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Introducción: El neumotórax es una patología prevalente en accidentes de tipo traumático en tórax, pero que también se puede encontrar de forma espontánea por causas atribuibles enfermedad bullosa, neumonía, obstrucción de las vía aérea, malignidad, entre otras. Caso clínico: Paciente masculino joven quien debuta con neumotórax espontaneo requirió manejo en unidad de cuidados intensivos con posterior aparición de bullas en imágenes diagnósticas y patología. Discusión: El neumotórax espontaneo primario (PSP) en población joven, se ve influenciada por factores psicosociales como la edad, genero, hábitos, entorno y factores genéticos, en el 80% de los pacientes con PSP se ha demostrado presencia de bullas o blebs apicales, además de la porosidad de la pleura que suele ocurrir en adolescentes altos con cuerpos atléticos; pero también se observa que el consumo de tabaco que puede aumentar el riesgo. Conclusiones: El neumotórax espontaneo por enfisema bulloso ha incrementado en los jóvenes por el uso de sustancias psicoactivas, vapeadores, cigarrillos.
Introduction: Pneumothorax is a pathology prevalent in traumatic accidents in the thorax, but it can also be found spontaneously due to causes attributable to bullous disease, pneumonia, airway obstruction, malignancy, among others. Case report: Young male patient who debuted with spontaneous pneumothorax who required management in the intensive care unit with subsequent appearance of bullae in diagnostic images and pathology. Discussion: Primary spontaneous pneumothorax (PSP) in the young population is influenced by psychosocial factors such as age, gender, habits, environment, and genetic factors. In 80% of patients with PSP, the presence of bullae or apical blebs has been demonstrated, in addition from the porosity of the pleura that usually occurs in tall adolescents with athletic bodies; but it is also observed that tobacco use can increase the risk. Conclusions: Spontaneous pneumothorax due to bullous emphysema has increased in young people due to the use of psychoactive substances, vapers, and cigarettes.
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Introduction: Hip fractures are a pathology of traumatic origin that generates a high impact on public health. The objective is to evaluate the interobserver reproducibility of the Tronzo classification for intertrochanteric fractures. Methods: Observational, analytical and retrospective study carried out in Ibagué - Colombia, 48 hip radiographs were analyzed, classified by 10 observed among specialists and training personnel, using the Tronzo classification. Interobserver reproducibility is assessed using the kappa concordance coefficient. Results: Among all those observed in the study, there is greater agreement in the identification of intertrochanteric fractures of lesser and greater severity (Tronzo I and V), the main exponents of this agreement are the most experienced staff, the staff in training, with intermediate experience they agree when identifying those of intermediate severity and for those with less experience the concordance becomes evident when evaluating the intermediate grades. Conclusion: The concordance increases with the experience for the identification of the types with high complexity. This classification is not suitable for clinical practice, another system is necessary for this type of fracture in clinical conduct.
Introducción: Las fracturas de cadera son una patología de origen traumático que genera un alto impacto en la salud pública. El objetivo es evaluar la reproducibilidad interobservador de la clasificación de Tronzo para fracturas intertrocantéricas. Métodos: Estudio observacional, analítico y retrospectivo realizado en Ibagué Colombia, se analizaron 48 radiografías de cadera, clasificadas por 10 observado entre especialistas y personal en formación, utilizando la clasificación de Tronzo. La reproducibilidad interobservador se evalúa mediante el coeficiente de concordancia kappa. Resultados: Entre todos los observados del estudio existe mayor acuerdo en la identificación de fracturas intertrocantéricas de menor y mayor gravedad (Tronzo I y V), los principales exponentes de este acuerdo son el personal de mayor experiencia, el personal en formación, con experiencia intermedia están de acuerdo al identificar a los de gravedad intermedia y para los que tienen menos experiencia la concordancia se hace evidente a la hora de evaluar los grados intermedios. Conclusión: La concordancia aumenta con la experiencia para la identificación de los tipos con alta complejidad. No es adecuado para la práctica clínica esta clasificación, es necesario otro sistema para este tipo de fracturas en las conductas clínicas.
