RESUMEN
PURPOSE: The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). METHODS: Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). RESULTS: The mean age was 45.3 ± 8.0 years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11 months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. CONCLUSION: TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections.
Asunto(s)
Artrodesis , Clavos Ortopédicos , Gentamicinas , Osteomielitis , Tibia , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Artrodesis/efectos adversos , Masculino , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Persona de Mediana Edad , Tibia/cirugía , Adulto , Osteomielitis/cirugía , Osteomielitis/etiología , Osteomielitis/prevención & control , Articulación del Tobillo/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Seudoartrosis/cirugía , Seudoartrosis/prevención & control , Seudoartrosis/etiología , Calidad de Vida , Calcáneo/cirugíaRESUMEN
INTRODUCTION: Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. This study aimed to assess the impact of sex on sociodemographic, clinical, and laboratory parameters in patients with HF who were included in the Colombian Heart Failure Registry (RECOLFACA). METHODS: This was a cross-sectional analytical research. All 2528 patients included in RECOLFACA were analysed. The Mann-Whitney U test was used to compare median values as well as first and third quartiles (Q1-Q3). The age-related trend of NT-proBNP levels for both men and women groups was statistically evaluated. RESULTS: The study included 2528 patients with HF (1072 women and 1456 men). The echocardiographic evidence showed that men presented reduced left ventricular ejection fraction (LVEF) (79.63 vs. 69.75%, respectively; p < 0.001) more often than women, which had a significantly higher proportion of preserved LVEF (20.46 vs.11.24%, respectively; p < 0.001). Women displayed a higher value of systolic blood pressure (p < 0.001) and heart rate (p = 0.014) compared to men. Haemoglobin, creatinine, and sodium levels were significantly higher in men. Men had a considerably lower glomerular filtration rate value, with the median reaching a G3a value for chronic renal failure. According to age, the levels of NT-proBNP in each sex increased equivalently with age. CONCLUSION: Sex differences presented in this study are comparable to those discovered in other nations. However, certain variations show that these sex differences may differ by geographical area, which should encourage further investigations to describe them.
RESUMEN
Background: The value of Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitor) therapy in individuals with heart failure with preserved EF (HFpEF) was unknown until the EMPEROR-Preserved trial. We aimed to assess the proportion of patients with HFpEF that are eligible for empagliflozin therapy within the Colombian Heart Failure Registry (RECOLFACA). Methods: RECOLFACA enrolled adult patients with a HF diagnosis during 2017-2019 from 60 medical centers in Colombia. Criteria of the EMPEROR-Preserved Trial were used to recruit participants. The main outcome was individual eligibility with N-terminal pro-B-type natriuretic peptide (NT-proBNP) criteria, while the secondary outcome was eligibility without NT-proBNP data. Results: RECOLFACA had 799 patients with HFpEF (mean age70.7 ± 13.5; 50.7 % males). According to the major selection criteria of the EMPEROR Preserved Trial, 73.7 % patients would be eligible for empagliflozin therapy initiation when considering the NT-proBNP threshold. The NT-proBNP threshold represented the main determinant of ineligibility in patients with this biomarker measure (13.6 %; n = 16). In patients without NT-proBNP data, the main reasons for exclusion were the diagnosis of symptomatic hypotension or a systolic blood pressure below 100 mmHg (7.5 %), having an eGFR < 20 ml/min/1.73 m2 (4.3 %), and haemoglobin < 9 g/dl (3.1 %). Excluding NT-proBNP criteria increased empagliflozin eligibility to 80.6 %. Conclusion: Most patients with HFpEF from RECOLFACA are potential candidates for empagliflozin therapy initiation according to the EMPEROR-Preserved trial criteria. These findings favor the utilization of SGLT-2 inhibitor medications in daily medical practice, which may further decrease morbidity and mortality in HF patients, regardless of their EF classification.
