Características de pacientes con SARS-CoV-2 en estado crítico en un centro COVID-19 de referencia en Uruguay

Introducción: la pandemia de COVID-19 produjo una alta mortalidad en el mundo. Sin embargo, las presentaciones más críticas de la enfermedad han sido poco caracterizadas en nuestra región. Objetivo: estudiar la presentación clínica, evolución y mortalidad en pacientes ingresados en la unidad de medicina intensiva de un centro COVID-19 de referencia. Pacientes y método: estudio clínico, prospectivo, observacional de SARS-CoV-2 durante las primeras etapas de la pandemia en Uruguay. Se definió mortalidad en unidad de cuidados intensivos (UCI) como desenlace primario. Resultados: en 274 pacientes, la edad mediana fue de 65 años (IQR 54-73), el sexo masculino representó el 57% y el índice de Charlson tuvo una mediana de 3 (IQR 2-5). La mortalidad en UCI fue 59,9%. Las principales causas de muerte fueron: hipoxemia refractaria, disfunción orgánica múltiple y shock refractario. La edad (Odds Ratio (OR) = 1,06; IC de 95% 1,03 - 1,09), ocupación de camas (OR = 1,04, IC 95%: 1,02 - 1,07), sexo masculino (OR = 2,14, IC 95%: 0,93 - 5,06), ventilación mecánica invasiva (OR = 51,7, IC 95%: 16,5 - 208,6), coinfección al ingreso (OR = 2,34, IC 95%: 0,88 - 6,77) y enfermedad renal crónica previa (OR = 13,1, IC 95%: 2,29 - 129,2) fueron predictores independientes de mortalidad. La primera ola de la pandemia se produjo por la circulación de las variantes P.6 y P.1 del coronavirus, en una población con muy bajo porcentaje de vacunación (8%). Conclusiones: estos resultados en pacientes críticos aportan una descripción detallada del impacto de la pandemia por SARS-CoV-2 en un centro de referencia y constituyen una base para enfrentar futuros eventos epidémicos.

Introduction: COVID-19 has caused high mortality worldwide. However, the most critical presentations of the disease have been poorly characterized in our region. Objective: to study the clinical presentation, progression, and mortality in patients admitted to the Intensive Care Unit (ICU) of a COVID-19 Reference Center. Patients and methods: clinical, prospective, observational study of SARS-CoV-2 during the early stages of the pandemic in Uruguay. ICU mortality was defined as the primary outcome. Results: in 274 patients, the median age was 65 years (IQR 54-73), male gender accounted for 57%, and the Charlson Index was 3 (IQR 2-5). ICU mortality was 59.9%. The main causes of death were refractory hypoxemia, multiple organ dysfunction, and refractory shock. Age (Odds Ratio (OR) = 1.06; 95% CI 1.03 - 1.09), bed occupancy (OR= 1.04, 95% CI: 1.02 -1.07), male gender (OR= 2.14, 95% CI 0.93 - 5.06), invasive mechanical ventilation (OR= 51.7, 95% CI 16.5 - 208.6), coinfection at admission (OR= 2.34, 95% CI 0.88 - 6.77), and pre-existing chronic kidney disease (OR= 13.1, 95% CI 2.29 - 129.2) were independent predictors of mortality. The first wave of the pandemic was driven by the circulation of the P.6 and P.1 variants of the coronavirus in a population with a very low vaccination percentage (8%). Conclusions: these results in critical patients provide a detailed description of the impact of the SARS-CoV-2 pandemic in a reference center and serve as a foundation for addressing future epidemic events.