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Introducción: La sarcopenia es un factor de riesgo para morbilidad, mortalidad y discapacidad en adultos mayores, por lo que su manejo es prioridad en geriatría. El objetivo de este artículo, consiste en caracterizar una población de adultos mayores de dos hogares geriátricos y establecer la prevalencia de sarcopenia y el grado de dependencia. Métodos: Estudio de corte transversal desarrollado en la ciudad de Pereira-Colombia. Se incluyó a una población de 72 adultos desde los 65 hasta los 98 años, usando muestreo probabilístico. Se determinó la sarcopenia por medio de los Criterios del Consenso Europeo sobre Definición y Diagnóstico de Sarcopenia; evaluándose la fuerza de prensión, índice de masa muscular esquelética, en caso de presentarse sarcopenia, la severidad de esta junto a la velocidad de marcha, y el grado de dependencia según la escala de Barthel. Resultados: Participaron finalmente 57 personas. El 68,4% (n=39) eran mujeres. La mediana de la edad fue de 83 años. El 2% no presentó sarcopenia, 9% presentaban sospecha de sarcopenia, 28% tenían sarcopenia confirmada y 61% sarcopenia grave. Según la escala de Barthel, el 31,5% eran independientes, 45,6% tenían dependencia leve, 15,8% moderada, 5,3% severa y 1,8% total. Conclusiones: La prevalencia de sarcopenia en los hogares geriátricos de Pereira es mayor en comparación a la reportada en la literatura. Del mismo modo, encontrarse en un hogar geriátrico privado no garantiza una mejor condición física y/o calidad de vida.
Introduction: Is a risk factor for morbidity, mortality and disability in older adults, so its management is a priority in geriatrics. The aim of this article is to characterize a population of older adults from two geriatric homes and to establish the prevalence of sarcopenia and the degree of dependence. Methods: Cross-sectional study developed in the city of Pereira-Colombia. A population of 72 adults from 65 to 98 years of age was included, using probability sampling. Sarcopenia was determined by means of the Criteria of the European Consensus on Definition and Diagnosis of Sarcopenia, evaluating grip strength, skeletal muscle mass index, in case of sarcopenia, the severity of sarcopenia together with walking speed, and the degree of dependence according to the Barthel scale. Results: 57 people participated. A total of 68.4% (n=39) were women. The median age was 83 years. Two percent had no sarcopenia, 9% had suspected sarcopenia, 28% had confirmed sarcopenia and 61% had severe sarcopenia. According to the Barthel scale, 31.5% were independent, 45.6% had mild, 15.8% moderate, 5.3% severe and 1.8% total dependence. Conclusions: The prevalence of sarcopenia in nursing homes in Pereira is higher compared to that reported in the literature. Similarly, being in a private nursing home does not guarantee a better physical condition and/or quality of life
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Apendicite , COVID-19 , Apendicite/epidemiologia , Apendicite/cirurgia , Humanos , Pandemias , SARS-CoV-2RESUMO
Introducción: La colangiopancreatografía retrógrada endoscópica (CPRE) se ha convertido en el estándar de oro para el diagnóstico y tratamiento de la coledocolitiasis. La Sociedad Americana de Endoscopia Gastrointestinal (ASGE) propuso en 2010 estratificar a los pacientes en 3 niveles de riesgo; sin embargo, los estudios han encontrado resultados controvertidos sobre los parámetros predictivos de estos criterios diagnósticos. El objetivo de este estudio consiste en determinar el desempeño de los criterios predictivos de alto riesgo de la ASGE 2010 en el diagnóstico de coledocolitiasis en una población del Caribe colombiano. Métodos: Estudio transversal retrospectivo, en el que se incluyeron pacientes con sospecha de coledocolitiasis, y que fueron llevados a evaluación por CPRE, cumpliendo los criterios propuestos por la ASGE de alta probabilidad. El resultado obtenido se comparó con la presencia de coledocolitiasis en la CPRE, a partir de la cual se estimaron los valores y los intervalos de confianza del 95% para la sensibilidad, la especificidad, el valor predictivo positivo y negativo, y la razón de probabilidad positiva y negativa. Resultados: En este estudio se incluyeron los datos de 118 pacientes. La edad media de los pacientes era de 46 años (RIQ= 31; 17- 89); el 78% (n= 92) eran mujeres. El 65,3% (n= 77) eran mayores de 55 años. El resultado de la CPRE fue positivo en el 81,4% (n= 96) de los pacientes. La presencia de un perfil hepático alterado (90%) resultó ser la prueba más sensible, la colangitis clínica (86%) la más específica, la presencia de litiasis ductal por US (85%) fue la prueba con mayor valor predictivo positivo, y la presencia de litiasis ductal por US (35%) fue la prueba con mayor valor predictivo negativo. Conclusión: Los parámetros predictivos de los criterios de la ASGE 2010 para el diagnóstico de coledocolitiasis muestran variabilidad con respecto al rendimiento propuesto en las guías.
