Resumen La actividad de la pesca, produce identificación y conocimientos del oficio en un contexto dado. En este artículo se presentan 2 estudios de casos: 1) Trabajadoras en proceso de transformación de ostiones, 2) Operadores de descarga de pescado, en otra empresa pesquera. Ambas situaciones se analizan desde el modelo centrado en la persona en actividad, los cuales se llevaron a cabo mediante el esquema de la intervención ergonómica, presentando las siguientes etapas de la intervención: Análisis de la demanda; Prediagnóstico; y Propuesta de la intervención. Las actividades estudiadas, muestran las inequidades vinculadas a los determinantes de la actividad, como la organización del trabajo, el pago mediante bonos de producción, el trabajo temporal. Ambas empresas, en el territorio, generan el desarrollo de conocimientos y habilidades que son transmitidas en generaciones. representan para las personas la única fuente estable de ingresos, pero llevándolas a realizar un compromiso con su salud.

Resumo A atividade pesqueira produz a identificação e o conhecimento do comércio num determinado contexto. Neste artigo são apresentados dois estudos de caso: 1) Mulheres trabalhadoras em processo de transformação de ostras; 2) Operadoras de descarregamento de pescado, numa outra empresa pesqueira. Ambas as situações são analisadas a partir do modelo centrado na pessoa em atividade, as quais foram realizadas através do esquema de intervenção ergonómica, apresentando as seguintes etapas da intervenção: análise da demanda; pré-diagnóstico; e proposta de intervenção. As atividades estudadas mostram as desigualdades vinculadas aos determinantes da atividade, como a organização do trabalho, o pagamento por meio de bónus de produção, o trabalho temporário. Ambas as empresas, no território, geram o desenvolvimento de conhecimentos e competências que são transmitidos de geração em geração. Elas representam a única fonte estável de rendimento para as pessoas, mas levando-as a se comprometerem com a sua saúde.

Résumé L'activité de pêche produit l'identification et la connaissance du métier dans un contexte donné. Dans cet article 2 études de cas sont présentées : 1) Travailleuses dans le processus de transformation des huîtres, 2) Opérateurs de déchargement de poisson, dans une autre entreprise de pêche. Les deux situations sont analysées à partir du modèle centré sur la personne en activité, qui a été réalisé à travers le schéma d'intervention ergonomique, présentant les étapes suivantes de l'intervention : Analyse de la demande ; Prédiagnostic ; et Proposition de l'intervention. Les activités étudiées montrent les inégalités liées aux déterminants de l'activité, tels que l'organisation du travail, le paiement par les primes à la production, le travail temporaire. Les deux entreprises, sur le territoire, génèrent le développement de savoirs et de compétences qui se transmettent de génération en génération. ils représentent la seule source stable de revenus pour les personnes, mais les amènent à s'engager pour leur santé.

Abstract Fishing activity produces identification and knowledge of the trade in a given context. In this article two case studies are presented: 1) Women workers in the process of transformation of oysters; 2) Fish unloading operators, in another fishing company. Both situations are analyzed from the model centered on the person in activity, which were carried out through the ergonomic intervention scheme, presenting the following stages of the intervention: analysis of the demand; pre-diagnosis; and proposal of the intervention. The activities studied show the inequities linked to the determinants of the activity, such as the organization of work, payment through production bonuses, temporary work. Both companies, in the territory, generate the development of knowledge and skills that are transmitted in generations. they represent the only stable source of income for people, but leading them to make a commitment to their health.

Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.

Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Asbtract: This work is part of the research results, of the Creativity Group for the Social Transformation of the Center for Psychological and Sociological Research (CIPS), in the Project: Public-Private Partnerships for Solidarity (APPS), National CTI Program: Local Development. The purpose of this article is to assess the business strategies of CNAs in the municipality of Centro Habana based on local development during the 2014-2017 period. The main results point to the existence of notable differences in the business strategies of CNAs in the municipality of Centro Habana and their contribution to local development. Among the deficiencies found are the legal framework, the lack of support from the municipal government, the orientation of the strategies to maximize the economic benefits and the detriment of the social ones, and, lack of contribution to local development.