Introdução: a COVID-19 causou alta morbimortalidade em todo o mundo, embora as formas graves da doença tenham sido pouco caracterizadas nos países da América Latina. Objetivos: analisar o quadro clínico, a evolução e a mortalidade em pacientes com COVID-19 atendidos em uma unidade de terapia intensiva (UTI) em um Centro de Referência. Métodos: Estudo clínico, prospectivo e observacional de pacientes com SARS-CoV-2 durante a primeira onda da pandemia no Uruguai. A mortalidade na UTI foi o resultado primário. Resultados: oram estudados 274 pacientes, com uma mediada de idade de 65 anos (IQR 54-73), sendo a maioria do sexo masculino (57%). O índice de Charlson foi de 3 (IQR 2-5). A mortalidade geral na UTI foi de 59,9%. As principais causas de morte foram hipoxemia refratária, disfunção orgânica múltipla e choque refratário. A idade (Odds Ratio (OR) = 1,06; IC 95% 1,03-1,09), ocupação de leitos (OR = 1,04; IC 95%: 1,02-1,07), sexo masculino (OR = 2,14; IC 95%: 0,93-5,06), ventilação mecânica invasiva (OR = 51,7; IC 95%: 16,5-208,6), coinfecção na admissão (OR = 2,34; IC 95%: 0,88-6,77) e doença renal crônica pré-existente (OR = 13,1; IC 95%: 2,29-129,2) foram preditores independentes de mortalidade. A primeira onda da pandemia foi impulsionada pela circulação das variantes P.6 e P.1 do SARS-CoV-2 em uma população com uma taxa de vacinação muito baixa (8%). Conclusões: esses resultados em pacientes críticos fornecem uma descrição detalhada do impacto da pandemia SARS-CoV-2 em um Centro de Referência e constituem uma base para o enfrentamento de futuros eventos epidêmicos.

Single-cell and spatial transcriptomics identify a macrophage population associated with skeletal muscle fibrosis.

Macrophages are essential for skeletal muscle homeostasis, but how their dysregulation contributes to the development of fibrosis in muscle disease remains unclear. Here, we used single-cell transcriptomics to determine the molecular attributes of dystrophic and healthy muscle macrophages. We identified six clusters and unexpectedly found that none corresponded to traditional definitions of M1 or M2 macrophages. Rather, the predominant macrophage signature in dystrophic muscle was characterized by high expression of fibrotic factors, galectin-3 (gal-3) and osteopontin (Spp1). Spatial transcriptomics, computational inferences of intercellular communication, and in vitro assays indicated that macrophage-derived Spp1 regulates stromal progenitor differentiation. Gal-3+ macrophages were chronically activated in dystrophic muscle, and adoptive transfer assays showed that the gal-3+ phenotype was the dominant molecular program induced within the dystrophic milieu. Gal-3+ macrophages were also elevated in multiple human myopathies. These studies advance our understanding of macrophages in muscular dystrophy by defining their transcriptional programs and reveal Spp1 as a major regulator of macrophage and stromal progenitor interactions.

Single-cell and spatial transcriptomics identify a macrophage population associated with skeletal muscle fibrosis.

The monocytic/macrophage system is essential for skeletal muscle homeostasis, but its dysregulation contributes to the pathogenesis of muscle degenerative disorders. Despite our increasing knowledge of the role of macrophages in degenerative disease, it still remains unclear how macrophages contribute to muscle fibrosis. Here, we used single-cell transcriptomics to determine the molecular attributes of dystrophic and healthy muscle macrophages. We identified six novel clusters. Unexpectedly, none corresponded to traditional definitions of M1 or M2 macrophage activation. Rather, the predominant macrophage signature in dystrophic muscle was characterized by high expression of fibrotic factors, galectin-3 and spp1. Spatial transcriptomics and computational inferences of intercellular communication indicated that spp1 regulates stromal progenitor and macrophage interactions during muscular dystrophy. Galectin-3 + macrophages were chronically activated in dystrophic muscle and adoptive transfer assays showed that the galectin-3 + phenotype was the dominant molecular program induced within the dystrophic milieu. Histological examination of human muscle biopsies revealed that galectin-3 + macrophages were also elevated in multiple myopathies. These studies advance our understanding of macrophages in muscular dystrophy by defining the transcriptional programs induced in muscle macrophages, and reveal spp1 as a major regulator of macrophage and stromal progenitor interactions.

Passive Leg Raise: Feasibility and Safety of the Maneuver in Patients With Undifferentiated Shock.