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard for diagnosis and treatment of choledocholithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) in 2010 proposed stratifying patients into 3 risk levels; however, studies have found controversial results about the predictive parameters of these diagnostic criteria. The objective of this study is to determine the performance of the high-risk predictive criteria of the ASGE 2010 in the diagnosis of choledocholithiasis in a Colombian Caribbean population. Methods: Retrospective cross-sectional study, which included patients with suspected choledocholithiasis, and who were taken for evaluation by ERCP, meeting the criteria proposed by the ASGE of high probability. The result obtained was compared with the presence of choledocholithiasis on ERCP, from which values and 95% confidence intervals were estimated for sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio. Results: A total of 118 patient data were included in this study. The median age of the patients was 46 years (IQR= 31; 17- 89); 78% (n= 92) were female. 65.3% (n= 77) were older than 55 years. The ERCP result was positive in 81.4% (n= 96) of the patients. The presence of an altered liver profile (90%) was found to be the most sensitive test, clinical cholangitis (86%) the most specific, the presence of duct lithiasis by US (85%) was the test with the highest positive predictive value, and the presence of duct lithiasis by US (35%) was the test with the highest negative predictive value. Conclusions: The predictive parameters of the ASGE 2010 criteria for the diagnosis of choledocholithiasis show variability with respect to the performance proposed in the guidelines.
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Hidradenitis suppurativa is a chronic and debilitating skin disease, whose lesions can range from inflammatory nodules to abscesses and fistulas in the armpits, groin, perineum, inframammary region. Diagnosis can be confused with a large number of clinical pictures, and although studies on hidradenitis suppurativa are not so scarce in the literature, doctors are often unaware of this disease and therefore its diagnosis is often late. Pharmacological treatment ranges from retinoids to immunosuppression and radiation therapy, and surgical treatment ranges from incision and drainage to more complete excisions and laser therapies. Hidradenitis suppurativa is a disease seen and treated mainly by dermatologists and general surgeons, however, it is necessary for general practitioners to have basic knowledge about this entity, as they are the first line of care in the health system.
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BACKGROUND: Subarachnoid hemorrhage (SAH) continues to be a condition that carries high rates of morbidity, mortality, and disability around the world. One of its complications is neurogenic pulmonary edema (NPE), which is mainly caused by sympathetic hyperactivity. Due to the complexity of the pathophysiological process and the unspecificity of the clinical presentation, it is little known by general practitioners, medical students and other health care workers not directly related to the neurological part, making the management of this chaotic condition difficult. This review aims to present recent evidence on clinical concepts relevant to the identification and management of NPE secondary to SAH. MAIN BODY OF THE ABSTRACT: NPE is defined as a syndrome of acute onset following significant central nervous system (CNS) injury. Its etiology has been proposed to stem from the release of catecholamines that produce cardiopulmonary dysfunction, with this syndrome being associated with spinal cord injury, cerebrovascular disorders, traumatic brain injury, status epilepticus, and meningitis. NPE has long been considered a rare event; but it may occur more frequently, mainly in patients with SAH. There are two clinical presentations of NPE: the early form develops in the first hours/minutes after injury, while the late form presents 12-24 h after neurological injury. Clinical manifestations consist of non-specific signs of respiratory distress: dyspnea, tachypnea, hypoxia, pink expectoration, crackles on auscultation, which usually resolve within 24-48 h in 50% of patients. Unfortunately, there are no tools to make the specific diagnosis, so the diagnosis is by exclusion. The therapeutic approach consists of two interventions: treatment of the underlying neurological injury to reduce intracranial pressure and control sympathetic hyperactivity related to the lung injury, and supportive treatment for pulmonary edema. SHORT CONCLUSION: SAH is a severe condition that represents a risk to the life of the affected patient due to the possible complications that may develop. NPE is one of these complications, which due to the common manifestation of a respiratory syndrome, does not allow early and accurate diagnosis, being a diagnosis of exclusion. Therefore, in any case of CNS lesion with pulmonary involvement, NPE should be suspected immediately.