RESUMEN
Introduction: Transplantation with fresh cadaveric osteochondral allograft (FOCA) is frequently used in defects of the femoral condyle and tibial plateau to preserve the knee joint. However, the use of FOCA in bipolar lesions remains controversial in cases with bipolar defects and a history of infection. Case Report: We present a 21-year-old male patient with a massive post-traumatic osteochondral defect of the lateral compartment of the knee and a history of infection, treated by a two-stage approach. In stage 1, infection was eradicated, and joint function recovered with aggressive debridement, polymethyl methacrylate beads, bone cement spacers, and Judet's quadricepsplasty. In stage 2, transplantation was performed with a bipolar FOCA. All treatments were planned using 3D-printed models. Conclusion: The two-stage approach and 3D planning can increase the chances of transplant success by preparing the future allograft bed and obtaining an optimal match between the cadaveric allograft and the patient's defect in cases with potential contraindications, such as a bipolar lesion in the femoral condyle and tibial plateau and a history of infection. A combined approach may lead to a more beneficial outcome for the patient to preserve joint function and improve quality of life.
RESUMEN
This work analyzed exhaustion markers in CD8+ T-cell subpopulations in 21 samples of peripheral blood mononuclear cells (PBMCs) from individuals with ocular toxoplasmosis (n = 9), chronic asymptomatic toxoplasmosis (n = 7), and non-infected people (n = 5) by using RT-qPCR and flow cytometry techniques. The study found that gene expression of PD-1 and CD244, but not LAG-3, was higher in individuals with ocular toxoplasmosis versus individuals with asymptomatic infection or uninfected. Expression of PD1 in CD8+ central memory (CM) cells was higher in nine individuals with toxoplasmosis versus five uninfected individuals (p = .003). After ex vivo stimulation, an inverse correlation was found between the exhaustion markers and quantitative clinical characteristics (lesion size, recurrence index, and number of lesions). A total exhaustion phenotype was found in 55.5% (5/9) of individuals with ocular toxoplasmosis. Our results suggest that the CD8+ exhaustion phenotype is involved in the pathogenesis of ocular toxoplasmosis.
RESUMEN
INTRODUCTION: Chronic kidney disease (CKD) represents one of the most frequent comorbidities observed in heart failure (HF) patients and has been observed to increase this population's risk of adverse outcomes. Nevertheless, evidence analyzing kidney dysfunction in HF is scarce in Latin American populations. We aimed to analyze the prevalence of kidney dysfunction and assess its association with mortality in patients diagnosed with HF enrolled in the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of the different categories of eGFR in mortality risk. A p value of <0.05 was considered significant. All statistical tests were two-tailed. RESULTS: From the total 2,514 evaluated patients, 1,501 (59.7%) patients had moderate kidney dysfunction (eGFR <60 mL/min/1.73 m2), while 221 (8.8%) patients were classified as having a severe kidney dysfunction (eGFR <30 mL/min/1.73 m2). Patients with lower kidney function were most commonly males, had higher median age, and reported a higher prevalence of cardiovascular comorbidities. Moreover, different patterns of medications prescription were observed when comparing CKD versus non-CKD patients. Finally, eGFR <30 mL/min/1.73 m2 was significantly associated with a higher mortality risk compared to eGFR >90 mL/min/1.73 m2 status (HR: 1.87; 95% CI, 1.10-3.18), even after an extensive adjustment by relevant covariates. CONCLUSION: CKD represents a prevalent condition in the setting of HF. Patients with CKD and HF present with multiple sociodemographic, clinical, and laboratory differences compared with those only diagnosed with HF and present a significantly higher risk of mortality. A timely diagnosis and optimal treatment and follow-up of CKD in the setting of HF may improve the prognosis of these patients and prevent adverse outcomes.
Asunto(s)
Insuficiencia Cardíaca , Insuficiencia Renal Crónica , Masculino , Adulto , Humanos , Pronóstico , Colombia/epidemiología , Prevalencia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnósticoRESUMEN
OBJECTIVE: To determine the frequency of sleep problems in low-income, urban pediatric populations in cities at different altitudes in Colombia. METHODS: A descriptive, cross-sectional population-based observational study was conducted in children aged between 2 and 12 years in the low income, urban areas of three cities in Colombia (Santa Marta, Bucaramanga, and Bogotá) located at 15, 959, and 2640 m above sea level, respectively. Sociodemographic data were collected, and the Spanish version of the Pediatric Sleep Questionnaire was used. RESULTS: 1989 children were surveyed, distributed as follows: Santa Marta (32.0%), Bucaramanga (33.4%), and Bogotá (34.6%). The overall prevalence of sleep problems was 39.0%. Children from Santa Marta had the highest frequency of parasomnias (58.0%); those from Bucaramanga had the highest frequency of attention deficit symptoms (4.0%) and apneic pauses witnessed by parents or caregivers (5.7%). Finally, Bogotá, the only high-altitude location, had the highest frequency of sleep disordered breathing (17.2%). CONCLUSIONS: The study found a high frequency of sleep problems in the pediatric population, especially at higher altitudes when compared to lower altitude settings. Sleep disorders warrant early detection and timely therapeutic intervention.
