Aplicabilidad de modelos predictivos de falla renal en enfermedad renal crónica: una revisión de alcance / Usability of predictive models of kidney failure in chronic kidney disease: a scoping review

Resumen Introducción: la identificación de los pacientes con mayor riesgo de progresar a falla renal es fundamental para la planeación del tratamiento en la enfermedad renal crónica, pero no ha podido llevarse a cabo consistentemente. Los modelos de predicción podrían ser una herramienta útil, sin embargo, su usabilidad en la Enfermedad Renal Crónica es limitada hasta ahora y no se comprenden muy bien las barreras y limitaciones. Métodos: se desarrolló una revisión de alcance de la literatura disponible sobre modelos predictivos de falla renal o reglas de pronóstico en pacientes con Enfermedad Renal Crónica. Las búsquedas se realizaron sistemáticamente en Cochrane, Pubmed y Embase. Se realizó una revisión ciega e independiente por dos evaluadores para identificar estudios que informaran sobre el desarrollo, la validación o la evaluación del impacto de un modelo construido para predecir la progresión al estadio avanzado de la enfermedad renal crónica. Se realizó una evaluación crítica de la calidad de la evidencia proporcionada con el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: de 1279 artículos encontrados, fueron incluidos 19 estudios para la síntesis cualitativa final. La mayoría de los estudios eran primarios, con diseños observacionales retrospectivos y unos pocos correspondieron a revisiones sistemáticas. No se encontraron guías de práctica clínica. La síntesis cualitativa evidenció gran heterogeneidad en el desarrollo de los modelos, así como en el reporte de las medidas de desempeño global, la validez interna y la falta de validez externa en la mayoría de los estudios. La calificación de la evidencia arrojó una calidad global baja, con inconsistencia entre los estudios e importantes limitaciones metodológicas. Conclusiones: la mayoría de los modelos predictivos disponibles, no han sido adecuadamente validados y, por tanto, se consideran de uso limitado para evaluar el pronóstico individual del paciente con enfermedad renal crónica. Por lo tanto, se requieren esfuerzos adicionales para centrar el desarrollo e implementación de modelos predictivos en la validez externa y la usabilidad y disminuir la brecha entre la generación, la síntesis de evidencia y la toma de decisiones en el ámbito del cuidado del paciente.

Abstract Background: the identification of patients at higher risk of progressing to kidney failure is essential for treatment planning in chronic kidney disease, but it has not been possible to do this consistently. Predictive models could be a useful tool, however, their usability in chronic kidney disease is limited and the barriers and limitations are not well understood. Methods: a scoping review of the available literature on ESRD predictive models or prognostic rules in chronic kidney disease patients was developed. Searches were systematically executed on Cochrane, MEDLINE, and Embase. a blind and independent review was carried out by two evaluators to identify studies that reported on the development, validation, or impact assessment of a model constructed to predict the progression to an advanced stage of chronic kidney disease. A critical evaluation of the quality of the evidence provided with the GRADE system (Grading of Recommendations Assessment, Development and Evaluation) was made. Findings: of 1279 articles found, 19 studies were included for the final qualitative synthesis. Most of the studies were primary, with retrospective observational designs and a few corresponded to systematic reviews. No clinical practice guidelines were found. The qualitative synthesis showed high heterogeneity in the development of the models, as well as in the reporting of global performance measures, internal validity, and the lack of external validity in most of the studies. The evidence rating was of low overall quality, with inconsistency between studies and important methodological limitations. Conclusions: most of the available predictive models have not been adequately validated and, therefore, are of limited use to assess the individual prognosis of patients with chronic kidney disease. Therefore, additional efforts are required to focus the development and implementation of predictive models on external validity and usability and bridge the gap between generation, synthesis of evidence, and decision-making in the field of patient care.

Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents.

