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Chronically injured areas have the possibility of transforming into malignant tissue, with squamous cell carcinoma being the most common type. This rare entity is known as Marjolin's ulcer. Most of these ulcers derive from chronic burn wounds. This case report exhibits a rare Marjolin's ulcer that developed on a 50-year-old male with a previous saphenectomy on his left leg. The patient was brought to the operating room (OR), for excision of the ulcer with a rotation flap to correct the defect. There is still no definite treatment protocol for Marjolin's ulcer. In the present article, the most common treatments are discussed. The main takeaway of this case is the prevention of Marjolin's ulcer by timely treating ulcerative lesions.

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The complexity of the user interfaces and the operating modes present in numerous assistive devices, such as intelligent prostheses, influence patients to shed them from their daily living activities. A methodology to evaluate how diverse aspects impact the workload evoked when using an upper-limb bionic prosthesis for unilateral transradial amputees is proposed and thus able to determine how user-friendly an interface is. The evaluation process consists of adapting the same 3D-printed terminal device to the different user-prosthesis-interface schemes to facilitate running the tests and avoid any possible bias. Moreover, a study comparing the results gathered by both limb-impaired and healthy subjects was carried out to contrast the subjective opinions of both types of volunteers and determines if their reactions have a significant discrepancy, as done in several other studies.

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In recent years, and now especially with the arrival of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), there has been increased interest in understanding the role of bats in the dynamics of transmission and origin of this pandemic agent. To date, no systematic reviews have been published on this topic. This systematic review aimed to summarize and highlight the frequency of bat infections reported in currently available observational studies for coronavirus. The purpose of this study was also to examine the differences between the pool prevalence by technique and country. We performed a systematic literature review with meta-analysis, using three databases to assess coronavirus (CoV) infection in bats and its diagnosis by serological and molecular tests. We carried out random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In all, 824 articles were retrieved (1960-2021). After screening by abstract/title, 43 articles were selected for full-text assessment. Of these, 33 were finally included for qualitative and quantitative analyses. From the total of studies, the pool prevalence by RT-PCR (n=14,295 bats) for CoV was 9.8% (95% CI 8.7-10.9%); Italy reported the highest pooled prevalence (44.9%, 95% CI 31.6-58.1%), followed by the Philippines (29.6%). Regarding the ELISA, the pool prevalence for coronavirus from 15 studies, including 359 bats, was 30.2% (95% CI 14.7-45.6%). The results for coronaviruses with the MIF were significantly lower, 2.6% (95% CI 1.5-3.7%). A considerable proportion of infected bats tested positive, particularly by molecular tests. This essential condition highlights the relevance of bats and the need for future studies to detail their role as potential reservoirs of SARS-CoV-2. In this meta-analysis, bats were positive in almost 10% by RT-PCR, suggesting their relevance and the need to understand their potential participation in maintaining wild zoonotic transmission.

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Resumen Objetivo: Identificar la epidemiología clínica y los procesos diagnósticos y terapéuticos de las mujeres con miocardiopatía periparto en un centro de referencia cardiovascular. Método: Se realizó un estudio observacional descriptivo retrospectivo con pacientes de sexo femenino de entre 15 y 50 años con diagnóstico de cardiopatía periparto durante los últimos 10 años en una institución especializada de la ciudad de Medellín. Resultados: Hubo 17 mujeres con diagnóstico de cardiopatía periparto, con una edad media de 31 años (± 6.7). El número promedio de embarazos fue de 1.0, con un 52.9%. Las condiciones más frecuentes durante la gestación fueron obesidad y preeclampsia, con un 23.5% para ambas; se halló diabetes gestacional en una paciente (5.9%) y dos presentaron hemorragia del primer trimestre (11.8%). El 41.2% de las mujeres tuvieron parto vértice espontáneo. Ninguna mujer tuvo antecedentes cardiovasculares. Los síntomas presentados al momento del diagnóstico fueron deterioro de la clase funcional (100%), edema en miembros inferiores (52.9%), ortopnea (76.4%) y disnea paroxística nocturna (88.2%). La terapia farmacológica iniciada incluyó diuréticos (58.8%), inhibidores de la enzima convertidora de angiotensina (IECA) (64.7%), betabloqueadores (82.4%), bromocriptina (5.8%), ivabradina (23.5%) y antagonistas de la aldosterona (64.7%). Conclusiones: Este registro señala la similitud en nuestro medio de esta enfermedad, respecto a la epidemiología, la presentación y el manejo, con el resto del mundo. Muestra que el tratamiento farmacológico para falla cardiaca con la combinación de betabloqueadores, IECA y diuréticos sigue siendo el pilar fundamental en el tratamiento; además, destaca que la miocardiopatía periparto aún es una afección grave, con alta morbilidad y que permanece en insuficiencia cardiaca después del diagnóstico y con un riesgo importante de mortalidad.