Asunto(s)
Síndromes de la Apnea del Sueño , Trastornos del Sueño-Vigilia , Niño , Humanos , Preescolar , Colombia/epidemiología , Altitud , Estudios Transversales , Síndromes de la Apnea del Sueño/diagnóstico , Trastornos del Sueño-Vigilia/epidemiologíaRESUMEN
Toxoplasma gondii, as other apicomplexa, employs adhesins transmembrane proteins for binding and invasion to host cells. Search and characterization of adhesins is pivotal in understanding Apicomplexa invasion mechanisms and targeting new druggable candidates. This work developed a machine learning software called ApiPredictor UniQE V2.0, based on two approaches: support vector machines and multilayer perceptron, to predict adhesins proteins from amino acid sequences. By using ApiPredictor UniQE V2.0, five SAG-Related Sequences (SRSs) were identified within the Toxoplasma gondii proteome. One of those candidates, TgSRS12B, was cloned in plasmid pEXP5-CT/TOPO and expressed in E. coli BL21 DE3. The resulting recombinant protein was purified via affinity chromatography. Co-precipitation assays in CaCo and Muller cells showed interactions between TgSRS12B-His-tagged and the membrane fractions from both human cell lines. In conclusion, we demonstrated that ApiPredictor UniQE V2.0, a bioinformatic free software, was able to identify TgSRS12B as a new adhesin protein.
Asunto(s)
Toxoplasma , Escherichia coli/metabolismo , Humanos , Aprendizaje Automático , Plásmidos/genética , Proteínas Protozoarias/genética , Proteínas Protozoarias/metabolismo , Toxoplasma/genética , Toxoplasma/metabolismoRESUMEN
Introducción: la faringoamigdalitis aguda, independientemente de su origen, es de los diagnósticos más frecuentes en los servicios de urgencias. Aunque se ha establecido que en la mayoría de casos su origen es viral, ante la dificultad de identificar su agente etiológico con hallazgos clínicos se ha aumentado la formulación indiscriminada de antibióticos, principalmente en los servicios de urgencias, lo que contribuye con la emergencia de resistencias bacterianas y la aparición de efectos secundarios. Se propone evaluar la adherencia a la guía de práctica clínica para el manejo de faringoamigdalitis aguda en urgencias en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: se realizó un estudio de tipo descriptivo retrospectivo. Se revisaron 7762 historias clínicas de pacientes que consultaron por urgencias entre 2016 y 2019 por dolor de garganta. Se analizaron los datos de formulación de analgésicos, antibióticos, solicitud de la prueba rápida de detección de Estreptococo betahemolítico del grupo A (SBHGA) y el registro de la presencia de exudados al examen físico. Resultados: se incluyeron 7762 pacientes. Del total, 74,2 % recibieron antibiótico y 98 % analgesia. Se solicitó la prueba rápida de detección de SBHGA al 11,53 % de los pacientes. La presencia de exudados es el principal factor asociado a la formulación de antibióticos, y la solicitud de una prueba rápida de detección disminuye significativamente su formulación, dado que 21 % de dichos estudios fueron positivos
Objective: Sore throat is one of the most frequent complaints in the ER, both in children and adults. Although it has been established that most cases of acute tonsillitis are caused by viruses, given the difficulty in identifying its etiology based exclusively upon clinical signs, the indiscriminate prescription of antibiotics in the emergency setting has become very frequent. This practice may lead to the emergence of antibiotic resistance and secondary effects. We evaluated the adherence of ER physicians to clinical practice guidelines for the management of acute tonsillitis at Hospital Universitario San Ignacio in Bogotá, Colombia. Methods: A retrospective descriptive study was carried out. Clinical records for emergency visits between the years of 2016 and 2019 were reviewed. Data regarding rapid antigen detection test for GABHS (RAD), antibiotic and analgesic prescription and tonsillar exudates on physical exam, were recorded. Results: 7.762 patients with acute tonsillitis were included in the study. 74,2% were prescribed antibiotics and 98% received pain medication. For 11,53% of cases the rapid antigen test for GABHS was requested. Although tonsillar exudates are the main factor associated with the formulation of antibiotics, only 21% of rapid antigen detection tests were positive. As such, the systemic use of rapid diagnostic tests may help reduce unnecessary antibiotic prescription, bacterial resistance and drug side effects
