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PURPOSE: Fracture Liaison Services programs reduce mortality and the risk of refracture and increase treatment and adherence rates. Greater coverage is an important priority for the future. The aim was to determine the characteristics of patients over 50 years old who suffered fractures and the effectiveness of a Fracture Liaison Services program in a health care institution in Colombia. METHODS: This was a retrospective follow-up study of a cohort of patients with vertebral and nonvertebral fractures managed in a Fracture Liaison Services program. Sociodemographic, clinical and pharmacological variables were identified. Key performance indicators were used to evaluate the effectiveness of the program. Descriptive and bivariate analysis was performed. RESULTS: A total of 438 patients were analyzed. The average age was 77.5 years, and 78.5% were women. Hip and vertebral fractures were the most common (25.3% and 24.9%, respectively). Vertebral fractures prevailed in men (33.0% vs 22.7%; p = 0.041) and those of the radius/ulna in women (20.3% vs 10.6%; p = 0.031). A total of 29.7% had experienced a previous fracture, and 16.7% had received antiosteoporosis drugs. A total of 63.5% of the cases were managed surgically. At discharge, 58.8% received prescriptions for calcium/vitamin D, and 50.7% with prescriptions of antiosteoporotic therapy, especially teriparatide (21.2%) and denosumab (16.4%), without significant differences by sex. However, in women with hip fractures, anti-osteoporotic management prevailed (83.7% vs 64.0; p = 0.032). The effectiveness of the overall program per year was 74.6%. On follow-up, only 9.1% of patients had experienced a new fall, and of those 3.7% presented a new fracture. A total of 4.3% died during follow-up. CONCLUSIONS: Good adherence to the recommendations of the country's clinical practice guidelines was found, and overall, the effectiveness of the program was very satisfactory, with a low incidence of new fractures during follow-up. Fracture Liaison Services programs reduce mortality and the risk of refracture. A retrospective follow-up study of a cohort of patients with vertebral and nonvertebral fractures managed in a Fracture Liaison Services, showed that the effectiveness was 73.6%. On follow-up, 9.1% of patients had experienced a new fall, and of those 3.7% presented a new fracture.

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Antibiotics are frequently prescribed to patients with COVID-19. The aim was to determine the pattern of use of systemic antibiotics in a group of patients diagnosed with COVID-19 in Colombia between 2020-2022. This was a descriptive cross-sectional study designed to identify antibiotics prescription patterns for patients diagnosed with COVID-19 treated in eight clinics in Colombia. The AWaRe tool of the World Health Organization (WHO) was used to classify the antibiotics. A total of 10,916 patients were included. The median age was 57 years, and 56.4% were male. A total of 57.5% received antibiotics, especially ampicillin/sulbactam (58.8%) and clarithromycin (47.9%). Most of the antibiotics were classified as Watch (65.1%), followed by Access (32.6%) and Reserve (2.4%). Men (OR: 1.29; 95%CI: 1.17-1.43), older adults (OR: 1.67; 95%CI: 1.48-1.88), patients with dyspnea (OR: 1.26; 95%CI: 1.13-1.41), rheumatoid arthritis (OR: 1.94; 95%CI: 1.17-3.20), and high blood pressure at admission (OR: 1.45; 95%CI: 1.29-1.63), patients treated in-hospital (OR: 5.15; 95%CI: 4.59-5.77), patients admitted to the ICU (OR: 10.48; 95%CI: 8.82-12.45), patients treated with systemic glucocorticoids (OR: 3.60; 95%CI: 3.21-4.03) and vasopressors (OR: 2.10; 95%CI: 1.60-2.75), and patients who received invasive mechanical ventilation (OR: 2.37; 95%CI: 1.82-3.09) were more likely to receive a systemic antibiotic. Most of the patients diagnosed with COVID-19 received antibiotics, despite evidence showing that bacterial coinfection is rare. Antibiotics from the Watch group predominated, a practice that goes against WHO recommendations.

