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BACKGROUND: Intravascular leiomyomatosis (IVL) is a histologically benign smooth muscle tumor arising from the uterus that can spread through the pelvic veins and, on rare occasions, extend as far as the heart via the inferior vena cava. Despite its benign characteristics, it can behave like a malignant tumor leading to significant morbidity and even mortality if left untreated. CASE PRESENTATION: The patient is a 42-year-old woman with a past medical history of uterine leiomyomas. She presented with heavy bleeding and frequent spotting; therefore, she went to her gynecologist. After further evaluation, a mass within the uterus that expanded into the pelvic veins, inferior vena cava, and right atrium was discovered. After the complete removal of the mass, the patient underwent full recovery. IVL with cardiac extension was the final diagnosis. CONCLUSION: Although IVL is rare, it must be considered in women who underwent previous hysterectomies or myomectomies and present with symptoms of right heart failure. The ideal therapy will need the aid of a multidisciplinary team and will depend on the patient's symptoms, previous operative history, the tumor's extension, and resectability.
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Insuficiência Cardíaca , Leiomiomatose , Feminino , Humanos , Adulto , Leiomiomatose/diagnóstico por imagem , Leiomiomatose/cirurgia , Átrios do Coração/cirurgia , Veia Cava Inferior/cirurgia , GinecologistaRESUMO
OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.
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COVID-19 , Pneumotórax , Adulto , COVID-19/complicações , Feminino , Hematocele/diagnóstico , Hematocele/etiologia , Hematocele/cirurgia , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia , RNA Viral , Estudos Retrospectivos , Ruptura , SARS-CoV-2RESUMO
Delirium is an acute state of impaired consciousness and a medical urgency. Its broad range of alterations in mental status make diagnosis challenging. Awareness and accurate provisional diagnosis by nonpsychiatric clinicians are important for prompt management. Because delirium symptoms overlap and mimic other neuropsychiatric conditions, a referral to a consultant psychiatrist is often needed. The aim of this study was to determine the discriminating variables that are associated with concordance or discordance for a DSM-5 delirium diagnosis made by the consultation/liaison (C/L) psychiatrist as compared to the referral diagnosis/reasons given by the referring physicians for inpatients from a Tertiary Hospital in a Latin-American country. Prospective study of a cohort of 399 consecutive patients admitted to any ward of a university hospital in Medellin-Colombia and referred by a specialist physician to the C/L Psychiatry service. Analyses for diagnostic concordance used a nested sample of 140 cases diagnosed with delirium by the psychiatrist. Two multivariate logistic models were run, for delirium diagnosis concordance and discordance between the referring physician and C/L psychiatrist. The referral diagnosis was concordant with that of Psychiatry in 90/140 patients in 64.3%, with 35.7% discordance. Increasing age (ORâ =â 1.024) and internal medicine ward (ORâ =â 3.0) were significantly related (Wald statistic Pâ <â .05) to concordance in the multivariate analysis whose model accuracy was 68.6%. Trauma/orthopedics ward (ORâ =â 5.7) and SARS-CoV-2 infection (ORâ =â 3.8) were important contributors to the model fit though not significant. Accuracy of the discordance model was 70.7%, where central nervous system (CNS) disorder (ORâ =â 6.1) and referrals from ICU (ORâ =â 4.9), surgery (ORâ =â 4.6), neurology/neurosurgery (ORâ =â 5.1) and another consultant (ORâ =â 4.7) were significantly related (Wald statistic Pâ <â .05), while metabolic/endocrine disorder (ORâ =â 2.7) was important for model fit, but not significant. Concordance for delirium diagnosis was higher from services where education, guidelines and working relationships with C/L Psychiatry could have contributed beneficially whereas, surprisingly, CNS disorders and neurology/neurosurgery services had higher discordance, as well as the ICU. Routine use of brief sensitive delirium assessment tools such as the DDT-Pro could enhance provisional delirium diagnosis.
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COVID-19 , Delírio , Médicos , Humanos , Centros de Atenção Terciária , Estudos Prospectivos , Colômbia , SARS-CoV-2 , Encaminhamento e Consulta , Delírio/diagnóstico , Teste para COVID-19RESUMO
BACKGROUND: The Diaporthe/Phomopsis complex (D/P) is a group of soybean seed-borne fungi. The use of chemical fungicides, either for seed treatment or during the crop cycle, is the most adopted practice for treating fungal diseases caused by this complex. Worldwide, there is a search for alternative seed treatments that are less harmful to the environment than chemicals. Non-thermal plasma (NTP) is a novel seed treatment technology for pathogen removal. This research aimed to evaluate the effects of NTP on the in vitro performance of pure cultures of Diaporthe longicolla and elucidate the mechanisms underlying these effects. RESULTS: Active D. longicolla mycelium, growing in vitro, was exposed to different NTP treatments, employing a dielectric barrier discharge arrangement with different carrier gases (N2 or O2 ). Fungal growth, fresh biomass and colony appearance were negatively affected by plasma treatments (TN3 and TO3). Lipid peroxidation and antioxidant activities were higher in plasma-treated colonies comparison with non-exposed colonies (control). Fungal asexual spores (conidia) were also exposed to NTP, showing high susceptibility. CONCLUSION: Exposure of D. longicolla colonies to NTP severely compromised fungal biology. Ozone production during treatment and lipid peroxidation of fungal cell membranes appeared to be involved in the observed effects. © 2020 Society of Chemical Industry.