Asunto(s)
Humanos , Faringitis , DiagnósticoRESUMEN
Objetivo: la parotiditis recurrente benigna de la infancia (PRBI) es una enfermedad de importancia clínica. Sin embargo, su diagnóstico puede no realizarse correctamente debido al desconocimiento de esta entidad. El propósito de este estudio es describir los aspectos clínicos fundamentales de esta condición y proponer un enfoque terapéutico simple. Materiales y métodos: se realizó un análisis descriptivo de pacientes pediátricos con diagnóstico de parotiditis viral y PRBI entre los años 2008 y 2018, en el Hospital Universitario San Ignacio de Bogotá, Colombia. Resultados: se encontraron 41 pacientes con diagnóstico de PRBI; de estos, el 51,2 % fueron de sexo femenino, con una edad media de 7,1 años. A 32 pacientes (78 %) con diagnóstico de PRBI se les realizaron imágenes diagnósticas, a pesar de que la tasa de complicaciones fue baja (19,5 %). El diagnóstico fue hecho por los servicios de pediatría y otorrinolaringología en el 80 % de los casos. Conclusiones: hasta donde sabemos, este es el estudio con mayor número de pacientes con diagnóstico de PRBI en Latinoamérica. Es indispensable conocer esta enfermedad y tener en cuenta su curso benigno y pocas complicaciones, con el fin de destinar menos recursos en el uso de imágenes innecesarias y evitar el sobrediagnóstico de parotiditis por paramixovirus.
SUMMARY Objectives: Benign recurrent parotitis of childhood (BRPC) is a clinically relevant disease in childhood. Its diagnosis, however, is usually not made due to the lack of knowledge regarding such a condition. The aim of this study is to describe the most relevant aspects of this condition and propose a simple therapeutic approach. Materials and Methods: We did a descriptive analysis of pediatric patients diagnosed with viral parotitis and BRPC between 2008 and 2018, at the Hospital Universitario San Ignacio in Bogotá, Colombia. Results: 41 patients with BRPC where included; 51.2% were female, with a mean age of 7.1 years. Thirty-two patients (78%) with diagnosis of BRPC underwent diagnostic imaging, despite the low rate of complications (19,5%). The diagnosis was made by otolaryngologists or pediatricians in 80% of the cases. Conclusions: To our knowledge, this is the study with the largest number of BRPC cases in Latin America. It is essential to know about this disease and take into account its benign course and few complication rates, in order to avoid both wasting of resources in the use of unnecessary imaging and the overdiagnosis of mumps.
RESUMEN
Resumen Objetivo. Determinar los valores leucocitarios, proteínas totales, fibrinógeno, albúmina y globulina en mulares sanos jóvenes pertenecientes a la Policía Nacional de Colombia. Materiales y métodos. Se muestrearon 50 mulares sanos entre machos y hembras. Se obtuvieron muestras de sangre por venopunción yugular para el análisis de recuento total y diferencial de leucocitos, albúmina, globulina, y proteínas plasmáticas totales por medio de conteo en cámara de Neubauer, frotis sanguíneo y espectrofotometría. Los datos fueron analizados por estadística descriptiva, y se realizó un análisis comparativo con la media reportada para otros équidos utilizando la prueba de T-student (P<0,05) y la prueba de Wilcoxon. Se estableció una confiabilidad del 95% y un margen de error del 5%. Resultados. Los valores de leucocitos fueron: 11,32 ± 2,99 x 10⁹ células/μl Diferencial: Neutrófilos 5038,6 ± 2228,9 células/µl, Linfocitos: 5758 ± 1975,9 células/µl; monocitos 109,95 ± 156,9 células/µl, Relación N/L: 1,03 ± 0,66, Proteínas totales 7 ± 0,39 gr/dl, Albúmina 4,48 ± 0,18 gr/dl, globulina 2,51 ± 0,43 gr/dl, relación A/G 1,7 ± 0,71, fibrinógeno 206 ± 107,6. Conclusiones. Se encontraron diferencias de la media en el recuento de leucocitos totales, diferenciales y fibrinógeno, comparando con otros équidos; estos valores fueron más cercanos a los encontrados en burros catalanes jóvenes. Con otros mulares jóvenes no hubo diferencias en los valores de leucocitos, neutrófilos y linfocitos. Los valores medios de proteínas totales, albúmina y globulina, se encontraron muy cercanos a los valores reportados en equinos. Los resultados obtenidos muestran la importancia de investigar los parámetros hematológicos en mulares de acuerdo con la raza, la edad y el manejo.