BACKGROUND: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. METHODS: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. RESULTS: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. CONCLUSIONS: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

Factores asociados con inadecuados depósitos de hierro en mujeres en primer trimestre de gestación

RESUMEN Introducción: niveles bajos de ferritina sérica en la gestación se asocian con inadecuados depósitos de hierro, lo cual puede producir anemia, y aumentar el riesgo de mortalidad materna, parto prematuro y deficiencias a largo plazo en el desarrollo cognitivo del neonato. Objetivo: determinar la relación entre factores demográficos, económicos, familiares y de seguridad alimentaria con los inadecuados depósitos de hierro en mujeres en primer trimestre de gestación. Métodos: estudio descriptivo transversal, con 664 mujeres en primer trimestre de gestación. Depósitos de hierro inadecuados se definieron como una concentración de ferritina sérica <30 μg/L. Se estimó la prueba chi cuadrado, se calcularon odds ratio crudas y ajustadas mediante regresión logística binaria. Resultados: La proporción de mujeres con depósitos de hierro inadecuados fue de 32%, promedio geométrico de ferritina de 39,2 μg/L (rango 38,4 - 40,0 μg/L) Las gestantes que no deseaban el embarazo, tuvieron 1,1 veces más posibilidad de tener inadecuados depósitos de hierro comparado con las que si lo deseaban (OR= 2,10 IC95% 1,18-3,74). La inseguridad alimentaria incrementó en un 47% la probabilidad de tener inadecuados depósitos de hierro (OR= 1,47 IC95% 1,02-2,13). El apoyo familiar redujo en un 61% la probabilidad de inadecuados depósitos de hierro (OR= 0,39 IC95% 0,19-0,78). Conclusión: Una de cada tres mujeres presentó inadecuados niveles séricos de ferritina, lo cual se asoció principalmente con factores socioeconómicos y familiares, esto sugiere la necesidad de considerar otros aspectos no clínicos en las intervenciones que se hacen antes del embarazo para mejorar las reservas de hierro.

ABSTRACT Introduction: Low levels of serum ferritin in pregnancy are associated with inadequate iron stores, which can cause anemia and increase the risk of maternal mortality, premature delivery, and long-term deficiencies in the cognitive development of the newborn. Objective: To determine the relationship between demographic, economic, family and food security factors with inadequate iron stores in women in the first trimester of pregnancy. Methods: Descriptive cross-sectional study with 664 women in the first trimester of pregnancy. Inadequate iron stores were defined as a serum ferritin concentration <30 μg / L. The chi-square test was estimated, crude and adjusted odds ratios were calculated using binary logistic regression. Results: The proportion of women with inadequate iron stores was 32%, geometric average of ferritin 39.2 μg/L (rank 38.4 - 40.0 μg/L). Pregnant women who did not want a pregnancy were 1.1 times more likely to have inadequate iron stores compared to those who did (OR= 2.10; 95% CI 1.18-3.74). Food insecurity increased the probability of having inadequate iron stores by 47% (OR= 1.47; 95% CI: 1.02-2.13). Family support reduced the probability of inadequate iron stores by 61% (OR= 0.39; 95% CI 0.19-0.78). Conclusion: One in three women presented inadequate levels of serum ferritin, which was mainly associated with socioeconomic and family factors, this suggests the need to consider other non-clinical aspects in the interventions carried out before pregnancy to improve iron stores.

Oncological Follow-up with 2-[18F]-FDG PET/CT in Li-Fraumeni Syndrome

Li-Fraumeni syndrome is a rare disorder caused by abnormalities of the tumor-suppressor protein P53 gene. We present the case of a 26-years-old female diagnosed with bilateral ductal carcinoma. The genetic panel for breast cancer gene 1 (BRCA1) and BRCA2 mutations was negative and positive heterozygous germline tumor protein P53 gene mutations, considering Li-Fraumeni syndrome. A 2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was used for postsurgical staging to show the right lung hypermetabolic nodule. A lobectomy was accomplished, and histopathology reported pulmonary adenocarcinoma. A year later, oncological follow-up was conducted with 2-[18F]-FDG PET/CT without evidence of abnormalities.