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Ascomicetos , Sementes , Glycine max , TecnologiaRESUMO
Introducción. La colangiopancreatografía retrógrada endoscópica es la herramienta de elección para el manejo de una gran cantidad de enfermedades pancreáticas y biliares. Al ser un procedimiento invasivo, trae consigo riesgos que aumentan la morbimortalidad en los pacientes en quienes se practica. El objetivo de este estudio fue analizar las complicaciones más prevalentes relacionadas con el procedimiento, de los pacientes de una institución de tercer nivel de Medellín, entre los años 2014 y 2017.Métodos. Se presenta un estudio observacional, retrospectivo y analítico. Se analizaron las historias clínicas de los pacientes sometidos a colangiopancreatografía retrógrada endoscópica con diagnóstico de enfermedades biliares y pancreáticas. La información fue analizada usando estadística descriptiva e inferencial, mediante análisis univariado y multivariado, y se calculó la razón de momios (odds ratio, OR) con un intervalo de confianza del 95 %; se tomó como significativo un valor de p inferior a 0,25 en los análisis bivariados.Resultados. En los 1.546 pacientes sometidos a colangiopancreatografía retrógrada endoscópica, la edad promedio fue de 57,6 ± 19.3 años y el 59,1 % eran mujeres. Las complicaciones identificadas fueron: pancreatitis en 57 pacientes (3,7 %), sangrado en 28 (1,8 %), perforación en 8 (0,5 %) y mortalidad no discriminada de 42 pacientes (2,7 %). Como factores de riesgo con significancia estadística, se encontraron la papilotomía y el contraste del conducto de Wirsung (OR=3 y OR=3,55, respectivamente).Discusión. Los resultados obtenidos se encuentran en concordancia con los de la literatura mundial, con tasas de complicaciones y mortalidad similares. Por otra parte, el perfil sociodemográfico de la población de estudio difiere de las cifras internacionales, con predominancia de la enfermedad estudiada en edades mayores y con mayor cantidad de comorbilidades
Introduction: Endoscopic retrograde cholangiopancreatography is the tool for the management of a large number of pancreatic and biliary diseases. Being an invasive procedure, it brings risks that increase morbidity and mortality in patients in whom it is practiced. The objective of this study was to analyze the most prevalent complications related to the procedure of the patients of a third level institution in Medellin between 2014 and 2017.Methods: An observational, retrospective and analytical study is presented. The information was analyzed using descriptive and inferential statistics, by univariate and multivariate analysis, and the odds ratio (odds ratio, OR) was calculated with a 95% confidence interval; a value of p less than 0.25 was taken as significant in the bivariate analyzes. Results: In the 1,546 patients who underwent endoscopic retrograde cholangiopancreatography, the average age was 57.6 ± 19.3 years and 59.1% were women. The complications identified were: pancreatitis in 57 patients (3.7%), bleeding in 28 (1.8%), perforation in 8 (0.5%) and non-discriminated mortality of 42 patients (2.7%). As risk factors with statistical significance, papillotomy and Wirsung duct contrast were found (OR = 3 and OR = 3.55, respectively).Discussion: The results obtained are consistent with those of the world literature, with similar complication and mortality rates. On the other hand, the sociodemographic profile of the study population differs from international figures, with a predominance of the disease studied in older ages and with a greater number of comorbidities
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Humanos , Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Ducto Colédoco , Perfuração IntestinalRESUMO
Congenital anomalies of the inferior vena cava (IVC) are caused by an abnormal persistence or regression of embryonic precursor veins; they are usually incidental findings on imaging studies. These rare conditions have a 0.6% prevalence in individuals with congenital heart diseases and 0.3% in healthy patients. The purpose of this paper was to report two cases of interruption of IVC with hemiazygos continuation and its implications during surgery, highlighting that after recognizing this anomalous drainage the surgeon should be prepared to change the surgical strategies, especially in cardiovascular surgery, in order to obtain adequate circulatory flows or surgical exposure where venous cannulation could be difficult. We have also reported two cases of healthy patients with the same isolated IVC anomaly with no clinical repercussions, which can develop in the future.
