Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O, p < 0.01). Of note, children with a Vt less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H2O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H2O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H2O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

Cellular and molecular mechanisms of skin wound healing.

Wound healing is a complex process that involves the coordinated actions of many different tissues and cell lineages. It requires tight orchestration of cell migration, proliferation, matrix deposition and remodelling, alongside inflammation and angiogenesis. Whereas small skin wounds heal in days, larger injuries resulting from trauma, acute illness or major surgery can take several weeks to heal, generally leaving behind a fibrotic scar that can impact tissue function. Development of therapeutics to prevent scarring and successfully repair chronic wounds requires a fuller knowledge of the cellular and molecular mechanisms driving wound healing. In this Review, we discuss the current understanding of the different phases of wound healing, from clot formation through re-epithelialization, angiogenesis and subsequent scar deposition. We highlight the contribution of different cell types to skin repair, with emphasis on how both innate and adaptive immune cells in the wound inflammatory response influence classically studied wound cell lineages, including keratinocytes, fibroblasts and endothelial cells, but also some of the less-studied cell lineages such as adipocytes, melanocytes and cutaneous nerves. Finally, we discuss newer approaches and research directions that have the potential to further our understanding of the mechanisms underpinning tissue repair.

Comparison of dynamic cyclic fatigue resistance of Reciproc® Blue and WaveOne® Gold after sterilization and/or immersion in sodium hypochlorite.

Background: This study aims to compare the cyclic fatigue resistance (CFR) of the Reciproc Blue and WaveOne Gold instruments under a dynamic cyclical fatigue test. Material and Methods: 210 Reciproc Blue "R25" and WaveOne Gold "primary" files were assigned into 7 groups (n =15) for each brand. Groups G: Files were not exposed to NaOCl or sterilization. Groups A and D: files were immersed for 3 minutes in NaOCl 1 and 3 times, respectively. Groups B and E: Files were autoclaved 1 and 3 times, respectively. Groups C and F: files were exposed to both, NaOCl immersion and autoclaving 1 and 3 times, respectively. Subsequently, files underwent a dynamic CFR test. The chemical composition of the files' surface from Group G was analysed by energy-dispersive X-ray spectroscopy (EDS). Cyclic fatigue resistance time was statistically analysed using 1-way and 2-way analyses of variance (ANOVA) and T-test. A p-value ≤0,05 was set to be statistically significant. Results: There was a significantly higher CFR of RB files than WOG in groups A, B, C, D and G (p<0.05). WOG files were superior to RB in group E (p>0.05). There were no statistically significant differences between files in group F (p>0.05). RB files from groups B, C, D, E and F had significantly lower resistance than new ones (Group G) (p<0.05). WaveOne Gold files exposed to 5 % NaOCl immersion in combination with sterilization cycles (Groups C and F) had significantly lower CFR than new ones (p<0.05). Reciproc Blue and WaveOne Gold NiTi alloys differed in atomic wt % of carbon, oxygen, nickel and titanium. Conclusions: The Reciproc Blue files outperformed the WaveOne Gold files in terms of CFR. The Reciproc Blue files were more vulnerable to the cycles of NaOCl immersion or autoclave sterilisation. The combined autoclaving and NaOCl cycles had the most significant impact on the mechanical properties of both files. Key words:Cyclic fatigue, Reciproc blue, Wave one gold, Dynamic test, Simulated channels, Sodium hypochlorite, Sterilization.

Effectiveness of photobiomodulation with low-level lasers on the acceleration of orthodontic tooth movement: a systematic review and meta-analysis of split-mouth randomised clinical trials.

