Objective method for visual performance prediction.

We propose, implement, and validate a new objective method for predicting the trends of visual acuity through-focus curves provided by specific optical elements. The proposed method utilized imaging of sinusoidal gratings provided by the optical elements and the definition of acuity. A custom-made monocular visual simulator equipped with active optics was used to implement the objective method and to validate it via subjective measurements. Visual acuity measurements were obtained monocularly from a set of six subjects with paralyzed accommodation for a naked eye and then that eye compensated by four multifocal optical elements. The objective methodology successfully predicts the trends of the visual acuity through-focus curve for all considered cases. The Pearson correlation coefficient was 0.878 for all tested optical elements, which agrees with results obtained by similar works. The proposed method constitutes an easy and direct alternative technique for the objective testing of optical elements for ophthalmic and optometric applications, which can be implemented before invasive, demanding, or costly procedures on real subjects.

Tear film stability assessment by corneal reflex image degradation: publisher's note.

This publisher's note corrects the funding in J. Opt. Soc. Am. A36, B110 (2019).JOAOD60740-323210.1364/JOSAA.36.00B110.

Tear film stability assessment by corneal reflex image degradation.

Tear film stability assessment is one of the main tests in dry eye diagnosis. However, to date, no test methodology has been adopted as the gold standard due to several reasons, such as the methods being invasive, subjective, or unfeasible for the clinical environment. In this paper, a method that overcomes the above-mentioned limitations for tear film stability measurements is presented, and is based on the degradation of corneal reflex images caused by breakups. The experimental setup, which is based on recording the corneal reflex image or the first Purkinje image, is described, as well as the method used to determine tear film stability by means of the associated breakup time (BUT) using corneal reflex image degradation. Images obtained through simulations of the experimental setup are also shown. Moreover, BUT measurements performed using both the conventional fluorescein method and the proposed method in nine healthy adults are presented. Both the experimental and simulation images show corneal reflex image degradation due to the appearance of breakups in the tear film, highlighting the potential of the method to assess tear film stability. We have shown that the corneal reflex image degrades when the tear film breaks up and, thus, the proposed method can be used to assess tear film stability.

Experimental QR code optical encryption: noise-free data recovering.

We report, to our knowledge for the first time, the experimental implementation of a quick response (QR) code as a "container" in an optical encryption system. A joint transform correlator architecture in an interferometric configuration is chosen as the experimental scheme. As the implementation is not possible in a single step, a multiplexing procedure to encrypt the QR code of the original information is applied. Once the QR code is correctly decrypted, the speckle noise present in the recovered QR code is eliminated by a simple digital procedure. Finally, the original information is retrieved completely free of any kind of degradation after reading the QR code. Additionally, we propose and implement a new protocol in which the reception of the encrypted QR code and its decryption, the digital block processing, and the reading of the decrypted QR code are performed employing only one device (smartphone, tablet, or computer). The overall method probes to produce an outcome far more attractive to make the adoption of the technique a plausible option. Experimental results are presented to demonstrate the practicality of the proposed security system.

Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study.