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Introduction: Syphilis is a public health concern given its high impact on morbidity and mortality. Objective: We aimed to determine the association of syphilis seroreactivity and seroprevalence with sociodemographic variables of donors at a blood bank in the district of Barranquilla, Colombia, during 2015 and 2016. Materials and methods: We conducted a descriptive cross-sectional study based on the results of the treponemal and nontreponemal tests and the sociodemographic variables of the study population. We performed a univariate analysis to determine the absolute and relative frequencies for each categorical variable. We determined the seroreactivity against Treponema pallidum and the prevalence of active syphilis infection, and we used Pearson's chi-square test to evaluate the differences between the proportions. Results: We found a seroreactivity of 1.86% in individuals with previous T. pallidum infection, and a prevalence of 0.93% in those with active T. pallidum infection. These values were higher in adult men and older adults, widowers, the unemployed, and people living in municipalities of the Department of Atlántico other than Barranquilla and its metropolitan area. The incidence of syphilis infection showed a significant association with sex and occupation. Conclusion: In comparison to the national average, syphilis seroreactivity was high among blood donors. There was an association between syphilis infection incidence and sociodemographic variables such as sex and occupation.
Introducción. La sífilis es una enfermedad de interés en salud pública por sus elevadas tasas de morbilidad y mortalidad. Objetivo. Determinar la serorreacción y la seroprevalencia de sífilis según las variables sociodemográficas de los donantes de un banco de sangre del distrito de Barranquilla, Colombia, durante 2015 y 2016. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal basado en los resultados de las pruebas treponémicas y no treponémicas. Se analizaron las variables sociodemográficas de la población estudiada y se hizo un análisis univariado en el que se determinaron las frecuencias absoluta y relativa de cada una de las variables categóricas. Se determinó la serorreacción a Treponema pallidum y la prevalencia de la infección activa. Se utilizó la prueba de ji al cuadrado de Pearson para evaluar las diferencias entre las proporciones. Resultados. Se encontró una serorreacción de 1,86 % para la infección previa con T. pallidum y una prevalencia de 0,93 % para la infección activa, las cuales fueron más altas en hombres adultos y en adultos mayores, viudos, desempleados y personas residentes en otros municipios del departamento de Atlántico diferentes de Barranquilla y su área metropolitana. Se encontró una asociación significativa entre la sífilis y las variables de sexo y ocupación. Conclusión. Se registró una serorreacción elevada a T. pallidum en donantes de sangre, comparada con el promedio nacional. Se encontró asociación entre la sífilis, y las variables sociodemográficas de sexo y ocupación, principalmente.
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Bancos de Sangue , Doadores de Sangue , Sífilis/epidemiologia , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Bancos de Sangue/normas , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificaçãoRESUMO
Resumen Introducción. La sífilis es una enfermedad de interés en salud pública por sus elevadas tasas de morbilidad y mortalidad. Objetivo. Determinar la serorreacción y la seroprevalencia de sífilis según las variables sociodemográficas de los donantes de un banco de sangre del distrito de Barranquilla, Colombia, durante 2015 y 2016. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal basado en los resultados de las pruebas treponémicas y no treponémicas. Se analizaron las variables sociodemográficas de la población estudiada y se hizo un análisis univariado en el que se determinaron las frecuencias absoluta y relativa de cada una de las variables categóricas. Se determinó la serorreacción a Treponema pallidum y la prevalencia de la infección activa. Se utilizó la prueba de ji al cuadrado de Pearson para evaluar las diferencias entre las proporciones. Resultados. Se encontró una serorreacción de 1,86 % para la infección previa con T. pallidum y una prevalencia de 0,93 % para la infección activa, las cuales fueron más altas en hombres adultos y en adultos mayores, viudos, desempleados y personas residentes en otros municipios del departamento de Atlántico diferentes de Barranquilla y su área metropolitana. Se encontró una asociación significativa entre la sífilis y las variables de sexo y ocupación. Conclusión. Se registró una serorreacción elevada a T. pallidum en donantes de sangre, comparada con el promedio nacional. Se encontró asociación entre la sífilis, y las variables sociodemográficas de sexo y ocupación, principalmente.
Abstract Introduction: Syphilis is a public health concern given its high impact on morbidity and mortality. Objective: We aimed to determine the association of syphilis seroreactivity and seroprevalence with sociodemographic variables of donors at a blood bank in the district of Barranquilla, Colombia, during 2015 and 2016. Materials and methods: We conducted a descriptive cross-sectional study based on the results of the treponemal and nontreponemal tests and the sociodemographic variables of the study population. We performed a univariate analysis to determine the absolute and relative frequencies for each categorical variable. We determined the seroreactivity against Treponema pallidum and the prevalence of active syphilis infection, and we used Pearson's chi-square test to evaluate the differences between the proportions. Results: We found a seroreactivity of 1.86% in individuals with previous T. pallidum infection, and a prevalence of 0.93% in those with active T. pallidum infection. These values were higher in adult men and older adults, widowers, the unemployed, and people living in municipalities of the Department of Atlántico other than Barranquilla and its metropolitan area. The incidence of syphilis infection showed a significant association with sex and occupation. Conclusion: In comparison to the national average, syphilis seroreactivity was high among blood donors. There was an association between syphilis infection incidence and sociodemographic variables such as sex and occupation.