Although several studies have evaluated the effect of low-level laser therapy (LLLT) on orthodontic movement acceleration, results are still inconsistent. Such inconsistencies may be attributed to the differences in the LLLT application protocols, especially in terms of wavelength ranges. Objective: (i) to assess the clinical effects of LLLT on the acceleration of orthodontic movement and (ii) to establish the most effective LLLT wavelength to accelerate tooth movement during orthodontic treatments. MEDLINE (PubMed), Scopus, ScienceDirect, and LILACS were searched from inception to October 2022. Inclusion criteria: Split-mouth randomised clinical trials (RCTs) on systemically healthy patients reporting the effect of LLLT in accelerating orthodontic movements, specifically retraction of canines. The risk of bias was assessed using RoB-2. A random effect model was applied. Nineteen RCTs met the inclusion criteria for qualitative synthesis, and eighteen RCTs were included in the quantitative synthesis. Seventeen studies were rated as at some concerns of bias and two studies were classified as having a low risk of bias. In general terms, this systematic review and meta-analysis presents a moderate risk of bias. Findings of this systematic review and meta-analysis point to a tendency for faster orthodontic dental movement in the groups receiving LLLT treatment during the first (OR of 0.28 95% CI (0.07 to 0.48)), second (OR of 0.52 95% CI (0.31 to 0.73)), and third (OR of 0.41 95% CI (0.03 to 0.79)) month follow-up. Wavelengths ≤ 810 nm and energy density values ≤ 5.3 J/cm2 were associated with faster orthodontic tooth movement.

Secondary haemophagocytic lymphohistiocytosis in a patient with new-onset systemic lupus erythematosus: the challenges of timely diagnosis and successful treatment.

Haemophagocytic lymphohistiocytosis (HLH) is an immune-mediated disease driven by abnormal macrophage activation and regulatory cell dysfunction. HLH can be primary due to genetic mutations or secondary due to infection, malignancy or autoimmune conditions. We describe a woman in her early 30s who developed HLH while being treated for newly diagnosed systemic lupus erythematosus (SLE) complicated by lupus nephritis as well as concomitant cytomegalovirus (CMV) reactivation from a dormant infection. The trigger for this secondary form of HLH may have been either aggressive SLE and/or CMV reactivation. Despite prompt treatment with immunosuppressive therapies for SLE consisting of high-dose corticosteroids, mycophenolate mofetil, tacrolimus, etoposide for HLH and ganciclovir for CMV infection, the patient developed multiorgan failure and passed away. We demonstrate the difficulty in identifying a specific cause for secondary HLH when multiple conditions are present (SLE and CMV) and the fact that, despite aggressive treatment for both conditions, the mortality for HLH remains high.

Comparative outcomes of platelet concentrates and blood clot scaffolds for regenerative endodontic procedures: A systematic review of randomized controlled clinical trials.

Background: The main objective of this systematic review is to evaluate the effectiveness of platelet concentrates -Platelet-rich plasma (PRP) or Fibrin-rich plasma (PRF)- compared with blood clot (BC) as scaffolds for maturogenesis, in patients with immature permanent teeth with or without AP, in terms of the criteria for pulp revascularization success. Material and Methods: We reviewed randomized controlled clinical trials comparing regenerative endodontic therapies (maturogenesis) based on PRP or PRF versus the conventional BC approach, in necrotic teeth with or without apical periodontitis (AP) under clinical and radiographic criteria. We performed a strategic search in MEDLINE (PUBMED), EMBASE, and ISI Web of Science from inception to October 2022. This systematic review of the literature was developed following the Cochrane Collaboration and PRISMA statement recommendations. We used the Cochrane risk of bias tool v2 to assess the included studies' quality. We performed a qualitative synthesis of the evidence. Results: Ten randomized controlled clinical trials were included in this systematic review. Analyses of these studies suggest that maturogenesis is a successful therapy regardless of the method employed. However, further research should be conducted with more suitable research methodologies and more homogenous data for meta-analysis. Conclusions: Results from this systematic review suggest that BC maturogenesis approaches yield similar clinical and radiographic outcomes when compared to Platelet-concentrates based therapies (PRP and PRF). Key words:Maturogenesis, Revascularization, Platelet-rich plasma, Fibrin-rich plasma, blood clot, systematic review.