OBJECTIVES: In 2002, the Surviving Sepsis Campaign pointed out the need to recognize sepsis as an important cause of death and high economic and social costs. There are few epidemiologic studies of this disease in pediatrics and none in Colombia. The objective of this study was to describe the sociodemographic and clinical characteristics of patients with sepsis who were admitted at participating pediatric intensive care units. DESIGN: Prospective study. SETTING AND PATIENTS: A Web site, http://www.sepsisencolombia.com, was created, in which 19 pediatric intensive care units from the ten principal cities in the country reported epidemiologic data about patients with sepsis between March 1, 2009, and February 28, 2010. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 1,051 patients. Of these, 55% were male. Fifty-six percent came from urban areas. Fifty-six percent were <2 yrs of age. Seventy-six percent belonged to a low socioeconomic strata and 44% received government-subsidized health insurance. Forty-eight percent of patients had septic shock, 25% severe sepsis, and 27% sepsis. Forty-three percent were diagnosed with multiple organ dysfunction syndrome. In 54%, the infection was of respiratory origin followed by the abdomen as the site of origin in 18% of the patients. In almost 50%, the etiological agent was detected with Gram-negative bacteria being the most frequent and of highest mortality. Fifty percent had some type of relevant pathologic antecedent. Eleven percent had an invasive device on admission. Sixty-eight percent of the patients required mechanical ventilation. Mortality rate was 18%. The most important risk factors for mortality were age under 2 yrs, presence of shock or multiple organ dysfunction syndrome, and presence of Gram-negative bacteria. CONCLUSIONS: Sepsis is common in Colombian pediatric intensive care units. Clear risk factors for getting sick and dying from this disease were identified. Mortality resulting from this disease is considerable for a developing society like ours.

Optimization of the Light Sword Lens for Presbyopia Correction.

Purpose: We propose and evaluate the modifications of a light sword lens (LSL) to obtain better performance for distance vision while maintaining good operation for near and intermediate vision. Methods: The modifications consisted of assigning angular or circular windows for distance vision while rescaling the LSL profile in the remaining area of the element. The objective performance of the redesigned LSLs was verified numerically by the Strehl ratio and experimentally using correlation coefficients and Michelson contrast. Subjective assessments were provided by monocular visual acuity (VA) and contrast sensitivity (CS) through-focus curves for six patients with paralyzed accommodation. The tested object vergence range was [-4.0, 0.0] diopters (D). All experiments were conducted in a custom-made monocular visual simulator. Results: Computational simulations and objective experiments confirmed the better performance of the modified LSL for the imaging of distant objects. The proposed angular and radial modulations resulted in flat VA and CS through-focus curves, indicating more uniform quality of vision with clearly improved distance vision. The VA provided by the modified LSL profiles showed a maximal improvement of 1.5 lines of acuity with respect to the VA provided by the conventional LSL at distance vision. Conclusions: Optimized LSLs provide better imaging of distant objects while maintaining a large depth of focus. This results in comparable and acceptable quality for distance, intermediate, and near vision. Therefore, the modified LSLs appear to be promising presbyopia correctors. Translational Relevance: The new design of LSL reveals an improved performance for all ranges of vision and becomes a promissory element for a real presbyopia correction in clinical applications.

Model of the light sword intraocular lens: in-vitro comparative studies.

This work presents the first models of light sword intraocular lenses (LS IOLs) with angularly modulated optical power. We performed an experimental, comparative study with multifocal and extended depth of focus intraocular lenses, which are available on the market. The measurements conducted in an original optical bench were utilised for an analysis of point spread functions, elongated foci, modulation transfer functions and the areas defined by them. The LS IOL models perform homogeneous imaging in the whole range of designed defocus. The proposed concept of extended depth of focus seems to be promising for the development of presbyopia-correcting intraocular lenses capable of regaining fully functional vision.

Peripheral optical errors and their change with accommodation differ between emmetropic and myopic eyes.

The progression of myopia is thought to be controlled by the retinal image quality, but its triggering factors are not yet well known. The differences between the peripheral optics in emmetropic and myopic eyes might explain why some eyes become myopic. The present study further investigates peripheral optical quality and how it is affected by accommodation. The refraction and aberrations of the right eyes of five emmetropes and five myopes were measured using a laboratory Hartmann-Shack wave front sensor, specially designed for peripheral measurements with an open field of view. The off-axis optical quality was assessed in steps of 10 degrees out to +/-40 degrees horizontally and +/-20 degrees vertically for two different states of accommodation (targets at 0.5 D and 4.0 D). As expected, the emmetropes had a higher relative peripheral myopia, that is, more positive c(2)(0) coefficient, than the myopes. The new results of this study are that this well-known difference was found to be asymmetric over the visual field and that it increased with accommodation. This increase was because the relative peripheral defocus profile of the myopes did not show a consistent change between far and near vision, whereas the emmetropes became relatively more myopic in the periphery with accommodation. These findings may indicate a difference between emmetropic and myopic eyes that could be an important clue to understand myopia progression.