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Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bancos de Sangue , Doadores de Sangue , Sífilis/epidemiologia , Fatores Socioeconômicos , Treponema pallidum/isolamento & purificação , Treponema pallidum/imunologia , Bancos de Sangue/normas , Sorodiagnóstico da Sífilis , Estudos Soroepidemiológicos , Prevalência , Estudos Transversais , Determinantes Sociais da Saúde , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologiaRESUMO
Introducción La inestabilidad crónica lateral del tobillo es una patología frecuente en las personas que sufren esguinces. El tratamiento inicial es conservador y de no funcionar se recomienda el tratamiento quirúrgico; la técnica descrita por Broström y modificada por Gould es la más utilizada, efectiva y reportada en la actualidad. Con el advenimiento de la cirugía artroscópica, uno de los autores (JBGG) ha desarrollado una técnica mínimamente invasiva que se ha utilizado en la unidad de pie desde hace 8 años. Este trabajo evalúa los resultados funcionales, de dolor y cicatrización de los pacientes tratados con la técnica Artroscópica y la técnica de Broström-Gould abierta. Materiales & Métodos Se evaluaron un total de 111 pacientes, 50 con la técnica abierta y 61 con técnica artroscópica, operados por inestabilidad lateral crónica del tobillo entre enero de 2004 y diciembre de 2011. Se utilizo la escala AOFAS de tobillo y retropié para la medición del dolor, función y alineación, y la escala EVA para la medición del dolor. Resultados El promedio de puntuación final de la escala AOFAS fue de 90 puntos y la inestabilidad se revirtió en el 96% de los casos, para ambos grupo de pacientes. El dolor fue aliviado eficientemente por ambas técnicas. No se observaron diferencias estadísticamente significativas entre los grupos del estudio. Discusión La reparación artroscópica de la inestabilidad crónica lateral del tobillo fue tan efectiva para restablecer la función, estabilidad y eliminar el dolor del tobillo como la técnica abierta y puede tener una menor posibilidad de complicaciones relacionadas con las heridas.
Background Chronic lateral ankle instability is a common condition in people with inversion sprains. Initial treatment is conservative, and if that does not work a surgical approach is recommended, such as that described by Broström and later modified by Gould, and is the most used and effective. With the advent of arthroscopic surgery, one of the authors (JBGG) has recently developed a minimally invasive technique that has been used in the Surgical Foot and Ankle Unit of Imbanaco Medical Centre for 8 years. Therefore, this work aims to determine functional outcomes of patients treated with the arthroscopic technique compared with the open technique of Broström-Gould. Methods A total of 111 patients were evaluated, including 50 with the open method, and 61 with arthroscopic surgery technique for chronic lateral ankle instability between January 2004 and December 2011. The American orthopaedic foot and ankle score (AOFAS) scale for ankle and hindfoot was used for measuring pain, function, and alignment, and a visual analogue scale (VAS) was used to assess the pain. Results The final AOFAS score was 90 points, and instability was reversed in 96% of cases, for both groups of patients. The pain was relieved efficiently by both techniques. There were no statistically significant differences between the study groups. Discussion Arthroscopic repair of chronic lateral ankle instability is an effective tool to restore the function and stability, as well as eliminate ankle pain, and is comparable in effectiveness with the conventional technique. Additionally, there is a lower chance of complications related to wounds.
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Humanos , Ligamentos Laterais do Tornozelo , Artroscopia , Instabilidade Articular , LigamentosRESUMO
RESUMEN Objetivo: Estimar seroprevalencia de anticuerpos IgG e IgM para dengue y factores asociados. Método: estudio transversal, mediante la aplicación de encuesta y estimación serológica para IgG e IgM para dengue en mayores de 15 años con representabilidad por localidad y sexo. 478 sujetos encuestados en la ciudad de Barranquilla Colombia Análisis estadístico, mediante el programa SPSS®, versión 22. Se estimó la sero-prevalencia para el análisis univariado y el análisis bivariado mediante la odds ratio de proporciones con una p<0,05. Resultados: la seroprevalencia para IgG fue 88,2% (IC 95% =85,2-91,1) y para IgM de 11,8% (IC 95%= 8,80-14,75). Se encontró asociación estadística en edades de 30 a 49 y 50-69 años (OR=7,09 [2,6-19,3] y OR= 8,93 [2,9-27,0] respectivamente), pertenecer al régimen de salud subsidiado (OR=2,56[1,18-5,53]) y ocupación hogar (OR= 3,38[1,31-8,67]. Conclusiones: la alta seroprevalencia para IgG es explicada por la circulación de los cuatro serotipos en el país, los brotes epidémicos cada dos a tres años y los comportamientos y prácticas desfavorables relacionadas con el manejo de agua. Se requiere cambios de conducta frente al manejo de factores predisponentes, la atención oportuna de sintomáticos y vigilancia activa comunitaria e institucional ante casos sospechosos.