Association between cigarette smoking and the prevalence of post-endodontic periapical pathology: a systematic review and meta-analysis.

Objectives: This systematic review and meta-analysis aimed to assess the association of cigarette smoking with the prevalence of post-endodontic apical periodontitis in humans. Materials and Methods: We searched through PubMed/Medline, Web of Science, and Scopus from inception to December 2020. Risk of bias was performed by using the Newcastle-Ottawa Scale for cross-sectional, cohort, and case-control studies. We performed the statistical analysis in Review Manager 5.3 (RevMan 5.3). Results: 6 studies met the inclusion criteria for qualitative and quantitative synthesis. Statistical analysis of these studies suggests that there were no differences in the prevalence of post endodontic apical periodontitis (AP) when comparing non-smokers vs smoker subjects regarding patients (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.31-1.49; I2 = 58%) and teeth (OR, 1.71; 95% CI, 0.99-2.93; I2 = 72%). Conclusions: Our findings suggest that there was no association between cigarette smoking and post-endodontic apical periodontitis, as we did not find statistical differences in the prevalence of post-endodontic AP when comparing non-smokers vs smoker subjects. Therefore, smoking should not be considered a risk factor associated with endodontic failure.

Estilos de vida en adolescentes de la Provincia Sabana Centro departamento de Cundinamarca, Colombia (2017) / Lifestyles in adolescents of the Sabana Centro Province, department of Cundinamarca, Colombia (2017)

Objetivo: caracterizar los estilos de vida de estudiantes de grado 11 en los colegios oficiales de la Provincia Sabana Centro, Cundinamarca, a partir de creencias y prácticas en torno a la actividad física, el manejo del tiempo libre, los hábitos alimentarios, el consumo de sustancias psicoactivas y el autocuidado. Métodos: se realizó un estudio cuantitativo, descriptivo transversal en una muestra de 281 estudiantes. Resultados: la población objeto del estudio presenta hábitos y conductas no favorables, especialmente en lo concerniente a prácticas alimentarias, actividad física, manejo del sueño, uso de sustancias psicoactivas y sexualidad. Conclusión: la población escolar adolescente evidencia estilos de vida, actitudes y prácticas poco saludables, principalmente en lo relacionado a actividad física, hábitos alimentarios, manejo del sueño, uso de sustancias psicoactivas y sexualidad. Estos aspectos constituyen factores de riesgo frente al padecimiento de enfermedades crónicas no transmisibles a edades tempranas. Es necesario diseñar programas de fomento y promoción de la salud y prevención de la enfermedad que involucren procesos psicosociales.

Objective: to characterize the lifestyles of 11th grade students in the official schools of the Sabana Centro Province, Cundinamarca, based on beliefs and practices around physical activity, free time management, eating habits, consumption of psychoactive substances and self-care. Methods: a quantitative, descriptive cross-sectional study was carried out in a sample of 281 students. Results: the population object of the study presents unfavorable habits and behaviors, especially regarding eating practices, physical activity, sleep management, use of psychoactive substances and sexuality. Conclusion: the adolescent school population shows unhealthy lifestyles, attitudes and practices, mainly in relation to physical activity, eating habits, sleep management, use of psychoactive substances and sexuality. These aspects constitute risk factors for suffering from chronic non-communicable diseases at an early age. It is necessary to design programs for the promotion and promotion of health and disease prevention that involve psychosocial processes.

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions.