The Light Sword Lens - A novel method of presbyopia compensation: Pilot clinical study.

PURPOSE: Clinical assessment of a new optical element for presbyopia correction-the Light Sword Lens. METHODS: Healthy dominant eyes of 34 presbyopes were examined for visual performance in 3 trials: reference (with lens for distance correction); stenopeic (distance correction with a pinhole ϕ = 1.25 mm) and Light Sword Lens (distance correction with a Light Sword Lens). In each trial, visual acuity was assessed in 7 tasks for defocus from 0.2D to 3.0D while contrast sensitivity in 2 tasks for defocus 0.3D and 2.5D. The Early Treatment Diabetic Retinopathy Study protocol and Pelli-Robson method were applied. Within visual acuity and contrast sensitivity results degree of homogeneity through defocus was determined. Reference and stenopeic trials were compared to Light Sword Lens results. Friedman analysis of variance, Nemenyi post-hoc, Wilcoxon tests were used, p-value < 0.05 was considered significant. RESULTS: In Light Sword Lens trial visual acuity was stable in tested defocus range [20/25-20/32], Stenopeic trial exhibited a limited range of degradation [20/25-20/40]. Light Sword Lens and reference trials contrast sensitivity was high [1.9-2.0 logCS] for both defocus cases, but low in stenopeic condition [1.5-1.7 logCS]. Between-trials comparisons of visual acuity results showed significant differences only for Light Sword Lens versus reference trials and in contrast sensitivity only for Light Sword Lens versus stenopeic trials. CONCLUSIONS: Visual acuity achieved with Light Sword Lens correction in presbyopic eye is comparable to stenopeic but exhibits none significant loss in contrast sensitivity. Such correction method seems to be very promising for novel contact lenses and intraocular lenses design.

Prevalence of infection with Toxoplasma gondii among pregnant women in Cali, Colombia, South America.

The aim of this study was to determine the prevalence of toxoplasma antibodies among pregnant women in Cali, Colombia. In 2005, 955 pregnant women were tested for IgG and IgM antibodies and sociodemographic information was collected. Their average age was 25.1 years, overall IgG seroprevalence 45.8% (95% CI: 41.8%, 48.2%), IgM 2.8% (95% CI: 1.5%, 3.6%). Seroprevalence increased significantly with age, 39.0% in 14 to 19 years to 55.3% in 30 to 39 years (P = 0.001). There was a significant trend toward a higher seroprevalence in the lower socioeconomic strata (SES) (low: 49.0%, high: 29%, P = 0.004). The increase in seroprevalence by age was more significant in the lower socioeconomic strata (P = 0.002). Our results suggest a higher prevalence when compared with those of the national 1980 (33-37.6%) survey. In contrast to reports from other regions of the world, Cali has not seen a decrease in T. gondii seroprevalence over the past 25 years.

Geographical Distribution of Access to Healthcare in Patients Diagnosed with Hypospadias / Distribución geográfica del acceso a la asistencia sanitaria en pacientes con diagnóstico de hipospadias