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Introducción: : el trauma maxilofacial se considera una urgencia quirúrgica cuando está asociado con el trauma craneoencefálico (TCE). Se describirán los hallazgos demográficos más importantes en un grupo de pacientes seleccionados para el presente estudio.Describir las características sociodemográficas y clínicas de los pacientes diagnosticados con trauma maxilofacial, así como determinar las principales pautas de tratamiento y estabilización desarrolladas en un centro de tercer nivel de complejidad del municipio de Chía en Colombia. Materiales y métodos: estudio de carácter observacional y descriptivo, desarrollado para caracterizar a la población demográfica con trauma maxilofacial en la Clínica de la Universidad de La Sabana. Resultados: se analizaron 37 pacientes en el presente estudio, con una edad promedio de 35 años, y se encontró una mayor incidencia de presentación en el sexo masculino. Dentro de las causas más frecuentes se registran los eventos de tránsito en calidad de conductor de motocicleta en el 56 % de los casos; dentro de la clasificación de las fracturas, las panfaciales se encontraron en un 24,4 % de los casos, y son las más prevalentes; en el ámbito hospitalario, el 43 % de los pacientes presentaron un TCE grave. El tiempo de espera para realizar una intervención quirúrgica fue aproximadamente de 3,8 días. Finalmente, se definieron los requerimientos de manejo en la unidad de cuidados intensivos (UCI) a través de cinco variables como: uso de vasopresores, sedación, analgésicos, gastrostomía o traqueostomía y manejo adicional en la UCI. Conclusión: las instituciones deben estandarizar un protocolo de diagnóstico y manejo específico para lesiones traumáticas de acuerdo a su nivel de complejidad, ubicación geográfica y volumen de paciente con trauma maxilofaciales y trauma craneoencefálico debido a su alta prevalencia e implicaciones tanto en morbilidad como mortalidad.

Introduction: Maxillofacial trauma is considered a surgical emergency when associated with cranioencephalic trauma (CET). The most important demographic findings will be described in a group of patients selected for the present study. To describe the sociodemographic and clinical characteristics of patients diagnosed with maxillofacial trauma, as well as to determine the main treatment and stabilization guidelines developed in a third level complexity center in the township of Chía in Colombia. Materials and methods: This is a observational and descriptive study, developed by the Department of Clinical Pharmacology and Maxillofacial Surgery to characterize the demographic population with maxillofacial trauma at the Clínica de la Universidad de La Sabana. Results: We analyzed 37 patients in the present study, with an average age of 35 years, finding a higher incidence of presentation in the male gender. Among the most frequent causes; in 56% of cases, traffic events are recorded as a motorcycle driver. Within the classification of fractures, panfacial's fractures were found in 24.4% of the cases, being the most prevalent. In the hospital setting, 43% of patients had severe CET. The waiting time to perform a surgical intervention was approximately 3.8 days. Finally, management requirements were defined in the Intensive Care Unit (ICU) through 5 variables such as: use of vasopressors, sedation, analgesics, gastrostomy or tracheostomy and additional management in ICU. Conclusion: institutions must standardize a specific diagnosis and management protocol for traumatic injuries according to their level of complexity, geographic location, and volume of patients with maxillofacial trauma and cranioencephalic trauma due to its high prevalence and implications for both morbidity and mortality.

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BACKGROUND: Analgesics provide multiple clinical benefits but they are not without risks. OBJECTIVE: The aim of this study was to compare the outpatient prescribing pattern of analgesics between cities and municipalities in Colombia and to identify the variables associated with prescribing opioid analgesics. METHODS: This was a cross-sectional study that identified the prescription of analgesics for outpatient use from a population database of 8.5 million Colombians. A descriptive, bivariate, and multivariate analysis was performed. RESULTS: A total of 573,248 patients were identified who had received prescriptions for an analgesic. Mean age was 46.5 ± 23.6 years and 65.7% were females. The most commonly prescribed analgesics were non-opioid analgesics, antispasmodics, and opioid analgesics. The average milligram equivalent of morphine was higher in capital cities than in municipalities. Age ≥ 65 years (odds ratio [OR] 2.60, 95% confidence interval [CI] 2.54-2.67), male sex (OR 1.09, 95% CI 1.07-1.11), dispensing in cities (OR 2.25, 95% CI 2.20-2.30) and experiencing chronic pain (OR 13.25, 95% CI 10.89-16.14) were associated with an increased risk of receiving an opioid analgesic. CONCLUSIONS: Differences were found in the prescription of analgesics between capital cities and municipalities. The use of opioids does not appear to be in line with the recommendations for clinical practice, and they were mainly prescribed for elderly males with chronic non-oncological pain and for residents of capital cities.

