The resurgence of syphilis among pregnant women in southern Chile.

BACKGROUND: National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating. AIM: To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring. PATIENTS AND METHODS: We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records. RESULTS: Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes. CONCLUSIONS: Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.

Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.

Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.

Antifungal susceptibility profile of Trichosporon inkin: About three cases of White Piedra.

Trichosporon spp. usually cause systemic or superficial infections. Three cases of White Piedra produced by Trichosporon inkin are described. The in vitro antifungal activity to fluconazole, amphotericin B, ketoconazole and caspofungin against the three clinical isolates were evaluated. Sensitivity to fluconazole and ketoconazole was evidenced. However, the treatment of this mycosis is still a challenge.

Biodiversity and Human Health Interlinkages in Higher Education Offerings: A First Global Overview.

Introduction: Biodiversity is inextricably linked to human health. As an important area of research of the Convention on Biological Diversity and a key avenue for the dissemination of biodiversity and health knowledge, we investigated how well-embedded biodiversity and health interlinkages are in institutional higher education offerings. Methods: Using One Health education programs as a starting point, we collected a global list of institutions potentially carrying out education in the links between biodiversity and health through previously published research, academic partners of global conglomerates, and our own networks. We then analyzed the offerings from these institutions to determine the degree of integration of biodiversity and health interlinkages. Results: We found 105 educational offerings in biodiversity and health interlinkages from 89 institutions in 30 countries. These were primarily found in faculties of public health, veterinary sciences, and medicine, with varying degrees of coverage of the interlinkages. Conclusion: Education incorporating the links between biodiversity and health exists globally, but should be more widely integrated, particularly through inter-faculty and inter-institutional collaboration.

From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia.

Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia.

Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Retrospective analysis of patients with advanced or metastatic gastric cancer in Colombia.

Aims: To assess patient and disease characteristics, treatment patterns, and associated costs in patients with advanced or metastatic gastric cancer (A/MGC) in Colombia, in both the public and private hospitals. Materials and methods: A total of 145 patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed for at least 3 months after the last administration of a first-line cytotoxic agent were eligible for inclusion. Case-report forms were elaborated based on the patients' medical records from three Colombian hospitals. Estimates of treatment costs were calculated using unit costs from the participating hospitals. Results: Of the 145 patients, more than half (64.83%) were male, 79.56% were diagnosed with metastatic stage IV disease (mean age = 58.14 years). Prior to MGC diagnosis, 31.71% of the patients being operated on received a total gastrectomy; 66.9% of the patients received a doublet therapy, of which 5-fluorouracil (5-FU) in combination with cisplatin was the standard treatment (14%), followed by combination with leucovorin (12%). Only around 10% of the patients responded to first-line treatment. Out of 41.38% of the patients who received a second-line treatment, 71.67% were still administered a platinum analog and/or fluoropyrimidine. During the follow-up period, 52% of the patients progressed and 20% achieved stable disease. Best supportive care mostly consisted of outpatient visits after last line-therapy (72.41%), palliative radiotherapy (18.6%), and surgery (37.2%). Limitations and conclusions: Gastric cancer is one of the main causes of cancer-related death in Colombia, as most of the patients are diagnosed at an advanced stage, when prognosis is poor. Treatment patterns are highly heterogeneous. Second-line treatments were mostly initiated with paclitaxel, capecitabine, irinotecan, or cisplatin.

Internal Auditory Canal Dural Enhancement in Granulomatosis with Polyangeitis Disease.

Diffuse dural enhancement of the internal auditory canal in T1-weighted gadolinium-enhanced magnetic resonance imaging could be a helpful and early clinical sign in a very aggressive limited granulomatosis with polyangeitis disease, called previously Wegener Disease (WD).

[Hansen disease, an emergent condition in Chile]. / Enfermedad de Hansen. Una condición emergente en Chile.