Abstract Objective. To determine leukocyte, total protein, fibrinogen, albumin and globulin values in young mules belonging to the Colombian National Police. Matherials and Methods. 50 healthy male and female mules were sampled. Blood samples were obtained by jugular venipuncture for total and differential count analisis od leukocytes, albumin, globulin, and total plasma proteins by Neubauer counting chamber, blood smear and spectrophotometry. The data were analyzed by descriptive statistics, and a comparative analisis was performed with the mean reported for other equids using the T-student test (P<0.05) and the Wilcoxon test. A reliability of 95% with a margin of error 0f 5% were stablished. Results. Total White cell count: 11.32 ± 2.99 x 10⁹/L, differential count: neutrophils 5038.6 ± 2228 cells/µl, lymphocytes: 5758 ± 1975.9 cells/µl, monocytes: 109.95 ± 156.9 cells/µl, N/L ratio: 1.03 ± 0.66, total proteins 7 ± 0.39 gr/dl, albumin 4.48 ± 0.18 gr/dl, globulin 2.51 ± 0.43 gr/dl, A/G ratio 1.7 ± 0.71, fibrinogen 206 ± 107.6 gr /dl. Conclusions. Significant differences were established in the mean of total leukocytes, differentials and fibrinogen compared to other equids; these values were closer to those found in Catalans donkeys. In contrast, there were no differences in the values of leukocytes, neutrophils and lymphocytes with other young mules. The mean values of total proteins, albumin and globulin, were found to be closer to the values reported in horses. The results obtained show the importance of research on haematological parameters in mules according to breed, age, and management.
Resumo Objetivo. Determinar os valores de leucócitos, proteínas totais, fibrinogênio, albumina e globulina em mulas jovens saudáveis pertencentes à Policia Nacional da Colômbia. Materiais e métodos. Foram amostrados 50 machos e fêmeas. Amostras de sangue foram obtidas por punção venosa jugular para análise da contagem total e diferencial de leucócitos, albumina, globulina e proteínas plasmáticas totais por meio de contagem em câmara de Neubauer, esfregaço de sangue e espectrofotometria. Os dados foram analisados por estatística descritiva, e foi realizada uma análise comparativa com a média relatada para outros equídeos utilizando o teste T de Student (P<0,05) e o teste de Wilcoxon. Foi establecida uma confiabilidade de 95% e uma margem de erro de 5%. Resultados. Os valores de leucócitos foram: 11,32± 2,99 x 10 células/µl, Diferencial: Neutrófilos 5038.6 ± 2228.9 células/µl, Linfócitos: 5758 ± 1975,9 células/µl; monócitos 109,95 ± 156,9 células/µl, razão N/L: 1,03 ± 0,66, Proteins totais 7 ± 0,39 gr/dl, Albumina 4,48 ± 0,18 gr/dl, Globulina 2,51 ± 0,43 gr/dl, razão A/G: 1,7 ± 0,71, fibrinogênio 206 ± 107,6. Conclusões. Diferenças nas mëdias foram encontradas na contagem de leucócitos total, diferencial e fibrinogênio, quando comparados a outros equídeos; esses valores eram mais próximos dos encontrados em jovens burros catalães. Com outras mulas jovens não hove diferenças nos valores de leucócitos, neutrófilos e linfócitos. Os valores médios das proteínas totais, albumina e globulina, foram encontrados muito próximos aos valores relatados em cavalos. Os resultados obtidos mostram a importância da investigação dos parâmetros hematológicos em muares de acordo com a raça, idade e manejo.
