Uso de inhaladores para la enfermedad pulmonar obstructiva crónica en un grupo de pacientes colombianos

Introducción: En Colombia son escasos los datos sobre el uso de los inhaladores en pacientes con EPOC. Objetivo: Describir la técnica de uso de inhaladores de dosis medida y polvo seco en pacientes de un hospital colombiano. Materiales y métodos: Estudio descriptivo en pacientes mayores de 40 años con EPOC atendidos en un hospital en La Virginia, Risaralda, Colombia, entre el 1 de septiembre de 2019 al 31 de enero de 2020. La unidad de análisis fueron los pacientes. Se incluyeron variables sociodemográficas, clínicas y lista de chequeo para uso de inhaladores. Se aplicaron frecuencias y proporciones para variables discretas, estadísticas de tendencia central y dispersión para variables continuas. Resultados: Se incluyeron 104 pacientes con edad media de 73,6 ± 10,1 años; 57 eran mujeres (54,8 %). Además, 48 pacientes estaban clasificados como GOLD-D (46,2 %). Igualmente, 89 pacientes manifestaron haber recibido educación sobre el uso de broncodilatadores (85,6 %). Los más frecuentes fueron los inhaladores de dosis medida (DM) en 95 casos (91,3 %), seguido de los de polvo seco unidosis (7,7 %). Así mismo, 37 pacientes que usaron DM sin inhalocámara (35,6 %) no cumplieron los pasos de la lista de chequeo. En el sistema multidosis, el más realizado fue cerrar de manera adecuada el inhalador y el menos ejecutado, expulsar el aire lentamente evitando hacerlo cerca del inhalador (n = 6; 5,7 %). Discusión: Se lograron describir las características de la técnica de uso de los inhaladores en pacientes con EPOC. A pesar de que ningún paciente logró utilizar el inhalador de forma "perfecta", la mayoría han recibido educación por parte de los profesionales de la salud. Conclusión: Un alto porcentaje de pacientes usa inadecuadamente los dispositivos para suministrar los broncodilatadores. Esto puede impactar negativamente en el control de la enfermedad.

Introduction: In Colombia, there is limited data on the use of inhalers in patients with COPD. Objective: The objective was to describe the technique of using metered-dose inhalers and dry powder in patients in a Colombian hospital. Methods: Observational, descriptive study of patients over 40 years of age with COPD, treated in a hospital in La Virginia, Risaralda, Colombia, between September 1st, 2019 and January 31st, 2020. The unit of analysis were patients in consultation. Sociodemographic and clinical variables, and a checklist for use of inhalers were included. Frequencies and proportions were applied for discrete variables, statistics of central tendency and dispersion for continuous variables. Results: A total of 104 patients with an average age of 73.6 ± 10.1 years were included; 57 were women (54.8%). In addition, 48 patients were classified as GOLD-D (46.2%). Similarly, 89 patients reported having received education on the use of bronchodilators (85.6%). The most common were metered-dose (MD) inhalers in 95 cases (91.3%), followed by single-dose dry powder inhalers in eight patients (7.7%). Likewise, 37 patients who used DM without inhalochamber (35.6%) did not comply with the steps of the checklist. In the multidose system, the most performed was to properly close the inhaler and the least performed was to expel the air slowly, avoiding doing so near the inhaler (n=6; 5.7%). Discussion: The characteristics of the technique of using inhalers in patients with COPD were described. Although no patient was able to use the inhaler "perfectly", most have received education from health professionals. Conclusion: A high percentage of patients misuse the devices to deliver bronchodilators. This can negatively impact the control of the disease.

Clinical and Endoscopic Characterization of Gastrointestinal Kaposi's Sarcoma in an Institution in Southwestern Colombia between 2011 and 2020

Kaposi's sarcoma is an angioproliferative neoplasm associated with the human herpesvirus 8. According to the clinical characteristics and the degree of immunosuppression, there are four epidemiological forms: classic, endemic, iatrogenic, and epidemic. The latter is associated with acquired immunodeficiency syndrome (AIDS) and 40% GI involvement. There is little epidemiological, clinical, and endoscopic evidence of the disease. This study sought to characterize this condition in a Colombian population and compare the findings with publications from other countries. One hundred thirty-five records of patients who consulted between 2011 and 2020 for Kaposi's sarcoma were reviewed, of which 24 had GI involvement. Epidemiological, clinical, endoscopic, and treatment characteristics were obtained. Twenty-two patients were men. There were 21 patients infected with human immunodeficiency virus (HIV; 87.5%) and 19 receiving antiretroviral therapy (90%); 33.3% had HIV viral load > 100,000 copies/mL. The CD4+ count was <50 cells/µL in 28.6% of cases, between 50 and 100 cells/µL in 19.0%, and between 100 and 200 cells/µL in 14.4%. The rate of infection by other opportunistic infections was 41.7%. There were GI symptoms in 33% of the patients, and the most frequent were hematochezia, abdominal pain, nausea, and diarrhea. Most had concomitant skin lesions (70.8%). GI lesions were located mainly in the oropharynx (41.7%), stomach (20.8%), and colon (16.7%). The most common endoscopic finding was maculopapular erythema. This article provided insight into the local epidemiology of gastrointestinal Kaposi's sarcoma. In contrast to studies in other populations, GI symptoms were more frequent in this one, and there was a difference in endoscopic findings. Studies with larger populations are needed.