Hansen's disease (HD) is caused by Mycobacterium leprae. It has a chronic course and preferentially affects the skin and the peripheral nerves. It's an emergent infection in Chile due to migration waves. This case report affecting a migrant worker from Haiti that presented several compatible skin lesions, with hypoesthesia and unilateral madarosis that appeared before arrival. The diagnosis of a multibacillary form was established by clinical findings, presence of fast acid bacilli on a direct skin smear, and inflammatory cell surrounding nerve endings and granulomas on skin biopsy. Besides, specific rpoB and hsp65 gene segments from M. leprae were amplified from skin samples. Patient was treated with the WHO standard combined regimen for multibacillary forms during one year showing partial regression of skin lesions. Nasopharyngeal samples showed the presence of M. leprae rpoB copies detected by PCR decreasing until six months of therapy. Notifiable diseases databases showed a recent increment of cases, all related to migrant population. Hansen's disease is a new condition in Chile and clinicians should be aware of this possibility. Molecular tools may facilitate diagnosis and follow up.

Síndrome de Guillain Barré relacionados a infección por SARS - CoV 2 en Lima, Perú. Reporte de casos / Guillain Barre Syndrome cases related to SARS - CoV-2 infection in Lima, Peru. Case reports

RESUMEN La COVID -19 afecta predominantemente el sistema respiratorio, pero también se ha descrito compromiso extrapulmonar, incluido la afectación del sistema nervioso. Se describen los casos de dos pacientes con infección por SARS -CoV-2 que desarrollaron el síndrome de Guillain Barré.

SUMMARY COVID-19 predominantly affects the respiratory tract, but extrapulmonary involvement, including the nervous system has been reported. We report two patiets who presented SARS-COV-2 associated of Guillain-Barré syndrome

The resurgence of syphilis among pregnant women in southern Chile / Resurgencia de sífilis en mujeres embarazadas en una región del sur de Chile

ABSTRACT Background: National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating. Aim: To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring. Patients and Methods: We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records. Results: Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes. Conclusions: Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.

Antecedentes: Las tasas nacionales de VIH, gonorrea y sífilis han aumentado en Chile en los últimos años, pero no se sabe si la sífilis en mujeres embarazadas (ME) también está aumentando. Objetivo: Explorar las tasas de sífilis en ME en una región del sur de Chile y describir las características clínicas de las madres y los hijos. Pacientes y Métodos: Se seleccionaron ME con un VDRL o test de microhemaglutinación para T. pallidum positivos, referidas aun centro de alto riesgo obstétrico entre 2011 y 2019. La información clínica de las madres y sus hijos fue obtenida de fichas clínicas. Resultados: Las tasas de sífilis en ME aumentaron de 0,4 a 7,2 por 1000 nacidos vivos en el hospital de referencia entre 2013 y 2019, en paralelo a un aumento nacional y regional en ambos sexos. Se identificaron 29 casos de mujeres embarazadas con sífilis con mediana de edad 28 años, rango intercuartílico 23-32. Diecisiete por ciento tenía historia de abuso de drogas y 14% tenía una enfermedad de transmisión sexual previa. En siete casos, el diagnóstico ocurrió en el momento del parto (24,1%). Los estadios abarcaron sífilis primaria (3%), sífilis secundaria (14%), sífilis latente temprana (24%) y sífilis latente (59%). Todos, menos un caso, fueron tratados con penicilina G benzatina y el caso restante con eritromicina por sospecha de alergia a la penicilina. Se requirieron protocolos de desensibilización a penicilina en dos casos (7%). El momento del tratamiento fue inadecuado en 10 casos (35%). De 19 pacientes con seguimiento serológico disponible, 10 (53%) mostraron una disminución significativa en los títulos de VDRL (≥ 2 diluciones) y dos casos tuvieron reinfección. Dos pacientes (7%) evolucionaron con aborto, dos con sífilis congénita (7%, una asociada a terapia con macrólidos) y seis con parto prematuro o bajo peso al nacer (21%), totalizando 35% de resultados adversos durante el embarazo. Conclusiones: El resurgimiento de la sífilis entre las mujeres embarazadas está ocurriendo en el sur de Chile y está asociado a resultados adversos del embarazo.