RESUMEN
Resumen El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es una enfermedad caracterizada por la obstrucción recurrente de la vía aérea superior (VAS), con disminución en el flujo de aire, hipoxemia intermitente y despertares durante el sueño. En la fisiopatología del SAHOS se presentan dos factores esenciales: las alteraciones anatómicas y la disminución o ausencia del control neural. Durante el estudio del SAHOS se debe identificar el sitio o sitios de obstrucción de la VAS, que pueden ir desde las alas nasales hasta la hipofaringe. Otro factor importante en este síndrome es el influjo nervioso en el tono muscular de la hipofaringe, así como los cambios en el pH sanguíneo y secundarios a los microdespertares. La posición corporal y el estadio de sueño son factores determinantes de la severidad. La fisiopatología del SAHOS debe ser entendida para poder estudiar de forma adecuada a un paciente y darle la mejor opción de tratamiento.
Abstract Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease characterized by recurrent upper airway obstruction (UAO), with decreased airflow, intermittent hypoxemia, and awakening during sleep. Two essential factors are related to the pathophysiology of OSAHS: anatomical alterations and reduction or absence of neural control. While studying OSAHS, the site or sites of obstruction of the UA should be identified; they may extend from the nasal wings to the hypopharynx. Another important factor in this syndrome is the nervous influence on muscle tone of the hypopharynx, as well as the changes in blood pH, which are secondary to micro-arousals. Body position and sleep stage determine the severity. The pathophysiology of OSAHS should be understood to properly study a patient and provide the best treatment option.
RESUMEN
Introducción: La polisomnografía ha demostrado tener ciertas falencias en el diagnóstico del Síndrome de apnea-hipopnea obstructiva del sueño. Hay controversia respecto a las ayudas diagnósticas que requiere un paciente pediátrico antes de ser llevado a cirugía. Objetivo: Evaluar la utilidad diagnóstica de la fibronasolaringoscopia para detección de pacientes pediátricos con Síndrome de apnea-hipopnea obstructiva del sueño. Diseño: Estudio de pruebas diagnósticas.Materiales y métodos: Durante un año se realizaron 78 polisomnografías con igual número de fibronasolaringoscopias a pacientes pediátricos que por selección con encuestas podrían sugerir la presencia de un trastorno respiratorio del sueño. Se hizo posteriormente un análisis estadístico. Resultados: Encontramos una baja correlación entre los resultados con una sensibilidad del 71% y una especificidad del 62%. Sin embargo, la fibronasolaringoscopia presenta un valor predictivo negativo del 95%, que podría sugerir que las fibronasolaringoscopias normales se relacionan con una polisomnografía normal y ausencia de esta enfermedad. Conclusión: La fibronasolaringoscopia debe tomarse como una ayuda diagnóstica en casos de pobre correlación paraclínica-clínica y en pacientes sometidos a cirugía sin adecuada respuesta al manejo
Introduction: Polysomnography has shown to have certain shortcomings in the diagnosis of Obstructive Sleep Apnea syndrome. There is controversy regarding the appropriate workup required for pediatric patients when considering surgical treatment. Objective: To evaluate the diagnostic value of flexible nasolaryngoscopy in a pediatric population with Obstructive Sleep Apnea syndrome. Design: Diagnostic accuracy study. Methods: We included seventy-eight children with clinical suspicion of Obstructive Sleep Apnea, accordingly to a screening standard questionnaire. All children underwent polysomnography and flexible nasolaryngoscopy. Appropriate statistical analysis was performed. Results: We found a low correlation between polysomnography and flexible nasolaryngoscopy results. Flexible nasolaryngoscopy showed a sensitivity of 71% and a specificity of 62%, with a negative predictive value of 95%, indicating that a normal flexible nasolaryngoscopy correlates with a normal polysomnography. Conclusions: Flexible nasolaryngoscopy should be performed in cases with poor correlation between polysomnography results and clinical findings, and in all children with inadequate response to surgical treatment.