PURPOSE: Passive leg raise (PLR), in combination with technologies capable of capturing stroke volume changes, has been widely adopted in the management of shock. However, dedicated evaluation of safety, feasibility, and receptiveness of patients and nursing staff to PLR maneuver is missing. METHODS: A noninterventional, prospective trial recruited adult patients with onset of undifferentiated shock within 24 hours with persistent vasopressor requirements despite fluid resuscitation. A standardized PLR maneuver was used to compare two noninvasive hemodynamic monitoring systems, each without significant impact on the performance of the maneuver. Safety and efficacy of the PLR were evaluated via subjective and objective measures. Objective measures of patient comfort and tolerance were evaluated through changes in vital signs, sedation, and analgesia requirements. Nurses and awake patients completed surveys on their experience. RESULTS: Seventy-nine patients were enrolled. Testing was aborted in 2 cases for medical reasons (one patient developed rapid atrial fibrillation, second had profound desaturation). Of all, 5.4% of patients required additional vasopressor support after completion of the PLR maneuver due to persistent hypotension and 4.1% of patients required additional sedation. Among awake patients (N = 35), 6% reported pain and 29% reported discomfort. A total of 11% of nurses reported minor technical difficulties with the maneuver. CONCLUSION: Passive leg raise maneuver leads to a few serious but reversible complications in a selected population of hemodynamically unstable patients. Although it provides relevant diagnostic information, it may impact patient care. Treating physician should be aware of infrequent but possible complications and appreciate the impact of the maneuver on patients' comfort and nursing workload.

Effect of biomaterials hydrophobicity and roughness on biofilm development.

Most hospitalized patients are carriers of biomedical devices. Infections associated with these devices cause great morbidity and mortality, especially in patients in intensive care units. Numerous strategies have been designed to prevent biofilm development on biodevices. However, biofilm formation is a complex process not fully clarified. In the current study, roughness and hydrophobicity of different biomaterials was analyzed to assess their influences on the biofilm formation of four leading etiological causes of healthcare-associated infections, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis and Candida albicans, using a CDC biofilm reactor. Hydrophobic materials allowed the formation of more abundant and profuse biofilms. Roughness had effect on biofilm formation, but its influence was not significant when material hydrophobicity was considered.

Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock.

OBJECTIVES: Adequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used. DESIGN: Prospective, noninterventional study. SETTING: ICU at a large academic center. PATIENTS: Patients with new, undifferentiated shock, and vasopressor requirements despite fluid resuscitation were included. Patients with significant cardiac disease and conditions that precluded adequate passive leg raising were excluded. INTERVENTIONS: Carotid corrected flow time was measured via ultrasound before and after a passive leg raise maneuver. Predicted fluid responsiveness was defined as greater than 10% increase in stroke volume on noninvasive cardiac output monitoring following passive leg raise. Images and measurements were reanalyzed by a second, blinded physician. The accuracy of change in carotid corrected flow time to predict fluid responsiveness was evaluated using receiver operating characteristic analysis. MEASUREMENTS AND MAIN RESULTS: Seventy-seven subjects were enrolled with 54 (70.1%) classified as fluid responders by noninvasive cardiac output monitoring. The average change in carotid corrected flow time after passive leg raise for fluid responders was 14.1 ± 18.7 ms versus -4.0 ± 8 ms for nonresponders (p < 0.001). Receiver operating characteristic analysis demonstrated that change in carotid corrected flow time is an accurate predictor of fluid responsiveness status (area under the curve, 0.88; 95% CI, 0.80-0.96) and a 7 ms increase in carotid corrected flow time post passive leg raise was shown to have a 97% positive predictive value and 82% accuracy in detecting fluid responsiveness using noninvasive cardiac output monitoring as a reference standard. Mechanical ventilation, respiratory rate, and high positive end-expiratory pressure had no significant impact on test performance. Post hoc blinded evaluation of bedside acquired measurements demonstrated agreement between evaluators. CONCLUSIONS: Change in carotid corrected flow time can predict fluid responsiveness status after a passive leg raise maneuver. Using point-of-care ultrasound to assess change in carotid corrected flow time is an acceptable and reproducible method for noninvasive identification of fluid responsiveness in critically ill patients with undifferentiated shock.

Historia del enfoque psicosocial del Programa de Psicología de la Universidad Católica Luis Amigó / History of the Psico-social approach of the psychology program at Luis Amigó Catholic University

El presente artículo es producto de la recopilación de actas, artículos, y archivos que reposan en la dirección del programa y en la revista Poiésis. El programa de psicología de la Universidad Católica Luis Amigó, nace como respuesta a las problemáticas sociales vividas en el país a finales de los noventa. La formación de profesionales de las Ciencias Sociales, con la capacidad de intervenir de manera grupal, era su objetivo, ya que la psicología de consultorio y laboratorio, presente en la época, no correspondía de manera pertinente a estas necesidades.