ABSTRACT Objective: estimate the sero-prevalence of IgG and IgM antibodies for dengue and associated factors. Method: A cross-sectional study was done by means of a survey and serological estimation for IgG and IgM for dengue in subjects over 15 years of age with representability by location and gender. In all, 478 subjects were surveyed in the city of Barranquilla, Colombia. The SPSS® program, version 22, was used for the statistical analysis. Sero-prevalence was estimated for univariate analysis and bivariate analysis using the odds ratio of proportions with p <0.05. Results: The sero-prevalence for IgG was 88.2% (95% CI = 85.2-91.1); for IgM, it was 11.8% (95% CI = 8.80-14.75). A statistical association was found between subjects ages 30 to 49 and those ages 50 to 69 (OR = 7.09 [2.6-19.3] and OR = 8.93 [2.9-27.0] respectively) who are part of the subsidized health system (OR = 2.56 [1.18-5.53]) and list homemaker as their occupation (OR = 3.38 [1.31-8.67]). Conclusions: The high sero-prevalence for IgG is explained by circulation of the four serotypes in the country, epidemic outbreaks every two to three years, and unfavorable behavior and practices related to water management. Behavioral changes are needed when it comes to dealing with predisposing factors, timely symptomatic care and active community and institutional surveillance in response to suspected cases.
RESUMO Objetivo: estimar a soroprevalência de anticorpos IgG e IgM para dengue e fatores associados. Método: estudo transversal, realizado com a aplicação de questionário e estimativa sorológica para IgG e IgM para dengue em maiores de 15 anos com representabilidade por localidade e sexo. 478 sujeitos entrevistados na cidade de Barranquilla, Colômbia. Análise estatística por meio do programa SPSS®, versão 22. Foi estimada a soroprevalência para a análise univariada e a análise bivariada mediante a odds ratio de proporções com p<0,05. Resultados: a soroprevalência para IgG foi 88,2 % (IC 95 % =85,2-91,1) e para IgM de 11,8 % (IC 95%= 8,80-14,75). Constatou-se associação estatística em idades de 30 a 49 e 50 a 69 anos (OR=7,09 [2,6-19,3] e OR= 8,93 [2,9-27,0] respectivamente), pertencer ao sistema de saúde subsidiado (OR=2,56[1,18-5,53]) e ocupação do lar (OR= 3,38[1,31-8,67]. Conclusões: a alta soroprevalência para IgG é explicada pela circulação dos quatro sorotipos no país, os surtos epidêmicos a cada dois ou três anos e os comportamentos e práticas desfavoráveis relacionados com o uso da água. São requeridas mudanças de comportamento diante dos fatores predisponentes, atenção oportuna de sintomáticos e vigilância ativa comunitária e institucional ante casos suspeitos.
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Humanos , Estudos Soroepidemiológicos , Prevalência , Fatores de Risco , Dengue , Estudos Transversais , ColômbiaRESUMO
Las afasias se entienden como una pérdida de destrezas en el lenguaje, tanto hablado como escrito, y en la comprensión de contenidos. La afasia comúnmente es consecuencia de accidentes cerebrovasculares. A pesar de que los diversos tipos de afasias se correlacionan con áreas encefálicas especializadas para la comunicación, muchas poblaciones con lesiones cerebrales demuestran tener patologías del habla y del lenguaje no especificadas. Considerando las peculiaridades neuropsicológicas y neurofisiológicas que poseen las afasias, el presente estudio busca profundizar en las diferencias encontradas entre cada cuadro clínico de afasia, revisándose de este modo, los principales aportes contemporáneos para explicar las alteraciones lecto-escritoras producidas por la afasia.
Aphasias are understood like a loss of language skills, both spoken and written, and in the understanding of contents. Aphasia is commonly a consequence of stroke. Although various types of aphasia correlate with specialized brain areas for communication, many populations with traumatic brain injury shows unspecified speech and language pathologies. Considering the neuropsychological and neurophysiological peculiarities of aphasias, this research seeks to deepen the differences found between each clinical symptoms of aphasia, revising in this pathway, the main contemporary contributions to explain the reading-writing alterations produced by aphasia
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Humanos , Afasia/fisiopatologia , Afasia/etiologia , Acidente Vascular Cerebral/complicações , Neurofisiologia , NeuropsicologiaRESUMO
INTRODUCTION: Colombia promotes the diagnosis and treatment of gestational syphilis in a single visit using rapid diagnostic tests to prevent mother-to-child transmission. Additionally, integrated health programs pursue the coordinated prevention of mother-to-child transmission of syphilis/HIV. OBJECTIVE: To identify knowledge gaps among health workers in the prevention of mother-to-child transmission of syphilis/HIV and to provide recommendations to support these programs. MATERIALS AND METHODS: We conducted a descriptive study based on 306 surveys of health workers in 39 health institutions in the city of Cali. Surveys inquired about planning, management and implementation of services for pregnant women, clinical knowledge of HIV/syphilis rapid diagnostic tests, and prior training. RESULTS: Knowledge deficits in the management of gestational syphilis were detected among the surveyed health workers, including physicians. Rapid tests for syphilis are currently used in clinical laboratories in Cali, however, procedural deficiencies were observed in their use, including quality control assurance. During the two years prior to the survey, training of health workers in the prevention of mother-to-child transmission of syphilis/HIV had been limited. Health workers are interested in identifying and treating gestational syphilis in a single event, in using rapid diagnostic tests and in receiving training. CONCLUSIONS: Intensive training targeting health workers, policy/decision makers and academic groups is needed to ensure adequate implementation of new strategies for the prevention of mother-to-child transmission of syphilis/HIV.