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Abstract A patient with chronic brainstem CVA sequelae received one cycle of magnetic stimulation to treat her dysphagia and serendipitously obtained a minimal improvement in her axial movement. Two additional cycles gave her improved postural control and then distal movement, preceded by a display of ipsilateral and contralateral motor evoked potentials, respectively. Magnetic stimulation at 10 Hertz produces cortical disinhibition and reopens the critical neurodevelop ment periods. The ontogenic pattern of hemiplegia recovery in this patient may be explained by an increased and rejuvenated brain plasticity due to critical period reopening through cortical disinhibition. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

Resumen Una paciente con secuelas crónicas de un ACV del tallo cerebral recibió un ciclo de estimulación magnética para el manejo de la disfagia y, por serendipia obtuvo mejoría leve del movimiento axial. Dos ciclos adicionales le permitieron mejoría del control postural y luego la aparición de movimiento distal, precedidos por la visualización de los potenciales evocados motores ipsilateral y contralateral, respectivamente. La estimulación magnética a 10 Hertz produce desinhibición cortical y reabre los periodos críticos del neurodesarrollo. Es posible, que el patrón ontogénico de recuperación de la hemiplejía en esta paciente se explique por el incremento y rejuvenecimiento de la plasticidad cerebral debido a la reapertura de los periodos críticos, por medio de la desinhibición cortical. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

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The aim of this study was to investigate how social responsibility marketing campaigns can be effective in branding for young millennials. An empirical model was applied in three specific cases of cause marketing targeting Generation Y. A total sample of 547 young people was obtained, and the data were analysed through the structural equation methodology using PLS data technical analysis. The results showed that, for millennials, marketing actions with a cause are effective in positioning the brands that carry them out favourably as long as requirements such as the alignment of their objectives with the social ideals and their closeness to millennials are met. Likewise, all the communication elements of the message will influence its effectiveness. This study provides new evidence on the attitudes of young millennials towards brands' social marketing actions.

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Motor imagery (MI) promotes motor learning and encourages brain-computer interface systems that entail electroencephalogram (EEG) decoding. However, a long period of training is required to master brain rhythms' self-regulation, resulting in users with MI inefficiency. We introduce a parameter-based approach of cross-subject transfer-learning to improve the performances of poor-performing individuals in MI-based BCI systems, pooling data from labeled EEG measurements and psychological questionnaires via kernel-embedding. To this end, a Deep and Wide neural network for MI classification is implemented to pre-train the network from the source domain. Then, the parameter layers are transferred to initialize the target network within a fine-tuning procedure to recompute the Multilayer Perceptron-based accuracy. To perform data-fusion combining categorical features with the real-valued features, we implement stepwise kernel-matching via Gaussian-embedding. Finally, the paired source-target sets are selected for evaluation purposes according to the inefficiency-based clustering by subjects to consider their influence on BCI motor skills, exploring two choosing strategies of the best-performing subjects (source space): single-subject and multiple-subjects. Validation results achieved for discriminant MI tasks demonstrate that the introduced Deep and Wide neural network presents competitive performance of accuracy even after the inclusion of questionnaire data.

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Motion capture (Mocap) data are widely used as time series to study human movement. Indeed, animation movies, video games, and biomechanical systems for rehabilitation are significant applications related to Mocap data. However, classifying multi-channel time series from Mocap requires coding the intrinsic dependencies (even nonlinear relationships) between human body joints. Furthermore, the same human action may have variations because the individual alters their movement and therefore the inter/intraclass variability. Here, we introduce an enhanced Hilbert embedding-based approach from a cross-covariance operator, termed EHECCO, to map the input Mocap time series to a tensor space built from both 3D skeletal joints and a principal component analysis-based projection. Obtained results demonstrate how EHECCO represents and discriminates joint probability distributions as kernel-based evaluation of input time series within a tensor reproducing kernel Hilbert space (RKHS). Our approach achieves competitive classification results for style/subject and action recognition tasks on well-known publicly available databases. Moreover, EHECCO favors the interpretation of relevant anthropometric variables correlated with players' expertise and acted movement on a Tennis-Mocap database (also publicly available with this work). Thereby, our EHECCO-based framework provides a unified representation (through the tensor RKHS) of the Mocap time series to compute linear correlations between a coded metric from joint distributions and player properties, i.e., age, body measurements, and sport movement (action class).