Objective Hypospadias is a congenital disease of unknown etiology involving multiple epigenetic, genetic, and endocrinological factors. It is a highly incapacitating condition. Its surgical management is one of the most frequent surgical procedures done by pediatric urologists. Furthermore, the geographical distribution and healthcare access is limited in Colombia. The Colombian Ministry of Health has consolidated a nationwide registry called Integrated Social Protection Information System (SISPRO, in the Spanish acronym) to collect comprehensive information on the use and frequency of resources associated with health care in Colombia. The aim of the present study was to analyze the number of cases reported between 2014 and 2018 and the geographical distribution of access to healthcare of patients with hypospadias in Colombia. Methods An observational, retrospective study of hypospadias in Colombia, 2014­ 2018, was performed using data extracted from the Individual Health Records System (RIPS) in SISPRO. Satscan, version 9.6 was used to perform a distribution analysis of the georeferenced population using a Poisson model. To visualize the results, the software projected the result onto a Google Earth map. Results Between January 2014 and December 2018, a total of 8,990 cases of hypospadias were evaluated in Colombia. The geographical distribution in the national territory has areas with high evaluation rates. On average, the departments in which the majority of cases were evaluated during the study period were Bogotá, D.C., Antioquia, and Valle del Cauca (2,196, 1,818 and 1,151 cases, respectively). The statistical analysis of the space exploration (►Fig. 1) identified the area with the highest concentration of cases (red) and the areas in which the lowest number of patients was evaluated (blue). The geographical distribution showed increasing trends in areas near the center of the country, especially in the cities of Bogotá, Cali, Ibagué, and Pereira. Conclusion There is a greater concentration of cases evaluated in the center of the country, where the cities with better access to subspecialized medical care are located. This highlights inequalities in health services and the opportunity for surgical care among regions of the country. If we consider that the prevalence rates of hypospadias remain stable, 87% of the patients with hypospadias will not be evaluated by a subspecialist.

Objetivo Hipospadias es una enfermedad congénita de etiología desconocida que involucra múltiples factores epigenéticos, genéticos y endocrinológicos. Es una condición sumamente incapacitante. Su manejo quirúrgico es uno de los procedimientos quirúrgicos más frecuentes realizados por urólogos pediátricos. Además, la distribución geográfica y el acceso a la atención médica son limitados en Colombia. El Ministerio de Salud de Colombia ha consolidado un registro a nivel nacional denominado Sistema Integrado de Información de Protección Social (SISPRO) para recopilar información integral sobre el uso y frecuencia de los recursos asociados a la atención de la salud en Colombia. El objetivo del presente estudio fue analizar el número de casos notificados entre 2014 y 2018 y la distribución geográfica del acceso a la atención médica por los pacientes con hipospadias en Colombia. Métodos Se realizó un estudio observacional y retrospectivo de hipospadias en Colombia, 2014-2018, utilizando datos extraídos del Sistema de Registros Sanitarios Individuales (RIPS) en SISPRO. Se usó Satscan, versión 9.6 para realizar un análisis de distribución de la población georreferenciada usando un modelo de Poisson. Para visualizar los resultados, el software proyectó el resultado en un mapa de Google Earth. Resultados Entre enero de 2014 y diciembre de 2018, se evaluaron un total de 8.990 casos de hipospadias en Colombia. La distribución geográfica en el territorio nacional tiene áreas con mayor concentración de la atención de pacientes con hipospadias, al igual que áreas sin atención de esta condicion. En promedio, los departamentos donde se evaluaron la mayoría de los casos durante el período de estudio fueron Bogotá, D.C., Antioquia, y Valle del Cauca (439.2, 363.6, y 230.2, respectivamente). El análisis estadístico de la exploración espacial ([Figura 1]) identificó el área con la mayor concentración de casos (rojo) y las áreas donde se evaluó el menor número de pacientes (azul). La distribución geográfica mostró tendencias crecientes en áreas cercanas al centro del país, especialmente en las ciudades de Bogotá, Cali, Ibagué y Pereira. Conclusiones Existe una mayor concentración de casos evaluados en el centro del país, donde se encuentran las ciudades con un mejor acceso a atención médica subespecializada. Esto pone de relieve las desigualdades en el acceso a los servicios de salud y la oportunidad de atención quirúrgica entre las regiones del país. Si consideramos que las tasas de prevalencia de hipospadias permanecen estables, aproximadamente el 87% de los pacientes con hipospadias no serán evaluados por un subespecialista.