Tocilizumab in giant cell arteritis: differences between the GiACTA trial and a multicentre series of patients from the clinical practice.

OBJECTIVES: A potential point of concern among clinicians is whether results derived from the clinical trials can be reasonably applied or generalised to a definable group of patients seen in real world. It can be the case of the GiACTA study that is a phase III randomised controlled trial of tocilizumab (TCZ) in giant cell arteritis (GCA). To address this question, we compared the clinical features and the responses to TCZ from the GiACTA trial patients with those from a series of GCA seen in the daily clinical practice. METHODS: Comparative study of clinical features between patients from the GiACTA trial (overall n=251) and those from a multicentre series of real-world GCA patients undergoing TCZ therapy (n=134). The diagnosis of GCA in the GiACTA trial was established by the ACR modified criteria whereas in the series of real-world patients it was made by using the ACR criteria, a positive biopsy of temporal artery or the presence of imaging techniques consistent with large-vessel vasculitis in individuals who presented cranial symptoms of GCA. GiACTA trial patients received subcutaneous TCZ (162 mg every 1 or 2 weeks) whereas those from the clinical practice series were treated using standard IV dose (8 mg/kg/month) or subcutaneous (162 mg/week). RESULTS: Real-life patients undergoing TCZ were older with longer disease duration and higher values of ESR and had received conventional immunosuppressive therapy (mainly methotrexate) more commonly than those included in the GiACTA trial. Despite clinical differences, TCZ was equally effective in both GiACTA trial and clinical practice patients. However, serious infections were more commonly observed in GCA patients recruited from the clinical practice. CONCLUSIONS: Despite clinical differences with patients recruited in clinical trials, data from real-life patients confirm the efficacy of TCZ in GCA.

Contaminación por mercurio de leche materna de madres lactantes de municipios de Antioquia con explotación minera de oro / Mercury contamination in breast milk of nursing mothers in gold mining municipalities of Antioquia, Colombia

Resumen Introducción. La leche materna es esencial para el desarrollo del ser humano, pero puede contener sustancias tóxicas provenientes de la contaminación ambiental, especialmente en las áreas mineras. Objetivo. Determinar la prevalencia de la contaminación con mercurio de la leche materna de mujeres lactantes residentes en los municipios con explotación minera de oro. Materiales y métodos. Se hizo un estudio transversal de 150 madres lactantes de cuatro municipios mineros de Antioquia (El Bagre, Segovia, Remedios y Zaragoza), a quienes se les hizo una encuesta sobre factores sociodemográficos, ocupacionales y ambientales relacionados con el mercurio, y se les tomaron muestras de leche materna, de orina y de cabello. Se calculó el promedio de la concentración de mercurio y las prevalencias municipales de contaminación. Resultados. El promedio de la concentración de mercurio en la leche materna fue de 2,5 (± desviación estándar 9,2) µg/L. La prevalencia de muestras de leche materna con niveles altos de mercurio fue de 11,7 %. Conclusión. En este estudio se evidencia un grave problema en las regiones mineras auríferas de Antioquia por el efecto de la contaminación con mercurio en sectores de la población más vulnerable.

Abastract Introduction: Breast milk is essential for human development, but it may contain toxics derived from environmental pollution, especially in mining areas. Objective: To assess the prevalence of mercury contamination in breast milk and factors associated with its transfer to nursing mothers living in municipalities with gold mining. Materials and methods: We conducted a cross-sectional study with 150 nursing mothers in four municipalities of Antioquia (El Bagre, Segovia, Remedios and Zaragoza) with a mining tradition. We surveyed these mothers to obtain information on their sociodemographic, occupational and environmental factors related to mercury, and we took breast milk, urine and hair samples. We calculated mercury level averages and the contamination prevalence per municipality. Results: Mercury average in breast milk was 2.5 (± standard deviation: 9.2) mg/L. The prevalence of mercury contamination in samples with a high level of mercury was 11.7%. Conclusion: This study shows that there is a serious problem of mercury contamination in gold mining regions of Antioquia, with significant involvement of the most vulnerable population.

