Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study.

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

Déficit de Vitamina B12 en consumo de Metformina e Inhibidores de Bomba de Protones / Vitamin B12 Deficiency in consumption of Metformin and Proton Pump Inhibitors

Resumen El espectro de enfermedades asociadas con la deficiencia de la vitamina B 12 es amplio y abarca desde la ausencia de síntomas hasta el síndrome de malabsorción, insuficiencia medular, o síntomas neurológicos acompañados de parestesias, mielopatía o neuropatía. Existe evidencia sugestiva que indica que el empleo de inhibidores de bomba de protones (IBP) a largo plazo puede disminuir los niveles séricos de vitamina B12. Igualmente, estudios previos han asociado el déficit de vitamina B 12 a consumo en dosis altas de metformina, sin embargo, el mecanismo por el cual se genera la descompensación no está claro. Se ha llegado a describir una asociación aditiva de la administración de inhibidores bomba de protones/ Antagonistas receptor Histamina - 2 y metformina, sugiriendo que promueven la malabsorción de Vitamina B 12. Ambas categorías de medicamentos son ampliamente utilizadas, y en muchos casos sin prescripción médica, y su uso no debería ser pasado por alto. Cuando están clínicamente indicados, su uso debería ser monitorizado debido a la posibilidad de malabsorción de vitamina B 12 y sus consecuencias. Por tanto, en este artículo se revisan aspectos generales sobre la vitamina B12 y el estado del arte sobre la deficiencia de vitamina B12 en pacientes con consumo de metformina o uso de inhibidor de bomba de protones.

Abstract The spectrum of diseases associated with vitamin B12 deficiency is broad, ranging from no symptoms to malabsorption syndrome, spinal cord injury, neurological symptoms accompanied by paresthesia, myelopathy, or neuropathy. There is suggestive evidence that long-term use of proton pump inhibitors (PPIs) can lower serum levels of vitamin B12. Additionally, previous studies have associated vitamin B12 deficiency with high doses consumption of metformin; however, the mechanism in which this occurs is not clear. An additive association between the administration of proton pump inhibitors / Histamine H2 receptor antagonists, and metformin has been described, which suggest that these promote vitamin B12 malabsorption. Both categories of drugs are widely used, in many cases without a prescription, and its use should not be overlooked. When clinically indicated, their use should be monitored in view of the possibility of vitamin B12 malabsorption and its consequences. This article aims to review general aspects of vitamin B12 and delve into the state of the art regarding vitamin B12 deficiency in patients with metformin and / or proton pump inhibitor consumption.

VALIDATION OF THE ROCKALL SCORE IN UPPER GASTROINTESTINAL TRACT BLEEDING IN A COLOMBIAN TERTIARY HOSPITAL.

BACKGROUND: Rockall score is the most widely used prognostic scale for assessing risk of complications from non-varicose upper gastrointestinal bleeding (UGIB). Several studies have been conducted in adult populations with non-varicose UGIB in different parts of the world, with conflicting findings regarding the extent of association between the score and some morbidity and mortality outcomes. Also, there is controversy regarding the best cut-off point for the score. Moreover, no studies validating this score in Colombia have been carried out. OBJECTIVE: To assess the diagnostic performance of the Rockall score in predicting rebleeding and mortality in patients with non-varicose UGIB. METHODS: A prospective cohort study was conducted in patients requiring upper gastrointestinal endoscopy (UGIE) for non-varicose bleeding. The pre-and post-endoscopy Rockall scores were calculated and outcomes, including mortality, UGIB-associated mortality and in hospital rebleeding were determined at the 1 and 3-month time points. The association between the scores and these outcomes was assessed using the chi2 or the Fisher test, whereas the discrimination ability of the score was determined using the areas under the ROC curve (AUC). High discrimination ability was considered to exist in cases in which an AUC ≤0.7 with α=0.05 could be rejected. RESULTS: Overall, 177 patients were analyzed. In-hospital outcomes at 1 and 3 months were 12%, 17% and 23% for general mortality, 6%, 12% and 15% for UGIB mortality, and 19%, 30% and 37% for rebleeding. The post-endoscopy Rockall score was associated with the three outcomes at the three time points assessed, while the pre-endoscopy score was only associated with general mortality at the three time points, and rebleeding at 1 and 3 months. Regarding discrimination ability, although the AUC was greater than expected by randomness (0.5) in all cases, only one AUC ≤0.7 was rejected in the post-endoscopy score for in-hospital UGIB mortality (AUC=0.901; 95%CI: 0.845-0.958), at 1 month (AUC=0.836; 95%CI: 0.717-0.954) and at 3 months (AUC=0.869; 95%CI: 0.771-0.967), and for rebleeding at 1 month (AUC=0.793; 95%CI: 0.725-0.861) and at 3 months (AUC=0.806; 95%CI: 0.741-0.871). CONCLUSION: An association was found between the Rockall score and rebleeding and mortality in patients with non-varicose UGIB. Only the post-endoscopy score had a high predictive ability for rebleeding and UGIB mortality.

