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BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by non-scaring hair loss and preservation of hair follicles. The information available on disease course, and clinical features of AA is scarce worldwide, and almost nonexistent in Colombia. OBJECTIVE: To determine the clinical and sociodemographic characteristics of patients diagnosed with AA who presented to a dermatology consultation in five Colombian cities. MATERIAL AND METHODS: This was a retrospective and multicenter study on data from an ongoing National Registry of Alopecia Areata in Colombia (RENAAC) collected in Bogota, Cali, Cartagena, Barranquilla, and Medellin, Colombia from March 2022 through April 2023. Data was recorded in a standardized form by trained physicians. The variables were expressed as measures of central tendency and dispersion, and absolute and relative frequencies. RESULTS: A total of 562 patients were included, 59.4% of whom were women, aged between 15 and 49 years (63.9%) with a mean disease course of 1.7 years. The most common finding was multiple plaque (53.2%), the predominant AA subtype was patchy (71.4%), and 29.5% of the patients had a past dermatological history, 18.3% had a past endocrinological history, and 8.9% had a past psychiatric history. The treatments most widely used were steroid injections (76.4%), 5% topical minoxidil (46.4%), followed by high-potency corticosteroids (42.5%). STUDY LIMITATIONS AND CONCLUSIONS: AA was slightly predominant in women. As seen in other populations, this disease had an earlier onset in men vs women. Presentation in pediatric age was uncommon. The previous history of other dermatological diseases was checked in almost one third of the patients. Analysis of the co-presentation of AA with other autoimmune diseases is biased due to excluding patients with systemic erythematous lupus from the study.
Asunto(s)
Alopecia Areata , Sistema de Registros , Humanos , Alopecia Areata/epidemiología , Colombia/epidemiología , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven , Niño , Preescolar , Factores Sociodemográficos , Salud Urbana/estadística & datos numéricos , LactanteRESUMEN
BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by non-scaring hair loss and preservation of hair follicles. The information available on disease course, and clinical features of AA is scarce worldwide, and almost nonexistent in Colombia. OBJECTIVE: To determine the clinical and sociodemographic characteristics of patients diagnosed with AA who presented to a dermatology consultation in five Colombian cities. MATERIAL AND METHODS: This was a retrospective and multicenter study on data from an ongoing National Registry of Alopecia Areata in Colombia (RENAAC) collected in Bogota, Cali, Cartagena, Barranquilla, and Medellin, Colombia from March 2022 through April 2023. Data was recorded in a standardized form by trained physicians. The variables were expressed as measures of central tendency and dispersion, and absolute and relative frequencies. RESULTS: A total of 562 patients were included, 59.4% of whom were women, aged between 15 and 49 years (63.9%) with a mean disease course of 1.7 years. The most common finding was multiple plaque (53.2%), the predominant AA subtype was patchy (71.4%), and 29.5% of the patients had a past dermatological history, 18.3% had a past endocrinological history, and 8.9% had a past psychiatric history. The treatments most widely used were steroid injections (76.4%), 5% topical minoxidil (46.4%), followed by high-potency corticosteroids (42.5%). STUDY LIMITATIONS AND CONCLUSIONS: AA was slightly predominant in women. As seen in other populations, this disease had an earlier onset in men vs women. Presentation in pediatric age was uncommon. The previous history of other dermatological diseases was checked in almost one third of the patients. Analysis of the co-presentation of AA with other autoimmune diseases is biased due to excluding patients with systemic erythematous lupus from the study.