Abstract Objective: To identify the epidemiology and the diagnostic and therapeutic processes of women with peripartum cardiomyopathy on a cardiovascular reference center. Method: A retrospective descriptive observational study was conducted with female patients between 15 and 50 years of age with a diagnosis of peripartum cardiomyopathy during the last 10 years. Results: 17 women with a diagnosis of peripartum cardiomyopathy where included, with a mean age of 31 (± 6,7) years at the time of diagnosis. The average number of previous pregnancies was 1.0 in 52.9% of the population. Obesity and preeclampsia were present in 23.5% and 18.8%, respectively. Diabetes was found in one patient (5.9%) and two had hemorrhage of the first trimester (11.8%). 41.2% of the women had a spontaneous vertex delivery. The symptoms presented at the time of diagnosis were deterioration of their functional class in 100.0%, edema in the lower limbs in 52.9%, orthopnea in 76.4% and paroxysmal nocturnal dyspnea in 88.2%. Conclusions: Our data show that peripartum cardiomyopathy occurs with a mode of presentation similar to the rest of the world, pharmacological treatment for heart failure with the combination of beta blockers, ACE inhibitors/ARBs, and diuretics continue to be the fundamental pillar in the treatment of peripartum cardiomyopathy; It is also important to note that peripartum cardiomyopathy remains a serious condition with a high rate of critically ill patients who remain in heart failure after diagnosis with a significant risk of mortality.

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Advanced heart failure is a major health problem for which heart transplantation or left ventricular assist devices are the only effective treatments. Intra-aortic balloon pump inserted using femoral artery access as a bridge to heart transplantation is still frequently used, but has the disadvantage of limiting the patient's movements, hence exposing him or her to the hazards of immobility and threatening the success of the procedure or hindering recovery. Access through the subclavian artery has become an attractive alternative since it doesn't impair the patient's mobility, and there is increasing evidence supporting its use. We present the first case of subclavian counterpulsation balloon implantation in a cardiovascular care center in Colombia.

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PURPOSE: Institutional arthroplasty registries are very popular nowadays; however, very few efforts have been made in order to standardize the information to be collected, thus limiting the possibility of inter-institutional data interpretation. This manuscript reports the results of a single-country consensus designed to define the minimum standardized dataset to be recorded within an institutional arthroplasty registry. METHODS: A national consensus was carried out among all members of the Colombian Society of Hip and Knee Surgeons using the Delphi method. Eleven questions and answers comprising every potential domain of an institutional registry of hip and knee arthroplasty were defined. According to the methodology, anonymous voting and multiple discussion rounds were performed. Three levels of agreement were defined: Strong consensus: equal to or greater than 80%, weak consensus between 70 and 79.9%, and no consensus below 70%. RESULTS: All of the questions reached consensus level. The minimum dataset was defined to include demographic and clinical information, intraoperative and implant details, follow-up and early complications, implant survival, and functional outcome scores, as well as the validation model to assess information quality within the database. Currently, this dataset is being implemented voluntarily by the members of our national society. DISCUSSION: A national consensus is a feasible method to build homogeneous arthroplasty registries. We recommend such an exercise since it establishes the basis to compare and add data between institutions and the joint analysis of said information in a national registry.

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Coronary artery disease involving chronic occlusions and bifurcation lesions continues to be a challenge for the interventional cardiologist. The improvement in the techniques has allowed a higher success rate, however, the best intervention strategy is unknown in this subgroup of patients with chronic occlusions and associated bifurcation lesions. We present the case of a patient in whom, in an angiography for study of chest pain, a chronic total occlusion and a bifurcation lesion were evidenced and were successfully treated by coronary intervention.

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Introduction: In Chile the problem of violence against children by parents was reported by 71% of children; and 51.5% were physical violence. There are few studies in Chile about filicide. A descriptive overview, from a qualitative research perspective, about the meanings and experiences is something that little has been investigated in filicide committed by men. Objective: Characterize and describe the experiences and perceptions of a man who killed his son, from the stories. Method: Research single case under the qualitative approach, exploratory, descriptive and crosssectional. The data were produced through 10 interviews, semi-structured character. The material was analyzed using some tools from the proposed analysis of Grounded Theory, particularly open and axial coding. Results: Of the descriptive analysis four main categories emerged: perception of himself as damaged; perception of himself as damaging; ambivalence in the bond with significant figures; and justification of his violent act. Relational analysis, emerged as main feature the perception and experience of itself, without agency self. Conclusion: The experience of lack of agency on the subject of the investigation led to the ambivalence in the responsibility for their acts, including the killing of his son. The result of physical abuse your child, is difficult to experience as their own, as a result of their actions, not feeling with agency self.