Validação da pontuação Rockall no sangramento do trato gastrointestinal superior em um hospital terciário colombiano / Validation of the rockall score in upper gastrointestinal tract bleeding in a colombian tertiary hospital

ABSTRACT Background Rockall score is the most widely used prognostic scale for assessing risk of complications from non-varicose upper gastrointestinal bleeding (UGIB). Several studies have been conducted in adult populations with non-varicose UGIB in different parts of the world, with conflicting findings regarding the extent of association between the score and some morbidity and mortality outcomes. Also, there is controversy regarding the best cut-off point for the score. Moreover, no studies validating this score in Colombia have been carried out. Objective To assess the diagnostic performance of the Rockall score in predicting rebleeding and mortality in patients with non-varicose UGIB. Methods A prospective cohort study was conducted in patients requiring upper gastrointestinal endoscopy (UGIE) for non-varicose bleeding. The pre-and post-endoscopy Rockall scores were calculated and outcomes, including mortality, UGIB-associated mortality and in hospital rebleeding were determined at the 1 and 3-month time points. The association between the scores and these outcomes was assessed using the chi2 or the Fisher test, whereas the discrimination ability of the score was determined using the areas under the ROC curve (AUC). High discrimination ability was considered to exist in cases in which an AUC ≤0.7 with α=0.05 could be rejected. Results Overall, 177 patients were analyzed. In-hospital outcomes at 1 and 3 months were 12%, 17% and 23% for general mortality, 6%, 12% and 15% for UGIB mortality, and 19%, 30% and 37% for rebleeding. The post-endoscopy Rockall score was associated with the three outcomes at the three time points assessed, while the pre-endoscopy score was only associated with general mortality at the three time points, and rebleeding at 1 and 3 months. Regarding discrimination ability, although the AUC was greater than expected by randomness (0.5) in all cases, only one AUC ≤0.7 was rejected in the post-endoscopy score for in-hospital UGIB mortality (AUC=0.901; 95%CI: 0.845—0.958), at 1 month (AUC=0.836; 95%CI: 0.717—0.954) and at 3 months (AUC=0.869; 95%CI: 0.771—0.967), and for rebleeding at 1 month (AUC=0.793; 95%CI: 0.725—0.861) and at 3 months (AUC=0.806; 95%CI: 0.741—0.871). Conclusion An association was found between the Rockall score and rebleeding and mortality in patients with non-varicose UGIB. Only the post-endoscopy score had a high predictive ability for rebleeding and UGIB mortality.