Asunto(s)
Alopecia Areata , Sistema de Registros , Humanos , Alopecia Areata/epidemiología , Colombia/epidemiología , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven , Niño , Preescolar , Factores Sociodemográficos , Salud Urbana/estadística & datos numéricos , LactanteRESUMEN
INTRODUCTION: Hypofractionated whole breast irradiation (hWBI) and intraoperative radiotherapy (IORT) could be associated in breast cancer patients showing high-risk factors of local recurrence after breast conserving therapy (BSC). The aim of this trial was to evaluate, for the first time, the toxicity and cosmesis of hWBI after photon-IORT in high-risk patients treated by adjuvant chemotherapy. MATERIALS AND METHODS: Thirty-one high-risk localized breast cancer patients treated by BCS, IORT (20 Gy), and adjuvant chemotherapy were included from February 2019 to August 2020 in this prospective trial, of hWBI (40.5 Gy/2.67 Gy/15 fractions). Acute and late toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed after treatment. RESULTS: All patients completed their treatment and were evaluable after treatment. No patients showed severe (G3) acute/late toxicity. Excellent/good cosmesis at least 6 months after completing the treatment, was present in 93.6% of the patients. CONCLUSION: hWBI in high-risk localized breast cancer patients treated by chemotherapy seems to have similar toxicity and cosmetic results than conventionally fractionated WBI in combination to photon-IORT after BCS.
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Neoplasias de la Mama/radioterapia , Quimioterapia Adyuvante/métodos , Mastectomía Segmentaria/métodos , Cuidados Posoperatorios , Radioterapia Adyuvante/métodos , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Hipofraccionamiento de la Dosis de RadiaciónRESUMEN
INTRODUCTION: Hypofractionated whole breast irradiation (HWBI) is the current standard of treatment after breast conservative surgery (BCS). Intraoperative radiotherapy (IORT) must be associated to WBI in patients showing high-risk factors of local recurrence in the definitive pathology report. The aim of this trial was to evaluate, for the first time, the acute toxicity and cosmesis of HWBI after photon-IORT. MATERIALS AND METHODS: Twenty-six luminal breast cancer patients treated by BCS and IORT(20 Gy) were included between February and December 2019, in this prospective trial, of adjuvant HWBI (40.5 Gy/2.67 Gy/15 fractions). Acute toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed 3 months after treatment. RESULTS: All patients completed their treatment without interruptions. All cases were evaluable 3 months after treatment showing no toxicity ≥ G3 and excellent/good cosmesis assessment in 88% of the patients. CONCLUSION: HWBI seems to have similar acute toxicity and cosmesis results than conventionally fractionated WBI in combination to photon-IORT after BCS.
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Neoplasias de la Mama/radioterapia , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Estudios de Factibilidad , Femenino , Humanos , Periodo Intraoperatorio , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Fotones/uso terapéutico , Estudios Prospectivos , Hipofraccionamiento de la Dosis de Radiación , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
RESUMEN: La mucinosis linfedematosa asociada a obesidad es una dermatosis de reciente reconocimiento que corresponde al grupo de mucinosis cutáneas focales. Presenta un curso clínico caracterizado por la aparición progresiva de lesiones asintomáticas en las piernas de pacientes que concomitantemente cursan con obesidad y linfedema secundario en miembros inferiores.Su diagnóstico implica reconocer otros tipos de mucinosis cutáneas y realizar el diagnóstico diferencial respectivo, de acuerdo con el contexto clínico en el que se presenten las lesiones. Una vez establecido el diagnóstico, su manejo terapéutico debe ir dirigido a lograr una disminución significativa en el peso.
ABSTRACT: Lymphedematous mucinosis associated with obesity is a recently recognized dermatosis that corresponds to the group of focal cutaneous mucinosis. It presents a characteristic clinical course consisting of the progressive and asymptomatic appearance of lesions in the legs of adults who concomitantly have obesity and lymphedema secondary in the lower limbs, as in the clinical case that we will discuss. After having made the differential diagnosis with other possible types of cutaneous mucinosis, according to the clinical context in which the lesions occur, therapeutic management should be aimed at achieving a significant decrease in weight.
RESUMEN
Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.