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BACKGROUND: Athletes practicing strenuous physical activities may develop exercise-induced bronchoconstriction (EIB). We aimed to determine the prevalence and features of this condition in Mexico City (altitude, 2,240 m). METHODS: In the present study, 208 high school and college athletes performed a standardized EIB test on a treadmill. RESULTS: Responses to exercise had large between-subject variability in all physiological parameters (forced expiratory volume in one second [FEV1], heart rate, blood oxygen saturation level [SpO2], blood pressure), with nearly similar proportions of subjects in whom FEV1 increased or decreased. According to the recommended cut-off value of 10% FEV1 decrease, only 15 (7.2%) athletes had a positive EIB test. Weight lifters were more prone to develop EIB (three out of seven athletes; p = 0.01). Subjects with a positive EIB test already had a lower baseline forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio (96.4 vs. 103.2% of predicted, respectively; p = 0.047), and developed more respiratory symptoms after exercise than subjects with a negative test. There were no differences with respect to age, gender, body mass index, history of asthma or atopic diseases, smoking habit, and exposure to potential indoor allergens. CONCLUSIONS: The relatively low prevalence of EIB in athletes from Mexico City raises the possibility that high altitude constitutes a protective factor for EIB. In contrast, weight lifters were especially prone to develop EIB, which suggests that repetitive Valsalva maneuvers could be a novel risk factor for EIB. There was a large between-subject variability of all physiological responses to exercise.
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Altitude , Asma Induzida por Exercício/epidemiologia , Atletas , Broncoconstrição/fisiologia , Adolescente , Adulto , Criança , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , México , Prevalência , Instituições Acadêmicas , Universidades , Capacidade Vital , Adulto JovemRESUMO
Objetivo: Examinar y describir las condiciones de trabajo dadas por la utilización prolongada de equipos e instrumental odontológico en estudiantes de postgrado y en docentes de cada especialidad. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en estudiantes de posgrado y docentes de cada especialidad de la Facultad de Odontología. Se tomó el total de estudiantes matriculados en las siete especializaciones del programa de Odontología. La población estuvo conformada por 47 estudiantes y 22 docentes. Se adaptaron y aplicaron las guías del programa del Sistema de Vigilancia Epidemiológica para Desórdenes Musculoesqueléticos de la Extremidad Superior (dme-ES), la Guía de Priorización y la Guía Epidemiológica, Guía deparis, Guía pme. Los datos fueron analizados con el programa stata v9. Resultados: En los estudiantes se observó la mayor sintomatología en cuello (62%) y hombros (47%). La especialidad de endodoncia es la que más presentó sintomatología en la extremidad superior, y la zona anatómica más destacada la mano (83.3 %). Las mujeres presentan mayor sintomatología en cuello (74.1 %), mientras que los hombres presenta mayor molestia en el resto de las zonas anatómicas de la extremidad superior, destacándose el hombro (62,5 %). Conclusión: Se adaptaron los instrumentos específicos y permitió conocer los riesgos de desórdenes musculoesquelético de la extremidad superior (dme-es) en la actividad laboral odontológica y realizar un material educativo para la promoción de la salud y prevención en riesgos profesionales en odontólogos.
Objective: To examine and describe working conditions, provided by the prolonged use of equipment and dental instruments in post-graduate students and teachers in each specialty. Materials and methods: This was a descriptive cross-sectional study in post-graduate students and teachers in each specialty Dental Residency Program. It took the total students enrolled in the seven specializations. The population consisted of 47 students and 22 teachers. They adapted and applied the published guideline of Epidemiological Surveillance System for musculoskeletal disorders of the upper extremity (dme-es); the prioritizacion Guide, epidemiological Guide, >deparis Guide and >pme Guide. Data were analyzed using >stata v9. Results: We observed in students more symptoms in neck (62 %) and shoulders (47 %). The specialty of endodontics is the most present symptoms in the upper extremity, being hand the most prominent anatomical area (83.3 %). Women have more symptoms in the neck (74.1 %), whereas in men has greater discomfort in other anatomical areas of the upper extremity, standing shoulder (62.5 %). Conclusion: Specific data collection items were adapted to dental work and this allowed us to know the risks of musculoskeletal disorders of the upper extremity (dme-es) in the labor performance and develop dental educational materials for health promotion and risk prevention in dental professionals.
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Several natural and synthetic polypeptides possess important antimalarial activity. Shorter peptides with potent antimalarial activity have also been described, among them linear di-, tri-, tetra- and pentapeptides and their cyclic analogs. In an attempt to find dipeptides with antimalarial activities we show that linear and cyclic dipeptides, the latter known as diketopiperazines, still retain the fundamental core to preserve antimalarial activity. Thirteen linear dipeptides and ten diketopiperazines were investigated. Eight linear dipeptides showed IC(50) values between 2.78 and 7.07 µM, while eight diketopiperazines were also active with IC(50) values between 2.26 and 4.26 µM on Plasmodium berghei schizont cultures.