Peer teaching, a didactic strategy for learning basic electrocardiography / La enseñanza por pares, una estrategia didáctica para el aprendizaje de la electrocardiografía básica

Abstract Teaching electrocardiography is a very important area in undergraduate student training. A constant concern of professors is for physicians in training to acquire competence in reading and interpreting electrocardiograms (EKGs). This study describes and explores how the didactic strat egy of peer teaching improves learning processes for second-year medical students. Evidence was found that peer teaching fosters significant learning of cardiac physiology and electrocardiograms, in particular, because it allows students to acquire abilities and skills in EKG reading, and improves the understanding and interpretation of this test. In addition, it promotes horizontal peer relationships which facilitate the development of autonomy, self-learning and teamwork. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1971).

Resumen La enseñanza de la electrocardiografía es un área de gran importancia en la formación de los estudiantes de pregrado, para los docentes es una preocupación constante que los médicos en for mación adquieran las competencias para la lectura e interpretación del electrocardiograma (ECG). El presente estudio describe e indaga sobre cómo la estrategia didáctica de la enseñanza por pares mejora los procesos de aprendizaje de los estudiantes de segundo año de formación médica. Se halló evidencia de que la enseñanza por pares favorece el aprendizaje significativo de la fisiología cardiaca y del electrocardiograma, en particular, porque permite la adquisición de habilidades y destrezas a los estudiantes en la lectura del ECG y mejora la comprensión e interpretación de dicho examen; además, propicia relaciones horizontales entre pares que facilitan el desarrollo de la autonomía, el autoaprendizaje y el trabajo en equipo. (Acta Med Colomb 2021; 46. DOI:doi.org/10.36104/amc.2021.1971).

Evaluation of severity of bronchial asthma through an exercise bronchial challenge.

Optimum treatment of bronchial asthma requires accurate diagnosis and severity classification. We studied the use of an exercise bronchial challenge in the asthmatic patient as a diagnostic tool. An exercise bronchial challenge test was carried out in 431 asthmatic children and 114 children without a history of asthma in a moderate-altitude environment (2,230 m above sea level/7,314 feet above sea level). Values of peak expiratory flow (baseline and maximum fall) were analyzed through time in each asthma severity group (intermittent, mild persistent, moderate persistent, severe persistent, and nonasthmatic controls). There was a significant difference among responses of asthma severity groups for almost all variables. No difference was found between nonasthmatic and intermittent groups who had similar behavior, except in bronchodilator response. An exercise bronchial challenge helps classify a patient according to asthma severity; it is easy to reproduce and does not require expensive equipment. It allows diagnosing and classifying asthma severity easily and supplementing the clinical evaluation. Based on our results, we propose a fall of PEF >or= 11% as new cutoff point for making a diagnosis of persistent bronchial asthma. A fall of 11-25% indicates mild persistent asthma; from 25-50%, moderate persistent asthma; and a bigger fall, severe persistent asthma.

Prevalencia del consumo de sustancias psicoactivas y factores relacionados en soldados regulares adscritos a un batallón de una ciudad colombiana / Prevalence of psychoactive substance use and related factors in regular soldiers attached to a battalion in a Colombian city / Prevalência do consumo de substâncias psicoactivas e factores relacionados em soldados regulares afectos a um batalhão numa cidade colombiana

Objetivo: Calcular la prevalencia del consumo de Sustancias Psicoactivas (SPA y su relación con factores personales, demográficas, lúdicas y familiares en soldados adscritos a un batallón de una ciudad colombiana. Método: estudio cross sectional en una muestra de 384 soldados a los cuales se aplicó el instrumento ASSIST. Se realizó un análisis descriptivo y se calculó la prevalencia de SPA en la vida y a los tres meses, con sus respectivos intervalos de confianza (IC) del 95%, se determinó la asociación del desenlace con factores plausibles, por medio de la razón de prevalencias y sus respectivos IC del 95%, se construyeron modelos de regresión binomial simple y múltiple y regresión binomial negativos (cálculo de índice-Rate Rations (IRR)) y se calculó la prueba exacta de Fisher. Para determinar las variables candidatas a ingresar al modelo ajustado se aplicó el criterio de Hosmer-Lemeshow. Resultados: La prevalencia de consumo de SPA en la vida fue del 73,7% con predominio del consumo de bebidas alcohólicas 58,6%, del tabaco, 47,9%, cannabis, 41,1%, y la cocaína, 16,4%. La prevalencia de consumo de SPA en los últimos tres meses fue del 48,4%, con hegemonía del tabaquismo, 33,1%. Conclusiones: la alta prevalencia en el consumo de SPA se convierte en una preocupación exclusiva del ejército nacional, donde se contempla que el consumo de drogas ayuda a resistir las difíciles condiciones que se afrontan en medio del conflicto, y que los principales factores de riesgo son tener amigos o superiores que consumen y la disfuncionalidad familiar.