Índice de vulnerabilidad de adultos mayores en Medellín, Barranquilla y Pasto / Index of vulnerability of elderly people in Medellín, Barranquilla, and Pasto

Resumen Introducción. La vulnerabilidad puede entenderse como la carencia de recursos materiales e inmateriales que impide el aprovechamiento de oportunidades en distintos aspectos de la vida. Estos recursos de bienestar evitan el deterioro de la calidad de vida. Objetivo. Construir un índice de vulnerabilidad con las características de los capitales físico, humano, social y funcional de los adultos mayores de tres ciudades de Colombia en el 2016, y determinar los factores asociados con esta condición. Materiales y métodos. Se hizo un estudio transversal con información primaria mediante 1.514 encuestas a personas de 60 años omásde Medellín, Barranquilla y Pasto. En la construcción del índice se usó el análisis factorial con losmétodos de componentes principales y de rotación ortogonal varimax. Resultados. Las condiciones que generaban vulnerabilidad se relacionaron principalmente con el capital humano (calidad de vida, salud mental y hábitos); los demás capitales aportaron un solo componente, así: capital físico (ocupación), capital social (acompañamiento) y capital funcional (independencia funcional). La vulnerabilidad fue mayor en los residentes de Pasto. Los factores asociados con la vulnerabilidad fueron la ciudad de residencia, el sexo, el nivel educativo y el rol en el hogar. Conclusión. En el 58,55 % de las personas mayores, la vulnerabilidad se explicó por el uso del tiempo, la independencia funcional y el bienestar subjetivo. Estos hallazgos aportan elementos para el mejoramiento de la calidad de vida, principalmente en cuanto a la capacidad funcional para mantener la independencia, estar ocupados y fortalecer la salud mental.

Abstract Introduction: Vulnerability can be defined as a lack of material and immaterial resources, which prevents the use of opportunities that may advance one's self-interest. The presence of these welfare resources prevents reductions in the quality of life. Objective: The objective of this study was to build an index of vulnerability using characteristics of the physical, human, social and functional capital of adults in three cities of Colombia in the year 2016 and to determine the factors that contribute most to vulnerability. Materials and methods: We conducted a transversal study with primary information sources applying 1,514 surveys among people aged 60 years and over in Medellín, Barranquilla, and Pasto. For the construction of the vulnerability index, we used factor analysis with varimax rotation and the principal component method. Results: The conditions that lead to a person's vulnerability were related mainly to human capital (quality of life, mental health and habits). The other types of capital that contributed to vulnerability were physical capital (occupation), social capital (accompaniment), and functional capital (functional independence). The highest vulnerability was registered among the residents of Pasto. The factors associated with vulnerability were the city of residence, the sex, the educational level and the role of the person in the home. Conclusion: In 58.55% of elderly people vulnerability was explained by the use of time, the functional independence and the subjective well-being. These findings contribute to the improvement of the quality of life, mainly those related to maintaining functional independence as long as possible, being occupied, improving mental health, and avoiding the risks of depression, anxiety, cognitive deterioration and deleterious habits.