Compensation of Presbyopia With the Light Sword Lens.

Purpose: We present the first physiological evaluation of the use of the light sword lens (LSL) for presbyopia compensation. The LSL is an axially asymmetric optical element designed for imaging with extended depth of focus. Methods: A monocular visual simulator setup is implemented to measure visual acuity (VA). Physiological presbyopia is "mimicked" in human subjects by paralysis of the ciliary muscle, using topical application of a muscarinic antagonist. The effect of a contact lens-configured LSL on the mimicked presbyopia visual system is evaluated by measuring VA as a function of target vergence. The ability of the LSL to compensate presbyopia for 2 photopic luminance values was also analyzed. Results: The average VA values for 11 subjects suggest that the LSL can compensate for presbyopia across a wide range of target vergences for which the LSL was designed (-3 to 0 D). However, the proposed corrector element causes a loss of distance VA. The mean logMAR VA in that target vergence range was 0.07. The VA curves also show that luminance does not affect the expected behavior of the LSL-corrected presbyopic eye. Conclusions: These results indicate that the LSL has significant potential as a visual aid for presbyopia.

Assessment of imaging with extended depth-of-field by means of the light sword lens in terms of visual acuity scale.

We present outcomes of an imaging experiment using the refractive light sword lens (LSL) as a contact lens in an optical system that serves as a simplified model of the presbyopic eye. The results show that the LSL produces significant improvements in visual acuity of the simplified presbyopic eye model over a wide range of defocus. Therefore, this element can be an interesting alternative for the multifocal contact and intraocular lenses currently used in ophthalmology. The second part of the article discusses possible modifications of the LSL profile in order to render it more suitable for fabrication and ophthalmological applications.

Psicoterapia de constructos personales: intervención centrada en dilemas en un caso de ansiedad generalizada / Psychotherapy of personal constructs: intervention focused on dilemmas in a case of generalized anxiety

Esta presentación de caso, expone una intervención de Constructos Personales centrada en dilemas implicativos en una adolescente de 16 años de la ciudad de Medellín diagnosticada con Porfiria Aguda Intermitente de acuerdo con la Clasificación Internacional de Enfermedades (CIE 10) y con Trastorno De Ansiedad Generalizada (TAG) acorde a los criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales, quinta edición (DSM 5). El proceso terapéutico se desarrolló en deciseís sesiones, teniendo como punto de referencia los parámetros propuestos por Senra, Feixas y Fernandes (2005), quienes plantean un protocolo general para el abordaje de estructuras dilemáticas, igualmente se consideró la elaboración posterior de Feixas y Compañ (2015) para el diseño del proceso terapéutico. Se definieron los dilemas implicativos a partir de la entrevista, la técnica de rejilla y la autocaracterización (Kelly, 1955). Durante la psicoterapia se abordaron dos de las configuraciones dilemáticas, las cuales se relacionaban con competencia personal e interacción social. En la etapa de finalización del tratamiento se evidenciaron cambios significativos a nivel del sistema de construcciones personales tales como el aumento de la autoestima, mayor percepción de cercanía con las personas significativas, así como una mayor adecuación de éstos a sus construcciones valoradas, transformaciones cuantificadas gracias a la Técnica de Rejilla de Kelly. Igualmente, a nivel sintomático se lograron cambios notables, partiendo de la comparación de las mediciones pre-post tratamiento obtenidas con el inventario de ansiedad y depresión de Beck (BAI, BDI II). Estos resultados aportan evidencia a la Psicología de Constructos Personales, confirmando hallazgos anteriormente expuestos en la literatura científica.