Introducción: Aunque estadísticamente en Chile el problema de violencia infantil por parte de los padres ha sido reportado por un 71% de los niños y, un crítico 51,5% corresponde a violencia física, existen pocos estudios sobre casos en que esta violencia se extrema, como en el filicidio, y menos aún que profundicen las experiencias e historias de hombres que han dado muerte a sus hijos. Objetivo: En este contexto, el estudio que se presenta acometió el propósito de caracterizar y describir en su complejidad la experiencia de un hombre que asesinó a su propio hijo, y aportar con ello nuevos resultados que ponen en entre dicho la repugnancia cultural que invisibiliza socialmente el contenido de esta problemática y, ofrecen nuevos elementos para su interpretación y comprensión psicológica. Metodología: Siguiendo una estrategia de investigación cualitativa, el estudio efectuado, de carácter exploratorio, descriptivo y corte transversal, profundizó su experiencia mediante la realización de 10 entrevistas semiestructuradas y el análisis cualitativo basado en el modelo de procesamiento de información propuesto por la Teoría Fundamentada. Resultados: De este modo, se describió la vivencia y percepción sobre su propia experiencia de vida, cuyo vector de interpretación central conjugó la vivencia de no sentirse sujeto de su historia y, el reconocimiento de percibirse sin competencias para dirigir o agenciar su vida. Conclusión: Esto permitió comprender la ambivalente responsabilidad asumida por este hombre respecto de los maltratos físicos y muerte infligida a su hijo.

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Objetivo: describir las características clínico-epidemiológicas de las infecciones por Enterobacter. Metodología: se revisaron las historias clínicas de 54 pacientes hospitalizados durante agosto de 2004 a agosto de 2006, en la Clínica Cardiovascular de Medellín, con diagnóstico de infección por Enterobacter confirmado por Gram y cultivo. Resultados: 64.8 por ciento de los pacientes del estudio eran hombres con edad media de 48 años. Las especies que se aislaron con mayor frecuencia fueron E. cloacae (75 por ciento) y E. aerogenes (17 por ciento). El tiempo promedio de aislamiento fue de nueve días, luego del ingreso. Las muestras en que se que se aisló la bacteria fueron principalmente orina (42 por ciento) y hemocultivos (34 por ciento); la infección de tracto urinario y la de torrente circulatorio fueron las infecciones que más causó Enterobacter en los pacientes del estudio. La infección fue considerada nosocomial en el 75 por ciento de los casos. Los betalactámicos fueron los antibióticos que con más frecuencia se emplearon como terapia empírica, luego del diagnóstico de infección por Enterobacter y antes del antibiograma, cuyos resultados generaron un cambio en el tratamiento antibiótico en 78 por ciento de los casos. Conclusión: es importante que se tenga en cuenta un manejo empírico de acuerdo a los perfiles de resistencia que esta bacteria está mostrando en la institución.

Objective: to describe the clinical and epidemiological characteristics of infections by Enterobacter. Methods: clinical records of 54 patients who had been hospitalized and had received a confirmed diagnosis of Enterobacterinfection were reviewed. Results: 64.8% of patiens were male, with a mean age of 48. The species which were most commonly isolated included E. cloacae (75%) and E. aerogenes (17%). Mean time for isolation was 9 days after admission to the hospital ward. The samples from which the microorganisms were most commonly isolated were urine (42%) and blood (34%). Urinary tract and bloodstreaminfection were the most commonly caused by Enterobacter. The infection was considered to be hospital-acquired in 75% of cases. Betalactams antibiotics were the empirical choice at the time of treatment, after the infection diagnosis and before the results of antibiograms the treatment was adjusted in 78% of the patients.Conclusion: it is important to keep in mind the local resistance profiles when it comes to treatment of this infection in the institution.

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Pain control after arthroplasty has been a key concern for orthopedic surgeons. After total knee arthroplasty (TKA), a small group of patients developed a painful joint with suboptimal range of motion. Manipulation under anesthesia increases flexion and extension while decreasing pain in most cases. The objective of the present investigation is to asses the effect of a multimodal pain management protocol on arthrofibrosis in primary TKAs. A cohort of 1136 patients who underwent primary TKA was selected. Patients were divided into 2 groups: group A had 778 procedures performed using a traditional approach to pain control; group B included 358 procedures that received multimodal pain management. Group A had an incidence of manipulation of 4.75% (37/778). Of 357 patients, 8 required manipulation in group B, which is an incidence of 2.24%. We recommend that orthopedic surgeons consider using a multimodal pain management protocol for TKA.

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