hypothyroidism complicated by renal dysfunction Hiroshima J Med Sci 2000 49 Davis RG Madsen KM Fregly MJ Tisher CC Kidney structure in hypothyroidism Am J Pathol 1983 113 Grcevska L Polenakovic M Petrusevka G Membranous nephropathy associated with thyroid disorders Nephron 2000 86 Valentín M Bueno B Gutiérrez E Membrano proliferative glomerulo nephritis associated with autoimmune thyroidits Nefrología 2004 24 ^s3
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100010 Estado confusional, lesión pulmonar y glúteos que languidecen. Efectos secundarios de procedimientos estéticos Seconday effects of aesthetic procedures Peña-Varela Julián Jiménez-Navarrete Manuel Fco ,Hospital México Servicio de Medicina Interna 03 2009 2009 51 48 49

Los procedimientos estéticos a cargo de personal no médico son cada vez más frecuentes, muchos no controlados médicamente y promotores de efectos secundarios desde leves a graves. Se presenta el caso de una mujer de 29 años de edad, sin problemas de salud relevantes, quien acudió a un centro de estética para inyectarse silicio orgánico en sus glúteos, con la finalidad de aumentar su volumen, desarrolló posteriormente un síndrome de embolismo masivo.

Aesthetic procedures performed by non medical personnel are increasing in frequency. Many are not medical controlled and cause side effects from mild to serious. We present the case of a 29-year-old woman, with no relevant health problems, who went to a aesthetics center to have organic silicon injected into her buttocks to increase volume, developing later a massive pulmonary embolism syndrome.

 embolismo masivo silicio orgánico massive embolism syndrome organic silicium Price EA Schueler H Perper JA Massive systemic silicone embolism: a case report and review of literature Am J Forensic Med Pathol 2006 27 Janet J Silicio orgánico Silicio orgánico Birchall JD Espie AW Biological Implications of the Interaction (Via Silanol Groups) of Silicon with Metal Ions. Ciba Foundation Symposium 121 - Silicon Biochemistry Biological Implications of the Interaction (Via Silanol Groups) of Silicon with Metal Ions. Ciba Foundation Symposium 121 - Silicon Biochemistry Co AC Abad-Casintahad MF Espinoza-Thaebtharm A Submental fat reduction by mesotherapy using phosphatidylcholine alone vs. Phosphatidylcoline and organic silicium: a pilot study J Cosmet Dermatol 2007 6 Ellenbogen R Rubin L Injectable fluid silicone therapy. Human morbidity and mortality JAMA 1975 234 Matsuba T Sujiura T Irei M Kyan Y Kunishima N Uchima H Miyagi S Iwata Y Matsuba K Acute Pneumonitis Presumed to be Silicone Embolism Internal Medicine 1994 33 Schmid A Tzur A Leshko L Krieger BP Silicone Embolism Syndrome CHEST 2005 127 Gurvits GE Silicone Pneumonitis after a Cosmetic Augmentation Procedure N Eng J Med 2006 354 Villa A Sparacio F Severe pulmonary complications after silicone fluid injection Am J Emerg Med 2000 18
S0001-600220090001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000100011 Costa Rica en el Exterior , 03 2009 2009 51 50 50