Objective: To calculate the prevalence of Psychoactive Substances (PAS) use and its relationship with personal, demographic, recreational and family factors in soldiers attached to a battalion in a Colombian city. Method: cross sectional study in a sample of 384 soldiers to whom the ASSIST instrument was applied. A descriptive analysis was carried out and the prevalence of PAS in life and at three months was calculated, with their respective 95% confidence intervals (CI), the association of the outcome with plausible factors was determined by means of the prevalence ratio and their respective 95% CI, simple and multiple binomial regression and negative binomial regression models were constructed (calculation of the index-Rate Rations (IRR)) and Fisher's exact test was calculated. The Hosmer-Lemeshow criterion was applied to determine the candidate variables to be included in the adjusted model. Results: Lifetime prevalence of PAS use was 73.7%, with a predominance of alcoholic beverages (58.6%), tobacco (47.9%), cannabis (41.1%), and cocaine (16.4%). The prevalence of PAS consumption in the last three months was 48.4%, with smoking predominating, 33.1%. Conclusions: the high prevalence of PAS consumption becomes an exclusive concern of the national army, where it is considered that drug consumption helps to resist the difficult conditions faced in the midst of the conflict, and that the main risk factors are to have

Objetivo: Calcular a prevalência do consumo de Substâncias Psicoactivas (SPA) e a sua relação com factores pessoais, demográficos, recreativos e familiares em militares afectos a um batalhão de uma cidade colombiana. Método: estudo transversal numa amostra de 384 militares aos quais foi aplicado o instrumento ASSIST. Realizou-se uma análise descritiva e calculou-se a prevalência de PAS na vida e aos três meses, com os respectivos intervalos de confiança (IC) a 95%, determinou-se a associação do desfecho com factores plausíveis através da razão de prevalência e respectivos IC a 95%, construíram-se modelos de regressão binomial simples e múltipla e de regressão binomial negativa (cálculo das Razões de Taxa de Indexação (IRR)) e calculou-se o teste exato de Fisher. O critério de Hosmer-Lemeshow foi aplicado para determinar as variáveis candidatas a entrar no modelo ajustado. Resultados: A prevalência de uso de SPA na vida foi de 73,7%, com predomínio de bebidas alcoólicas 58,6%, tabaco 47,9%, cannabis 41,1% e cocaína 16,4%. A prevalência do uso de SPA nos últimos três meses foi de 48,4%, com predomínio do tabagismo, 33,1%. Conclusões: A elevada prevalência do consumo de SPA tornou-se uma preocupação exclusiva do exército nacional, onde se considera que o consumo de drogas ajuda a suportar as difíceis condições enfrentadas no meio do conflito e que os principais factores de risco são ter

Cardiac arrest in adult intensive care units in the Medellin metropolitan area, Colombia: observational study / Paro cardiaco en las unidades de cuidado intensivo de adultos del área metropolitana de Medellín, Colombia. Estudio observacional

Abstract Introduction: In-hospital cardiac arrest (CA) is a rare but life-threatening event. However, the epidemiology of this event in intensive care units (ICU) is not clear. Objective: To determine the clinical characteristics of CA in adult patients hospitalized in several ICU of the Metropolitan Area of the Aburrá Valley, Colombia, over a period of 1 year. Methods: Observational study for a limited period of 1 year for adult patients with CA in the ICU of the hospitals of the Metropolitan Area of the Aburrá Valley, Colombia: San Vicente Foundation University Hospital, IPS University, and Manuel Uribe Ángel Hospital. Results: Of 3710 eligible patients who were treated in 91 beds, 646 CA events occurred during this period, of which 151 were candidates for resuscitation maneuvers. The overall incidence of CA in the ICU was 17.1%, without differences between the 3 hospitals included and the incidence of resuscitable CA was 39.9 cases per 1000 admissions to the ICU. The most common CA rhythm was asystole 54.3% and the overall survival at hospital discharge was 3.3%. Conclusion: In the analyzed ICU, CA was an infrequent event, but it presents a high mortality at discharge from the ICU and hospital. However, the few patients who survive have a good neurological prognosis.