BACKGROUND: Immunization reminders in electronic health records (EHR) provide clinical decision support (CDS) that can reduce missed immunization opportunities. Little is known about using CDS rules from a regional immunization information system (IIS) to power local EHR immunization reminders. OBJECTIVE: This study aimed to assess the impact of EHR reminders using regional IIS CDS-provided rules on receipt of immunizations in a low-income, urban population for both routine immunizations and those recommended for patients with chronic medical conditions (CMCs). METHODS: We built an EHR-based immunization reminder using the open-source resource used by the New York City IIS in which we overlaid logic regarding immunizations needed for CMCs. Using a randomized cluster-cross-over pragmatic clinical trial in four academic-affiliated clinics, we compared captured immunization opportunities during patient visits when the reminder was "on" versus "off" for the primary immunization series, school-age boosters, and adolescents. We also assessed coverage of CMC-specific immunizations. Up-to-date immunization was measured by end of quarter. Rates were compared using chi square tests. RESULTS: Overall, 15,343 unique patients were seen for 26,647 visits. The alert significantly impacted captured opportunities to complete the primary series in both well-child and acute care visits (57.6% on vs. 54.3% off, p = 0.001, and 15.3% on vs. 10.1% off, p = 0.02, respectively), among most age groups, and several immunization types. Captured opportunities for CMC-specific immunizations remained low regardless of alert status. The alert did not have an effect on up-to-date immunization overall (89.1 vs. 88.3%). CONCLUSION: CDS in this population improved captured immunization opportunities. Baseline high rates may have blunted an up-to-date population effect. Converting Centers for Disease Control and Prevention (CDC) rules to generate sufficiently sensitive and specific alerts for CMC-specific immunizations proved challenging, and the alert did not have an impact on CMC-specific immunizations, potentially highlighting need for more work in this area.

Differential Requirement of Gata2a and Gata2b for Primitive and Definitive Myeloid Development in Zebrafish.

Germline loss or mutation of one copy of the transcription factor GATA2 in humans leads to a range of clinical phenotypes affecting hematopoietic, lymphatic and vascular systems. GATA2 heterozygous mice show only a limited repertoire of the features observed in humans. Zebrafish have two copies of the Gata2 gene as a result of an additional round of ancestral whole genome duplication. These genes, Gata2a and Gata2b, show distinct but overlapping expression patterns, and between them, highlight a significantly broader range of the phenotypes observed in GATA2 deficient syndromes, than each one alone. In this manuscript, we use mutants for Gata2a and Gata2b to interrogate the effects on hematopoiesis of these two ohnologs, alone and in combination, during development in order to further define the role of GATA2 in developmental hematopoiesis. We define unique roles for each ohnolog at different stages of developmental myelopoiesis and for the emergence of hematopoietic stem and progenitor cells. These effects are not additive in the haploinsufficient state suggesting a redundancy between these two genes in hematopoietic stem and progenitor cells. Rescue studies additionally support that Gata2b can compensate for the effects of Gata2a loss. Finally we show that adults with loss of combined heterozygosity show defects in the myeloid compartment consistent with GATA2 loss in humans. These results build on existing knowledge from other models of GATA2 deficiency and refine our understanding of the early developmental effects of GATA2. In addition, these studies shed light on the complexity and potential structure-function relationships as well as sub-functionalization of Gata2 genes in the zebrafish model.

TLR7 ligation augments hematopoiesis in Rps14 (uS11) deficiency via paradoxical suppression of inflammatory signaling.

Myelodysplastic syndrome (MDS) is a hematological malignancy characterized by blood cytopenias and predisposition to acute myeloid leukemia (AML). Therapies for MDS are lacking, particularly those that have an impact in the early stages of disease. We developed a model of MDS in zebrafish with knockout of Rps14, the primary mediator of the anemia associated with del(5q) MDS. These mutant animals display dose- and age-dependent abnormalities in hematopoiesis, culminating in bone marrow failure with dysplastic features. We used Rps14 knockdown to undertake an in vivo small-molecule screening, to identify compounds that ameliorate the MDS phenotype, and we identified imiquimod, an agonist of Toll-like receptor-7 (TLR7) and TLR8. Imiquimod alleviates anemia by promoting hematopoietic stem and progenitor cell expansion and erythroid differentiation, the mechanism of which is dependent on TLR7 ligation and Myd88. TLR7 activation in this setting paradoxically promoted an anti-inflammatory gene signature, indicating cross talk via TLR7 between proinflammatory pathways endogenous to Rps14 loss and the NF-κB pathway. Finally, in highly purified human bone marrow samples from anemic patients, imiquimod led to an increase in erythroid output from myeloerythroid progenitors and common myeloid progenitors. Our findings have both specific implications for the development of targeted therapeutics for del(5q) MDS and wider significance identifying a potential role for TLR7 ligation in modifying anemia.