This article is the result of the compilation of minutes, articles, and files that lie in the office of the Program's Director and in the archives of Poiésis Journal. The psychology program at Luis Amigó Catholic University was born in response to the social issues experienced in the country towards the end of the 1990's. Its main objective was to train professionals in the social sciences with an ability for group interventions, as the office and lab psychology of the time did not pertinently meet those needs.

Prevalencia de fluorosis y experiencia de caries dental en un grupo de escolares en el área urbana del Municipio de Yondó (Antioquia, Colombia), 2010 / Prevalence of fluorosis and dental caries experience in a school age group in the urban area of the Municipality of Yondó (Antioquia, Colombia), 2010

Introducción y Objetivo: La caries dental y la fluorosis dental son problemas de Salud Pública que requieren sistemas de vigilancia y control en edades tempranas. El objetivo fue determinar la prevalencia de fluorosis dental en escolares de 12 años, y la historia de caries en escolares de 5 y 12 años en la Institución Educativa Luis Eduardo Díaz del área urbana del Municipio de Yondó (Antioquia) durante el año 2010. Materiales y Métodos: Estudio transversal en una población de 62 escolares de 5 años y 145 de 12 años. Se realizó examen clínico y se estableció la experiencia de caries dental (índices ceo-d; 5 años, COP-D; 12 años) y la prevalencia de fluorosis dental (Índice de Dean). Se calcularon frecuencias, medianas y promedios por sexo en el caso de caries dental y prevalencia de fluorosis global y por grados de severidad. Cálculo de razones de prevalencia de fluorosis por sexo con sus intervalos de confianza al 95% (RP, IC95%). Se analizaron las principales fuentes de agua del área de estudio. Resultados: El promedio ceo-d a los 5 años fue de 2,37 ±3,39, con experiencia de caries del 61%. A los 12 años se encontró un promedio COP-D de 0,73 ±1,28, y una experiencia de caries del 33,1%. No se encontraron diferencias estadísticamente significativas por sexo. La prevalencia global de fluorosis fue de 97,9%, con mayor prevalencia en hombres, aunque sin diferencias significativas (RP 1,05, IC95% 0,98- 1,12). El análisis fisicoquímico no mostró niveles altos de concentración de flúor en agua. Conclusión: Se encontraron niveles altos de experiencia de caries dental a los 5 años y alta prevalencia de Fluorosis a los 12 años que exigen acciones de mejoramiento y estrategias en salud pública para esta población.

Introduction and Objetive: Dental caries and dental Fluorosis are public health problems, which require surveillance and control systems in primary ages. We aim to determine the prevalence of dental Fluorosis in school children age 12 and the caries experience of school children between 5 and 12 years old at the Institution “Luis Eduardo Diaz”, located in the urban area of the Municipality of Yondó (Antioquia, Colombia), during 2010. Materials and Methods: A cross-sectional study was conducted in 62 scholars of 5 years and 145 scholars of 12 years. Clinical examinations were carried out and the caries dental experience was established (DMFT and dmf indexes) and the prevalence of dental Fluorosis (Dean’s index). Prevalence, mean and median and for sex were estimated in case of dental caries and the global prevalence of Fluorosis and taking into account severity groups and sex. We calculate the prevalence ratio for sex and the 95% confidence intervals (PR, 95% CI). The main water sources of the study area were analyzed. Results: Mean dmf for 5 years was 2,37(±3,39) and the dental experience was 61%. At 12 years a DMTF mean was 0,73 (±1,28) and the dental experience was 33,1%. No statistical significance was found for sex. The global prevalence of Fluorosis was of 97,9%, the frequency was higher in males but the differences do not have statistical significance (RP 1z5, 95%CI 0,98- 1,12). The physicochemical analysis did not show high levels of fluoride concentrations in water. Conclusion: Higher levels of dental caries in case of scholars of 5 years dental Fluorosis for scholars of 12 years were found. Improvement actions and public health strategies are required for these populations.

Food insecurity among Latin American recent immigrants in Toronto.

Food security is an important social determinant of health. The 2004 Canadian Community Health Survey, Cycle 2.2 reported high prevalence of food insecurity among low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Our findings indicate that the primary correlate of a household's food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs may be effective.