Resumen Introducción: El paro cardiaco intrahospitalario es un evento poco frecuente, pero potencialmente mortal. No obstante, no es clara su epidemiología en las unidades de cuidado intensivos. Objetivo: Determinar las características clínicas del paro cardiorrespiratorio en pacientes adultos hospitalizados en varias unidades de cuidado intensivo (UCI) del Área Metropolitana del Valle de Aburrá, Colombia, en un período de 12 meses. Métodos: Estudio observacional por período limitado a un año para pacientes adultos con paro cardiorrespiratorio en las UCI de los hospitales del Área Metropolitana del Valle de Aburrá, Colombia: Hospital Universitario San Vicente Fundación, IPS Universitaria, y Hospital Manuel Uribe Ángel. Resultados: De 3710 pacientes elegibles que fueron atendidos en 91 camas se presentaron en este período 646 eventos de paro cardiorrespiratorio, de los cuales 151 fueron candidatos a man iobras de reanimación. La incidencia global de paro en UCI fue de 17,1% (IC 95%: 15,9%-18,3%), sin diferencias entre los tres hospitales incluidos y una incidencia de paro cardiorrespiratorio susceptible de recibir reanimación cardiopulmonar de 39,9 casos por cada 1000 admisiones a la UCI. El ritmo de paro más común fue la asistolia (54,3%) y la sobrevida global al alta hospitalaria fue de 3,3%. Conclusión: El paro cardiorrespiratorio no fue un evento frecuente en las UCI analizadas, pero presenta una alta mortalidad al alta de UCI y hospitalaria. Sin embargo, los pocos pacientes que logran sobrevivir tienen buen pronóstico neurológico.

Linfadenectomía paraaórtica extraperitoneal por laparoscopia como método clasificatorio en pacientes con diagnóstico de carcinoma de cérvix localmente avanzado: reporte de casos / Laparoscopic extraperitoneal para-aortic lymphadenectomy as a classification method in locally advanced cervical cancer: Report of a series of cases

Resumen Describimos la experiencia quirúrgica de diez pacientes sometidas a linfadenectomía paraaórtica extraperitoneal laparoscópica (LPEL) para clasificación en carcinoma de cérvix localmente avanzado (CCLA) y revisión de la literatura. Métodos: Búsqueda de literatura en MEDLINE y EMBASE usando palabras clave: "Uterine Cervical Neoplasms; Neoplasm Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. Describimos la técnica quirúrgica para LPEL y resultados obtenidos en 10 pacientes intervenidas. Resultados: Diez pacientes con CCLA fueron sometidas a LPEL, rango de edad entre 29 y 65 años, sangrado operatorio entre 5 y 30cc, recuento ganglionar entre 2 y 11 ganglios; no complicaciones intraoperatorias y estancia hospitalaria entre uno y tres días. Conclusión: Es la primera experiencia reportada de LPEL para el CCLA en Colombia, siendo un procedimiento factible, seguro y útil para identificar compromiso paraaórtico adaptando el tratamiento.

Abstract A description is presented on the surgical experience of 10 patients who underwent laparoscopic extraperitoneal para-aortic lymphadenectomy (LEPL) in order to classify locally advanced cervical carcinoma (LACC), as well as a literature review. Methods: A literature search was performed in MEDLINE and EMBASE using the following keywords:''Uterine Cervical Cancer; Cancer Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. The surgical technique for LEPL is described, as well as the outcomes of the 10 patients who underwent surgery. Results: A total of 10 patients, with ages between 29 and 65 years and with LACC underwent LPEL. There were surgical blood losses between 5 to 30 cc, a lymph node count between 2 and 11, no surgical complications, and a hospital stay of between 1 and 3 days. Conclusion: This is the first experience reported for LPEL for LACC in Colombia. It is a safe, feasible, and useful procedure to identify para-aortic involvement.