RESUMO Contexto O escore de Rockall é a escala de prognóstico mais amplamente usada para avaliar o risco de complicações de sangramento gastrointestinal superior não varicoso. Vários estudos foram conduzidos em populações adultas com sangramento gastrointestinal superior não varicoso em diferentes partes do mundo, com achados conflitantes quanto à extensão da associação entre o escore e alguns desfechos de morbimortalidade. Há também controvérsias em relação ao melhor ponto de corte para a pontuação. Além disso, não foram realizados estudos que validem essa pontuação na Colômbia. Objetivo Avaliar o desempenho diagnóstico do escore de Rockall na previsão de ressangramento e mortalidade em pacientes com sangramento gastrointestinal superior não varicoso. Métodos Um estudo de coorte prospectivo foi conduzido em pacientes que necessitaram de endoscopia digestiva alta (EDA) para sangramento não varicoso. Os escores de Rockall pré e pós-endoscopia foram calculados e os resultados, incluindo mortalidade, mortalidade associada ao sangramento gastrointestinal superior não varicoso e ressangramento intra-hospitalar foram determinados nos pontos de tempo de 1 e 3 meses. A associação entre os escores e esses desfechos foram avaliados pelo teste de chi2 ou Fisher, enquanto a habilidade de discriminação do escore foi determinada pelas áreas sob a curva ROC (AUC). Alta capacidade de discriminação foi considerada existente nos casos em que uma AUC ≤0,7 com α=0,05 poderia ser rejeitada. Resultados No geral, 177 pacientes foram analizados. Os desfechos hospitalares em 1 e 3 meses foram de 12%, 17% e 23% para mortalidade geral, 6%, 12% e 15% para mortalidade com hemorragia digestiva alta e 19%, 30% e 37% para ressangramento. O escore de Rockall pós-endoscopia foi associado aos três desfechos nos três momentos avaliados, enquanto o escore pré-endoscopia foi associado apenas à mortalidade geral nos três momentos, e ressangramento em 1 e 3 meses. Em relação à capacidade de discriminação, embora a AUC fosse maior do que o esperado pela aleatoriedade (0,5) em todos os casos, apenas uma AUC ≤0,7 foi rejeitada no escore pós-endoscopia para mortalidade com hemorragia digestiva alta intra-hospitalar (AUC =0,901; 95%IC: 0,845—0,958), em 1 mês (AUC =0,836; 95%IC 0,717—0,954) e em 3 meses (AUC =0,869; 95%IC: 0,771—0,967), e para ressangramento em 1 mês (AUC =0,793; 95%IC: 0,725—0,861) e aos 3 meses (AUC =0,806; 95%IC: 0,741—0,871). Conclusão Foi encontrada associação entre o escore de Rockall, ressangramento e mortalidade em pacientes com hemorragia digestiva alta não varicosa. Apenas o escore pós-endoscopia teve alta capacidade preditiva para ressangramento e mortalidade por sangramento gastrointestinal superior não varicoso.

Diagnostic performance of platelet count/spleen diameter ratio to detect esophageal varices in patients with cirrhosis / Rendimiento diagnóstico del índice de recuento de plaquetas/diámetro del bazo para detectar várices esofágicas en pacientes con cirrosis

Abstract Introduction: The platelet count/spleen diameter (PC/SD) ratio is a noninvasive method for the diagnosis of esophageal varices (EV) used as an alternative to endoscopy in patients with cirrhosis. Objective: To evaluate the diagnostic performance of the PC/SD ratio (cut-off point <909) to detect EV in patients with cirrhosis treated at a tertiary referral hospital in Bogotá D.C., Colombia. Materials and methods: A prospective diagnostic test accuracy study was conducted in 66 patients with cirrhosis treated at the Hospital Universitario de La Samaritana between July and December 2018. A descriptive analysis of the data was performed. In addition, the diagnostic performance of the PC/SD ratio (cut-off point <909) for the detection of EV was compared with the findings reported in the esophagogastroduodenoscopy (gold standard), calculating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). A significance level of p<0.05 was considered. Results: The mean age of the participants was 65.5 years, 53.03% were female, and the most common causes of cirrhosis were alcohol consumption (40.90%) and autoimmune hepatitis (22.72%). EV was diagnosed in 48 patients (72.72%). The PC/SC ratio showed sensitivity of 60%, specificity of 78%, PPV of 0.88, NPV of 0.42, LR+ of 2.73, and LR- of 0.51. Conclusion: The low sensitivity, specificity, and NPV found in the present study suggest that the PC/SD ratio (cut-off point <909) may not be a useful diagnostic test for detecting EV in patients with cirrhosis.