Aislamiento e identificación de microorganismos del género Methanococcus y Methanobacterium de cuatro fuentes de Bogotá, DC / Isolation and identification of methanococcus and methanobacterium microorganisms from four different sources in Bogota, DC

Las bacterias metanogénicas obtienen su energía mediante la producción metabólica de gas metano, utilizando sustratos como dióxido de carbono, acetato y sustratos de metilo a través de procesos de hidrólisis y acetogenesis y son esenciales en la degradación anaerobia de la materia orgánica en la naturaleza. El propósito de esta investigación fue aislar bacterias metanogénicas para conservarlas en la colección de cultivos de la Universidad Colegio Mayor de Cundinamarca. El muestreo se realizó por duplicado de cuatro fuentes ubicadas en Bogotá D.C, Colombia, las cuales ofrecían las características ambientales para su desarrollo. El procedimiento incluyó la toma de la muestra en ambiente anaerobio, aislamiento en medios selectivos e identificación por observación de las características microscópicas con coloración de Gram y de características macroscópicas en los medios selectivos y verificación de producción de metano mediante prueba piloto. Los resultados permitieron evidenciar la presencia de bacterias de los géneros Methanococcus y Methanobacterium a partir de las fuentes seleccionadas para el estudio. Se concluyó que el mejor método para la conservación de estos géneros es la congelación con la adición de agentes reductores y glicerol como criopreservante.

Validación de escala de la seguridad alimentaria doméstica en Antioquia, Colombia / Validation of a household food security scale in Antioquia, Colombia

OBJETIVO: Adaptar y validar en hogares de Antioquia, Colombia, una escala de seguridad alimentaria anteriormente aplicada en hogares de Caracas, Venezuela. MATERIAL Y MÉTODOS: El estudio se realizó en 44 municipios del departamento de Antioquia, Colombia, durante los años 2003 y 2004, en una muestra representativa de los hogares rurales y urbanos del departamento de Antioquia, constituida por 1 624 hogares con niños menores de 10 años; los hogares fueron seleccionados de manera aleatoria, con un índice de confianza de 95 por ciento y un error de 3 por ciento. Se validó la escala de seguridad alimentaria doméstica utilizada por Paulina Lorenzana en Venezuela, y se determinó la consistencia interna de la escala mediante el coeficiente de correlación de Spearman y el coeficiente alfa de Cronbach. La validez del constructo se estableció mediante el método de componentes principales para datos categóricos. Se utilizaron el procedimiento de Prinqual y el modelo de Rasch para definir los componentes y los ítems de la escala. RESULTADOS: El análisis factorial arrojó dos componentes: 1) las variables relacionadas con "inseguridad alimentaria sin hambre" que lo explican en 95 por ciento y 2) las relacionadas con "inseguridad alimentaria con hambre" que lo explican en 89.4 por ciento. El coeficiente alfa de Cronbach para el primer componente fue de de 0.95 y para el segundo de 0.89. Al ser analizados con el modelo Rasch, todos los ítems presentaron valores infit en un rango de 0.8 a 1.2. La escala se correlacionó significativamente con la disponibilidad de alimentos, el recurso de la limosna, el trabajo infantil, el tamaño del hogar y la ocupación del jefe de familia (p< 0.000). CONCLUSION: La escala puede considerarse un instrumento confiable para la valoración de la inseguridad alimentaria en los hogares de Antioquia.

OBJETIVE: To adapt and validate in households of Antioquia, Colombia, a food security scale previously applied in households of Caracas, Venezuela. MATERIAL AND METHODS: The study was carried out in 44 municipalities in the department of Antioquia, Colombia, in 2003 and 2004, with a randomly selected sample of 1 624 rural and urban households with children under 10 years of age, representative for family units located in the department of Antioquia. The sample was selected using a confidence interval of 95 percent and an error of 3 percent. Household food security scale previously used by Paulina Lorenzana in Venezuela were validated for this survey. Internal consistency of the scale was determined using the Spearman correlation coefficient and Cronbach's Alpha coefficient. Construct validity was established through principal components analysis for categorical data. Prinqual procedure and Rasch modeling were used to define the components and items in the scale. RESULTS: Factor analysis showed two components: 1) variables related to "food insecurity without hunger", which is explained in 95 percent; 2) variables related to "food insecurity with hunger", which is explained in 89.4 percent. Cronbach's Alpha coefficients for "food insecurity without hunger" and "food insecurity with hunger" were 0.95 and 0.89, respectively. When analyzed using Rasch modeling, all items showed infit values within a range of 0.8 and 1.2. The scale correlated significantly (p<0.000) with food availability, begging, children's labor, household size, and occupation of the head of household. CONCLUSIONS: The scale can be considered a reliable instrument for assessing food insecurity in Antioquia households.

