[Diagnostic test scale SI5: Assessment of sacroiliac joint dysfunction]. / Escala de diagnóstico SI5: evaluación de disfunción de la articulación sacroiliaca.

OBJECTIVE: Sacroiliac joint dysfunction is a known cause of low back pain. We think that a diagnostic score scale (SI5) may be performed to assess diagnostic utility of clinical signs of sacroiliac joint dysfunction. The primary aim of the present study was to conduct the pilot study of our new diagnostic score scale, the SI5, for sacroiliac joint syndrome. MATERIAL AND METHODS: We reviewed the literature on clinical characteristics, diagnostic tests and imaging most commonly used in diagnosing sacroiliac joint dysfunction. Our group evaluated the diagnostic utility of these aspects and we used those considered most representative to develop the SI5 diagnostic scale. The SI5 scale was applied to 22 patients with low back pain; afterwards, the standard test for diagnosing this pathology (selective blockage of the SI joint) was also performed on these patients. The sensitivity and specificity for each sign were also assessed and the diagnostic scale called SI5 was then proposed, based on these data. RESULTS: The most sensitive clinical tests for diagnosing SI joint dysfunction were 2 patient-reported clinical characteristics, the Laguerre Test, sacroiliac rocking test and Yeomans test (greater than 80% sensitivity). The tests with greatest diagnostic specificity (>80%) were the Lewitt test, Piedallu test and Gillet test. The proposed SI5 test score scale showed sensitivity of 73% and specificity of 71%. CONCLUSIONS: Sacroiliac joint syndrome has been shown to produce low back pain frequently; however, the diagnostic value of examination tests for sacroiliac joint pain has been questioned by other authors. The pilot study on the SI5 diagnostic score scale showed good sensitivity and specificity. However, the process of statistical validation of the SI5 needs to be continued.

[Morphological characteristics of cerebral aneurysm of Willis' circle: a direct anatomical study]. / Características morfológicas de aneurimas cerebrales del polígono de Willis: estudio anatómico directo.

OBJECTIVE: To determine the prevalence and morphologic characteristics of unruptured aneurysms of Willis' circle in a sample of mestizo Colombian population. MATERIALS AND METHODS: A mixture of resin and mineral red was injected into cerebral arteries by dissection and canalization of common carotids and vertebral arteries of the encephalons of 125 mestizo male cadavers of 16 to 65 years old. The procedure was carried out during the autopsy course at the Legal Medicine Institute, Bucaramanga - Colombia. Then the encephalons were extracted and fixed. After that, the Willis' circles were identified and the presence of aneurysms at this level was determined with magnifying glass. RESULTS: A total of nine aneurysms were observed in six brains (4.8%). The most frequent location was the supraclinoid segment of the intern carotid artery, with 4 cases (44.4%), three of which were localized in the origin of the anterior choroidal artery. Additionally, three aneurysms were found in the anterior communicating artery (33.3%). From the remaining cases, one (11.1%) was localized in the pre-communicating segment of the anterior cerebral artery, and the other in the bifurcation of the basilar artery. The average size of the aneurysms was 2.49 mm SD 0.37. The affected encephalons presented concomitant variations of the Willis' circle configuration, being predominant the presence of hypoplasic posterior communicanting arteries. CONCLUSION: The aneurysm prevalence in the evaluated sample was similar to the reported in other populations. In this work, the presence of aneurysms on the origin of the anterior chorioid artery, an unusually reported localization, was prominent.

Accidente cerebrovascular de la arteria basilar: cannabis como factor de riesgo en jóvenes / Cerebrovascular accident of basilar artery: Cannabis as a risk factor in young people / Acidente Vascular Cerebral (AVC) da artéria basilar: cannabis como fator de risco em jovens

Introducción. La arteria basilar se forma de las arterias vertebrales, cursa sobre el puente y se bifurca originando las arterias cerebrales posteriores. Irriga parte del tronco encefálico, cerebelo, tálamo y los lóbulos occipitales y temporales cerebrales. Su obstrucción es rara (1% de los accidentes isquémicos), puede ocurrir en cualquier parte de su trayecto, con cuadro clínico diverso. En jóvenes se añaden otros factores de riesgo distintos a los cardiovasculares, se incluye el consumo de sustancias psicoactivas. El objetivo de este artículo es presentar el caso de un adulto joven, su evolución posterior a la intervención endovascular y la asociación, pasada por alto, al consumo de cannabinoides. Caso clínico. Individuo de 23 años con 14 horas de parálisis facial periférica derecha, diplopía, disartria, hemiparesia e hiperreflexia izquierda, disfagia, náuseas y emesis. Tomografía Axial Computarizada de cráneo simple sin alteraciones. Posteriormente, al realizarse resonancia magnética nuclear, se evidencia isquemia pontomesencefálica y focos isquémicos agudos lacunares en lóbulos cerebelosos. Se consideró comprometido el territorio de la arteria basilar, por lo que se realizó angiotomografía que evidenció una obstrucción crítica de dicho vaso a nivel del tercio distal. Se realizó trombectomía con stent-retriever con recanalización total de la arteria basilar con flujo en toda su extensión. Al egreso fue clasificado como TOAST idiopático. Conclusiones. Las escalas etiológicas para stroke creadas para adultos mayores sobreestiman la etiología idiopática en pacientes jóvenes, lo cual puede ocasionar que el consumo de cannabis sea pasado por alto como causante pese a la asociación reportada por la literatura.