Resumen Introducción. El índice de recuento de plaquetas/diámetro del bazo (RP/DB) es un método no invasivo para el diagnóstico de varices esofágicas (VE) que se usa como alternativa a la endoscopia en pacientes con cirrosis. Objetivo. Evaluar el rendimiento diagnóstico del índice RP/DM (punto de corte <909) para detectar VE en pacientes cirróticos atendidos en un hospital de tercer nivel de Bogotá D.C., Colombia. Materiales y métodos. Estudio prospectivo de validez de prueba diagnóstica realizado en 66 pacientes cirróticos atendidos en el Hospital Universitario de La Samaritana entre julio y diciembre de 2018. Se realizó un análisis descriptivo de los datos. Además, el rendimiento diagnóstico del índice RP/DM (punto de corte <909) para la detección de VE se comparó con los hallazgos de la esofagogastroduodenoscopia (prueba de oro), calculándose su sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN), razón de probabilidad positiva (LR+) y razón de probabilidad negativa (LR-). Se consideró un nivel de significancia de p<0.05. Resultados. La edad promedio de los participantes fue 65.5 años, 53.03% eran mujeres y las causas más comunes de cirrosis fueron consumo de alcohol (40.90%) y hepatitis autoinmune (22.72%). Las VE fueron diagnosticadas en 48 pacientes (72.72%). El índice RP/DM tuvo una sensibilidad de 60%, una especificidad de 78%, un VPP de 0.88, un VPN de 0.42, una LR+ de 2.73 y una LR- de 0.51. Conclusión. La baja sensibilidad, especificidad y VPN encontrados en el presente estudio sugieren que el índice RP/DM (punto de corte <909) podría no ser una prueba diagnóstica útil para detectar VE en pacientes cirróticos.

Hepatopatías autoinmunes. Hallazgos clínicos y de laboratorio en pacientes de un hospital de referencia nacional / Autoimmune liver diseases. Clinical and laboratory findings in patients in a national reference hospital

Introducción. Las enfermedades autoinmunes del hígado son un grupo de patologías caracterizadas por una respuesta autoinmune contra los hepatocitos y/o el epitelio biliar. Sus manifestaciones clínicas son variadas, con alteraciones en las pruebas de función hepática y presencia de autoanticuerpos. Metodología. Estudio observacional descriptivo con 101 pacientes atendidos en el Hospital Universitario de La Samaritana de Bogotá D.C., entre enero a diciembre de 2019, con los diagnósticos de hepatitis autoinmune, colangitis biliar primaria, colangitis esclerosante primaria y síndrome de sobreposición. Se evaluaron los parámetros clínicos y de laboratorio, con el fin de caracterizar su frecuencia en estas patologías, debido a la importancia de un diagnóstico precoz. Resultados. Se encontraron 54 casos de hepatitis autoinmune, 19 casos de colangitis biliar primaria, 4 casos de colangitis esclerosante primaria y 24 casos de síndrome de sobreposición. El 81% fueron mujeres y la edad promedio fue de 55 años. El 39% de los pacientes tenían cirrosis. En general, los resultados se ajustaron a lo descrito internacionalmente, como es el predominio en mujeres y la comorbilidad autoinmune. Conclusión. Los hallazgos indican que cualquier alteración del perfil bioquímico hepático debe ser considerado, y se debe descartar la presencia de hepatopatías autoinmunes para diagnosticarlas de manera precoz, evitando que lleguen a cirrosis y sus complicaciones, con la necesidad de un trasplante hepático como única alternativa terapéutica.

Introduction. Autoimmune liver diseases are a group of pathologies characterized by an autoimmune response against hepatocytes and/or the biliary epithelium. Their clinical manifestations are varied, with alterations in liver function tests and the presence of autoantibodies. Methodology. Descriptive study with 101 patients who attended at the Hospital Universitario de La Samaritana in Bogota D.C., between January and December 2019, with the diagnoses of autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and overlap syndrome. Clinical and laboratory parameters were evaluated in order to characterize their frequency in these pathologies, due to the importance of an early diagnosis. Results. There were 54 cases of autoimmune hepatitis, 19 cases of primary biliary cholangitis, 4 cases of primary sclerosing cholangitis, and 24 cases of overlap syndrome. Of all patients, 81% were women, the average age was 55 years, and 39% had cirrhosis. In general, the findings were consistent with what has been described worldwide, such as a higher prevalence in women and autoimmune comorbidity. Conclusion. The findings indicate that any alteration in the liver biochemical profile should be considered to rule out an autoimmune liver disease for an early diagnosis, avoiding the possibility of cirrhosis and its complications, with the need for a liver transplant as the only therapeutic alternative.