[Validation of a household food security scale in Antioquia, Colombia]. / Validación de escala de la seguridad alimentaria doméstica en Antioquia, Colombia.

OBJECTIVE: To adapt and validate in households of Antioquia, Colombia, a food security scale previously applied in households of Caracas, Venezuela. MATERIAL AND METHODS: The study was carried out in 44 municipalities in the department of Antioquia, Colombia, in 2003 and 2004, with a randomly selected sample of 1 624 rural and urban households with children under 10 years of age, representative for family units located in the department of Antioquia. The sample was selected using a confidence interval of 95% and an error of 3%. Household food security scale previously used by Paulina Lorenzana in Venezuela were validated for this survey. Internal consistency of the scale was determined using the Spearman correlation coefficient and Cronbach's Alpha coefficient. Construct validity was established through principal components analysis for categorical data. Prinqual procedure and Rasch modeling were used to define the components and items in the scale. RESULTS: Factor analysis showed two components: 1) variables related to "food insecurity without hunger", which is explained in 95%; 2) variables related to "food insecurity with hunger", which is explained in 89.4%. Cronbach's Alpha coefficients for "food insecurity without hunger" and "food insecurity with hunger" were 0.95 and 0.89, respectively. When analyzed using Rasch modeling, all items showed infit values within a range of 0.8 and 1.2. The scale correlated significantly (p < 0.000) with food availability, begging, children's labor, household size, and occupation of the head of household. CONCLUSION: The scale can be considered a reliable instrument for assessing food insecurity in Antioquia households.

Síndrome de bardet-biedl asociado a síndrome antifosfolipidico / Syndrome of bardet-buedl association a antiphospholipid syndrome

El síndrome de Bardet-Biedl se caracteriza por la presenica de retinopatía, obesidad, polidactilia, hipogonadismo y daño renal variable. Hasta ahora no se había reportado su asociación con síndrome Antifosfolipídico. Caso clínico: adolescente masculino de 15 años con retinitis pigmentaria e insuficiencia renal crónica. La biopsia renal reveló: obsolescencia glomerular marcada con fibrosis intersticial severa. Evaluación inmunológica normal, cariotipo 46, XY, ruptura de cromátidas en autosomas, 1p, 2p, 9p, 14q, 15q. Se diagnóstico Síndrome de Bardet-Biedl. Se inició hemodiálisis con corta duración de accesos vasculares. Al año recibió trasplante renal de cadáver con disfunción temprana del injerto. A los 26 días, se realizó trasplantectomía por trombosis arterial y venosa renal. El ecodoppler reportó trombosis venosa profunda. Se realizaron pruebas hematológicas: anticoagulante lúpico: LA1 149 seg LA2 147 seg (VN: 0-45), anticardiolipina: IgG 80 GPL/ml (VN:<10), IgM<7 MPL/ml. (normal). Se inició tratamiento con enoxaparina y warfarina, con mejoría del proceso trombólico

Vasculitis leucocitoclástica: a propósito de un caso / Leukocytoclastic vasculitis: a purpose of case

La vasculitis leucocitoclástica o necrotizante cutánea engloba un grupo amplio y heterogéneo de síndromes que se caracterizan por inflamación de vasos capilares, mediada por inmunocomplejos, manifestaciones clínicas dermatológicas y cambios histológicos dados por edema endotelial. infiltración por polimorfonucleares, hemorragia y trombosis. Se presenta el caso de un escolar femenino de 6 años de edad, quien en foorma brusca inicia sintomatología caracterizada por artralegias y mialgias generalizadas de fuerte intensidad, fiebre de 40 grados centígrados, horas despues lesiones equimóticas de tamaño variable que progresan rápidamente con aparición de necrosis en piel y gangrena en manos y pies. Se investigan etiologías infecciosas: virales y bacterianas negativas; pruebas inmunológicas y de coagulación reportan, AntiDNA elevado, C3 bajo IgM Anticardiolipina positivo, Productos de degradación del fibrinógeno y Dímero D elevados y Proteína C baja. Se realiza amputación y necrectomía en manos y miembros inferiores. El estudio anatomopatológico concluye Vasculitis Leucocitoclástica. Hecemos una revisión de esta enfermedad por considerarla un reto diagnóstico