Enfermedad de Hansen. Una condición emergente en Chile / Hansen disease, an emergent condition in Chile

Resumen La enfermedad de Hansen (EH) es una infección secundaria a Mycobacterium leprae, de curso crónico y que afecta preferentemente la piel y los nervios periféricos. Es una condición emergente en Chile debido a la migración humana. Presentamos un caso que afectó a un trabajador inmigrante desde Haití, que presentó antes de su arribo múltiples lesiones cutáneas en placas, con hipoestesia y madarosis unilateral. El diagnóstico de la forma multibacilar se estableció por los hallazgos clínicos, la presencia de bacilos ácido-alcohol resistentes en una muestra cutánea y la detección de células inflamatorias alrededor de los terminales nerviosos y granulomas en una biopsia de piel, desde donde se amplificaron segmentos específicos de los genes rpoB y hsp65 de M. leprae. El paciente fue tratado con el esquema combinado estándar de la OMS para la forma multibacilar durante un año, con regresión parcial de las lesiones. Durante el seguimiento se detectó por RPC una disminución del número de copias del gen rpoB de M. leprae en muestras nasofaríngeas hasta el sexto mes. El registro de enfermedades de notificación obligatoria demuestra un incremento reciente de casos de EH en Chile, todos relacionados con población migrante. La enfermedad de Hansen es una nueva condición clínica y los clínicos deben estar atentos a esta posibilidad diagnóstica. Las pruebas moleculares pueden ayudar en el diagnóstico y seguimiento.

Hansen's disease (HD) is caused by Mycobacterium leprae. It has a chronic course and preferentially affects the skin and the peripheral nerves. It's an emergent infection in Chile due to migration waves. This case report affecting a migrant worker from Haiti that presented several compatible skin lesions, with hypoesthesia and unilateral madarosis that appeared before arrival. The diagnosis of a multibacillary form was established by clinical findings, presence of fast acid bacilli on a direct skin smear, and inflammatory cell surrounding nerve endings and granulomas on skin biopsy. Besides, specific rpoB and hsp65 gene segments from M. leprae were amplified from skin samples. Patient was treated with the WHO standard combined regimen for multibacillary forms during one year showing partial regression of skin lesions. Nasopharyngeal samples showed the presence of M. leprae rpoB copies detected by PCR decreasing until six months of therapy. Notifiable diseases databases showed a recent increment of cases, all related to migrant population. Hansen's disease is a new condition in Chile and clinicians should be aware of this possibility. Molecular tools may facilitate diagnosis and follow up.

Microscopic characterization of esophageal regions of a group of Capybara (Hydrochoerus hydrochaeris) free in Brazil / Caracterização microscópica das regiões esofágicas de um grupo de Capivaras (Hydrochoerus hydrochaeris) livres no Brasil / Caracterización microscópica de las regiones esofágicas de un grupo de capibaras (Hydrochoerus hydrochaeris) libres en el Brasil

Morphological studies on wildlife animals have increased in an attempt to explore and understand minutely their adaptive evolution and how it relates to or differentiate from domestic animals. The aim of this study was to describe microscopically esophageal regions (cranial, middle and caudal) of a group of male and female capybaras, using histological techniques. Samples were harvested, fixed, processed and analyzed. All three esophageal regions were covered by keratinized stratified epithelium, thicker in folds apex and towards the caudal region, proximal to the stomach. In this layer, stratum granulosum was well developed. The submucosa, constituted of loose connective tissue, showed no glands. The muscular layer, externally lined by serous and/or adventitial layer, presented two orientations (circular and longitudinal) in the three regions, and it showed striated skeletal muscle fibers with developed nerve plexus