Tamización para el virus de la hepatitis C en tres hospitales de Cundinamarca, Colombia / Screening for hepatitis C virus in three hospitals in Cundinamarca, Colombia

Introducción. La infección por el virus de la hepatitis C (VHC) es un problema de salud pública en el mundo. La Organización Mundial de la Salud (OMS) calcula en más de 70 a 100 millones las personas infectadas. La mayoría de ellas, a lo largo del mundo entero, no han sido diagnosticadas y permanecen sin tratamiento. Objetivo. Determinar la prevalencia de anticuerpos contra el VHC en pacientes con factores de riesgo para la infección, en tres hospitales del departamento de Cundinamarca, Colombia, mediante la prueba rápida SD Bioline en sangre capilar, y la confirmación de la infección por la prueba de ARN-PCR en tiempo real (PCR-RT). Metodología. Estudio de tipo observacional descriptivo donde se incluyeron pacientes adultos atendidos en los servicios de consulta externa de los hospitales de La Mesa, Ubaté y Zipaquirá. Se definieron como factores de riesgo para hepatitis C: antecedente transfusional antes de 1996, cirugías mayores (tórax, abdomen, ortopédicas), tatuajes, piercing. Se empleó como prueba rápida el kit comercial SD Bioline HCV (Standard Diagnostics, INC. Corea). Esta prueba contiene una membrana recubierta con antígenos recombinantes del VHC (core, NS3, NS4, NS5). Resultados. Entre enero y octubre de 2018 se tamizaron 1.856 pacientes, 1.531 mujeres (82%) y 325 (18%) hombres, con edad promedio de 45 años y rango de edad de 18 a 89 años. Los principales factores de riesgo identificados fueron los antecedentes de cirugía y las transfusiones antes de 1996. Se detectaron 2 pacientes mujeres positivas, mayores de 50 años, y como factor de riesgo el haber sido sometidas a cirugía mayor y el antecedente transfusional antes de 1996, confirmadas por la técnica de PCR-RT, lo que da una prevalencia global de la infección del 0,1%, pero del 0,05% en las personas con antecedente quirúrgico, 0,25% entre los mayores de 50 años, y 0,6% en los pacientes con antecedente transfusional antes de 1996. Conclusiones. Este estudio realizado en una población seleccionada por factores de riesgo asociados, mostró una prevalencia global de infección por VHC de 0,1%. Nuestros resultados de tamización con prueba rápida en una población seleccionada con factores de riesgo, sugieren que la estrategia de tamización se debe dirigir a personas mayores de 50 años con antecedente transfusional y cirugía mayor.

Introduction. Infection with hepatitis C virus (HCV) is a worldwide public health problem. The World Health Organization (WHO) estimates that more than 70 to 100 million people are infected. Most of them, throughout the world, have not been diagnosed and remain untreated. Objective. To determine the prevalence of antibodies against HCV in patients with risk factors for infection, in three hospitals in the department of Cundinamarca, Colombia, by means of the rapid SD Bioline test in capillary blood, and the confirmation of infection by real-time PCR (RT-PCR). Methodology. Adult patients treated in the outpatient services of the La Mesa, Ubaté and Zipaquirá hospitals. Risk factors for hepatitis C were defined as: transfusion history before 1996, major surgeries (chest, abdomen, orthopedic), tattoos, and piercing. The commercial SD Bioline HCV kit (Standard Diagnostics, INC. Korea) was used as the rapid test. This kit contains a membrane coated with recombinant HCV antigens (core, NS3, NS4, NS5). Results. Between January and October 2018, 1,856 patients were screened, 1,531 women (82%) and 325 (18%) men, with an average age of 45 years and an age range of 18 to 89 years. The main risk factors identified were a history of surgery and transfusions before 1996. Two positive female patients were detected, older than 50 years, and as a risk factor, having undergone major surgery and a history of transfusion before 1996, confirmed by the RT-PCR assay, which gives a global prevalence of infection of 0.1%, but of 0.05% in people with surgery history, 0.25% among those over 50 years of age, and 0.6% in patients with a transfusion history before 1996. Conclusions. This study, carried out in a population selected for associated risk factors, showed an overall prevalence of HCV infection of 0.1%. Our results suggest that screening with a rapid test in a selected population with risk factors should be directed at people over 50 years of age with a history of transfusion and major surgery.