Participación del acompañante en el cuidado del paciente hospitalizado. Instituciones de segundo nivel. Area Metropolitana. Medellín 1999-2000 / Participation of familiar attendant in the care of the hospitalized person in institutions of second level of attention in the metropolitan area of Medellin, 1999-2000

Estudio descriptivo transversal para identificar las oportunidades de participación en el cuidado que el equipo de enfermería propicia a los acompañantes del paciente hospitalizado. Nace como respuesta a los interrogantes continuos desde la practica académica y por vivencias personales con familiares hospitalizados. Se realiza una entrevista estructurada a 265 acompañantes de instituciones de salud del segundo nivel de complejidad, en las cuales se indagó por aspectos socio-demográficos de los usuarios y acompañantes, las acciones de cuidado que ejecuta el acompañante y cuáles son indicados, explicados y apoyados por el equipo de enfermería. La educación que éste proporciona al acompañante es otro asunto que se cuestionó en la muestra. De los usuarios con acompañante el 54 por ciento son de sexo femenino, los de mayor tiempo de compañía están en el grupo etáreo de 64 a 77 años y se caracterizan por un nivel bajo de escolaridad. Como primera causa de morbilidad está los problemas gasasculares. trointestinales; seguidos de los problemas cardiovLas personas que más acomp edad de 45 años.añan son los hijos ás realizan los acompañantes son los relcionados con la subsistencia, como el baño y la alimentación, accioade sexo femenino, con promedio de Los cuidados que nes como la lectura, el juego y la música son realmizados sólo en el 10 por ciento en contraste con la conversación que es una de las acciones que más se realizan. La interacción del equipo de enfermería con el acompañante es mínima para casi todos los cuidados explorados en el estudio, se presentó la mayor interacción en la indicación, explicación y apoyo del baño. La auxiliar de enfermería es quien más interactúa con el acompañante en estas categorías; sobresale la poca interacción del profesional en enfermería. La educación, es impartida por el profesional de enfermería en mayor proporción; sin embargo, sólo se brinda al 11 por ciento del total de usuarios hospitalizados. Solo sí se penetra en el misterio del cuidado y se aborda profundamente el carácter humano y cultural de éste podemos trascender la relación con el usuario en términos de confianza, respeto y pertinencia con su familia y con el entorno social.

Ehrlichiosis humana: enfermedad potencialmente mortal en niños / Human ehrlichiosis: mortal potentially disease in children

Ehrlichiosis es una enfermedad infecciosa rara, poco conocida en Venezuela, causada por bacterias del género Ehrlich, transmitida por picadura de garrapata infectada, caraterizada por fiebre intensa, manifestaciones sistémicas, exantema y complicaciones graves: meningoencefalitis, insuficiencia respiratoria y renal y coagulación intravascular. El diagnóstico se hace a través de un frotis de capa blanca, donde se detectan morulas (inclusiones), los métodos serológicos como inmunoflorescencia indirecta determinan aumento o disminución de los títulos de anticuerpos. La reacción cadena de polimerasa en la fase aguda tiene sensibilidad del 85 por ciento y especificidad de 100 por ciento. Se presenta el caso de un adolescente masculino de 12 años de edad, ingresado en el Hospital "J.M de Los Ríos", con diagnóstico de síndrome febril prolongado, caracterizado por hipertemia intermitente de 40°C de 30 días de evolución, debilidad general, pérdida de peso (5 Kg), mialgias, artralgias y rash cutáneo intermitente y antecedente de exposición intensa con canes portadores de pulgas y garrapatas. Inicialmente se descartan enfermedades infecciosas comunes, neoplásicas y autoinmunes. En los estudios del frotis de capa blanca del paciente, se observó morulas intra citoplasmáticas (inclusiones) en los granulocitos así como también se demostró la Ehrlichia platys en los canes del paciente