This case presentation exposes an intervention of personal constructs, focused on implicative dilemmas in a 16-year-old girl from Medellin diagnosed with intermittent acute porphyria (AIP) according to the International Classification of Diseases (ICD 10) and with disorder of generalized anxiety (DGA) according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5). The therapeutic process was developed in sixteen sessions, having as reference the parameters proposed by Senra, Feixas, and Fernandes (2005), who propose a general protocol for the approach of dilemmatic structures, the subsequent elaboration of Feixas and Compañ was also considered (2015) for the design of the therapeutic process. The implicative dilemmas were defined from the interview, the grid technique and the self-characterization (Kelly, 1955). During psychotherapy, two of the dilemmatic configurations were addressed, which related to personal competence and social interaction. In the stage of completion of the treatment, significant changes were evidenced at the level of the personal construction system such as the increase of self-esteem, greater perception of closeness with significant people, as well as, a greater adaptation of these to their value constructions; quantified transformations thanks to Kelly's Grid Technique. Similarly, significant changes were achieved at the symptomatic level, based on the comparison of pre-post treatment measurements obtained with Beck's anxiety and depression inventory (BAI, BDI II). These results provide evidence to the psychology of personal constructs, which confirms findings previously exposed in the scientific literature.

Night myopia studied with an adaptive optics visual analyzer.

PURPOSE: Eyes with distant objects in focus in daylight are thought to become myopic in dim light. This phenomenon, often called "night myopia" has been studied extensively for several decades. However, despite its general acceptance, its magnitude and causes are still controversial. A series of experiments were performed to understand night myopia in greater detail. METHODS: We used an adaptive optics instrument operating in invisible infrared light to elucidate the actual magnitude of night myopia and its main causes. The experimental setup allowed the manipulation of the eye's aberrations (and particularly spherical aberration) as well as the use of monochromatic and polychromatic stimuli. Eight subjects with normal vision monocularly determined their best focus position subjectively for a Maltese cross stimulus at different levels of luminance, from the baseline condition of 20 cd/m(2) to the lowest luminance of 22 × 10(-6) cd/m(2). While subjects performed the focusing tasks, their eye's defocus and aberrations were continuously measured with the 1050-nm Hartmann-Shack sensor incorporated in the adaptive optics instrument. The experiment was repeated for a variety of controlled conditions incorporating specific aberrations of the eye and chromatic content of the stimuli. RESULTS: We found large inter-subject variability and an average of -0.8 D myopic shift for low light conditions. The main cause responsible for night myopia was the accommodation shift occurring at low light levels. Other factors, traditionally suggested to explain night myopia, such as chromatic and spherical aberrations, have a much smaller effect in this mechanism. CONCLUSIONS: An adaptive optics visual analyzer was applied to study the phenomenon of night myopia. We found that the defocus shift occurring in dim light is mainly due to accommodation errors.

Obstrucción intestinal por semillas de Vasconcellea: reporte de tres casos y revisión de la literatura / Intestinal obstruction due to Vasconcellea seeds: Report of three cases and literature review / Obstrução intestinal por sementes de Vasconcellea: reporte de três casos e revisão da literatura

Vasconcellea spp., es una especie de papaya andina que crece en las áreas rurales cerca a Medellín, Colombia. Debido al agradable y dulce sabor de sus frutos, con frecuencia los niños ingieren accidentalmente sus semillas. Luego de la ingestión, las semillas se engranan en la luz del colon y obstruyen la salida de la materia fecal, lo que causa dolor y distensión abdominal, y favorece la translocación bacteriana. El diagnóstico se basa en la historia clínica y el tacto rectal. El tratamiento depende del grado de afectación local y sistémica e incluye la desimpactación del contenido rectal bajo anestesia general y lavados del colon con solución salina al 0,9%. En los casos más graves se ha requerido colostomía derivativa. En la literatura médica no existen reportes de obstrucción intestinal por semillas de Vasconcellea, posiblemente porque se han confundido con las del género Carica. En este artículo se describen tres casos tratados en servicios pediátricos de Medellín en los años 2012 y 2013; observamos que es una entidad poco sospechada, lo que lleva a un diagnóstico tardío con posibles consecuencias catastróficas. Es importante educar a la población para prevenir la ingestión de las semillas.