Embarazo y lesión hepática inducida por medicamentos. Reporte de un caso y revisión de la literatura / Pregnancy and drug-induced liver injury. Case report and literature review

La lesión hepática inducida por medicamentos o DILI (del inglés, Drug-Induced Liver Injury) es una condición relativamente rara, y más aún durante el embarazo. Usualmente es subdiagnosticada, y cuando se presenta en nuestro medio, pocas veces es notificada a los sistemas de registros nacionales, con un importante subregistro a nivel nacional y de Latinoamérica. Su forma de presentación clínica, tiempo de latencia, patrón de lesión hepática y reacciones idiosincráticas dificultan el diagnóstico oportuno, así como la ausencia tanto de pruebas diagnósticas objetivas, como de cambios histológicos patognomónicos que confirmen esta entidad. Se presenta el primer caso reportado en la literatura de una mujer en primer trimestre de gestación, quien cursó con DILI secundario al uso de tionamidas por sospecha clínica de hipertiroidismo.

Drug-induced liver injury (DILI) is a relative rare condition among general population and among pregnant women. It is usually underdiagnosed, and when identified, it is rarely notified to the national registry systems, especially locally, and in general in Latin America. Clinical presentation, time before symptom onset, patterns of liver injury and idiosyncratic reactions make an early diagnosis difficult, as well as the absence of diagnostic tests or histological changes that are unique to this pathology to confirm the diagnosis. We present the first case reported in the literature of a woman, who during the first trimester of pregnancy presented with DILI, secondary to the use of thionamides due to suspected hyperthyroidism.

Biocompatible and Antimicrobial Electrospun Membranes Based on Nanocomposites of Chitosan/Poly (Vinyl Alcohol)/Graphene Oxide.

Tissue engineering is gaining attention rapidly to replace and repair defective tissues in the human body after illnesses and accidents in different organs. Electrospun nanofiber scaffolds have emerged as a potential alternative for cell regeneration and organ replacement. In this paper, porous membranes, based on nanofibrous chitosan (CS), polyvinyl alcohol (PVA), and graphene oxide (GO), were obtained via electrospinning methodology. Three different formulations were obtained varying GO content, being characterized by Fourier Transform Infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). In vitro tests were carried out, consisting of hydrolytic degradation inside simulated biological fluid (SBF), and in vivo tests were carried out, where the material was implanted in Wistar rats' subcutaneous tissue to determine its biocompatibility. The antibacterial activity was tested against Gram-positive bacteria Bacillus cereus and Staphylococcus aureus, and against Gram-negative Salmonella enterica and Escherichia coli, by contact of the electrospun nanofiber scaffolds above inoculum bacterial in Müeller Hinton agar with good inhibition only for scaffolds with the higher GO content (1.0%). The results confirmed good biocompatibility of the nanofibrous scaffolds after in vivo tests in Wistar rats, which evidences its high potential in applications of tissue regeneration.

Características de la disfagia en pacientes de un centro de gastroenterología en Bogotá D. C, Colombia / Characteristics of dysphagia in patients of a gastroenterology center in Bogotá D. C, Colombia

Resumen Introducción: la epidemiología de la disfagia está pobremente definida. Es un síntoma que se asocia con el envejecimiento, y en poblaciones jóvenes sigue siendo tema de incertidumbre. También es un problema que no siempre informan los pacientes y es poco comprendido en la población general. Objetivo: describir las características clínicas y epidemiológicas de la disfagia a partir de una muestra de pacientes adultos remitidos a un centro especializado en gastroenterología. Metodología: estudio observacional, descriptivo y retrospectivo, realizado en un centro especializado en gastroenterología en Bogotá D. C. durante 2016, en el cual se revisaron 3148 historias clínicas y se recopilaron aquellas de pacientes cuyo motivo de consulta fuera disfagia o la refirieran como síntoma asociado, y cuyo diagnóstico se confirmara con pruebas complementarias. Resultados: de 3148 historias clínicas, 85 (2,7 %) presentaron disfagia como motivo de consulta principal o síntoma asociado. La mayoría correspondió a mujeres (70,5 %). El grupo de edad más afectado fue entre 70 y 79 años. La enfermedad por reflujo gastroesofágico (ERGE) representó el diagnóstico más frecuente. Conclusión: la prevalencia de disfagia encontrada es similar a la reportada en la literatura. La ERGE es causa frecuente de disfagia. La disfagia continúa siendo un problema predominantemente de adultos mayores.