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Pessoal de Saúde/educação , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Serviços de Saúde Materna , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/métodos , Sífilis Congênita/prevenção & controle , Sífilis/tratamento farmacológico , Colômbia/epidemiologia , Estudos Transversais , Gerenciamento Clínico , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Pesquisas sobre Atenção à Saúde , Humanos , Serviços de Saúde Materna/organização & administração , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Melhoria de Qualidade , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Sífilis Congênita/epidemiologiaRESUMO
Se presenta el caso de una primigesta de 22 semanas de edad gestacional referida a nuestro servicio con el diagnóstico prenatal de espina bífida abierta. Se coordinó un equipo multidisciplinario nacional e internacional en el lapso de tres semanas para llevar a cabo la primera cirugía intrauterina de corrección de espina bífida. La operación se realizó a las 25 semanas y el parto por cesárea se produjo a las 37 semanas, obteniéndose buenos resultados a corto plazo. Demostramos que esta cirugía, altamente especializada y que involucra un gran equipo multidisciplinario, se puede realizar exitosamente en nuestro país.
We report the first successful case of fetal surgery for spina bifida repair in Peru. A pregnant woman was referred to our center at 23 weeks' gestation because of prenatal diagnosis of spina bifida. We formed a multidisciplinary international team with the goal of performing the first open intrauterine surgery in Peru. We performed a successful intrauterine surgery at 25 weeks of gestation and a healthy infant was born by cesarean section at 37 weeks of gestation. We demonstrated the feasibility of this complex intrauterine surgery in our local setting.
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Abstract: Vascular rings are embryonic malformations of the aortic complex that encircle the trachea and the esophagus and that, occasionally, produce symptoms. Ductal ligaments (DLs) are important elements in the constitution of vascular rings. Part of the surgical treatment of symptomatic vascular rings consists in dividing the DLs. The objective of this work is to try to locate the DLs using multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in patients with vascular rings. With this goal in mind, we reviewed 86 MRI studies and 16 MDCT studies in patients with vascular rings, with the parameters normally used in heart and large vessel studies. In 14 of the 16 MDCT cases, we were able to locate the DLs. We were unable to locate them in any of the MRI cases in the planes and sequence we used. We conclude that, although several sources of medical literature assert that DLs in vascular rings cannot be seen using any imaging procedure, it is possible to identify them using MDCT.
Resumen: Los anillos vasculares son malformaciones de origen embrionario del complejo aórtico, que rodean la tráquea y el esófago y que ocasionalmente producen síntomas. Los ligamentos ductales (LDs) son elementos importantes en la constitución de los anillos vasculares. Parte del tratamiento quirúrgico de los anillos vasculares sintomáticos consiste en seccionar los LDs. El objetivo de este trabajo es tratar de localizar los LDs con tomografía computarizada multidetector (TCMD) e imágenes de resonancia magnética (IRM) en pacientes con anillos vasculares, con los parámetros que normalmente se usan en estos procedimientos en los estudios de corazón y grandes vasos. Con este objetivo, revisamos 86 estudios realizados con IRM y 16 con TCMD de pacientes con anillos vasculares. En 14 de los 16 casos estudiados con TCMD fue posible la localización de los LDs. En ninguno de los casos estudiados con IRM, en los planos y secuencia empleados por nosotros, fue posible localizarlos. Concluimos que, aunque varias fuentes de literatura médica aseveran que los LDs en los anillos vasculares no pueden ser vistos por ningún procedimiento de imagen, su identificación es factible por medio de TCMD.
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Resumen Introducción. Para la prevención de la transmisión materno-infantil de la sífilis en Colombia, se promueve el diagnóstico y el tratamiento en una sola consulta mediante el uso de pruebas de diagnóstico rápido, así como programas de eliminación conjunta de la transmisión materno-infantil de la sífilis y el HIV. Objetivo. Detectar los vacíos de capacitación del personal de salud en torno a la prevención de la transmisión materno-infantil de la sífilis y el HIV, y hacer recomendaciones para mejorar los programas. Materiales y métodos. Se hizo un estudio descriptivo mediante 306 encuestas hechas al personal de salud de 39 instituciones de Cali. Se indagó sobre la planeación, la gestión y la ejecución de los servicios ofrecidos a las mujeres gestantes, los conocimientos clínicos sobre la sífilis, el HIV y las pruebas rápidas, así como sobre las capacitaciones recibidas. Resultados. Se encontraron deficiencias en el conocimiento del manejo de la sífilis gestacional entre el personal de salud, incluidos los médicos. Las pruebas de diagnóstico rápido para sífilis se utilizan en los laboratorios de la ciudad, pero se detectaron fallas en su uso adecuado, especialmente en el control de calidad. La capacitación en temas de prevención de la transmisión materno-infantil de la sífilis y el HIV había sido escasa en los dos años anteriores. El personal de salud expresó su interés por diagnosticar y tratar la sífilis gestacional en una sola consulta, usar las pruebas de diagnóstico rápido y asistir a actividades de capacitación. Conclusiones. Se requiere la capacitación intensiva del personal de salud, de quienes toman las decisiones y de los grupos académicos, para lograr una adecuada implementación de las nuevas estrategias de prevención de la transmisión materno-infantil de la sífilisy el HIV.