Vasconcellea spp., is a species of Andean papaya commonly cultivated in rural communities close to Medellín, Colombia. Due to the pleasant and sweet flavor of its fruits, children frequently ingest its seeds accidentally. After ingestion, the seeds are engaged in the colonic lumen and block the exit of stools, causing pain and bloating, and promoting bacterial translocation. Diagnosis is based on clinical history and rectal examination. Treatment depends on the degree of local and systemic involvement and includes disimpaction of rectal contents under general anesthesia and colonic washes with 0.9% saline solution. In severe cases derivative colostomy has been required. In the literature there are no reports of intestinal obstruction due to Vasconcellea seeds, possibly because it has been mistaken for seeds of the genus Carica. In this article, three cases treated at pediatric services in Medellín, Colombia, in 2012 and 2013 are described. We note that this is a rarely suspected disease, leading to late diagnosis and potential catastrophic consequences. It is important to educate people to prevent the ingestion of the seeds.

Vasconcellea spp., é uma espécie de mamão papaia andino que cresce nas áreas rurais perto a Medellín, Colômbia. Devido ao agradável e doce sabor de seus frutos, com frequência as crianças ingerem acidentalmente suas sementes. Depois da ingestão, as sementes se engrenam na luz do cólon e obstruem a saída da matéria fecal, o que causa dor e distensão abdominal, e favorece a translocação bacteriana. O diagnóstico se baseia na história clínica e o tato retal. O tratamento depende do grau de afetação local e sistémica e inclui a desimpactação do conteúdo retal sob anestesia geral e lavagens do cólon com solução salina a 0,9%. Nos casos mais graves foi necessário colostomia derivativa. Na literatura médica não existem reportes de obstrução intestinal por sementes de Vasconcellea, possivelmente porque se confundiram com as do gênero Carica. Neste artigo se descrevem três casos tratados em serviços pediátricos de Medellín nos anos 2012 e 2013; observamos que é uma entidade pouco suspeitada, o que leva a um diagnóstico tardio com possíveis consequências catastróficas. É importante educar à população para prevenir a ingestão das sementes.

Epidemiología de la sepsis en pediatría: primer estudio colombiano multicéntrico / Epidemiology of sepsis in pediatrics: first colombiam multicenter survey

En el año 2002 la campaña Sobreviviendo a la Sepsis estableció algunos lineamientos para disminuir la elevada mortalidad en el mundo por la sepsis. Entre estos lineamientos se encuentra la recomendación para reconocer que la sepsis es una enfermedad que causa probablemente muchas muertes y un alto costo de atención en las unidades de cuidado intensivo pediátrico. Conocer sobre el comportamiento de este padecimiento probablemente sea el primer paso para poder impactarla. En el mundo hay pocos estudios de la epidemiología de la sepsis en niños y, en Colombia, menos aun. Quizá el estudio realizado en Estados Unidos en los años noventa sea de los más representativos. En Latinoamérica, especialmente en Brasil. Se han desarrollado también algunos estudios sobre la epidemiología de la enfermedad. Los autores se proponen iniciar un estudio multicéntrico sobre la epidemiología de la sepsis pediátrica en Colombia, por lo que se ha diseñado una página en Internet www.sepsisencolombia.com. para la recolección de los datos y la actualización permanentemente a la comunidad científica local en este tema.

In 2002, the Surviving sepsis campaign defined a strategy that aimed to reduce the high mortality due to sepsis. One point of this strategy was a recommendation to recognize that the sepsis is an important cause of deaths and high economic costs in the pediatric intensive care units. Knowledge of the disease is the first step to impact it. There are few studies of the sepsis epidemiology in the world children, and even less in Colombia. Maybe, the most important study in this field was developed in the United States in the nineties. In Latin-America there are others studies, especially in Brazil, but none in Colombia. The authors pretend to do a multicenter study about the epidemiology of the pediatric sepsis in Colombia. A web site has been designed to collect data and to give up-to-date information to the local scientific community about this topic: www.sepsisencolombia.com.