Asunto(s)
Humanos , Síndromes de la Apnea del Sueño , Polisomnografía , Apnea Obstructiva del SueñoRESUMEN
STUDY OBJECTIVES: To determine the prevalence of sleep complaints in adults in Colombia at different altitudes. DESIGN: Cross-sectional, population-based and observational study. SETTING: Urban areas in three cities (Bogotá, Bucaramanga, Santa Marta) located between 15 and 2640 masl. Subjects Over 18 years old. INTERVENTIONS: Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Berlin questionnaire, STOP-Bang questionnaire and diagnostic criteria for restless leg syndrome (IRLSSG). MEASUREMENTS AND RESULTS: The overall prevalence of sleep complaints was 59.6% (CI 95%: 57.3; 61.8%). According to the Pittsburgh scale, 45.3% (CI 95%: 43.0; 47.5) required medical assistance. The Berlin questionnaire indicated that 19.0% (CI 95%: 17.3; 20.8%) had a high risk of sleep apnea (OSA) compared to 26.9% (CI 95%: 24.9; 29.0%) according to STOP-Bang. Among the subjects, 13.7% (CI 95%: 12.3; 15.3%) had excessive daytime sleepiness and 37.7% (CI 95%: 35.5; 39.8%) had a restless leg syndrome. When comparing cities, significant differences in the overall frequency of subjects requiring care were found between Santa Marta (higher frequency) and the other two cities. Differences in sleep problem frequency (Pittsburgh) were observed between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (higher frequency) and the other two cities. The high risk of OSA (STOP-Bang) was different between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (high frequency) and Bucaramanga. CONCLUSIONS: We observed a high prevalence of sleep complaints with significant differences among the cities, indicating a need to pay a greater attention to these problems.
RESUMEN
Evaluar el estado nutricional de niños de primero de primaria entre los 5 y 7 años de edad, y comparar curvas de crecimiento y desarrollo de la OMS y colombianas.Materiales y Métodos: Estudio de corte transversal, con una muestra de 336 niños de 6 instituciones educativas de Manizales, Colombia. La información se obtuvo enviando encuestas a los padres, se tomaron medidas antropométricas en cada institución y se categorizaron según la resolución 2121 del 2010 del ministerio de la protección social de Colombia. Resultados: Promedio de edad de los niños 7±0,54años. Los perfiles talla/edad e IMC/edad calculados según curvas de desarrollo de la OMS y colombianas resultaron significativamente diferentes (p=0,000). Según curvas colombianas el 61,2% resultaron con peso adecuado, 22,5% con riesgo de delgadez,y 4% con delgadez, el 87,7% resultaron con talla adecuada, 9,8% con riesgo de talla baja, y 2,5% con talla baja. La categorización de talla según curvas colombianas resultó relacionada con haber tenido lactancia materna (p=0,044), haber tenido antecedentes patológicos en los últimos 3 meses. La categorización IMC según curvas colombiana resultó relacionada con la educación de la madre (p=0,004) y del padre (p=0,035).Conclusiones: Las tablas Colombianas difieren de las tablas de la OMS, tanto paratalla/edad como para IMC/edad. La población presentó una alta proporción de riesgo a la delgadez y delgadez, y una proporción significativa de riesgo de talla baja y tallabaja, lo cual sugeriría la necesidad de una intervención...
Asunto(s)
Humanos , Antropometría , Crecimiento y Desarrollo , Desnutrición , Atención PosnatalRESUMEN
El grupo de anomalías congénitas de la fosa posterior se clasifica en tres tipos: la malformación de Chiari 1 es la más frecuente y la malformación de Chiari 3 es la menos común. El tipo 1 se caracteriza por un descenso de las amígdalas cerebelosas a través del foramen magno y se asocia, entre otras anomalías, con siringohidromielia. Virtualmente todos los pacientes con malformación de Chiari 2 presentan mielomeningocele, que es el responsable de una distensión inadecuada del cuarto ventrículo, con la consecuente hipoplasia de la fosa posterior; los pacientes con Chiari 3 presentan un encefalocele occipital o cervical alto. La resonancia magnética es la modalidad imaginológica de elección en el estudio de los pacientes con malformación de Chiari. En el presente artículo se revisa la literatura pertinente y se muestran casos representativos de los diferentes tipos de malformación de Chiari en estudios de resonancia magnética.
The group of congenital anomalies of the posterior fossa is classified into three types; Chiari 1 malformation is the most frequent one and and Chiari 3 the least common. Type 1 is characterized by downward displacement of the cerebellar tonsils through the foramen magnum; among other anomalies, it is associated with syringohydromyelia. Almost all patients with Chiari 2 have a myelomeningocele, which is responsible for the inadequate distention of the fourth ventricle with the consequent hypoplastic posterior fossa; patients with Chiari 3 have occipital or cervical cephalocele. Magnetic resonance (MR) is the imaging modality of choice in the evaluation of patients with Chiari malformation. In this article we review the pertinent literature available and demonstrate representative cases of the different types of Chiari malformation in magnetic resonance studies.