Abstract Introduction: The epidemiology of dysphagia is poorly defined. It is a symptom that is associated with aging but is still a matter of uncertainty in young populations. Also, it is is not always reported by patients and is poorly understood in the general population. Objective: The objective of this study was to describe the clinical and epidemiological characteristics of dysphagia in a sample of adult patients referred to a center specializing in Gastroenterology. Methodology: This is an observational, descriptive and retrospective study carried out in a specialized gastroenterology center in Bogotá DC in 2016. We reviewed 3,148 clinical histories of patients to identify those whose reason for consultation was dysphagia or who were referred to the clinic with dysphagia as an associated symptom and whose diagnoses had been confirmed by complementary tests. Results: Of the 3,148 medical records, 85 (2.7%) presented dysphagia as the main reason for consultation or as an associated symptom. The majority were women (70.5%). The largest proportion of those affected were between 70 and 79 years old. Gastroesophageal reflux disease was the most frequent diagnosis. Conclusion: The prevalence of dysphagia found is similar to that reported in the literature. Gastroesophageal reflux disease is a frequent cause of dysphagia. Dysphagia continues to be a problem especially among the elderly.

Exhaled breath analysis for gastric cancer diagnosis in Colombian patients.

We present here the first study that directly correlates gastric cancer (GC) with specific biomarkers in the exhaled breath composition on a South American population, which registers one of the highest global incidence rates of gastric affections. Moreover, we demonstrate a novel solid state sensor that predicts correct GC diagnosis with 97% accuracy. Alveolar breath samples of 30 volunteers (patients diagnosed with gastric cancer and a controls group formed of patients diagnosed with other gastric diseases) were collected and analyzed by gas-chromatography/mass-spectrometry (GC-MS) and with an innovative chemical gas sensor based on gold nanoparticles (AuNP) functionalized with octadecylamine ligands. Our GC-MS analyses identified 6 volatile organic compounds that showed statistically significant differences between the cancer patients and the controls group. These compounds were different from those identified in previous studied performed on other populations with high incidence rates of this malady, such as China (representative for Eastern Asia region) and Latvia (representative for Baltic States), attributable to lifestyle, alimentation and genetics differences. A classification model based on principal component analysis of our sensor data responses to the breath samples yielded 97% accuracy, 100% sensitivity and 93% specificity. Our results suggest a new and non-intrusive methodology for early diagnosis of gastric cancer that may be deployed in regions lacking well-developed health care systems as a prediagnosis test for selecting the patients that should undergo deeper investigations (e.g., endoscopy and biopsy).

Características de los pacientes con cáncer gástrico del departamento de Cundinamarca, remitidos al Hospital Universitario de la Samaritana entre los años 2004 y 2009 / Characteristics of patients with gastric cancer referred to the Hospital Universitario de la Samaritana in Cundinamarca department from 2004 to 2009

Se realizó un estudio observacional descriptivo de los pacientes sometidos a esofagogastroduodenoscopia durante los años 2004 y 2009 en el Hospital Universitario de La Samaritana y con diagnóstico histológico de cáncer gástrico gástrico (CG). Se encontraron 259 casos, con predominio de los hombres (153 hombres, 106 mujeres), con edad promedio de 66 años. Fue notoria la proporción de pacientes (40%) que consultaron por hemorragia digestiva alta y con diagnóstico final de CG. El 97% de casos correspondió a tumores avanzados, y la morfología Bormann III y IV fueron las más comunes (72% y 16% respectivamente). Se observó una leve mayoría (53%) de adenocarcinomas de tipo intestinal respecto al difuso. La localización proximal de los tumores (cardias, fondo, cuerpo) fue la predominante (56,4%), en especial entre hombres (65%).La mayoría de los pacientes (69,4%) provenía de regiones del departamento de Cundinamarca situadas por encima de los 2.000 metros sobre el nivel del mar (msnm). Se plantea la necesidad de crear programas de detección temprana del CG en las regiones de alta incidencia.