Toxoplasmosis congénita: aspectos clínicos y epidemiológicos de la infección durante el embarazo / Congenital toxoplasmosis: clinical and epidemiological aspects of the infection during pregnancy

Se presenta una revisión actualizada sobre la toxoplasmosis durante el embarazo y de su consecuencia la toxoplasmosis congénita. Se pretende ilustrar a los profesionales de la salud con los diferentes aspectos tanto epidemiológicos como clínicos concernientes a esta enfermedad. Se revisan conceptos actuales de la parasitología y de la epidemiología de la transmisión materno-fetal, así como la presentación clínica de la infección perinatal. Se discuten nuevos adelantos en el diagnóstico y su influencia en el tratamiento de la mujer embarazada, del feto y del recién nacido. También se discuten las controversias recientes sobre las diversas estrategias de prevención primaria y secundaria durante el embarazo.

We present an updated review on toxoplasmosis during the pregnancy and its more feared outcome, the damage to the fetus and the newborn. The scope of this review is to summarize current and important epidemiological and clinical aspects concerning this disease. Several new parasitological and epidemiological concepts are reviewed, as well as the clinical presentation of the perinatal infection. In addition, we discussed current diagnostic approaches and treatment of the pregnant woman, fetus and newborn. Recent controversies on the different strategies for primary and secondary prevention of toxoplasmosis during the pregnancy are also discussed.

Guía de práctica clínica para toxoplasmosis durante el embarazo y toxoplasmosis congénita en Colombia: [revisión] / Clinical practice guidelines for toxoplasmosis during pregnancy and congenital toxoplasmosis in Colombia: [review]

La toxoplasmosis congénita puede llevar a serias consecuencias en el desarrollo neurológico y en la salud visual del niño y es, en la mayoría de casos, el resultado de una infección primaria en una mujer inmunocompetente que se encuentre embarazada. El médico responsable del control prenatal requiere, entonces, de unas guías de manejo que le permitan establecer, de acuerdo con la mejor evidencia posible, el riesgo de una mujer en gestación, asesorar, prevenir y tomar decisiones importantes sobre:1. La indicación de la realización de pruebas de laboratorio para el diagnóstico de infección...

Efecto de la dieta en el resultado perinatal de la paciente obesa embarazada

En un estudio propectivo randomizado se estudian 60 pacientes obesas divididas en grupos de 20 pacientes de acuerdo con el porcentaje de obesidad en: 20-29 por ciento; 30-39 por ciento y 40 por ciento de sobrepeso. A la mitad de los pacientes se les instaura dieta similar a la usada en la diabética gestacional. La otra mitad se le administra dieta libre y sirve de control. Se determina peso del R.N, morbimortalidad fetal y materna. No se encontró diferencia en el peso del R.N; la incidencia de macrosómicos es similar en ambos grupos (13.3 por ciento). No se presentó mortalidad materna ni fetal en ninguno de los grupos. La incidencia de césareas por fetos grandes para la edad gestacional en el grupo estudio vs. grupo control fue de 38.4 por ciento vs. 53.8 por ciento y los antecedentes de familiares de diabetes son más frecuentes a medida que aumenta la obesidad. En los tres grupos de obesidad del grupo estudio se encontró correlación entre el peso del RN y la edad gestacional, contrario a lo encontrado con el grupo control. Se concluye que aunque en este estudio no hay diferencia en la morbimortalidad materna-fetal, ni en el peso del RN, con relación a recibir a recibir o no dieta, ésta es benéfica en la regulación del metabolismo energético fetal que lo lleva a adquirir uan relación normal del creciemiento fetal