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La deshumanización es la reducción de las cualidades que distinguen a las personas como seres humanos, llevando al profesional a actuar sin ser capaz de experimentar empatía. La educación en ciencias de la salud enfrenta la dificultad que representa el desarrollar mecanismos que permitan implementar un componente humano óptimo desde la formación profesional. El propósito de no implicarse emocionalmente es, quizá, un mecanismo de defensa que aparta del sufrimiento ajeno. Esta actitud impersonal compromete la empatía, desgasta el ideal y promulga la necesidad de una educación afectiva para conservar la empatía durante los años de formación. Objetivo: identificar el componente humano en estudiantes de un programa de ciencias de la salud en la Fundación Universitaria del Área Andina, Pereira, 2021. Método: estudio cuantitativo, descriptivo, transversal, muestra de 146 estudiantes seleccionados en forma no probabilística. La captura y procesamiento de la información básica según las variables de estudio se realizó a través del programa STATA 15. Resultados: el puntaje de medición de empatía global obtenido en la investigación fue de 97 lo que indica un nivel sobresaliente (88-113). Conclusiones: es importante generar estrategias que impacten desde la academia, que promuevan la empatía y el factor humanístico.

Dehumanization is the reduction of the qualities that distinguish people as human beings, leading the professional to act without being able to experience empathy. Health sciences education faces the difficulty of developing mechanisms to implement an optimal human component from professional training. The purpose of not getting emotionally involved is, perhaps, a defense mechanism that keeps away from the suffering of others. This impersonal attitude compromises empathy, wears out the ideal and promulgates the need for an affective education to preserve empathy during the formative years. Objective: to identify the human component in students of a health sciences program at the Fundación Universitaria del Área Andina, Pereira, 2021. Method: quantitative, descriptive, cross-sectional study, sample of 146 students selected in a non-probabilistic way. The capture and processing of the basic information according to the study variables was carried out through the STATA 15 program. Results: the global empathy measurement score obtained in the research was 97, which indicates an outstanding level (88-113). Conclusions: it is important to generate strategies that have an impact from the academy, which promote empathy and the humanistic factor.

A desumanização é a redução das qualidades que distinguem as pessoas como seres humanos, levando o profissional a atuar sem ser capaz de sentir empatia. O ensino das ciências da saúde enfrenta a dificuldade de desenvolver mecanismos para implementar uma componente humana óptima na formação profissional. O objetivo de não se envolver emocionalmente é, talvez, um mecanismo de defesa que se afasta do sofrimento dos outros. Esta atitude impessoal compromete a empatia, desgasta o ideal e promulga a necessidade de uma educação afectiva para preservar a empatia durante os anos de formação. Objetivo: identificar a componente humana nos estudantes de um curso de ciências da saúde da Fundación Universitaria del Área Andina, Pereira, 2021. Método: estudo quantitativo, descritivo, transversal, amostra de 146 estudantes seleccionados de forma não probabilística. A captura e o processamento das informações básicas de acordo com as variáveis do estudo foram realizados utilizando o programa STATA 15. Resultados: a pontuação global da medida de empatia obtida na investigação foi de 97, o que indica um nível excelente (88-113). Conclusões: É importante gerar estratégias que tenham impacto a partir da academia, que promovam a empatia e o fator humanístico.

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ABSTRACT Given that one of the central elements in marketing spending is advertising, this study aims at analysing how the advertising planning process is influenced by the types of responses expected from the audience, the measurement methods used to assess advertising effectiveness and the expected results. This study was empirical and exploratory based on the application of a cross-sectional survey to 150 marketing managers of medium and large-sized companies in Colombia. The results show if organisations measure the level of compliance with the goals established in terms of IMC, they will make better decisions and allocate marketing budgets consistent with their objectives, resources and capabilities. As the results of the present study indicate, organisations can experience weaknesses in implementing measurement methods that guarantee the proper calculation of organisational results concerning advertising investment.