State and parameter estimation for a class of Nonlinear Systems based on Sliding Mode Approach.

In this paper, simultaneous state estimation and parameters identification for a class of nonlinear systems are addressed. With the aim of solving this problem, an adaptive observer based on the sliding mode (AOSM) approach is designed. The main advantage of the proposed adaptive observer design is that it combines the robustness and finite time convergence of the sliding mode observers, with the simplicity of tuning of high-gain observers, reducing tuning effort. The finite time convergence of the proposed adaptive observer is established using a Lyapunov approach. Furthermore, a comparative study of the proposed adaptive observer against schemes from literature is presented, in order to show the advantages of the proposed approach. Finally, numerical results are provided to demonstrate the effectiveness and performance of the proposed approach under noise and external disturbances.

Observer-based super twisting design: A comparative study on quadrotor altitude control.

This paper addresses the design of a continuous super twisting control combined with a high-order sliding mode observer for a class of nonlinear systems. An analysis of closed-loop stability is provided by means of Lyapunov approach, where sufficient conditions are given to ensure the convergence and to select the gains of the proposed controller. Numerical simulation and experimental results illustrate the performance of the proposed control-observer scheme for controlling the altitude of a quad-rotor aircraft. Furthermore, a comparative study against similar approaches from literature is included for illustrating that proposed methodology requires less control effort while shows the best performance.

Association between type 2 diabetes mellitus and the evolution of endodontic pathology.

OBJECTIVE: The purpose of the present study was to assess the influence of type 2 diabetes mellitus (DM) on the evolution of pulpal and periapical pathology. METHOD AND MATERIALS: Two reviewers independently conducted a systematic search for articles published between 1 January 2001 and 31 December 2018 on MEDLINE/PubMed, ISI Web of Science, and Scopus databases. An additional manual search was also carried out. RESULTS: Ten studies fulfilling the inclusion criteria were included in the review (two longitudinal studies with 1-year follow-up comparing the success of primary root canal treatment between type 2 diabetic patients and non-diabetic patients, and eight cross-sectional studies). Analysis of the ten studies showed that inadequate control of type 2 DM may predispose and influence the inflammatory pulpal and periapical disease evolution. CONCLUSIONS: The present systematic review suggests that there are biologic bases to suggest that type 2 DM may act as a risk factor for developing an endodontic pathology, affecting the course of the disease in terms of susceptibility, prevalence, progression, and tissue healing capacity as a consequence of a disrupted immune response. However, more well-designed clinical investigations carrying out suitable research methodologies are needed to elucidate the influence of type 2 DM on the pulpal and periapical disease evolution.

Desafíos de la protección jurídica y la gestión del patrimonio cultural ecuatoriano / Legal protection and management's challenges of ecuadorian cultural heritage / Desafios da protecção jurídica e gestão do património cultural do equador