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Fiebre Chikungunya/complicaciones , Enfermedades Endémicas , Fiebre Reumática/epidemiología , Fiebre Reumática/etiología , Femenino , Humanos , América Latina/epidemiología , Masculino , PrevalenciaRESUMEN
Brachiaria spp. is the predominate pasture grass for cattle grazing in the Orinoco watershed in Colombia. However, it has been recognized that this grass can cause liver damage, leading to photosensitization in ruminants; such injury is caused by the steroidal saponins found in this plant. Liver samples taken from five clinically-healthy bulls' left and right liver lobes and portal vein entrance were processed by routine histological techniques to evaluate liver lesions caused by Brachiaria decumbens in cattle grazing on Colombia's Eastern plains. The main lesions observed in these tissues were mononuclear cell cholangiohepatitis, foamy macrophages, moderate bile pigment accumulation, hepatocyte death, binucleated hepatocytes, moderate bile duct hyperplasia and multiple foci of mild fibrosis in portal areas; these were corroborated by Masson's trichrome staining. Such lesions were predominantly distributed at the portal vein entrance, frequently being located in the periportal region. This type of lesion has usually been attributed to Brachiaria decumbens consumption, and was present in clinically healthy animals exclusively feeding on this type of grass. Thus we conclude that the tissue alterations found herein were caused by Brachiaria decumbens. This research should be expanded to involve a larger selection of cattle populations, throughout a broader geographical region.
En la Orinoquía colombiana hay una considerable cantidad de ganado bovino que se alimenta predominantemente de Brachiaria spp. Sin embargo, se ha reconocido que esta pastura puede ocasionar daño hepático y posterior fotosensibilización en rumiantes, por las saponinas esteroidales que contiene. Con el propósito de evaluar las lesiones hepáticas en ganado bovino procedente de los Llanos Orientales colombianos, se tomaron y procesaron, mediante técnicas histológicas de rutina, muestras de hígado de los lóbulos derecho e izquierdo, así como de la entrada de la vena porta de cinco toros clínicamente sanos. Las principales lesiones observadas en estos tejidos fueron colangiohepatitis mononuclear, macrófagos espumosos, acumulación moderada de pigmentos biliares, muerte de hepatocitos, hepatocitos binucleados, moderada hiperplasia de ductos biliares y múltiples focos de fibrosis leve en áreas periportales, que fueron corroborados por tinción tricrómica de Masson. Estas lesiones se distribuyeron predominantemente en la entrada de la vena porta y se localizaron con frecuencia en la entrada de la región periportal. Dado que estas lesiones se atribuyen comúnmente al consumo de Brachiaria decumbens, y estaban presentes en animales clínicamente sanos exclusivamente alimentados con esta pastura, se concluye que las lesiones aquí encontradas fueron causadas por la Brachiaria decumbens. Se sugiere ampliar este estudio involucrando más bovinos, granjas y municipios.
RESUMEN
En este estudio se evaluó la adaptación de una cepa compatible con Acidithiobacillus ferrooxidans a altas densidades de pulpa de calcopirita, esfalerita y galena, con dos distribuciones de tamaño de partícula, -200 y -325 serie Tyler de tamices. Los microorganismos fueron adaptados por la disminución gradual de la fuente principal de energía, sulfato ferroso, y el aumento en el contenido de mineral, para finalmente realizar un subcultivo sin la adición de fuente de energía externa. La realización de subcultivos en serie resultó ser una estrategia eficaz para la adaptación a altas densidades de pulpa de esfalerita, calcopirita y galena indicando que el protocolo empleado es adecuado. Los resultados muestran que la cepa compatible con Acidithiobacillus ferrooxidans es más resistente a altas concentraciones de esfalerita, seguido por calcopirita y finalmente por galena. El tamaño de partícula juega un papel fundamental en la adaptación de los microorganismos al mineral.
In this study the adaptation of Acidithiobacillus ferrooxidans-like to high concentrations of chalcopyrite, sphalerite and galena were evaluated with two mineral-particle sizes: 200 and 325 Tyler mesh. The strain was adapted using two simultaneous processes. The first one consisted in a gradual decreasing of the main energy source, ferrous sulphate. The second one consisted in a gradual increasing of the mineral content. Finally, a test was made without ferrous sulphate. The serial subculturing was found to be an efficient strategy to adapt Acidithiobacillus ferrooxidans-like to higher concentrations of chalcopyrite, sphalerite and galena. This indicates that a suitable protocol was employed. The results showed that Acidithiobacillus ferrooxidans-like is more resistant to high concentration of sphalerite, chalcopyrite and galena in descendant order. The particle size played an important role in the adaption of microorganism to the mineral.