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Antimaláricos/química , Dipeptídeos/química , Antimaláricos/síntese química , Antimaláricos/farmacologia , Cristalografia por Raios X , Dipeptídeos/síntese química , Dipeptídeos/farmacologia , Conformação Molecular , Peptídeos Cíclicos/síntese química , Peptídeos Cíclicos/química , Peptídeos Cíclicos/farmacologia , Plasmodium berghei/efeitos dos fármacosRESUMO
We have synthesized two new benzologues of Nitazoxanide (NIT) and Tizoxanide (TIZ), using a short synthetic route. Both compounds were tested in vitro against six protozoa (Giardia intestinalis, Trichomonas vaginalis, Entamoeba histolytica, Plasmodium berghei, Leishmania mexicana and Trypanosoma cruzi). Compound 1 (benzologue of NIT) showed broad antiprotozoal effect against all parasites tested, showing IC(50)'s<5 µM. This compound was five-times more active than NIT, and 18-times more potent than metronidazole against G. intestinalis. It was 10-times more active than pentamidine against L. mexicana, and it was sevenfold more potent than benznidazole versus T. cruzi. This compound could be considered as a new broad spectrum antiprotozoal agent.
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Antiprotozoários/síntese química , Antiprotozoários/farmacologia , Tiazóis , Giardia/efeitos dos fármacos , Estrutura Molecular , Nitrocompostos , Plasmodium/efeitos dos fármacos , Tiazóis/síntese química , Tiazóis/farmacologia , Trichomonas vaginalis/efeitos dos fármacosRESUMO
A series of ten novel hybrids from benzimidazole and pentamidine were prepared using a short synthetic route. Each compound was tested in vitro against the protozoa Trichomonas vaginalis, Giardia lamblia, Entamoeba histolytica, Leishmania mexicana, and Plasmodium berghei, in comparison with pentamidine and metronidazole. Some analogues showed high bioactivity in the low micromolar range (IC(50)<1 microM) against the first four protozoa, which make them significantly more potent than either standard. 1,5-bis[4-(5-methoxy-1H-benzimidazole-2-yl)phenoxy]pentane (2) was 3- and 9-fold more potent againstG. lamblia than metronidazole and pentamidine, respectively. This compound was 23-, 108-, and 13-fold more active than pentamidine against T. vaginalis, E. histolytica and L. mexicana, respectively. Studying further structure-activity relationships through the use of bioisosteric substitution in these hybrids should provide new leads against protozoal diseases.
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Antiprotozoários/síntese química , Antiprotozoários/farmacologia , Benzimidazóis/síntese química , Benzimidazóis/farmacologia , Desenho de Fármacos , Pentamidina/síntese química , Pentamidina/farmacologia , Animais , Antiprotozoários/química , Benzimidazóis/química , Entamoeba histolytica/efeitos dos fármacos , Giardia lamblia/efeitos dos fármacos , Concentração Inibidora 50 , Leishmania mexicana/efeitos dos fármacos , Metronidazol/farmacologia , Estrutura Molecular , Testes de Sensibilidade Parasitária , Pentamidina/química , Plasmodium berghei/efeitos dos fármacos , Relação Estrutura-Atividade , Trichomonas vaginalis/efeitos dos fármacosRESUMO
The EtOAc extract of the stem bark of Hintonia latiflora showed the suppression of total parasitemia and the chemosuppression of schizont numbers, when tested in vivo against Plasmodium berghei infection in mice. Bioassay-directed fractionation of the EtOAc extract, using the in vitro 16 h and the in vivo 4-day suppression tests on P. berghei schizont numbers, led to the isolation of the new compound 5-O-beta-D-glucopyranosyl-7,4'-dimethoxy-3'-hydroxy-4-phenylcoumarin (1), along with the known 5-O-beta-D-glucopyranosyl-7-methoxy-3',4'-dihydroxy-4-phenylcoumarin (2). The structure of compound 1 was established on the basis of spectroscopic data interpretation. Compounds 1 and 2 suppressed the development of P. berghei schizonts in vitro with IC50 values of 24.7 and 25.9 microM, respectively. Compound 2 suppressed the development of schizonts at the dose of 40 mg/kg by 70.8% in the in vivo assay.