El sarcoma de Kaposi es una neoplasia angioproliferativa asociada al virus del herpes humano 8. Según las características clínicas y el grado de inmunosupresión, son cuatro las formas epidemiológicas: clásica, endémica, iatrogénica y epidémica, esta última asociada al síndrome de inmunodeficiencia adquirida (SIDA) y con un 40% de compromiso gastrointestinal. Existe escasa evidencia epidemiológica, clínica y endoscópica de la enfermedad. Este estudio buscó caracterizar esta condición en una población colombiana y contrastar los hallazgos con publicaciones de otros países. Se revisaron 135 registros de pacientes que consultaron entre el 2011 y 2020 por sarcoma de Kaposi, de los cuales 24 tenían compromiso gastrointestinal. Se obtuvieron características epidemiológicas, clínicas, endoscópicas y tratamientos. Veintidós pacientes eran hombres. Hubo 21 pacientes infectados por virus de la inmunodeficiencia humana (VIH; 87,5%) y 19 recibían terapia antirretroviral (90%). El 33,3% tenía carga viral VIH > 100 000 copias/mL. El recuento de CD4+ fue < 50 cel/µL en el 28,6% de los casos, entre 50 y 100 cel/µL en el 19,0%, y entre 100 y 200 cel/µL en el 14,4%. La tasa de infecciones por otros oportunistas fue de 41,7%. Hubo síntomas gastrointestinales en el 33% de los pacientes y los más frecuentes fueron hematoquecia, dolor abdominal, náuseas y diarrea. La mayoría tuvo lesiones cutáneas concomitantes (70,8%). Las lesiones gastrointestinales se localizaron principalmente en la orofaringe (41,7%), estómago (20,8%) y colon (16,7%). El hallazgo endoscópico más común fue eritema maculopapular. Este artículo mostró una visión de la epidemiología local del sarcoma de Kaposi gastrointestinal. En contraste con estudios en otras poblaciones, en este, los síntomas gastrointestinales fueron más frecuentes y hubo diferencia en los hallazgos endoscópicos. Son necesarios estudios con poblaciones más grandes.

Recent Advances in the Gold-Catalyzed Reactions of Propargyl Esters.

ConspectusLate-transition-metal-based complexes represent an indispensable catalytic tool in chemical synthesis due to their ability to increase molecular complexity rapidly and efficiently from readily accessible substrates in a single operation. Added to this is the exquisite control of product chemo-, diastereo-, enantio-, and site-selectivities achieved by catalytic systems of the transition-metal salts that have been developed to mediate a wide range of functional group transformations. Within this venerable synthetic toolbox, complexes and salts of Au(I) and Au(III) have emerged in recent years as an invaluable addition as a result of their potent σ- and π-Lewis acidities and ability to stabilize cationic reaction intermediates. The insights provided by mechanistic studies examining the various electronic, steric, and stereoelectronic factors at play in the organogold species that are expected to be formed in the catalytic chemistry of the transition-metal complex have also been pivotal in understanding and exploring their potential synthetic utility. Illustrative of this, for example, is the contribution made by the gold-catalyzed cycloisomerization chemistry of propargyl esters in synthetic strategies to a variety of bioactive natural products and compounds of current pharmaceutical and materials interest. This Account summarizes our efforts over the past decade toward realizing new single-step strategies for carbocyclic and heterocyclic synthesis that relied on the gold-catalyzed reactions of propargyl esters. It outlines synthetic methods developed by the group that exploited the unique reactivities of the gold-carbene species typically generated from the [2,3]-sigmatropic rearrangement of the compound class containing a terminal or electron-deficient alkyne moiety on exposure to the transition-metal salt. This Account also describes the realization of synthetic methods initiated by the gold-catalyzed 1,3-acyloxy migration of propargyl esters with an electronically unbiased disubstituted C≡C bond that delivers the corresponding allenyl ester that is primed for further reactivity on activation by the group 11 metal complex. The studies formed a part of an ongoing overarching program within our group that was focused on determining reactivities in gold catalysis that would enable their application as readily recognizable disconnections in retrosynthetic analysis. They were additionally a part of efforts aimed at evaluating the opportunities offered by the relativistic effects possessed by a Au(I) and Au(III) complex, the most pronounced among the d-block elements and thus the catalyst of choice in alkyne activation chemistry, to generate new chemical space. For instance, we demonstrated in several studies the cycloisomerization of 1,3- and 1,4-enyne esters to be a reliable strategy for the in situ formation of a wide range of 1,4-cyclopentadienyl derivatives. Their further reaction with an appropriately placed functional group or a second starting material was then shown to afford a variety of synthetic targets containing the five-membered ring structure. An example of this was the assembly of a new member of the 1H-isoindole compound family that was found to exhibit potent TNF-α (tumor necrosis factor-α) inhibitor activity.

Nephrectomy improves both antihypertensive requirement and left ventricular mass for pediatric renal hypertension.

BACKGROUND: Renal hypertension causes left ventricular (LV) hypertrophy leading to cardiomyopathy. Nephrectomy has been utilized to improve blood pressure and prepare for kidney transplantation in the pediatric population. We sought to investigate antihypertensive medication (AHM) requirement and LV mass in patients undergoing nephrectomy with renal hypertension. METHODS: We performed a single institution retrospective review from 2009 to 2021 of children who have undergone nephrectomy for hypertension. Primary outcome was decrease in number of AHM. Secondary outcomes included change in LV mass and elimination of AHM. LV mass was measured using echocardiogram area-length and linear measurements. Non-parametric analyses were utilized to assess significance. RESULTS: Thirty-one patients underwent nephrectomy. Median age was 12.5 years (0.8-19 years). Median of 3 AHM (range 1-5 medications) were used pre-operatively and patients had been managed for median 2.5 years. Twenty-nine had preoperative echocardiogram. Forty-eight percent of patients had LVH at nephrectomy. Median AHM after surgery was 1 (range 0-4 medications) at 30 days and 12 months, (p < 0.001). By 12 months after nephrectomy, 79.2% of patients had decreased the number of AHM. Eight (26%) patients were on no AHM 30 days after surgery, and 13 (43%) at 12 months. Systemic vascular disease and multicystic dysplastic kidney were the only factors associated with lack of improvement in AHM (p = 0.040). Fourteen patients had pre- and post-operative echocardiogram and 11 (79%) had improvement in LV mass (p = 0.016, 0.035). CONCLUSIONS: Nephrectomy is effective in improving LV mass and reducing AHM for children with renal hypertension. Improvement is less likely in patients with systemic vascular disease and multicystic dysplastic kidneys. A higher resolution version of the Graphical abstract is available as Supplementary information.