Resumen El presente trabajo forma parte de los resultados de investigación del Grupo de Creatividad para la Transformación Social del Centro de Investigaciones Psicológicas y Sociológicas (CIPS), en el proyecto: Alianzas público-privadas solidarias (APPS), del Programa Nacional CTI: Desarrollo Local. Este artículo tiene como objetivo valorar las estrategias empresariales por las cooperativas no agropecuarias (CNA) en el municipio Centro Habana en función del desarrollo local, durante el periodo 2014-2017. Los principales resultados apuntan a la existencia de notables diferencias en cuanto a las estrategias empresariales de las CNA del municipio Centro Habana y su contribución al desarrollo local. Entre las deficiencias encontradas figuran el marco legal, la falta de apoyo del gobierno municipal, la orientación de las estrategias a la maximización de los beneficios económicos e detrimento de los sociales y falta de contribución al desarrollo local.

Abstract Objective: To describe a case of Langerhans cell histiocytosis in a pediatric patient. Method: A 4-year-old patient with proptosis, diplopia, fever and loss of visual acuity, with evident image in a computed tomography of orbital mass with bone erosion. An excisional biopsy was performed by coronal craniotomy. The histopathological result was Langerhans cell histiocytosis. Results: The anatomopathological study showed a neoplasm of small round and blue cells, compatible with Rhabdomyosarcoma. Immunohistochemical tests concluded the diagnosis of Langerhans cell histiocytosis. Conclusion: Langerhans cell histiocytosis is a rare disease that requires clinical suspicion and a timely diagnosis to adjust the treatment and improve the survival of patients.

Resumen Objetivo: Describir un caso de histocitosis de células de Langerhans en un paciente pediátrico. Método: Paciente de 4 años con proptosis, diplopía, fiebre y pérdida de agudeza visual, con imagen en tomografía computarizada evidente de masa orbitaria con erosión ósea. Se realizó biopsia excisional por craneotomía coronal, el resultado histopatológico fue histiocitosis de células de Langerhans. Resultados: El estudio anatomopatológico transoperatorio mostró una neoplasia de células pequeñas redondas y azules, compatible con rabdomiosarcoma. Las pruebas de inmunohistoquímica concluyeron el diagnóstico de histiocitosis de células de Langerhans. Conclusión: La histiocitosis de células de Langerhans es una enfermedad poco frecuente que requiere de una sospecha clínica y diagnóstico oportuno, adecuar el tratamiento y mejorar la sobrevida de los pacientes.

Abstract: Atherosclerotic aneurysm or dissection of the aortic arch and proximal descending thoracic aorta is one of the major challenges for a cardiovascular surgeon. The new hybrid prosthesis Thoraflex has become an important devise to simplify the surgical treatment of this very complex and technically demanding aortic pathology. This hybrid prosthesis consists of a 4-branched arch graft with a stent-graft at the distal end. The proximal part is a gelatin-coated woven polyester prosthesis. The stented section is a self-expanding endoprosthesis constructed of thin-walled polyester and nitinol ring stents that is left in the proximal descending aorta as a “frozen elephant trunk”. We present our initial experience with the Thoraflex prosthesis in four patients, three of them with chronic aortic dissection and one with an atherosclerotic aneurysm.

Resumen: El compromiso simultáneo del arco aórtico y aorta descendente proximal, ya sea por disección o aterosclerosis, constituye uno de los mayores desafíos que puede enfrentar un cirujano cardiovascular. La prótesis híbrida Thoraflex, introducida en los últimos años, ha resultado ser una importante ayuda para el tratamiento quirúrgico de esta compleja y grave patología. Esta consiste en un tubo protésico de Dacron con 4 ramas, para el reemplazo del arco aórtico y sus troncos braquiocefálicos y perfusión corporal distal, y una endoprótesis que queda como “trompa de elefante suspendida” en la aorta descendente proximal. Presentamos en esta oportunidad nuestra experiencia inicial en 4 pacientes, 3 con disección aórtica crónica y una con un aneurisma aterosclerótico, usando la prótesis híbrida Thoraflex.