Resumen Introducción: El presente trabajo pretende valorar los principales desafíos de la protección jurídica y de la gestión del patrimonio cultural ecuatoriano, teniendo en cuenta referentes teóricos internacionales y nacionales para comprender su estado actual. Objetivo: Se analiza la legislación cultural de la materia, en particular la Ley Orgánica de Cultura del año 2016 y su actual Reglamento de 2017. Se valoran aspectos relacionados a la protección del patrimonio cultural inmaterial y su relación con el sistema de protección de derechos colectivos de propiedad intelectual de las comunidades y pueblos ecuatorianos. Materiales y métodos: la metodología empleada tiene en cuenta, desde el enfoque de la transdisciplinariedad y los métodos lógicos, elementos históricos-sociológicos, culturales y jurídicos, lo que supone la combinación de métodos de las ciencias sociales en general, y de las ciencias jurídicas en particular. Como resultados se demuestra que existen desafíos en la protección jurídica y en la gestión del patrimonio cultural nacional, tales como: la integración de sujetos responsables con estos bienes, a través de la transferencia de competencias, en procesos de preservación, especialmente en el contexto comunitario; insuficientes mecanismos de gestión en las medidas de protección de los centros históricos, así como en las estrategias de trabajo entre el Ministerio de Cultura y Patrimonio y el ente administrativo que atiende derechos colectivos de propiedad intelectual sobre conocimientos tradicionales de las diferentes comunidades y grupos sociales. En conclusión, si bien la protección jurídica y la gestión del patrimonio cultural se evidencian en las políticas públicas y legislación cultural adoptada, no son pocos los desafíos que presenta este país en esta área.

Abstract Introduction: The present work aims to assess the main challenges of the legal protection and management of Ecuadorian cultural heritage, taking into account international and national theoretical references to understand its status. The cultural legislation Objective: it's analyzed, in particular, Organic Culture Law of year 2016, and its current Regulation of 2017. Aspects related to protection of intangible cultural heritage and its relationship with system of protection intellectual collective property rights are valued of Ecuadorian communities and peoples. Methodology: The methodology used takes into account, from the perspective of transdisciplinarity and logical methods, historical-sociological, cultural and legal elements, which implies the combination of methods of the social sciences in general, and of legal sciences in particular. As Results, there are legal protection and management challenges such as: the integration of responsible subjects with these assets, through the transfer of competences, in preservation processes, especially in the community context. Insufficient management mechanisms in the protection measures of the historical centers, as well as strategies between the Ministry of Culture and Heritage and the administrative office that deals with collective intellectual property rights over traditional knowledge of different communities and social groups. In Conclusion, although legal protection and management is evident in the public policies and cultural legislation adopted, there are many challenges that this country presents in this area.

Resumo Introdução: Este trabalho tem como objetivo avaliar os principais desafios da protecção jurídica e de gestão do património cultural do Equador, levando em conta os teóricos nacionais e internacionais para compreender o seu estado atual. legislação pertinente objectivo cultural é analisado, particularmente a Lei Orgânica da Cultura 2016 e 2017. normas vigentes relativas à protecção de aspectos do património cultural intangível e sua relação com o sistema de proteção dos direitos coletivos são valorizados propriedade intelectual das comunidades e povos equatorianos. Materiales e métodos: a metodologia leva em conta, a partir da perspectiva da transdisciplinaridade e lógicos métodos, elementos histórico-sociológicas, culturais e legais, que é a combinação de métodos de ciências sociais em geral, e ciências jurídicas particular. Como resultado mostra que há desafios na proteção jurídica e de gestão de nacional, como património cultural: a integração de sujeitos responsáveis por esses ativos por meio da transferência de competências, em processos de preservação, especialmente ao nível da comunidade; mecanismos de gestão insuficientes as medidas de protecção dos centros históricos, bem como estratégias de trabalho entre o Ministério da Cultura e do Património e do corpo administrativo servindo coletivos direitos de propriedade intelectual sobre o conhecimento tradicional das diferentes comunidades e grupos sociais. Em conclusão, embora a protecção jurídica e gestão do património cultural são evidentes em políticas públicas e legislação cultural adotada, existem alguns desafios deste país nesta área.