Asunto(s)
Humanos , Anomalías Congénitas , Meningomielocele , Fosa Craneal Posterior , EncefaloceleRESUMEN
El propósito de esta revisión es resaltar la epidemiología, presentación clínica y características imaginológicas de las malformaciones cavernosas del sistema nervioso central, especialmente en sus diferentes localizaciones, con el objetivo de brindarle al radiólogo claves para el diagnóstico de esta patología potencialmente curable. De las bases de datos de nuestras instituciones recolectamos casos de malformaciones cavernosas. Las imágenes de TC, MR y angiografía fueron evaluadas, y el tamaño, la localización, las características imaginológicas y los hallazgos asociados fueron registrados. Adicionalmente, se revisó la literatura científica pertinente a este tema para proveer una manera práctica de hacer una aproximación diagnóstica de esta malformación. Las malformaciones cavernosas son lesiones vasculares congénitas compuestas por vasos sinusoidales que forman una masa compacta. Pueden ocurrir en cualquier sitio del encéfalo y de la médula espinal. Imaginológicamente pueden presentar ciertas características alarmantes que pueden simular otras patologías más agresivas e incluso malignas. El conocimiento de los hallazgos característicos según su localización es esencial para evitar tratamientos innecesarios. Las malformaciones cavernosas del SNC pueden presentar ciertos rasgos que se sobreponen con patologías más malignas. Complicaciones asociadas como son la hemorragia y el edema perilesional pueden afectar aún más el diagnóstico adecuado. Por esta razón, es indispensable que el radiólogo conozca el comportamiento imaginológico de estas lesiones.
The purpose of this revision is to highlight the demographics, clinical presentation, and imaging features of cavernous malformations (CA) of the central nervous system, especially in its different locations, with the purpose of providing the radiologist clues regarding the diagnosis of this potentially curable pathology. We collected cases of cavernous malformations from the databases at our institutions. CT, MR and angiographic studies were evaluated and lesion size, location, imaging characteristics, multiplicity, and associated findings were recorded. Additionally, the scientific literature pertinent to the subject was reviewed in a practical manner in order to provide a practical manner of making a diagnostic approach of this malformation. Cavernous malformations are congenital vascular lesions composed of sinusoid- type blood vessels that assemble into a compact mass. They may occur in any location in the brain and in the spinal cord. In terms of imaging, they may present certain alarming characteristics that may mimic more aggressive or malignant entities. Associated complications such as hemorrhage and perilesional edema may affect adequate diagnosis at an ever larger degree. For this reason, it is essential that the radiologist is familiar with the imaging behavior of these lesions.
Asunto(s)
Humanos , Malformaciones Vasculares del Sistema Nervioso Central , Imagen por Resonancia Magnética , Hemangioma Cavernoso del Sistema Nervioso Central , Malformaciones VascularesRESUMEN
La papilomatosis mamaria es un proceso benigno poco frecuente, asociado con el desarrollo de cáncer de mama. El limitado número de series y casos publicados no ha permitido definir algunos aspectos de su manejo y seguimiento. Este artículo presenta los casos de dos mujeres (uno de estos casos corresponde a la variante juvenil mamaria), seguidos por la discusión de dicha patología. Se hace énfasis en los hallazgos imagenológicos y en su correlación con la patología
Plasmacytomas are frequent extradural manifestations in patients with history of multiple myeloma (MM). We present a case of a patient with past history of MM, who consulted due to neurologic symptoms. The magnetic resonance showed an extradural mass with typical features of a spinal meningioma: a narrow canal and compressive myelopathy. Hystopathological analysis confirmed a plasmacytoma.
Asunto(s)
Humanos , Plasmacitoma , Neoplasias de la Columna Vertebral , Estenosis Espinal , Mieloma MúltipleRESUMEN
Se presenta el caso de una mujer joven que consultó por una masa en los tejidos blandos de la región frontal izquierda, la cual correspondió a un hemangiopericitoma meníngeo anaplásico. Debido a la baja frecuencia de este tumor y a las pocas descripciones existentes, revisamos los hallazgos clínicos e imaginológicos.