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Adaptación Biológica/fisiología , Adaptación Biológica/genética , Adaptación Biológica/inmunologíaRESUMEN
We previously reported linkage of bipolar disorder to 5q33-q34 in families from two closely related population isolates, the Central Valley of Costa Rica (CVCR) and Antioquia, Colombia (CO). Here we present follow up results from fine-scale mapping in large CVCR and CO families segregating severe bipolar disorder, BP-I, and in 343 population trios/duos from CVCR and CO. Employing densely spaced SNPs to fine map the prior linkage peak region increases linkage evidence and clarifies the position of the putative BP-I locus. We performed two-point linkage analysis with 1134 SNPs in an approximately 9 Mb region between markers D5S410 and D5S422. Combining pedigrees from CVCR and CO yields a LOD score of 4.9 at SNP rs10035961. Two other SNPs (rs7721142 and rs1422795) within the same 94 kb region also displayed LOD scores greater than 4. This linkage peak coincides with our prior microsatellite results and suggests a narrowed BP-I susceptibility regions in these families. To investigate if the locus implicated in the familial form of BP-I also contributes to disease risk in the population, we followed up the family results with association analysis in duo and trio samples, obtaining signals within 2 Mb of the peak linkage signal in the pedigrees; rs12523547 and rs267015 (P = 0.00004 and 0.00016, respectively) in the CO sample and rs244960 in the CVCR sample and the combined sample, with P = 0.00032 and 0.00016, respectively. It remains unclear whether these association results reflect the same locus contributing to BP susceptibility within the extended pedigrees.
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Indio Americano o Nativo de Alaska/genética , Trastorno Bipolar/genética , Cromosomas Humanos Par 5/genética , Ligamiento Genético , Linaje , Colombia , Costa Rica , Familia , Femenino , Frecuencia de los Genes , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Humanos , América Latina , Escala de Lod , Masculino , Polimorfismo de Nucleótido Simple/genéticaRESUMEN
AIMS: The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia. PATIENTS AND METHODS: The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application. RESULTS: A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time lost per patient because of migraine was 0.3, 2 and 5.2 days, respectively. CONCLUSION: A sub register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians.
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Trastornos Migrañosos/epidemiología , Personal de Hospital , Adulto , Colombia , Eficiencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ocupaciones , Calidad de Vida , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Organización Mundial de la SaludRESUMEN
Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p <0.001 for all measurements) from baseline to endpoint on the SAS (-9.69+/-5.33; percentage change, 87.2%), the Barnes Akathisia Scale (-1.00+/-1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (-1.48+/-2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: -1.52+/-1.91-mg equivalents of benztropine; p < 0.001). Significant mean baseline to endpoint improvements (p < 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; -25.28+/-18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0-6 scale, -13.41+/-10.16; percentage change, 54.4%), and the Clinical Global Impressions Severity scale (-1.16+/-1.19; percentage change, 26.4%). Spontaneously reported treatment- emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.
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Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Discinesia Inducida por Medicamentos/epidemiología , Haloperidol/efectos adversos , Haloperidol/uso terapéutico , Pirenzepina/análogos & derivados , Pirenzepina/efectos adversos , Pirenzepina/uso terapéutico , Adolescente , Adulto , Benzodiazepinas , Femenino , Humanos , América Latina , Masculino , Persona de Mediana Edad , Olanzapina , Escalas de Valoración Psiquiátrica , Esquizofrenia/complicaciones , Esquizofrenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
El tratamiento de la rinitis alérgica se ha convertido en un constante reto para el otorrinolaringólogo; la disponibilidad de múltiples medicamentos, desde los antihistamínicos de primera generación hasta los corticoesteroides tópicos nasales, presentan la clara desventaja de que una vez el paciente los suspende, la sintomatología alérgica reaparece. La inmunoterapia con alergenos es actualmente el método diagnóstico y terapéutico más confiable en el tratamiento de alergias a alergenos inhalados. De las diferentes técnicas disponibles, la Titración cutánea de punto final - SET (por sus siglas en inglés: Skin endpoint titration) - ha demostrado ser muy segura, efectiva a largo plazo y la que más se ha acercado a lo que se ha llamado la respuesta cutánea "patrón de oro". La aplicación de esta técnica requiere de un estricto entrenamiento que contemple la consecución adecuada de alergenos, la aplicación de las pruebas cutáneas, su interpretación y el mantenimiento del tratamiento. El presente artículo expone los principios básicos teórico-prácticos de la técnica de SET y su aplicación clínica en el paciente con rinitis alérgica
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Rinitis , VacunasRESUMEN
OBJECTIVE: This study was designed to investigate risk factors in the final outcome of patients with civilian penetrating abdominal trauma and duodenal injuries, the value of the different surgical approaches used, and to define when more complex procedures are indicated, instead of the simple primary repair. METHODS: The study design was a retrospective review of prospectively collected data of a 4-year period (July 1992 to June 1996). RESULTS: A total of 167 patients were admitted with penetrating abdominal trauma and duodenal injuries at San Juan de Dios Hospital in Santafé de Bogotá, Colombia. CONCLUSION: The independent and significant risk factors that determine the severity of duodenal injury and need for complex procedures, as identified in this series, are preoperative or intraoperative shock; Abdominal Trauma Index higher than 25; and associated injuries to the pancreas, superior mesentric vessels, and colon. These factors are associated with an increased incidence of septic complications, duodenal fistula, and late mortality.