Urología de precisión: conceptualización desde el cáncer de próstata / Precision urology: a view from prostate cancer

No hay duda de que la práctica diaria de la urología es un constante ejercicio de ajustar factores, variables o determinantes demográficos, clínicos, paraclínicos, histopatológicos e imagenológicos para lograr clasificar a un paciente en determinado grupo de partida para definir su ruta o plan de manejo. Es en ese punto donde la semántica de los términos medicina o cuidado personalizado y medicina de precisión de encuentran y a su vez divergen. Hemos adoptado el término de la medicina de precisión desde la perspectiva de la aplicación clínica de la farmacogenómica, entendida como el desarrollo de moléculas a dianas o alteraciones de las denominadas «ómicas¼ (genómica, transcriptómica y proteómica, entre otras). La medicina de precisión abarca o agrupa los determinantes del cuidado personalizado que corresponde a la adaptación metódica y meticulosa de los resultados de los estudios de investigación (medicina basa en evidencia) actuales a las condiciones clínicas, circunstancias de la atención médica, tecnología disponible, acceso a servicios y habilidades clínicas, sumado al perfilamiento biológico del tumor por medio de la información obtenida de diferentes plataformas, incluidas nuevas tecnologías en diagnostico por imágenes (por ejemplo), por lo que podríamos definirlo como una aproximación o integración de datos obtenidos de una forma más precisa con el fin de ajustar el tratamiento1. El término también abarca un control del «daño colateral¼, entendido como la disminución de los efectos secundarios o no deseados por una intervención, una denominación ampliamente usada en la terapia antibiótica o citotóxica en cáncer2,3. Este daño puede ocurrir por acciones como una identificación errónea o subóptima de la severidad o significancia de una lesión, emplear estrategias de tratamiento inadecuadas por ser insuficientes o exageradas para una enfermedad determinada.

There is no doubt that the daily practice of urology is a constant exercise of adjusting demographic, clinical, paraclinical, histopathological and imaging factors, variables or determinants in order to classify a patient in a certain starting group to define his or her management plan. It is at this point where the semantics of the terms personalized medicine or personalized care and precision medicine meet and diverge. We have adopted the term precision medicine from the perspective of the clinical application of pharmacogenomics, understood as the development of molecules to targets or alterations of the so-called "omics" (genomics, transcriptomics and proteomics, among others). Precision medicine encompasses or groups together the determinants of personalized care that corresponds to the methodical and meticulous adaptation of the results of current research studies (evidence-based medicine) to clinical conditions, circumstances of medical care, available technology, access to services and clinical skills, added to the biological profiling of the tumor by means of information obtained from different platforms, including new technologies in diagnostic imaging (for example), so we could define it as an approximation or integration of data obtained in a more precise way in order to adjust the treatment1. The term also encompasses a control of "collateral damage", understood as the reduction of side effects or unwanted effects of an intervention, a term widely used in antibiotic or cytotoxic therapy in cancer2,3. This harm can occur by actions such as misidentification or suboptimal identification of the severity or significance of a lesion, employing treatment strategies that are inadequate because they are insufficient or exaggerated for a given disease.

El reto de crear un equipo de investigación efectivo / The challenge of creating an effective research team

En el mundo actual, donde el acceso a la información y los últimos avances de la ciencia están a tan solo un clic, la academia y la investigación en la práctica diaria juegan un papel clave. Conforme las instituciones trabajan para subir su ranking académico, en un ámbito tan competitivo, aumenta la presión sobre los investigadores y profesionales para la creación de nuevas publicaciones y proyectos de investigación con alto impacto científico1. Esto, sumado al poco apoyo a la investigación en la región, la necesidad de cumplir labores asistenciales y las trabas administrativas, dificulta el adecuado desarrollo para llevar a cabo estos proyectos y disminuyen la motivación del equipo clínico. Es por esto, y en búsqueda de la optimización de recursos, que la creación de un equipo de investigación es imperiosa para poder cumplir las necesidades de producción científica y complementar efectivamente el trabajo en conjunto. Pero esto, a su vez, también presenta un gran reto, pues aunque las habilidades necesarias para el trabajo en equipo parecen intuitivas, no suelen ser materia de educación en la formación actua

Asociación entre disfunción cráneocervical y trastornos temporomandibulares en adultos jóvenes / Association between craniocervical dysfunction and temporomandibular disorders young adults