Malnutrición por exceso y déficit en niños, niñas y adolescentes, departamento de Antioquia 2015 / Malnutrition by excess and deficiency in children and adolescents, department of Antioquia 2015 / Nutrição deficiente por ingestão excessiva ou exígua em crianças e adolescentes, Departamento de Antioquia 2015

Resumen Objetivo: determinar la prevalencia de malnutrición por exceso y déficit en menores de 17 años del departamento de Antioquia por subregión y municipio. Metodología:estudio transversal con fuente secundaria basado en la información de un estudio poblacional en el departamento de Antioquia. Se calcularon los indicadores de malnutrición por déficit y exceso según peso para la talla, índice de masa corporal (IMC) y talla para la edad y se exploró la asociación conjunta de variables de persona y lugar a través de una regresión multinomial sobre los indicadores mencionados. Resultados y discusión:el riesgo de malnutrición por exceso según el peso para la talla fue del 23% y el de déficit del 7,6%; según el IMC el riesgo de malnutrición por exceso fue del 25,6% y el de déficit del 17,7%. La subregión con mayor riesgo de malnutrición por déficit fue Occidente, 37% siendo Peque el municipio más prevalente, 60,4% en contraste con el Valle de Aburrá que fue la subregión con mayor malnutrición por exceso, donde se destacó el municipio de Titiribí, 46,3%. La malnutrición fue más prevalente los niños hombres menores de 17 años, con asiento en la zona urbana, alimentación insana cuya familia tenía ingresos por debajo de salario mínimo legal vigente para el año 2014 Conclusiones:se deben priorizar intervenciones nutricionales en los menores de 17 años en salud pública en los municipios de la subregión del occidente y del Valle de la Aburrá, especialmente en Peque y Titiribí, donde la malnutrición por déficit y exceso fue mayor.

Abstract Objective: to determine the prevalence of malnutrition by excess and deficiency in children under 17 in the department of Antioquia by subregions and municipalities. Methodology: a cross-sectional study with secondary data sources based on the information retrieved from a population-based study in the department of Antioquia. The indicators of malnutrition by excess and deficiency were calculated based on weight-for-height, body mass index (BMI) and height-for-age. In addition, the joint association of person and place variables was explored through a multinomial regression for the indicators mentioned. Results and discussion: the risk of malnutrition by excess according to weight-for-height values was 23%, and the deficiency 7.6%; according to BMI values, the risk of malnutrition by excess was 25.6% and the deficiency 17.7%. The western subregion had the highest risk of malnutrition by deficiency (37%); in this area, Peque was the municipality with the highest prevalence (60.4%). In contrast, the Aburrá Valley was the subregion with the highest values for malnutrition by excess, where the municipality of Titiribí stood out with 46.3%. Malnutrition was more prevalent among male children under 17 living in urban areas, with unhealthy diets and families with incomes below the current legal minimum wage for the year 2014. Conclusions:it is necessary for public health to prioritize nutrition interventions targeting children under 17 in the municipalities of the western and Valle Aburrá subregions, especially at Peque and Titiribí, where malnutrition by deficit and excess was greater.

Resumo Objetivo: determinar a prevalência de nutrição deficiente por ingestão excessiva ou exígua em menores de 17 anos do Departamento de Antioquia, nas sub-regiões e municípios. Metodologia: estudo transversal com fonte secundária, baseado na informação de uma pesquisa populacional no Departamento de Antioquia. Calcularam-se indicadores de nutrição deficiente por exigüidade e por excesso segundo a altura e os quilogramas, o Índice de Massa Corporal, e a altura para a idade. Também explorou-se a associação conjunta de variáveis de pessoa e lugar, através de uma regressão multinomial sobre os indicadores mencionados. Resultados e discussão: o risco de nutrição deficiente por excesso segundo os quilogramas para a altura foi de 23%, e o risco de nutrição deficiente por exigüidade foi de 7,6%. Segundo o IMC, o risco de nutrição deficiente por excesso foi de 25,6% e por exigüidade de 17,7%. A sub-região de mais alto risco de nutrição deficiente por exigüidade foi Ocidente, com 37%, sendo Peque o município mais prevalente, com 60,4%. Em contraste, El Valle de Aburrá foi a sub-região com maior prevalência de nutrição deficiente por excesso, destacando o município de Titiribí, com 46,3%. A nutrição deficiente mais prevalente foi nos sujeitos masculinos menores de 17 anos que moravam nas áreas urbanas, com alimentação insalubre e família com renda menor ao salário mínimo legal do ano 2014. Conclusões: Deve dar-se prioridade às intervenções nutricionais nos menores de 17 anos nos programas de saúde pública dos municípios da sub-região Ocidente e Valle de Aburrá, especialmente em Peque e Titiribí, onde a nutrição deficiente por exigüidade e excesso foi mais alta.