Epidemiological behavior, geographic distribution and initial clinical management of cutaneous leishmaniasis in Boyacá. 2008-2015 / Comportamiento epidemiológico, distribución geográfica y manejo clínico inicial de la leishmaniasis cutánea en Boyacá. 2008-2015

Abstract Introduction: Leishmaniasis is a reemerging disease that causes more sequelae and disability than any other of its kind in areas where geographical conditions favor the presence of the vector. Objective: To describe the behavior, geographical distribution and initial clinical management of cutaneous leishmaniasis in the department of Boyacá between 2008 and 2015. Materials and methods: Observational, retrospective study on a sample of patients diagnosed with cutaneous leishmaniasis in the department of Boyacá, Colombia, registered in the mandatory epidemiological notification sheets of the Colombian public health surveillance system from 2008 to 2015. Results: 63.6% of patients were men with occupations related to forestry activities and from rural areas. 81% of the reported cases were located in western Boyacá, along the Magdalena River basin, one of the main tributaries of Colombia. Inadequate initial clinical management was observed in 25% of the study sample, which is a risk factor for resistance to pentavalent antimonials. Conclusion: It is necessary to implement follow-up strategies for patients with cutaneous leishmaniasis in order to verify the cure criteria for the disease and propose strategies for its prevention in the identified populations that are at greater risk.

Resumen Introducción. La leishmaniasis es una de las enfermedades reemergentes que más secuelas y discapacidad causa en zonas donde las condiciones geográficas favorecen la presencia del vector. Objetivo. Describir el comportamiento, la distribución geográfica y el manejo clínico inicial de la leishmaniasis cutánea en el departamento de Boyacá, Colombia, entre los años 2008 y 2015. Materiales y métodos. Estudio observacional descriptivo de tipo retrospectivo cuya muestra correspondió a las fichas de notificación epidemiológica obligatoria del Sistema de Vigilancia en Salud Pública pertenecientes a pacientes diagnosticados con leishmaniasis cutánea en Boyacá del 2008 al 2015. Resultados. De los afectados, el 63.6% correspondió a hombres con ocupaciones afines a actividades forestales y procedentes de zonas rurales. El 81% de los casos se localizaron en el occidente del departamento junto a la cuenca del Rio Magdalena, uno de los principales afluentes del territorio colombiano. Se evidenció un tratamiento clínico inicial inadecuado en el 25% de la muestra, lo que constituyó un factor de riesgo para resistencia a los antimoniales pentavalentes. Conclusión. Es necesaria la implementación de estrategias de seguimiento a los pacientes con la finalidad de constatar los criterios de curación de la enfermedad y plantear estrategias para su prevención.

[Persistent abdominal pain caused by superior mesenteric artery and celiac trunk dissection that does not respond to conservative treatment]. / Dolor abdominal persistente por disección de arteria mesentérica superior y tronco celiaco, que no responde a tratamiento conservador.

We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up.

Aneurismas de carótida extracraneal: técnicas quirúrgicas y endovasculares. A propósito de 4 casos / Extracranial carotid aneurisms: surgical and endovascular techniques. Report of 4 cases

Se presentan 4 casos de aneurismas o pseudoaneurismas de la arteria carótida interna extracraneal. A diferencia de la estenosis carotídea, esta patología es poco frecuente; por lo que las recomendaciones en cuanto al diagnóstico y tratamiento no son uniformes y aun están en discusión, representando así un reto para los médicos de la especialidad. Cada uno de los casos descritos fue tratado de forma particular a las características de anatomía, forma de presentación y riesgos de cada paciente. Los casos fueron de sexo masculino y con un rango etario desde 24 años hasta 77 años de edad. Dos de ellos fueron tratados de forma quirúrgica convencional y dos de forma endovascular. Se presenta las opciones de tratamiento quirúrgico y endovascular en nuestro medio en una enfermedad en la que se tiene experiencia limitada en la mayoría de centros médicos a nivel mundial. (AU)