RESUMEN Objetivo: Determinar la asociación entre disfunción cráneocervical y Trastornos Temporomandibulares en adultos jóvenes. Material y Métodos: Se realizó un estudio observacional, transversal y retrospectivo en una muestra probabilística donde se evaluaron 180 adultos jóvenes entre 18 y 35 años, distribuidos en dos grupos con y sin trastorno temporomandibular según el Eje I del Índice de Criterios Diagnósticos para Trastornos Temporomandibulares. El primer grupo estuvo conformado por 87 estudiantes con diagnóstico de trastorno temporomandibular y el segundo por 93 estudiantes sin este diagnóstico. Posteriormente, se les realizó el Índice de Disfunción Cráneocervical y Movilidad Cervical para medir el grado de movimiento cervical y postura cráneocervical. Los datos fueron analizados mediante estadística descriptiva e inferencial utilizando la prueba de Chi-cuadrado (p=0,05). Resultados : Los trastornos temporomandibulares predominaron en el género femenino (69 %). El diagnóstico de dolor relacionado a trastorno temporomandibular predominó para mialgia y artralgia (38 %) y el grado de disfunción cráneocervical predominante fue leve (40,4 %). Los estudiantes con disfunción cráneocervical leve presentaron mialgia (83,3 %) y los estudiantes con disfunción cráneocervical severa presentaron ambos (mialgia y artralgia: 55,6 %). Los estudiantes sin trastorno temporomandibular presentaron disfunción cráneocervical leve (61,9 %) y los con trastorno temporomandibular presentaron disfunción cráneocervical moderada (27 %). Los estudiantes con disfunción cráneocervical presentaron trastorno temporomandibular en un 64,7 %. Conclusiones: En este estudio encontramos que existió una asociación entre disfunción cráneocervical y trastornos temporomandibulares en los adultos jóvenes evaluados.

ABSTRACT Introduction : The close anatomical and functional relationship involving the cranio-cervico-mandibular system has caused a high prevalence of signs and symptoms of craniocervical dysfunction in subjects with temporomandibular disorder, especially postural and pain problems. Objective: To determine the association between craniocervical dysfunction and Temporomandibular Disorders in young adults. Material and Methods: 180 young adults between 18 and 35 years old were evaluated, distributed in two groups with and without temporomandibular disorder according to Axis I of the Index of Diagnostic Criteria for Temporomandibular Disorders. The first group consisted of 87 students with a diagnosis of temporomandibular disorder and the second of 93 students without this diagnosis. Subsequently, the Craniocervical Dysfunction and Cervical Mobility Index was performed to measure the degree of cervical movement and craniocervical posture. The data were analyzed by descriptive and inferential statistics using the Chi-square test (p = 0.05). Results: Temporomandibular disorders predominated in the female gender (69%). The diagnosis of pain related to temporomandibular disorder predominated for myalgia and arthralgia (38%) and the predominant degree of craniocervical dysfunction was mild (40.4%). Students with mild craniocervical dysfunction presented myalgia (83.3%) and students with severe craniocervical dysfunction presented both (myalgia and arthralgia: 55.6%). Students without temporomandibular disorder had mild craniocervical dysfunction (61.9%) and those with temporomandibular disorder had moderate craniocervical dysfunction (27%). Students with craniocervical dysfunction presented temporomandibular disorder in 64.7%. Conclusions: In this study we found that there was an association between craniocervical dysfunction and temporomandibular disorders in the young adults evaluated.

Revista Urología Colombiana RUC: 35 de años evolución, cambio e impacto / Revista Urología Colombiana RUC: 35 years of evolution, change and impact

La Revista Urología Colombiana materializa un objetivo de la Sociedad Colombiana de Urología (SCU) como medio de difusión científico oficial de los resultados de investigación original, y de otro tipo trabajos de diferente diseño metodológico, con el único propósito de contribuir al incremento del conocimiento médico en el campo de nuestra especialidad. Tardaría casi 30 años desde la fundación de la SCU para lograr la aparición de RUC, que precedida por publicaciones efímeras como el "Boletín de Actividades" o el resumen del congreso.

The Revista Urología Colombiana materializes an objective of the Colombian Society of Urology (SCU) as a means of official scientific dissemination of the results of original research, and other work of different methodological design, with the sole purpose of contributing to the increase of medical knowledge in the field of our specialty. It would take almost 30 years since the foundation of the SCU to achieve the appearance of RUC, which was preceded by ephemeral publications such as the "Bulletin of Activities" or the summary of the congress.

El rol de la simulación en la practica y entrenamiento urológico / The role of simulation in urological practice and training

La práctica de la urología ya no es como previamente se concebía. Hace muchos años se pensaba que el modelo de aprendizaje quirúrgico era "lea, vea, ayude, haga y enseñe"; estrategia que permitió formar a grandes, talentosos y hábiles cirujanos,[1] sin embargo, ya no es de esta manera. La cirugía mínimamente invasiva y la robótica ha permitido reconocer que se requiere una curva de aprendizaje previo a operar un paciente real. De aquí que un número importante de "horas de vuelo" sean necesarias para adquirir un grupo de habilidades y destrezas para la competencia en un área.[2] De igual manera, la cirugía es una profesión que depende de la adquisición y aplicación de habilidades psicomotoras, cuya limitación de obtenerlas, se traducirá en consecuencias negativas para su entrenamiento y finalmente para el paciente.

The practice of urology is no longer as it was previously conceived. Many years ago it was thought that the surgical learning model was "read, see, help, do and teach"; a strategy that trained great, talented and skilled surgeons,[1] however, it is no longer this way. Minimally invasive surgery and robotics have made it possible to recognize that a learning curve is required prior to operating on a real patient. Hence, a significant number of "flight hours" are necessary to acquire a set of skills and abilities for competence in an area.[2] Similarly, surgery is a profession that depends on the acquisition and application of psychomotor skills, the limitation of which, if not obtained, will result in negative consequences for your training and ultimately for the patient.