A novel pathogenic variant in PRF1 associated with hemophagocytic lymphohistiocytosis.

Familial Hemophagocytic Lymphohistiocytosis type 2 (FHL2) results from mutations in PRF1. We described two unrelated individuals who presented with FHL, in whom severely impaired NK cytotoxicity and decrease perforin expression was observed. DNA sequencing of PRF1 demonstrated that both were not only heterozygous for the p.54R > C/91A > V haplotype but also presented with the novel variant p.47G > V at the perforin protein. Perforin mRNA was found to be increased in a individual with that genotype. A carrier of the novel variant also demonstrated altered perforin mRNA and protein expression. Phylogenetic analysis and multiple alignments with perforin orthologous demonstrated a high level of conservation at Gly47. PolyPhen-2 and PROVEAN predicted p.47G > V to be "probably damaging" and "deleterious", respectively. A thermodynamic analysis showed that this variant was highly stabilizing, decreasing the protein internal energy. The ab initio perforin molecular modeling indicated that Gly47 is buried inside the hydrophobic core of the MACPF domain, which is crucial for the lytic pore formation and protein oligomerization. After the in silico induction of the p.47G > V mutation, Val47 increased the interactions with the surrounding amino acids due to its size and physical properties, avoiding a proper conformational change of the domain. To our knowledge, this is the first description supporting that p.47G > V is a pathogenic variant that in conjunction with p.54R > C/91A > V might result in the clinical phenotype of FHL2.

Using Twitter to Measure Public Discussion of Diseases: A Case Study.

BACKGROUND: Twitter is increasingly used to estimate disease prevalence, but such measurements can be biased, due to both biased sampling and inherent ambiguity of natural language. OBJECTIVE: We characterized the extent of these biases and how they vary with disease. METHODS: We correlated self-reported prevalence rates for 22 diseases from Experian's Simmons National Consumer Study (n=12,305) with the number of times these diseases were mentioned on Twitter during the same period (2012). We also identified and corrected for two types of bias present in Twitter data: (1) demographic variance between US Twitter users and the general US population; and (2) natural language ambiguity, which creates the possibility that mention of a disease name may not actually refer to the disease (eg, "heart attack" on Twitter often does not refer to myocardial infarction). We measured the correlation between disease prevalence and Twitter disease mentions both with and without bias correction. This allowed us to quantify each disease's overrepresentation or underrepresentation on Twitter, relative to its prevalence. RESULTS: Our sample included 80,680,449 tweets. Adjusting disease prevalence to correct for Twitter demographics more than doubles the correlation between Twitter disease mentions and disease prevalence in the general population (from .113 to .258, P <.001). In addition, diseases varied widely in how often mentions of their names on Twitter actually referred to the diseases, from 14.89% (3827/25,704) of instances (for stroke) to 99.92% (5044/5048) of instances (for arthritis). Applying ambiguity correction to our Twitter corpus achieves a correlation between disease mentions and prevalence of .208 ( P <.001). Simultaneously applying correction for both demographics and ambiguity more than triples the baseline correlation to .366 ( P <.001). Compared with prevalence rates, cancer appeared most overrepresented in Twitter, whereas high cholesterol appeared most underrepresented. CONCLUSIONS: Twitter is a potentially useful tool to measure public interest in and concerns about different diseases, but when comparing diseases, improvements can be made by adjusting for population demographics and word ambiguity.