Abstract Introduction: Colombia promotes the diagnosis and treatment of gestational syphilis in a single visit using rapid diagnostic tests to prevent mother-to-child transmission. Additionally, integrated health programs pursue the coordinated prevention of mother-to-child transmission of syphilis/HIV. Objective: To identify knowledge gaps among health workers in the prevention of mother-to-child transmission of syphilis/HIV and to provide recommendations to support these programs. Materials and methods: We conducted a descriptive study based on 306 surveys of health workers in 39 health institutions in the city of Cali. Surveys inquired about planning, management and implementation of services for pregnant women, clinical knowledge of HIV/syphilis rapid diagnostic tests, and prior training. Results: Knowledge deficits in the management of gestational syphilis were detected among the surveyed health workers, including physicians. Rapid tests for syphilis are currently used in clinical laboratories in Cali, however, procedural deficiencies were observed in their use, including quality control assurance. During the two years prior to the survey, training of health workers in the prevention of mother-to-child transmission of syphilis/HIV had been limited. Health workers are interested in identifying and treating gestational syphilis in a single event, in using rapid diagnostic tests and in receiving training. Conclusions: Intensive training targeting health workers, policy/decision makers and academic groups is needed to ensure adequate implementation of new strategies for the prevention of mother-to-child transmission of syphilis/HIV.
Assuntos
Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/métodos , Sífilis Congênita/prevenção & controle , Sífilis/tratamento farmacológico , Pessoal de Saúde/educação , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Serviços de Saúde Materna , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis Congênita/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis/diagnóstico , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Estudos Transversais , Colômbia/epidemiologia , Pesquisas sobre Atenção à Saúde , Gerenciamento Clínico , Melhoria de Qualidade , Serviços de Saúde Materna/organização & administraçãoRESUMO
This study identifies the most common microorganisms present in type III gold cast posts related to pulpal disease and evaluates the sterilization/disinfection method before cementation in the root canal. Forty-five type III gold cast posts were aseptically collected in sterile sealed plastic bags and taken to the microbiology laboratory to carry out the study: fifteen cast posts had no treatment, fifteen were disinfected (immersion in 70% alcohol during 15 minutes), and fifteen were autoclaved at 121°C for 15 minutes by using saturated steam under 15 psi pressure. By using a two-proportion z-test, the difference was statistically significant (p > 0.05) and demonstrates that, in spite of the aseptic pattern used in the cast post collection and laboratory procedures, some cast posts arrive contaminated at the consulting office. The disinfection process worked out in a high percentage and demonstrated that the sterilization by autoclaving eliminated completely the pathogenic microbiota without affecting the cast post shape and integrity that could compromise their final fitting.
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One of the pathogenic causes of cutaneous inflammatory pseudotumors is chronic localized fibrosing leukocytoclastic vasculitis (CLFLCV), a vasculitic reaction pattern seen in granuloma faciale (GF), a localized vasculitis, and erythema elevatum diutinum (EED), a generalized vasculitis. Patients with myelodysplastic syndromes (MDSs) are at risk for a diverse spectrum of cutaneous neutrophilic dermatoses such as EED. Herein, we report a 74-year-old man who presented with a large ulcerative, fungating tumor affecting the right flexor ankle caused by CLFLCV. During his workup and management, MDS and Philadelphia chromosome-negative chronic myeloid leukemia was diagnosed. Surgical excision of the inflammatory mass promptly triggered tumor recurrence, whereas antineutrophil therapy (dapsone coupled with hydroxyurea, and prednisone) lead to tumor regression. Histopathologic examination revealed an eosinophilic-rich small-vessel neutrophilic vasculitis associated with storiform and angiocentric fibrosis (GF-like). In the regions of fibrosis, dilated lymphatic and vascular spaces were numerous, some of which were congested with small CD3-positive lymphocytes (intralymphatic and intravascular lymphocytosis). These findings indicate coexisting localized lymphedema. By direct immunofluorescence, IgM and C4d vessel deposits were detected. The pathogenesis of the fibrotic nodules and plaques of CLFLCV is suspected to be due to recurring bouts of immune-complex vasculitis, creating a cycle of vessel damage followed by reparative granulation tissue. Poor lymphatic drainage may be the underlying factor initiating and maintaining recurrent, localized episodes of immune-complex vasculitis and progressive fibrosis. Although his tumor histopathology resembled GF-eosinophilic rich CLFLCV-the clinical context points to a solitary and paraneoplastic case of EED.