Anterolateral thigh versus radial forearm flap for cervical esophageal reconstruction in cancer patients: A retrospective cohort study in Colombia.

OBJETIVO: Este estudio tuvo como objetivo describir los resultados clínicos del colgajo anterolateral de muslo y radial de antebrazo, para la reconstrucción hipofaríngea y esofágica en un hospital de cuarto nivel en Bogotá, Colombia. MÉTODOS: Estudio retrospectivo inlcuyo 38 pacientes a los que se les realizó reconstrucción funcional esofágica con colgajo de antebrazo radial o anterolateral de muslo (ALT) entre febrero de 2010 y diciembre de 2017. RESULTADOS: Edad media fue de 51 años. El 80% genero femeninp. Los defectos laringoesofágicos estuvieron presentes en el 80%. Se requirió reconstrucción circunferencial total en el 60% de los pacientes. Se realizaron injertos braquio-radiales en el 26% y colgajos anterolaterales de muslo en el 74%. La tasa global de complicaciones tempranas fue del 30%, de las cuales el 20% fueron fístulas (braquio-radial, 2,8%; colgajo libre de ALT, 8,3%). Las complicaciones tardías (20%) incluyeron estenosis y obstrucción de la luz del injerto distal. Solo el 10% de los pacientes no pudieron tolerar la alimentación oral y el 50% de este paciente necesitó gastrostomía permanente. En cuanto al seguimiento oncológico durante el postoperatorio de 24 meses, no se observó recidiva tumoral. CONCLUSIÓN: Los resultados funcionales de la reconstrucción con colgajo braquio-radial y ALT fueron satisfactorios. Nuestros hallazgos sugieren que la ALT tiene una menor incidencia de complicaciones posoperatorias que el colgajo radial de antebrazo. La elección del tipo de colgajo dependerá del tamaño y la ubicación del defecto. Los defectos pequeños y parcialmente cubiertos se benefician del uso de un colgajo radial, y para reconstrucciones faríngeas más grandes y circunferenciales con posibles requisitos de radioterapia, se benefician de un colgajo ALT. OBJECTIVE: This study aimed to describe clinical outcomes of anterolateral thigh (ALT) and radial forearm flap in hypopharyngeal and esophageal reconstruction in a fourth level hospital in Bogotá, Colombia. METHODS: This retrospective study included 38 patients who esophageal functional reconstruction using radial forearm or ALT flap at our center between February 2010 and December 2017. RESULTS: Mean age was 51 years. About 80% of the included patients were females. Laryngoesophageal defects were present in 80%. Total circumferential reconstruction was required in 60% of patients. Brachial-radial grafts were performed in 26% and anterolateral thigh flaps in 74%. Overall, early complication rate was 30%, which 20% were fistulae (brachial-radial, 2.8%; ALT free flap, 8.3%). Late complications (20%) included stenosis and distal graft lumen obstruction. Only 10% of patients were unable to tolerate oral feeding and 50% of this patient needed permanent gastrostomy. Regarding oncological follow-up during the 24-month post-operative, no tumor recurrence was observed. CONCLUSIONS: Functional outcomes of reconstruction with brachial-radial and ALT flap were satisfying. Our findings suggest that ALT has a lower incidence of post-operative complications than radial forearm flap. The choice of the type of flap will depend on the size and location of the defect. Small and partially covered defects benefit from the use of a radial flap, and for larger and circumferential pharyngeal reconstructions with possible radiotherapy requirements, they benefit from an ALT flap.

[Age does not affect the outcome of allogeneic hematopoietic precursor transplantation for acute myeloid leukemia]. / Resultados a largo plazo de una cohorte chilena: la edad del paciente no incide en el resultado del trasplante alogénico de precursores hematopoyéticos para leucemia mieloide aguda.

BACKGROUND: In our country, transplantation centers differ in the age limit for allogeneic hematopoietic transplantation (ALOHT). In our program, transplants with age- adjusted conditioning are performed in patients until 70 years old. Currently more than 60% of ALOHT reported to the Center for International Bone Marrow Transplantation Research (CIBMTR) are performed in patients older than 40 years. AIM: To report our experience with ALOHT in acute myelogenous leukemia (AML), analyzing patient age at transplantation in different periods and transplant results in different age groups. MATERIAL AND METHODS: A retrospective analysis of the database of adult hematopoietic transplants in AML patients was performed. Demographic data, disease characteristics, transplant data, survival and relapse times, and mortality were collected. RESULTS: In our program, 1030 transplants were performed in adults and 119 ALOHT were performed in AML patients, between 1990 and 2020. The median age of patients in all periods was 41 years, (range 16-69). The median age was 33 and 45 years, in the periods 1990-2000 and 2000-2020 respectively (p < 0.01). Seventy-eight patients received myeloablative conditioning (median age 44 years) and 41 reduced intensity conditioning (median age 53 years). Five-year overall survival was 44.6% (confidence intervals (CI) 41-48). Non relapse mortality of all periods was 19% (CI 17 - 40%) and relapse rate was 17 % (CI 16-22). No difference in five years overall survival among patients younger than 40, 41 to 50 and over 51 years was observed. CONCLUSIONS: Overall Survival, non-relapse mortality and relapse rate were similar in younger and older patients in our program and similar to those previously reported in other centers.