Nivel de riesgo de consumo de alcohol en trabajadores de una empresa de servicios de transporte público de la ciudad de Medellín / Level of risk for alchohol consumption among the drivers of an urban public transportation company in Medellin

Objetivo: estudiar el nivel de riesgo de consumo de alcohol en conductores de una empresa de transporte público. Metodología: se realizó un estudio observacional de corte transversal en una muestra de 145 conductores en una empresa de transporte de Medellín Colombia. En ellos se aplicó una encuesta autodiligenciada que incluía datos sociodemográficos, de organización del trabajo y el test AUDIT para medir el nivel de riesgo de consumo de alcohol. Resultados: el perfil sociodemográfico, de organización del trabajo y los niveles de riesgo hallados coinciden con lo encontrado previamente en estudios nacionales e internacionales. En los resultados para el test de AUDIT, el 12,5% tenía un puntaje mayor o igual a 8, indicador global de un consumo de riesgo y perjudicial, y el 17% un puntaje que indicaba una problable dependencia. Conclusiones: con lo hallado en este estudio recomendamos la necesidad de continuar haciendo estudios que creen una línea base para diseñar una propuesta articulada que integre las acciones de cada uno de los actores del Sistema General de Seguridad Social, fundamentada en la politica de reducción del consumo de sustancias psicoactivas en la población trabajadora.

Objective: to study the level of risk for alcohol consumption among drivers from transportation company. Methodology: a cross-sectional study with a sample of 145 drivers from a transportation company in Medellín, Colombia. A self-survey was used that included socio-demographic data, work organization data, and the AUDIT test to measure the level of risk for alcohol consumption. Results: the socio-demographic and work organization profiles, together with the risk level values are consistent with the findings of previous national and international studies. The AUDIT test results showed that 12.5% of the subjects had a score greater then or equal to 8. This is a global indicator of risky and harmful consumption. Furthermore, the score of 17% of the subjects suggested probable dependece. Conclusion: this study´s findings suggest that further research is required in order to establish the grounds for designing a coordinated proposal integrating the actions of each of the Social Security for System´s actors. Such proposal should be based on the policy for decreasing consumptions of psychoactive substances in the working population.

Intoxicación por ácido nítrico: presentación de caso / Nitric acid Poisoning: case report

El ácido nítrico (HNO3) es un líquido corrosivo que al contacto con agentes reductores genera óxidos del nitrógeno, los cuales son responsables de la intoxicación inhalatoria. Presentamos dos casos de intoxicación por inhalación gases de ácido nítrico secundarios a exposición laboral. Los hallazgos imaginológicos fueron similares en ambos casos y compatibles con el síndrome de dificultad respiratoria del adulto: infiltrados alveolares, bilaterales y difusos en la radiografía de tórax y patrón en empedrado en la tomografía. Uno de los pacientes falleció y el otro evolucionó de manera satisfactoria después del manejo con N-acetil cisteína y ventilación mecánica. El diagnóstico de intoxicación por ácido nítrico fue hecho basado en el antecedente de exposición de estos pacientes y en la evolución de los hallazgos radiológicos.

Estudio dinámico del piso pélvico en pacientes con constipación: resonancia magnética dinámica frente a defecografía / Dynamic study of pelvic floor in patients with constipation: dynamic magnetic resonance vs. Defecography

Objetivo: evaluar la concordancia de los hallazgos de la defecografía y resonancia magnética en pacientes con constipación. Materiales y método: se diseñó un trabajo descriptivo prospectivodel tipo concordancia de una prueba diagnóstica. El estudio se hizo doble ciego con 17 pacientes. Resultados: los 17 pacientes eran de sexo femenino, con edades entre los 31 y 77 años. La duración de los síntomas varió entre 3 y 120 meses. El diagnóstico más frecuente fue el de rectocele (11 pacientes), y la resonancia magnética tuvo, para este diagnóstico, sensibilidad del 100%, especificidad del 50%...