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Traumatismos Abdominales/clasificación , Duodeno/lesiones , Heridas Penetrantes/clasificación , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/cirugía , Adolescente , Adulto , Anciano , Colombia , Enfermedades Duodenales/etiología , Enfermedades Duodenales/mortalidad , Duodeno/cirugía , Femenino , Fístula/etiología , Fístula/mortalidad , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Heridas Penetrantes/mortalidad , Heridas Penetrantes/cirugíaRESUMEN
A randomized blinded clinical trial was performed in 53 patients bitten by Bothrops sp. and Porthidium sp. in Antioquia and Chocó, Colombia, in order to compare the efficacy and safety of two antivenoms made of whole IgG obtained by either ammonium sulphate (monovalent anti-B. atrox) or caprylic acid (polyvalent) fractionation. Additionally, antivenoms were compared by electrophoretic and chromatographic analyses and anticomplementary activity in vitro. With a protocol of 2, 4 and 6 antivenom vials for the treatment of mild, moderate and severe envenomings, respectively, both antivenoms were equally efficient to neutralize the most relevant signs of envenoming and to clear serum venom levels in patients from the first hour and later on. Three patients with severe envenoming and initially treated with less than six vials on admission had persistent or recurrent venom antigenemia within 12-48 h. Monovalent antivenom fractionated by ammonium sulphate precipitation had higher amounts of protein aggregates and nonimmunoglobulin proteins than polyvalent antivenom fractionated by caprylic acid precipitation. Both antivenoms presented anticomplementary activity in vitro, being higher in the monovalent product. In agreement, monovalent antivenom induced a significantly higher incidence of early antivenom reactions (52%) than polyvalent antivenom (25%).