Anacardium excelsum phytochemical analysis and in vitro antimicrobial activity against oral cavity microorganisms / Análisis fitoquímico y actividad antimicrobiana in vitro de Anacardium excelsum sobre microorganismos de cavidad bucal

ABSTRACT Infections of the oral cavity have a broad microbial etiological profile that varies according to each microenvironment in the mouth. Such infections often require antimicrobial treatment, which can lead to the development of resistance. There is thus a need to find new therapeutic strategies based on natural plant-derived compounds. The aim of this study was to determine the phytochemical nuclei and the antimicrobial effect of Anacardium excelsum leaf and stem extracts, and of fractions derived from the leaf extract, against Streptococcus mutans ATCC 25175, Staphylococcus aureus ATCC 35548, Escherichia coli ATCC 25922, Enterococcus faecalis ATCC 19433 and Candida albicans ATCC 10231. The plant material was collected from the Quindío Botanical Garden (Calarcá, Quindío-Colombia), located at an altitude of 1500 meters above sea level. Hydroalcoholic extracts of A. excelsum leaves and stems, and fractions of the hydroalcoholic leaf extract, were obtained by percolation extraction. Phytochemical nuclei were identified by thin layer chromatography. The antimicrobial activity of the extracts and fractions (at concentrations of 2, 5, 10, 20 and 40 mg / ml) against the five ATCC reference strains was evaluated using the well diffusion technique on Mueller-Hinton agar. The leaf extract showed no antimicrobial activity against E. coli, but it did show antimicrobial activity against S. mutans, S. aureus, E. faecalis and C. albicans, at a concentration of 10 mg/ml, with zones of inhibition of 9 to 11 mm. The ethyl acetate and acetone fractions obtained from A. excelsum leaf extract had greatest antimicrobial activity at 10 mg/ml. In conclusion, (1) the A. excelsum leaf extract, and the ethyl acetate and acetone fractions obtained from the leaf extract, had the greatest antimicrobial activity on all the study microorganisms, and (2) the phytochemical nuclei in the fractions (ethyl acetate and acetone) were found to contain phenolic-type compounds, tannins, triterpene-type terpenes and steroidal-type terpenes, which might explain the antimicrobial activity observed.

RESUMEN Las infecciones de la cavidad bucal se caracterizan por presentar un amplio perfil etiológico microbiano que varía de acuerdo a cada microambiente en boca. En muchos casos estas infecciones requieren tratamiento antimicrobiano que puede conducir al desarrollo de resistencia. Estos hechos en conjunto generan la necesidad de buscar nuevas estrategias terapéuticas, provenientes de compuestos naturales derivados de plantas. El objetivo de este estudio fue determinar los núcleos fitoquímicos y el efecto antimicrobiano de extractos de hojas y tallos, y de fracciones derivadas del extracto de hojas de Anacardium excelsum contra Streptococcus mutans ATCC 25175, Staphylococcus aureus ATCC 35548, Escherichia coli ATCC 25922, Enterococcus faecalis ATCC 19433 y Candida albicans ATCC 10231. El material vegetal se colectó del Jardín Botánico del Quindío (Calarcá, Quindío-Colombia), situado a una altura de 1500 msnm. Se obtuvieron extractos hidroalcohólicos de hojas y tallos, y fracciones a partir del extracto hidroalcohólico de hojas de A. excelsum mediante extracción por percolación. La identificación de los núcleos fitoquímicos fue realizado por cromatografía en capa delgada. La evaluación de la actividad antimicrobiana de extractos y fracciones, en concentraciones de 2, 5, 10, 20 y 40 mg/ml, frente a las 5 cepas de referencia ATCC, se realizó mediante la técnica de difusión con aplicación en pozo sobre agar Mueller-Hinton. El extracto de hojas no presentó actividad antimicrobiana sobre E. coli pero si sobre S. mutans, S. aureus, E. faecalis y C. albicans, en una concentración de 10 mg/ml, con halos de inhibición desde 9 a 11 mm, y las fracciones de acetato de etilo y acetona obtenidas del extracto de hojas de A. excelsum, presentaron mayor actividad antimicrobiana en una concentración de 10 mg/ml. En conclusión, 1. El extracto de hojas y las fracciones de acetato de etilo y acetona obtenidas del extracto de hojas de A. excelsum presentaron mayor actividad antimicrobiana sobre todos los microorganismos en estudio; 2. La evaluación de los núcleos fitoquímicos en las fracciones acetato de etilo y de acetona mostraron compuestos de tipo fenólico, taninos, terpenos del tipo triterpenos y terpenos del tipo esteroidal, que posiblemente expliquen la actividad antimicrobiana obtenida.

Reporte de dos casos de trauma vascular / Two Parallel Case Reports of Vascular Trauma

Los traumas vasculares periféricos poseen una frecuencia elevada en relación con las lesiones vasculares y conllevan a una incapacidad significativa a pacientes relativamente jóvenes. La identificación oportuna y el manejo inicial adecuado de este tipo de lesión son muy importantes para su posterior evolución. Este artículo tuvo como objetivo exponer la importancia del tratamiento oportuno del trauma vascular en dos pacientes llegados el mismo día al servicio de urgencias del Hospital Militar Central "Dr. Luis Díaz Soto". Se presenta como primer caso a un paciente masculino de 44 años de edad, con antecedentes de salud aparente. Sufrió una herida de aproximadamente 12 cm en el brazo izquierdo, que se acompañó de sangramiento e hipotensión arterial. Se le colocó injerto protésico y se le realizó anastomosis término-terminal en la arteria humeral porque presentaba sección completa de esta; su evolución fue favorable. El segundo caso se trata de un paciente masculino de 60 años de edad, con antecedentes de salud aparente. Sufrió un trauma en el antebrazo izquierdo que le provocó una herida de alrededor de 8 cm, con sangramiento, palidez y frialdad del tercio distal del antebrazo, cianosis reversible de la mano, impotencia funcional, ausencia de pulso radial e hipotensión arterial. Se le realizó anastomosis término-terminal de arteria radial porque presentaba sección completa de esta y su evolución resultó favorable. El tratamiento oportuno y acertado del trauma vascular evitó la pérdida de la vida de los pacientes, disminuyó la presencia de complicaciones, aseguró una evolución rápida y redujo incapacidades en estos(AU)