RESUMEN Dado que uno de los rubros protagonistas en el gasto de mercadeo es la publicidad, este estudio tiene por objetivo analizar cómo los tipos de respuestas esperados por parte de la audiencia, los métodos de medición utilizados para medir la eficacia publicitaria y los resultados esperados, influencian la planeación de la publicidad. Este estudio fue empírico exploratorio a partir de la aplicación de una encuesta de corte transversal a l50 gerentes de mercadeo de empresas medianas y grandes de Colombia. En los resultados se evidencia que los métodos de medición de la eficacia publicitaria no se relacionan de manera significativa con la gestión de la publicidad, lo cual dificulta la obtención de resultados fiables y limita la toma de decisiones organizacional.

RESUMO Dado que um dos principais itens dos gastos de marketing é a publicidade, este estudo tem como objetivo analisar como os tipos de respostas esperadas pelo público, os métodos de medição usados para medir a eficácia da publicidade e os resultados esperados influenciam o planejamento da publicidade. Este estudo foi empírico exploratório a partir da aplicação de uma pesquisa transversal a 150 gerentes de marketing de médias e grandes empresas da Colômbia. Os resultados mostram que os métodos de medir a eficácia da publicidade não estão significativamente relacionados ao gerenciamento da publicidade, o que dificulta a obtenção de resultados confiáveis e limita a tomada de decisão organizacional.

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Introducción: Candida spp. Es la principal causa de fungemia, cuya incidencia ha aumentado en los últimos años. Existen datos locales insuficientes sobre este tipo de infecciones. Materiales y métodos: Este fue un estudio observacional retrospectivo de 44 pacientes diagnosticados con candidiasis invasiva hospitalizados en la Fundación Valle del Lili, el cual es un centro de cuarto nivel afiliado a la Universidad Icesi en el Suroccidente Colombiano, entre los años 2012 a 2017. Resultados: Se identificaron 44 pacientes con candidiasis invasiva, 27 de ellos mujeres (61%). La mediana de edad fue de 56 años (36 - 70). Más del 50% tenían una enfermedad crónica subyacente, uso de antibióticos (84%), catéter venoso central (80%), ventilación mecánica (68%) y nutrición enteral (66%) El 80% requirió manejo en unidad de cuidados intensivos (UCI) donde debutaron con sepsis (68%) y falla respiratoria (61%). En el 90% de los casos se aisló alguna especie de Candida spp. A partir de hemocultivo y sólo al 22% se le realizó prueba de sensibilidad. El tratamiento de elección fue con fluconazol (80%), asociado a caspofungina (70%). La tasa de mortalidad fue del 49%, con una mediana de 33 (22-49,5) días desde el ingreso hasta el fallecimiento. C. albicans fue el principal microorganismo aislado. La resistencia a azoles en especies no albicans existe en nuestro medio. Conclusión: La candidiasis se presenta como candidemia asociada a infección bacteriana concomitante, que cobra mayor importancia en el contexto del paciente inmunosuprimido asociado a elevadas tasas de mortalidad.

Introduction: Candida spp. is the main cause of fungemia, whose incidence has increased in recent years. There are insufficient local data about this pathology. Materials and methods: This was an observational, retrospective chart review of 44 patients diagnosed with invasive candida who were hospitalized at Fundación Valle del Lili, which is a fourth level center affiliated to Icesi university between 2012 and 2017. Results: We identified 44 patients with invasive candidiasis, 27 of them women (61%). The median age was 56 years (36 - 70). More than 50% had an underlying chronic disease, use of antibiotics (84%), central venous catheter (80%), mechanical ventilation (68%) and enteral nutrition (66%). 80% required management in an intensive care unit. Sepsis (68%) and respiratory failure (61%) were the most common clinical presentation. Almost 90% of the cases, had positive blood cultures, but only 22% presented susceptibility tests. The treatment was mainly fluconazole (80%), associated with caspofungin (70%). The mortality rate was 49%, median of 33 (22-49.5) days from admission to death. Candida albicans was the main isolated organism. Azole resistance in non-albicans species was observed. Conclusion: Candidiasis presents as bacterial infection associated candidemia, which becomes more important in the context of the immunosuppressed patient with high mortality rates.