We present 4 cases of extracranial internal carotid aneurisms or pseudo aneurisms. Opposite to carotid stenosis, this entity is rare, and recommendations for its diagnosis and treatment are not standardized and subject to controversy. Each of the cases presented here were treated differently. All cases were males ranging in age from 24 to 77 years of age; 2 were treated using conventional surgical methods and the remaining two using an endovascular approach. We present here the surgical options for a rare entity with limited worldwide experience. (AU)

Dolor abdominal persistente por disección de arteria mesentérica superior y tronco celiaco, que no responde a tratamiento conservador / Persistent abdominal pain caused by superior mesenteric artery and celiac trunk dissection that does not respond to conservative treatment

Reportamos el caso de un paciente varón de 32 años con dolor abdominal recurrente tipo cólico a causa de disección de arteria mesentérica superior (AMS) y tronco celíaco, el cual se resolvió luego de la colocación de 3 stents en AMS. El paciente presentó una clínica atípica lo cual dificultó el diagnóstico. Discutimos la clínica, métodos diagnósticos y alternativas de tratamiento. Iniciamos con un manejo conservador con analgesia, anticoagulación plena, antihipertensivo y control de imágenes, pero al séptimo día luego de reiniciar la vía oral, presenta angina abdominal, por lo cual procedimos a tratamiento endovascular con resultado exitoso y buena evolución, sin eventos, a un seguimiento de 2 años

We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up

Relación entre depresión y rasgos de personalidad en jóvenes y adultos con conducta intencional suicida de Ibagué, Colombia / Correlation between depression and personality traits in suicidal behavior among adolescents and adults from Ibagué, Colombia

Resumen Introducción. La conducta intencional suicida es una de las condiciones médicas más preocupantes y peligrosas en el mundo. Se presume que por cada muerte autoinfligida, se presentan alrededor de 20 intentos de suicidio. Objetivo. Identificar la relación entre depresión y rasgos de personalidad en personas con intento de suicidio. Materiales y métodos. Estudio correlacional de corte transversal en el que participaron 25 personas entre 18 y 40 años de edad, quienes intentaron suicidarse durante el 2014 y 2015 en Ibagué, Colombia. Se empleó una ficha de datos sociodemográficos, el cuestionario "Big Five" y el Inventario de depresión Estado-Rasgo. Resultados. Se evidencia que en los participantes existen correlaciones significativas de carácter negativo, por un lado, entre la subdimensión de la personalidad, el control de emociones y la depresión como estado y, por el otro, entre esta misma subdimensión y la distimia como estado. Esto sugiere que a mayor depresión como estado o como rasgo, menor estabilidad emocional. Otras correlaciones identificadas aluden a una relación moderada entre la dimensión de la personalidad, la estabilidad emocional y la depresión. Conclusión. Las variables empleadas (depresión y estabilidad emocional) cobran gran importancia al momento de diseñar acciones preventivas en salud.

Abstract Introduction: Intentional suicidal behavior is one of the most troubling and dangerous medical conditions in the world. It is presumed that for each self-inflicted death, about 20 suicide attempts occur. Objective: To identify the correlation between depression and personality traits in patients who have attempted suicide. Materials and methods: Cross-sectional correlational study involving 25 people aged between 18 and 40 who attempted suicide during 2014 and 2015 in Ibagué, Colombia. A sociodemographic data sheet, the "Big Five" questionnaire and the State-Trait Depression Inventory were used for the analysis. Results: Significant negative correlations are evident in the analyzed sample regarding the personality sub-dimension, the control of emotions and depression as a state, on the one hand, and between the same sub-dimension and dysthymia as a state, on the other. This suggests a lower emotional stability in the presence of depression as a state or as a trait. Other correlations identified refer to a moderate relation between the personality dimension, emotional stability and depression. Conclusion: The variables considered in this study (depression and emotional stability) are of great importance when designing preventive health actions.