Peripheral vascular traumas have a high frequency in relation to vascular lesions, and lead to significant disability in relatively young patients. Timely identification and adequate initial management of this type of lesion are very important for its subsequent evolution. This article aimed to show the importance of timely treatment of vascular trauma in two patients who arrived on the same day at the emergency service of Dr. Luis Díaz Soto Central Military Hospital. The first case presented corresponds to a 44-year-old male patient apparently without previous heath conditions. He had a wound of approximately twelve centimeters on the left arm, which was accompanied by bleeding and arterial hypotension. The patient was placed a prosthetic graft and performed an end-to-end anastomosis in the brachial artery because it was completely sectioned. The patient's evolution was favorable. The second case corresponds to a 60-year-old male patient with an apparent health history. He suffered a trauma to his left forearm that caused a wound of about 8 cm, with bleeding, paleness and coldness of the distal third of the forearm, reversible cyanosis of the hand, functional impotence, absence of radial pulse and arterial hypotension. End-to-end anastomosis of the radial artery was performed because the patient presented complete section of the artery and his evolution was favorable. Timely and correct treatment of vascular trauma prevented the loss of life in both patients, reduced the presence of complications, ensured a rapid evolution, and reduced their disabilities(AU)

Co-stimulation with opposing macrophage polarization cues leads to orthogonal secretion programs in individual cells.

Macrophages are innate immune cells that contribute to fighting infections, tissue repair, and maintaining tissue homeostasis. To enable such functional diversity, macrophages resolve potentially conflicting cues in the microenvironment via mechanisms that are unclear. Here, we use single-cell RNA sequencing to explore how individual macrophages respond when co-stimulated with inflammatory stimuli LPS and IFN-γ and the resolving cytokine IL-4. These co-stimulated macrophages display a distinct global transcriptional program. However, variable negative cross-regulation between some LPS + IFN-γ-specific and IL-4-specific genes results in cell-to-cell heterogeneity in transcription. Interestingly, negative cross-regulation leads to mutually exclusive expression of the T-cell-polarizing cytokine genes Il6 and Il12b versus the IL-4-associated factors Arg1 and Chil3 in single co-stimulated macrophages, and single-cell secretion measurements show that these specialized functions are maintained for at least 48 h. This study suggests that increasing functional diversity in the population is one strategy macrophages use to respond to conflicting environmental cues.

Resultados a largo plazo de una cohorte chilena: la edad del paciente no incide en el resultado del trasplante alogénico de precursores hematopoyéticos para leucemia mieloide aguda / Age does not affect the outcome of allogeneic hematopoietic precursor transplantation for acute myeloid leukemia

BACKGROUND: In our country, transplantation centers differ in the age limit for allogeneic hematopoietic transplantation (ALOHT). In our program, transplants with age- adjusted conditioning are performed in patients until 70 years old. Currently more than 60% of ALOHT reported to the Center for International Bone Marrow Transplantation Research (CIBMTR) are performed in patients older than 40 years. AIM: To report our experience with ALOHT in acute myelogenous leukemia (AML), analyzing patient age at transplantation in different periods and transplant results in different age groups. MATERIAL AND METHODS: A retrospective analysis of the database of adult hematopoietic transplants in AML patients was performed. Demographic data, disease characteristics, transplant data, survival and relapse times, and mortality were collected. RESULTS: In our program, 1030 transplants were performed in adults and 119 ALOHT were performed in AML patients, between 1990 and 2020. The median age of patients in all periods was 41 years, (range 16-69). The median age was 33 and 45 years, in the periods 1990-2000 and 2000-2020 respectively (p < 0.01). Seventy-eight patients received myeloablative conditioning (median age 44 years) and 41 reduced intensity conditioning (median age 53 years). Five-year overall survival was 44.6% (confidence intervals (CI) 41-48). Non relapse mortality of all periods was 19% (CI 17 - 40%) and relapse rate was 17 % (CI 16-22). No difference in five years overall survival among patients younger than 40, 41 to 50 and over 51 years was observed. Conclusions: Overall Survival, non-relapse mortality and relapse rate were similar in younger and older patients in our program and similar to those previously reported in other centers.

Genetic similarities versus morphological resemblance: Unraveling a polyploid complex in a Mediterranean biodiversity hotspot.

The Balkan Peninsula is recognized as one of the hotspots of biodiversity in Europe. This area has shown since the Last Glacial Maximum appropriate conditions for species diversification and hybridization, which has led to the existence of numerous taxonomically unresolved entities. Here, we focus on the Western Balkans and explore the genetic structure and relationships among species belonging to the V. austriaca - V. orbiculata diploid-polyploid complex, including populations showing intermediate morphologies. A combination of nuclear markers (microsatellites), plastid DNA regions (trnH-psbA, ycf6-psbM) and ploidy level estimations using flow cytometry are employed to assess the genetic structure and evolutionary dynamics of this polyploid complex. To reconstruct the evolutionary history, an approximate Bayesian computation approach is combined with projections of the species distribution models onto the climatic scenarios of the Mid-Holocene (6 ka BP) and Last Glacial Maximum (22 ka BP). Four main groups were found: one well-established entity within the diploid level, V. dalmatica, a second diploid-tetraploid group which corresponds to V. orbiculata, a hexaploid cluster harboring V. austriaca subsp. jacquinii individuals, and an enigmatic tetraploid group. According to the molecular data obtained, this latter cluster represents an allopolyploid cryptic lineage −with V. orbiculata and V. dalmatica as putative parents− morphologically similar to V. orbiculata, but genetically more related to V. austriaca subsp. jacquinii. Veronica dalmatica and this "uncertain tetraploid" group are involved in the formation of the hexaploid taxon V. austriaca subsp. jacquinii, with the possibility of recent gene flow among different cytotypes. The present study supports a scenario of diversification from a diploid common ancestor leading to two different but interrelated lineages. The first one would correspond with the diploid V. orbiculata plus tetraploid individuals of this species arising through allo- and autopolyploidization, and the second one would involve all ploidy levels with allopolyploidization being prevalent.