Introduction. The basilar artery is formed from the vertebral arteries, runs over the pons and bifurcates, originating the posterior cerebral arteries. It irrigates part of the brainstem, cerebellum, thalamus, and the occipital and temporal lobes of the brain. Its obstruction is rare (1% of ischemic accidents), it can occur in any part of its path, with a diverse clinical condition. In young people, other risk factors other than cardiovascular ones are added; psychoactive substance use is included. The objective of this article is to present the case of a young adult, his evolution after endovascular intervention and the association, overlooked, to the consumption of cannabinoids. Clinical case. 23-year-old man with 14 hours of right peripheral facial paralysis, diplopia, dysarthria, left hyperreflexia and hemiparesis, dysphagia, nausea and emesis. Simple skull Computerized Axial Tomography without alterations. Subsequently, when a nuclear magnetic resonance was performed, pontomesencephalic ischemia and acute lacunar ischemic foci in the cerebellar lobes were evidenced. The basilar artery territory was considered compromised, so a CT angiography was performed, which revealed a critical obstruction of said artery at the level of the distal third. A stent-retriever thrombectomy was performed with total recanalization of the basilar artery with flow in its entirety. Upon discharge, he was classified as "idiopathic" according to the TOAST classification. Conclusions. The etiological scales for stroke created for older adults overestimate idiopathic etiology in young patients, which may cause cannabis use to be overlooked as a cause despite the association reported in the literature.

Introdução. A artéria basilar é formada pelas artérias vertebrais, passa pela ponte e se bifurca, originando as artérias cerebrais posteriores. Irriga parte do tronco cerebral, cerebelo, tálamo e os lobos occipital e temporal do cérebro. Sua obstrução é rara (1% dos acidentes isquêmicos), podendo ocorrer em qualquer parte de seu trajeto, com quadro clínico diverso. Nos jovens, são adicionados outros fatores de risco além dos cardiovasculares, incluindo o consumo de substâncias psicoativas. O objetivo deste artigo é apresentar o caso de um adulto jovem, sua evolução após a intervenção endovascular e a associação, despercebida, ao consumo de canabinoides. Caso clínico. Indivíduo de 23 anos com 14 horas de paralisia facial periférica direita, diplopia, disartria, hemiparesia e hiperreflexia esquerda, disfagia, náuseas e vômitos. Tomografia axial computadorizada de crânio simples sem alterações. Posteriormente, quando foi realizada a ressonância magnética nuclear, foram evidenciados isquemia pontomesencefálica e focos agudos de isquemia lacunar nos lobos cerebelares. O território da artéria basilar foi considerado comprometido, por isso foi realizada uma angiotomografia, que revelou uma obstrução crítica do referido vaso no terço distal. Foi realizada trombectomia stent-retriever com recanalização total da artéria basilar com fluxo em sua totalidade. No momento da alta, foi classificado como TOAST idiopática. Conclusões.As escalas etiológicas para AVC criadas para idosos superestimam a etiologia idiopática em pacientes jovens, o que pode fazer com que o uso de cannabis seja negligenciado como causa, apesar da associação relatada na literatura.

Diagnóstico de la aplicación de la guía 412 para hipertensión y diabetes en un municipio de Colombia / Diagnosis of the application of the guide 412 for hypertension and diabetes in a municipality of Colombia

Introducción: en Colombia se implementa la guía 412 para hipertensión arterial y diabetes mellitus tipo 2 para tratar y evitar complicaciones de la enfermedad cardiovascular, la cual representa una causa importante de morbimortalidad en población adulta. Materiales y métodos: se realizó un estudio descriptivo transversal con los pacientes asistentes a control de riesgo cardiovascular en una institución de primer nivel de atención, para dar una visión real de la forma como se aplica la guía. Se estableció un grupo de 306 pacientes asistentes a control mensual por diagnostico de enfermedades determinantes de riesgo cardiovascular, con base en la guía implementada y literatura actualizada del tema se establecieron las variables y las metas de control, se revisó la historia clínica de cada paciente extrayendo datos de interés para posterior análisis. Resultados: la hipertensión arterial se presento en el 89% de los pacientes y la diabetes mellitus en el 10%, los factores de riesgo asociados como historia familiar de enfermedad cardiovascular, alcoholismo, tabaquismo, sedentarismo, sobrepeso, no se interrogan adecuadamente. El 53,9% de los hipertensos se encontraron controlados y el 9,1% tienen control óptimo de hipertensión arterial y factores metabólicos; la asistencia a control nunca alcanzo el 70%. Discusión y conclusiones: el grupo de control de riesgo cardiovascular se ha incrementado en número de pacientes posiblemente paralelo a la implementación del nuevo sistema de seguridad social en salud; aunque la asistencia y la metodología de los controles mensuales tienen muchas limitaciones, muestra logros que determinan según la literatura disminución de morbimortalidad de la comunidad...

Introduction: in Colombia the guide 412 for hypertension and type 2 diabetes is followed through to treat and to avoid complications of the cardiovascular disease; which represents an important cause of morbility and mortality in adults. Materials and methods: a cross-sectional descriptive study was done on cardiovascular risk patients that attended to control in an institution of first level of attention to give a real vision of the form as the guide is applied. A group of 306 attending patients to monthly control by diagnosis of determining diseases of cardiovascular risk was set. With base in the implemented guide and up-to-date literature of the subject the variables and the control goals were set .The clinical history of each patient was reviewed and data of interest was extracting for later analysis. Results: the hypertension appeared in 89% of the patients and the type 2 diabetes in 10%, the associated factors of risk like family history of cardiovascular disease, alcoholism, smoking, physical inactivity, overweight, were not addressed suitably; The 53,9% of the hypertensive ones were controlled and the 9,1% have optimum control of hypertension and metabolic factors; The attendance to monthly control never reached 70%. Discussion and conclusions: the cardiovascular risk group has been increased in possibly parallel number of patients to the implementation of the new social security system in health; although the attendance and the methodology of the monthly controls have many limitations, this has showed positive results that determine according to Literature diminution of mortality of the community...