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Antivenenos/uso terapéutico , Bothrops , Venenos de Crotálidos/inmunología , Inmunoglobulina G/uso terapéutico , Mordeduras de Serpientes/terapia , Adolescente , Adulto , Anciano , Sulfato de Amonio/química , Animales , Antivenenos/efectos adversos , Antivenenos/aislamiento & purificación , Caprilatos/química , Fraccionamiento Químico/métodos , Niño , Preescolar , Colombia , Método Doble Ciego , Caballos , Humanos , Inmunoglobulina G/efectos adversos , Inmunoglobulina G/aislamiento & purificación , Lactante , Persona de Mediana Edad , Seguridad , Resultado del TratamientoRESUMEN
De manera relativamente frecuente y originado por un traumatismo toracoabdominal ya sea penetrante y/o cerrado, se presentan lesiones del diafragma que favorecen la aparicion de hernias diafragmaticas, que de no ser detectadas y manejadas de manera oportuna conllevan una importante morbimortalidad. Con el fin de establecer la sensibilidad y especificidad de la toracoscopia en el diagnostico de heridas diafragmaticas por arma cortopunzante especificamente del lado izquierdo, se realizó el presente trabajo. Es un estudio prospectivo de cohorte dinámica desarrollado entre mayo de 1995 y abril de 1997 en el hospital San Juan de Dios de Santa Fe de Bogota. Se incluyeron pacientes entre 15 y 50 años ingresados por urgencias que presentaran herida por arma cortopunzante toracoabdominal izquierda, normales hemodinámicamente y sin indicacion de cirugía inmediata. Previa firma de autorizacion se llevaron a toracoscopia y posterior laparotomia para verificacion de los hallazgos. El universo del estudio lo conformaron 28 pacientes, 26 hombres y 2 mujeres con un promedio de edad de 26 años y con una frecuencia modal de TRTS: 12, ISS: 9, ATI: 2, PT-TI: 5. La mitad de los pacientes presento herida diafragmática y en el 25 por ciento lesiones intraabdominales asociadas; el tiempo promedio de toracoscopia fue de 33 minutos y de laparotomia de 37 minutos. En el análisis estadistico se encontro una sensibilidad de la prueba del 100 por ciento con una tasa de falsos negativos de 0 por ciento y un valor predictivo negativo del 100 por ciento. En conclusion estamos frente a una prueba de alto rendimiento que nos garantiza el diagnostico de una lesion que de ser omitida tiene una alta morbimortalidad.
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Traumatismos Abdominales , Toracoscopía , Traumatismos Torácicos/diagnóstico , Heridas PenetrantesRESUMEN
Las lesiones del canal anal y del tercio inferior, presentaron una recurrencia significativamente mayor que las del tercio medio y superior, del 38 por ciento vs el 25 por ciento, p<0.0001. Se observó el doble de recurrencias locales con suturas mecanicas en comparacion con las manuales, del 28 por ciento vs el 13 por ciento, sin ser significativamente diferentes. Los principales factores pronosticos que afectaron la sobrevida fueron, el compromiso ganglionar y la penetracion a la pared rectal, valorados en la clasificacion de Astler Collery TNM, p<0.001. La sobrevida a 5 años fue similar en la reseccion anterior y en la reseccion abdominoperineal (63 por ciento y 58 por ciento, respectivamente) (p.=0.3 5). Variables comparables incluyeron unicamente adenocarcinomas y se tomo la distancia entre el borde inferior del tumor y el borde anal como medida para localizarlos: en el canal anal, de 0 a 3 cm; en el tercio inferior del recto, de 4 a 7 cm; en el tercio medio, de 8 a 12 cm. y en el tercio superior, de 12 a 15 cm; se analizaron variables en relacion con estas localizaciones. En conclusion, la preservacion del mecanismo esfinteriano mediante una reseccion anterior, no aumento la recurrencia local ni disminuyó la sobrevida a 5 años, y si logro una mejor calidad de vida
Asunto(s)
Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos , Neoplasias del Recto , Recurrencia , Análisis de SupervivenciaRESUMEN
Se presentan los resultados obtenidos en 33 pacientes adultos con diagnostico de carcinoma esofágico o gastroesofagico, sometidos a tratamiento quirurgico mediante la tecnica de esofagectomia transhiatal y ascenso gastrico al cuello, tratados en el Instituto Nacional de Cancerologia de Santafe de Bogota, en un periodo de 5 años. La edad promedio fue de 59 años; 24 casos (73 por ciento) pertenecian al sexo masculino y 9 casos (27 por ciento) al femenino.Treinta y un casos fueron llevados a cirugia en forma electiva y en 2 casos la cirugia fue efectuada de urgencia por perforacion esofágica durante dilataciones de la estenosis tumoral. La mayoria de los tumores (79 por ciento) se localizaban en el tercio inferior del esofago, y los restantes (21 por ciento) en el tercio media. Hubo complicaciones postoperatorias mayores en 14 casos y la mortalidad operatoria fue del 18 por ciento. Se efectuó seguimiento de 20 meses en promedio, con una sobrevida general de 29 meses para los pacientes con neoplasias del tercio medio, y de 19 para las lesiones del tercio inferior, cifras que guardan correlacion con la sobrevida segun el tipo histologico: 27 meses para el carcinoma escamocelular y 16 para el adenocarcinoma.