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Con el fin de visibilizar los desafíos de los y las profesionales de la psicología con formación en salud ocupacional que actúan en la gestión de riesgos psicosociales en Colombia, se analizó la actividad de estos profesionales, considerando las normas/valores que permean y constituyen sus prácticas en la ampliación/producción de la salud de los trabajadores. Para ello, se construyeron siete narrativas a partir de nutridos encuentros establecidos con el mismo número de psicólogos. Estas narrativas fueron analizadas bajo la perspectiva brasilera de Salud del Trabajador y la Ergología. Se sintetizan los hallazgos en tres aspectos: 1. El sistema institucional: la actividad de los psicólogos está mediada por algunos avances y límites del actual sistema institucional (Empresas, Gobierno, Aseguradoras de Riesgos Laborales, Trabajadores e Instituciones Educativas). 2. Renormatización: en medio de las lógicas de la economía capitalista los psicólogos reescriben en el cotidiano de trabajo las normas antecedentes (valores y normas del sistema institucional), creando líneas de fuga que les permite construir transformaciones para la salud de los trabajadores. Y, finalmente, el tercer hallazgo que a su vez constituye la conclusión de esta investigación, 3. Colectividad vs Especialismos: la necesidad de construir en la colectividad las técnicas, lógicas y dispositivos que permitan intervenir/conocer la actividad de trabajo, con el propósito de ampliar/ producir la salud de los trabajadores(AU)

In order to examine the challenges facing psychologists specialized in occupational health, involved in assessing psychosocial risk factors in Colombia, we analysed their activity considering the standards and values that permeate and constitute their practices regarding the expansion and production of worker health. Seven themes were constructed from well-attended meetings involving the same number of psychologists. These themes were analysed under the Brazilian’s perspective of Health of the Worker and Ergology. Findings were summarized along three lines: 1. The institutional system: psychologists’ activities are mediated by both advances and limitations of the current institutional system (companies, government, occupational risk insurance companies, workers and educational institutions). 2. Re-standardization (update): within a capitalist economic structure, through their daily activities psychologists rewrite pre-exsiting norms (values and norms of the institutional system), creating pathways that allow them to transform worker health. And finall , the third finding which, in turn, constitutes the conclusion of this investigation: 3. Collectiveness vs specialization: the need to build collective level techniques, logic and devices that allow insight and intervention on work activity, with the aim of expanding and promoting worker health(AU)

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Objetivo: La resistencia a los fármacos antituberculosis es de gran interés en salud pública. La coinfección con virus de la inmunodeficiencia humana (VIH) ha cambiado el comportamiento de dicha enfermedad. El objetivo de nuestro estudio es determinar la prevalencia de la resistencia a fármacos antituberculosis en pacientes coinfectados con tuberculosis (TB)/VIH. Método: Se realizó un estudio retrospectivo a partir de la revisión de los registros clínicos de casos nuevos y fracasos de TB coinfectados con VIH que consultaron a un centro de atención de nivel IV desde 2007 a 2010 y que contaban con pruebas de susceptibilidad. Resultados: Un 52% de los pacientes procedían de Santiago de Cali, y un 8%, de Buenaventura. La TB se presentó de forma extrapulmonar en el 80% de los pacientes. Del 48% de los sujetos que conocían su estado VIH previo al diagnóstico de la TB, el 40% estaban en terapia antirretroviral. El 16% de los casos eran fracasos, entre los cuales se detectó un caso multidrogorresistente. De los casos nuevos, se encontró monorresistencia a la isoniazida del 14%, y una resistencia total del 28%. Conclusiones: Se encontró una mayor prevalencia de resistencia a la esperada en población coinfectada TB/VIH; por lo que es necesario fortalecer el trabajo en equipo entre las entidades públicas y privadas para controlar dicha situación y fomentar el diagnóstico temprano y la realización de pruebas de susceptibilidad a fármacos antituberculosis.

Background: Resistance to anti-tuberculosis treatment is a matter of great interest in terms of public health. TB/HIV coinfection changed what was previously known about TB. Our study attempts to determine the prevalence of resistance to TB drugs among a local TB/HIV population. Methods: A retrospective study was conducted, which consisted of a review of the clinical records of new and relapsing cases of TB/HIV coinfected patients, with drug susceptibility tests, who attended an advanced medical care centre in Cali, Colombia, between 2007 and 2010. Results: Just over half (52%) of the patients were native from Cali, and 8% were from Buenaventura. An extra-pulmonary presentation of TB was seen in 80% of the subjects. Almost half (48%) were HIV positive before the diagnosis of tuberculosis was made, 40% of whom were on HAART treatment. Of the total cases, 16% were relapses, including one case of multi-drug resistant (MDR)-TB. Among the new cases, 14% were resistant to isoniazid only, making a total of 28% being resistant to this. Conclusions: There was a higher than expected prevalence of resistance in TB/HIV patients. There is an urgent need to improve the team work between public health organizations and private medical institutions, and this cooperation hould be of great priority, as it is a means to control and promote early diagnosis with drug-susceptibility tests.