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Granuloma de Células Plasmáticas/patologia , Leucemia Mieloide Crônica Atípica BCR-ABL Negativa/patologia , Linfedema/patologia , Linfocitose/patologia , Síndromes Paraneoplásicas/patologia , Vasculite Leucocitoclástica Cutânea/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Dapsona/uso terapêutico , Evolução Fatal , Granuloma de Células Plasmáticas/imunologia , Granuloma de Células Plasmáticas/terapia , Humanos , Hidroxiureia/uso terapêutico , Leucemia Mieloide Crônica Atípica BCR-ABL Negativa/tratamento farmacológico , Leucemia Mieloide Crônica Atípica BCR-ABL Negativa/genética , Leucemia Mieloide Crônica Atípica BCR-ABL Negativa/imunologia , Linfedema/imunologia , Linfedema/terapia , Linfocitose/imunologia , Linfocitose/terapia , Masculino , Síndromes Paraneoplásicas/imunologia , Síndromes Paraneoplásicas/terapia , Pentoxifilina/uso terapêutico , Prednisona/uso terapêutico , Indução de Remissão , Resultado do Tratamento , Vasculite Leucocitoclástica Cutânea/imunologia , Vasculite Leucocitoclástica Cutânea/terapiaRESUMO
La Enfermedad de Huntington (EH), ha sido reconocida como una de las tres enfermedades neurodegenerativas de mayor impacto a nivel mundial, junto al Parkinson y al Alzheimer. El daño producido porla EH afecta principalmente zonas del Sistema Nervioso Central (SNC), como los ganglios basales y tiene una base genética, que es transmitida de generación en generación de manera autosómica dominante. El problema genético específico se localiza en un defecto del brazo corto del cromosoma 4, llamado IT15, que tiene repeticiones trinucleicas superiores a 38 duplicaciones. La EH puede manifestarse en etapa juvenil o en etapa adulta. El diagnóstico de la EH ha resultado en la mayoría de los casos tardío y aúnno se ha descubierto un método eficaz para tratar la enfermedad. La Calidad de Vida (CV) de los pacientes con EH tiende a degradarse a medida que evoluciona la enfermedad, y aún faltan más estudios clínicos interdisciplinarios que la traten con eficacia.
Huntingtons Disease (HD) has been recognized as one of the three neurodegenerative diseases with greatest impact around the world, beside Parkinsons disease and Alzheimer disease. The damage caused by HD primarily affects areas of the Central Nervous System (CNS), such as the basal ganglia and it a genetic basis, which is transmitted from generation to generation in an autosomal dominant manner. The specific genetic problem is located on the short arm of chromosome 4, called IT15, which has tri-nucleic repetitions above 38 duplications. HD can occur in youth or adulthood stage. The diagnosis of HD has resulted in many delayed cases and there has not yet been found an effective method of treating disease. The Quality of Life (QoL) of patients with HD tends to degrade as the disease progresses and there are still more interdisciplinary clinical studies to be treated effectively.
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Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/fisiopatologia , Qualidade de Vida , NeurofisiologiaRESUMO
El 9 de diciembre de 2013 la Organización Panamericana de la Salud emitió una alerta epidemiológica debido a la detección de los primeros casos autóctonos de fiebre del Chikungunya en el continente americano; desde entonces este se ha convertido en un problema de salud pública. El primer reporte de un brote por el virus del Chikungunya se presentó en 1952-1953 en Tanzania. Las experiencias en epidemias en otros países han centrado la atención en que la presentación clínica no siempre tiene un comportamiento similar. Hasta 2005 todos los reportes mencionaban la presentación de la enfermedad como benigna y con cuadros clínicos bastantes similares, sin embargo, la aparición de epidemias después de ese año en las Islas Reunión y en la India describieron la presencia de cuadros graves, atípicos y un aumento de la mortalidad relacionados con la enfermedad. La región de las Américas debe prepararse para esta nueva epidemia. Esto hace necesario mejorar los conocimientos sobre la enfermedad; y un primer abordaje es a través de una descripción de la historia y epidemiología de la enfermedad por el virus del Chikungunya en el mundo.
On December 9, 2013, the Pan American Health Organization issued an epidemiological alert due to the detection of the first local (autochthonous) cases of Chikungunya fever in Las Americas, since it has become a public health problem. The first report of an outbreak of Chikungunya virus occurred in 1952-1953 in Tanzania. The experiences about epidemics in other countries, have focused attention on the clinical presentation does not always have a similar behavior. Until 2005, all reports mentioned the presentation of the disease as benign and clinical behavior quite similar, however, the emergence of epidemics after 2005 on Reunion Island and India, described the presence of severe disease, atypical and an increase in mortality associated with the disease. The Americas region must prepare for this new epidemic. So, is necessary to improve knowledge of the disease, and a first approach is through a description of the history and epidemiology of the disease Chikungunya virus worldwide.