Background: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary. Aim: To report our experience with mechanical trombolysis of proximal lower extremity DVT. Material and Methods: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015. Thirteen patients, 14 limbs, median age 34 years (22-85), 8 women, were admitted with pain and swelling of recent onset; one patient with venous gangrene. All patients initially received heparin in therapeutic doses without clinical improvement. Results: In all 13 cases, mechanical thrombolysis was performed using AngioJet®, and associated with single dose thrombolytic agent in 9. Additional angioplasty for residual stenosis was performed in 12 (7 stents) and IVCF were implanted in 8. All patients were subsequently anticoagulated. Early outcomes with disappearance of pain and decrease of edema, with no mortality or bleeding complications. The patient with foot gangrene required amputation. Conclusions: Mechanical thrombolysis with a single dose of a thrombolytic agent is safe and effective in patients with proximal DVT with an unfavorable evolution.

Mesenteric panniculitis is a rare inflammatory disorder of the mesenteric fat, of which there is, so far, about 200 cases reported in the literature. It occurs in elderly adults and its etiology is unknown but its association with gastrointestinal tumors, genitourinary and rheumatological diseases is known. Among its clinical manifestations are abdominal pain, altered bowel movements, weight loss, fever and vomiting. The definitive histopathological diagnosis is fundamentally, there is some tomographic stigma that might suggest its presence. It should be treated as soon as possible and corticosteroids are the drugs of choice. A patient diagnosed with idiopathic mesenteric panniculitis as a result of the evaluation of fever of unknown origin, which we further demonstrate the association of panniculitis with related disease IgG4, disorder recently discovered, characterized by lesions in flammatory pseudotumoral occurs, that occur with tissue infiltration IgG4 positive plasma cells.

La paniculitis mesentérica es un raro desorden inflamatorio de la grasa mesentérica, de la cual hay, hasta ahora, aproximadamente 200 casos reportados en la literatura. Se presenta en adultos a partir de la tercera década de la vida y su etiología es desconocida, pero es sabida su asociación con neoplasias gastrointestinales, genitourinarias y enfermedades reumatológicas. Entre sus manifestaciones clínicas están el dolor abdominal, las alteraciones del tránsito intestinal, la pérdida de peso, la fiebre y los vómitos. El diagnóstico definitivo es fundamentalmente histopatológico, también existen algunos estigmas tomográficos que podrían sugerir su presencia. Debe ser tratada a la mayor brevedad posible y los corticosteroides son los medicamentos a elegir. Se presentó un paciente con diagnóstico de paniculitis mesentérica idiopática, como resultado del estudio de una fiebre de origen desconocido, en el cual logramos además demostrar la asociación de la paniculitis con la enfermedad relacionada con IgG4, desorden recientemente descubierto, caracterizado por lesiones inflamatorias seudotumorales, que cursan con infiltración hística por células plasmáticas IgG4 positivas.

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number of mutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management.

El síndrome hemolítico urémico (SHU) es una entidad clínica definida por la tríada anemia hemolítica no inmune, trombocitopenia e insuficiencia renal aguda, en la que las lesiones subyacentes están mediadas por un proceso de microangiopatía trombótica (MAT) sistémico. Distintas causas pueden desencadenar el proceso de MAT que caracteriza el SHU. En este documento consideramos SHU atípico (SHUa) como el subtipo de SHU en el que los fenómenos de MAT son fundamentalmente consecuencia del daño producido en el endotelio de la microvasculatura renal y de otros órganos por desregulación de la actividad del sistema del complemento. En los últimos años se han identificado diversas mutaciones en genes del sistema del complemento asociados a SHUa, que explicarían aproximadamente el 60% de los casos de SHUa, y se han caracterizado funcionalmente numerosas mutaciones y polimorfismos asociados a SHUa que han permitido determinar que la patología se produce como consecuencia de la deficiente regulación de la activación del complemento sobre las superficies celulares y que lleva al daño endotelial mediado por la activación del C5 y de la vía terminal del complemento. Eculizumab es un anticuerpo monoclonal humanizado que inhibe la activación del C5, bloqueando la generación de la molécula proinflamatoria C5a y la formación del complejo de ataque de membrana. En estudios prospectivos en pacientes con SHUa su administración ha demostrado la interrupción rápida y sostenida del proceso de MAT, con una mejora significativa de la función renal a largo plazo y una reducción importante de la necesidad de diálisis y el cese de la terapia plasmática. En función de las evidencias científicas publicadas y la experiencia clínica acumulada, el Grupo Español de SHUa publicamos un documento de consenso con recomendaciones para el tratamiento de la enfermedad (Nefrología 2013;33(1):27-45). En la presente versión online del documento se actualizan los contenidos sobre la clasificación etiológica de las MAT, la fisiopatología del SHUa, su diagnóstico diferencial y su manejo terapéutico.