Polyploidy promotes species diversification of Allium through ecological shifts.

Despite the role of polyploidy in multiple evolutionary processes, its impact on plant diversification remains controversial. An increased polyploid frequency may facilitate speciation through shifts in ecology, morphology or both. Here we used Allium to evaluate: (1) the relationship between intraspecific polyploid frequency and species diversification rate; and (2) whether this process is associated with habitat and/or trait shifts. Using eight plastid and nuclear ribosomal markers, we built a phylogeny of 448 Allium species, representing 46% of the total. We quantified intraspecific ploidy diversity, heterogeneity in diversification rates and their relationship along the phylogeny using trait-dependent diversification models. Finally, we evaluated the association between polyploidisation and habitat or trait shifts. We detected high ploidy diversity in Allium and a polyploidy-related diversification rate shift with a probability of 95% in East Asia. Allium lineages with high polyploid frequencies had higher species diversification rates than those of diploids or lineages with lower polyploid frequencies. Shifts in speciation rates were strongly correlated with habitat shifts linked to particular soil conditions; 81.7% of edaphic variation could be explained by polyploidisation. Our study emphasises the role of intraspecific polyploid frequency combined with ecological drivers on Allium diversification, which may explain plant radiations more generally.

Environmental differences are correlated with the distribution pattern of cytotypes in Veronica subsection Pentasepalae at a broad scale.

BACKGROUND AND AIMS: The distribution of cytotypes and its potential correlation with environmental variables represent a cornerstone to understanding the origin and maintenance of polyploid lineages. Although many studies have addressed this question in single species at a regional scale, only a few have attempted to decipher this enigma in groups of closely related species at a broad intercontinental geographical scale. Here, we consider approx. 20 species of a diploid-polyploid complex (Veronica subsect. Pentasepalae) of recent and rapid diversification represented in Europe and North Africa to study the frequency and distribution of cytotypes and their relationship to environmental variables. METHODS: A total of 680 individuals (207 populations) were sampled. Ploidy levels were determined using flow cytometry. Ecological differentiation among cytotypes was tested using climatic and environmental variables related to temperature, precipitation, vegetation and biogeographical region, among others, and by performing univariate and multivariate (constrained principal coordinates analysis) analyses. KEY RESULTS: Four ploidy levels (2x, 4x, 6x and 8x) were found and genome downsizing was observed to occur within the group. Plants of different ploidy level are ecologically differentiated, with hexaploids and octoploids occurring in wetter and colder habitats with a higher seasonality than diploids. A south to north distribution pattern was found, with diploids occupying southern refugial areas and octoploids being more frequent in northern regions of Europe above the permafrost boundary. CONCLUSIONS: The distribution of cytotypes can be explained by ecological differentiation, the geographical position of refuge areas during the Quaternary climatic oscillations as well as by ice and permafrost retreat patterns. The Balkan Peninsula constitutes the most important contact zone between cytotypes. This work provides the first comprehensive ploidy screening within V. subsect. Pentasepalae at a broad scale and indicates that polyploidy and genome downsizing might have contributed to the colonization of new habitats in a recently diverged polyploid complex.

Preeclampsia - eclampsia diagnóstico y tratamiento / Preeclampsia - eclampsia diagnosis and treatment

La preeclampsia - eclampsia es una de las complicaciones que puede presentarse durante el embarazo parto o puerperio que aumentan la morbimortalidad materno perinatal y neonatal, siendo estas patologías las primeras causas de muerte materna en el país y una de las principales causas de muerte materna a nivel mundial. Se caracteriza por hipertensión asociada a proteinuria, o hipertensión y afectación de órganos blanco con o sin proteinuria en la última mitad del embarazo. Su oportuno diagnóstico y manejo ayudará a disminuir el riesgo de complicaciones que pueden presentarse como convulsiones, accidente cerebrovascular, síndrome de HELLP entre otros. Las acciones que se realicen para su diagnóstico y el manejo adecuado y oportuno pueden influir directamente en el pronóstico futuro de la paciente y de su hijo. En esta revisión se ha seleccionado artículos en idioma inglés o español que fueron los más relevantes sobre este tema

Preeclampsia - eclampsia is one of the complications that can occur during pregnancy, childbirth or puerperium, these ones increase perinatal and neonatal maternal morbidity and mortality, these pathologies being the first causes of maternal death in the country and one of the main causes of maternal death around the world. It is characterized by hypertension associated with proteinuria or hypertension, and involvement of white organs with or without proteinuria in the last half of pregnancy. Its timely diagnosis and management will help reduce the risk of complications that may occur such as seizures, stroke, HELLP syndrome and others. The actions taken for diagnosis and proper and timely management can directly influence the future prognosis of the patient and her child. In this review it has been selected articles in English and Spanish language that were the most relevant on this topic.Keywords: preeclampsia, eclampsia, seizures.