Os estudos morfológicos em animais de fauna silvestre têm aumentado na tentativa de explorar e conhecer em detalhes suas adaptações, e como estas se relacionam ou diferenciam com as dos animais domésticos. O objetivo deste trabalho foi descrever microscopicamente as regiões esofágicas (cranial, média e caudal) de um grupo de capivaras de ambos os sexos, por meio de técnicas histológicas de coloração. As amostras foram previamente obtidas, fixadas, processadas e analisadas. Observou-se que as três regiões esofágicas estavam revestidas por epitélio estratificado pavimentoso queratinizado, sendo mais espesso, em geral, no ápice das pregas e sua espessura aumenta em direção à regi ão caudal, próximo ao estômago. Nesta camada, o estrato granuloso está bem desenvolvido. A submucosa de tecido conjuntivo frouxo é aglandular. A camada muscular revestida pela serosa e/ou adventícia externamente, apresentou duas orientações (circular e longitudinal) nas três regiões, e é constituída por fibras musculares estriadas esqueléticas com plexos nervosos desenvolvidos.

Los estudios morfológicos en animales de fauna silvestre han aumentado en la tentativa de explorar y conocer en detalle sus adaptaciones, y como estas se relacionan o diferencian con las de los animales domésticos. El objetivo de este trabajo fue describir microscópicamente las regiones esofágicas (craneal, media y caudal) de un grupo de capibaras de ambos sexos por medio de técnicas histológicas de coloración. Las muestras fueron previamente obtenidas, fijadas, procesadas y analizadas. Se observó que las tres regiones esofágicas estaban revestidas de epitelio estratificado plano queratinizado, siendo más espeso, en general, en el ápice de los pliegues y su espesura aumenta en dirección a la región caudal, próxima al estómago. En esta camada, el estrato granuloso está bien desarrollado. La submucosa es de tejido conectivo laxo, es aglandular. La camada muscular revestida por la serosa y/o adventicia externamente, presentó dos orientaciones (circular y longitudinal) en las tres regiones, y es constituida de fibras musculares estriadas esqueléticas con plexos nerviosos desarrollados.

Del trigo y la cizaña / From wheat and tares

Diariamente en su quehacer, el clínico se enfrenta a situaciones e interrogantes que debe resolver como parte de la atención a sus pacientes: ¿cómo deberá abordar el estudio y el proceso diagnóstico de su enfermo, ¿cuál prueba solicitar?, ¿cuál será su rendimiento?, ¿qué tan sensible y específica será?, ¿cuál debe ser la mejor estrategia de tratamiento?, ¿cuál es la eficacia y la efectividad de los posibles tratamientos y cuál o cuáles serán más útiles para la condición de su paciente?, ¿cuál será el pronóstico?. Hace unos 30 años Covell y colaboradores informaron que en promedio, los médicos internistas se plantean dos preguntas por cada tres pacientes que ven en su consulta, y una revisión sistemática de la literatura reciente encontró que los clínicos intentan responder 51% (36-66%) de estas preguntas, logrando aclarar 78% (67-88%).Desde sus orígenes, la medicina basada en evidencia ha propendido por "el uso consciente, explícito y juicioso de la mejor evidencia actual en la toma de decisiones acerca del cuidado de pacientes individuales" y en este orden de ideas, ha propuesto elementos de juicio para reconocer los mejores artículos sobre diagnóstico , riesgo , pronóstico , análisis de decisión , tratamiento y muchos otros temas más. La tarea del médico al respecto consiste pues, en que una vez planteadas las preguntas o interrogantes clínicos, las traduzca en estrategias de búsqueda que le lleven hacia la información de la mayor calidad posible para responderlos. No siempre es fácil cumplir el cometido, pues existen diferentes barreras, tanto en personal experto como en entrenamiento, dentro de las cuales pueden citarse entre otras, dificultades en la formulación adecuado de la pregunta clínica, incapacidad para establecer la estrategia de búsqueda apropiada, limitaciones para establecer cuándo se ha adquirido información suficiente (cuándo detener la búsqueda), falta de entrenamiento en el uso de recursos informáticos, dificultades en el acceso a los recursos de información, falta de tiempo o aun no considerar que exista una respuesta a muchos de sus interrogantes.