Hyperglycemia associated with hospitalization is a frequent occurrence in clinical practice and it has gained particular relevance as a prognostic biomarker of clinical outcome in subjects admitted for different reasons. Patients with diabetes mellitus are a particular risk group who frequently present acute situations requiring care services in health institutions. In this review the diagnostic criteria of the various disorders of blood glucose are updated; the main pathogenic and pathophysiologic mechanisms determining its onset and probable association with medical complications are discussed. Goals of glycemic control for different clinical situations are also presented.

La hiperglucemia asociada a la hospitalización es un fenómeno frecuente en la práctica clínica y ha cobrado una relevancia particular como biomarcador pronóstico de la evolución clínica de los sujetos ingresados por diferentes causas. Los pacientes con diabetes mellitus constituyen un grupo de riesgo particular que presentan frecuentemente situaciones agudas y requieren de servicios asistenciales en instituciones de salud. En esta revisión se actualizan los criterios de diagnóstico de los diferentes trastornos de la glucemia y se exponen los principales mecanismos patogénicos y fisiopatológicos que determinan su desencadenamiento, así como su probable asociación con complicaciones médicas. Se exponen metas de control de la glucemia para diferentes situaciones clínicas.

Background: symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.

Introduction: To assess the influence of hyperglycemia on the course of patients with acute macrovascular accidents, 73 patients admitted due to acute coronary syndrome or cerebrovascular accident were studied, independently of its diabetes mellitus (21,9%) or not. Methods: There were early complications (vascular, septic and death); authors determined the presence of glycemia at admission, fasting and postprandial, as well as the glycosylated hemoglobin (HbA1c). The means of each determination were estimated and the groups of patients complicated were compared with a satisfactory evolution. Results: There was found that fasting glycemia was associated with the worse prognosis (p = 0,004) even though all averages were higher in the complicated patients group. The lipid profile was not associated with complications after a macrovascular process. Conclusions: Fasting hypoglycemia, in diabetes rank was associated with a unfavourable course in the group of study patients.

Introducción: Con la intención de evaluar la influencia de la hiperglucemia en la evolución de pacientes con accidentes macrovasculares agudos se estudiaron 73 personas hospitalizadas con síndrome coronario agudo o accidente cerebrovascular, independientemente de su condición de padecer diabetes mellitus (21,9 %) o no. Métodos: Se registraron complicaciones tempranas (vasculares, sépticas y muerte) y se determinó la glucemia al ingreso, de ayuno y posprandial, así como la hemoglobina glucosilada (HbA1c). Se calcularon las medias de cada determinación y se compararon los grupos de pacientes complicados con aquellos que evolucionaron satisfactoriamente. Resultados: Se halló que solo la glucemia de ayuno se asoció con un peor pronóstico (p=0,004), lo que no se confirmó con el resto del perfil glucémico ni con la HbA1c (p=0,25), aún cuando todos los promedios fueron superiores en el grupo de pacientes complicados. El perfil lipídico tampoco se asoció con las complicaciones posteriores a un proceso macrovascular. Conclusiones: La hiperglucemia de ayuno, en rango diabético, se asoció con una evolución desfavorable en el grupo de pacientes estudiados.

Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA), use large (18-25F) delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation™ endograft (TriVascular, USA) with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation™ (Group 1). Ten patients treated during the same period with commercially available endografts were used as controls (Group (2). The Ovation™ endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F) and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands). Procedure duration, length of stay (LOS) and complications were compared between groups. Fisher exact test and unpaired Student’s t test were used for comparisons. Results. Results. Technical success was 100%. We observed no difference between groups (age, sex, AAA size, ASA risk, preoperative lab work). Procedure time (hrs) was 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS), LOS (hrs) was 44,5 ± 10,7 vs. 49,5 ± 32,0 (NS) in Groups 1 and 2, respectively. Aneurysm neck length and ICU stay were shorter in Group 1 (p= 0,035 and 0,0451 respectively). During a 12 month follow up no adverse events, type I or III endoleak, or secondary interventions have occurred. Conclusion. Results with Ovation™ are comparable to other endografts currently available, achieving the same standards of efficacy and safety. Its highly flexible delivery system allows navigation through small vessels, easy deployment and effective sealing of AAA with necks > 7 mm, broadening the span of patients suitable for endovascular treatment.

Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA) requieren introductores de alto diámetro (18-25F) y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation™ (TriVascular, EEUU) con aquellas disponibles en el mercado. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation™ (Grupo 1). Grupo Control (2): diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation™ es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda). Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: Éxito técnico 100%. Sin diferencia entre grupos (edad, sexo, tamaño AAA, riesgo ASA, laboratorio preoperatorio). Tiempo operatorio (hrs): 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS). Estadía postoperatoria (hrs): 44,5 ± 10,7 vs 49,5 ± 32,0 (NS). El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451). Seguimiento (4,5-12 meses) sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation™ a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation ™ navega por vasos pequeños, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA.

A study was conducted to assess the usefulness of multi-scan axial tomography techniques to detect, in a subclinical stage, the coronary damage in patients presenting with diabetes mellitus (DM) to describe the frequency of asymptomatic atherosclerotic affection and its potential association with the fasting and postprandial hyperglycemia. In study were included 59 patients with type 2 diabetes to compare the results of coronary calcium determination with the findings of angiography by multi-scan axial computed tomography (CAT-M). There was a concordance of a 44.1% between both studies, as well as a predominance of soft plaques in the 55.9 % of patients. The 42.4 % showed a narrowing of arterial lumen, which was significant in the 16.5 % of total. A high figure of patients with hyperglycemia had coronary damage compared to those ills with a good glycemia control (p = 0.024). This relation was more evident with the postprandial hyperglycemia (= 0.016). Hyperglycemia had a high opportunity (5.99 times) to detect coronary lesions by TAC-C compared to other major atherosclerosis risk factors like the high blood pressure, smoking, dyslipemias expressed in a significant way (p = 0.045). We conclude that Angio TAC-C and Calcio Score techniques are useful to detect lesions of coronary arteries in patients with type 2 diabetes mellitus without symptoms of myocardial ischemia, which was associated to presence of a hyperglycemia, fundamentally postprandial.

Se realizó un estudio que evaluó la utilidad de las técnicas de tomografía axial multicorte en la detección, en fase subclínica, del daño coronario en pacientes con diabetes mellitus (DM), con el objetivo de describir la frecuencia de afectación aterosclerótica asintomática y su probable asociación con la hiperglucemia de ayuno y posprandial. Se incluyeron 59 pacientes con diabetes tipo 2, en el estudio se compararon los resultados de la determinación de calcio coronario con los hallazgos de la angiografía por tomografía axial computarizada multicortes (TAC-M). Se registró concordancia de un 44,1 % entre ambos estudios. Predominaron las placas blandas en el 55,9 % de los pacientes. El 42,4 % de los pacientes mostró estrechamiento de la luz arterial, lo que fue significativo en el 16,5 % del total. Un mayor número de pacientes con hiperglucemia presentaron daño coronario al compararlos con los enfermos con buen control glucémico (p=0,024). Esta relación fue más evidente con la hiperglucemia posprandial (p=0,016). La hiperglucemia mostró una mayor probabilidad (5,99 veces) de detectar lesiones coronarias por TAC-M al compararla con otros factores de riesgo ateroscleróticos mayores, como la hipertensión arterial, el tabaquismo, las dislipidemias y la obesidad, lo que se expresó de manera significativa (p=0,045). Concluimos que las técnicas de angio TAC-M y de calcio score son útiles en detectar lesiones de las arterias coronarias, en pacientes con diabetes mellitus tipo 2 asintomáticos de isquemia miocárdica, lo que se asoció a la presencia de hiperglucemia, fundamentalmente posprandial.