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Se presenta el caso de un lactante masculino de 14 meses de edad que consulta por vómito, astenia, adinamia y palidez generalizada. Ingresa con un peso de 5.4 kg y una talla de 69 cm, marcada disminución del panículo adiposo y de la masa muscular, sin edemas. Los análisis reportaron potasio sérico 2,02 mEq/L, cloro 89,4 mEq/L, sodio 134,5 mEq/L, magnesio 2,39 mg/dl, albumina 4,52 gr/dl, creatinina sérica 0,17 mg/dl, uroanálisis con proteinuria 75 mg/dl y ecografía renal normal. Se sospecha síndrome de Bartter, por lo que se solicitan gases venosos que muestran pH 7,519, pO2 60 mmHg, pCO2 32,5 mmHg, HCO3 25,8 mmol/l, BE 3,3 mmol/L, relación calcio/creatinina en orina: 0,056, aldosterona 11,9 ngr/dl y renina total 459 pg/ml. Con estos resultados se hace el diagnóstico de SB, siendo compatible con el tipo III. Se iniciaron suplementos de potasio y diuréticos ahorradores de potasio sin lograr un adecuado aumento del potasio sérico y solo hasta iniciar indometacina este se logra corregir,al igual que la adecuada ganancia pondoestatural. A continuación se hace una revisión de la literatura sobre el síndrome de Bartter...

A case of 14-month male infant presenting with vomit, asthenia, adynamia, and generalized paleness is presented. At admission, his weight is 5.4 kg and height 69 cm, with marked reduction of his adipose pannus and muscular mass, with no edema. The tests reported serum potassium 2.02 mEq/L, chlorine 89.4 mEq/L, sodium 134.5 mEq/L, magnesium 2.39 mg/ dl, albumin 4.52 gr/dl, serum creatinine 0.17 mg/dl, urinalysis with proteinuria 75 mg/dl, and a normal renal echography. Bartter syndrome was suspected reason why venous gases were ordered which showed pH 7.519, pO2 60 mmHg, pCO2 32,5 mmHg, HCO3 25.8 mmol/l, BE 3.3 mmol/L, urine calcium/creatinine ratio 0.056, aldosterone 11.9 ngr/dl and total renin 459 pg/ml. With these results, the patient was diagnosed with BS, being compatible with type III. Potassium supplements and potassium sparing diuretics were started without achieving a proper serum potassium increase and only after starting indomethacine it could be corrected as well as the appropriate pondostatural increase. Below, there is a literature review about the Bartter syndrome Bartter, tubulopathy, hypokalemia...

Apresenta-se o caso de um lactante masculino de 14 meses de idade que consulta por vômito, astenia, adinamia e palidez generalizada. Dá entrada com um peso de 5.4 kg e uma estatura de 69 cm, marcada diminuição do panículo adiposo e da massa muscular, sem edemas. Os exames mostraram potássio sérico 2,02 mEq/L, cloro 89,4 mEq/L, sódio 134,5 mEq/L, magnésio 2,39 mg/dl, albumina 4,52 gr/dl, creatina sérica 0,17 mg/dl, uroanálise com proteinúria 75 mg/dl e ecografia renal normal. Suspeita-se de síndrome de Bartter, por isso são solicitados gases venosos que mostram pH 7,519, pO2 60 mmHg, pCO2 32,5 mmHg, HCO3 25,8 mmol/l, BE 3,3 mmol/L, relação cálcio/ creatina na urina: 0,056, aldosterona 11,9 ngr/dl e renina total 459 pg/ml. Com estes resultados é feito o diagnóstico de SB, sendo compatível com o tipo III. Iniciaram-se suplementos de potássio e diuréticos economizadores de potássio sem obter-se um aumento adequado do potássio sérico, somente ao iniciar indometacina o mesmo é corrigido, da mesma forma que o adequado desenvolvimento pondoestatural. A seguir é feita uma revisão da literatura sobre a síndrome de Bartter...

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