This is a descriptive observational study of patients upon whom esophagogastroduodenoscopies had been performed at the hospital Universitario de La Samaritana from 2004 to 2009 and who had been diagnosed histologically with Gastric Cancer (GC). 259 cases, 153 men and 106 women, with average ages of 66 years were included. A very high proportion of patients (40%) who had sought medical assistance because of digestive hemorrhaging were ultimately diagnosed with GC. 97% of these cases had advanced tumors with Bormann levels III and IV being the most common (72% and 16% respectively). A large percentage of patients (53%) had diffuse intestinal adenocarcinomas. Proximal locations of these tumors in the cardia, fundus, corpus) predominated (56.4%) especially among male patients (65%).The majority of these patients (69.4%) came from regions of the department of Cundinamarca located more than 2,000 meters above sea level. Early detection programs for GC need to be established in regions of high incidence.

Niveles de vitamina B12 en pacientes colombianos con gastritis crónica atrófica / Levels of vitamin B12 in colombian patients with chronic atrophic gastritis

Se presenta un grupo de 75 pacientes adultos colombianos, con diagnóstico de gastritis crónica atrófica de acuerdo a los criterios de Sydney, de los cuales el 28% presentó deficiencia de vitamina B12 y al 9% se le diagnóstico anemia perniciosa.Las cifras de hemoglobina, volumen corpuscular medio no se correlacionaron con el déficit de vitamina B12. No se encontró una asociación estadística del déficit de la vitamina B12 con el género, edad mayor de 60 años de los pacientes o con la presencia del Helicobacter pylori (H. pylori).La edad promedio de los pacientes con déficit de vitamina B12 o con anemia perniciosa es menor a la que tradicionalmente se reporta para estas enfermedades.

We present a group of 75 Colombian adults who were diagnosed with chronic atrophic gastritis in accordance with the Sydney criteria. 28% of the group had vitamin B12 deficiencies: 9% were diagnosed with Pernicious anemia. Hemoglobin and mean corpuscular volume were not correlated with vitamin B12 deficiency. We found no statistical association of vitamin B12 deficiency with gender, patients over 60 years of age, or the presence of Helicobacter pylori (H. pylori). The average age of patients with vitamin B12 deficiency or pernicious anemia is less than that traditionally reported for these diseases.

Resistencia primaria a la claritromicina en aislamientos de Helicobacter pylori / Primary resistance to Clarithromycin in Helicobacter pylori isolates

En un estudio con 63 pacientes adultos, sometidos a endoscopia digestiva alta por síntomas dispépticos, se tomaron biopsias de mucosa gástrica para realizar: la prueba rápida de ureasa, histología convencional, cultivo selectivo para H. pylori y determinación de la susceptibilidad de los aislamientos bacterianos a la claritromicina mediante la técnica de difusión en disco (Kirby-Bauer). El porcentaje de recuperación del H. pylori (cultivo positivo) fue del 73%, se determinaron para el cultivo una sensibilidad de 66% y una especificidad del 100%. Se observó una prevalencia de la resistencia primaria a la claritromicina del 15%. No se observaron diferencias significativas por género, edad, diagnóstico endoscópico o histológico entre los pacientes con aislamientos sensibles o resistentes al antibiótico.

In a study of 63 adult patients, subjected to upper gastrointestinal endoscopy due to gastrointestinal disorders or indigestion, gastric mucous biopsies were taken in order to realize a rapid urease test, conventional histology, selective culture for H. pylori and to determine susceptibility of bacterial isolates to clarithromycin using Kirby-Bauer disk diffusion technique. The percentage of H. pylori recuperation (positive culture) was 73%. A sensitivity of 66% was determined for the culture, and a specificity of 100% was also determined. A prevalent primary resistance to clarithromycin of 15% was observed. Significant differences were not observed due to gender, age, endoscopic or histological diagnoses among the patients with sensitive isolates or resistance to antibiotics.

Hiperplasia linfoide folicular gástrica e infección por Helicobacter pylori en adultos colombianos / Gastric folliculau lymphoid hyperpasia and infection by Helicobacter pylori in colombian adults

Se realizó un estudio observacional, analítico de casos y controles, con 1.850 adultos sometidos a endoscopia digestiva alta remitidos al centro médico Endocentro Ltda. en Bogotá DC, por diversos síntomas y que no hubieran recibido tratamiento previo con antibióticos, antibacterianos o medicamentos que alteren la secreción gástrica. Se encontró una prevalencia para la gastritis crónica folicular de 8,4% (102 pacientes), 73 mujeres y 29 hombres, con edad promedio de 33,5 años, se detectó la presencia de actividad inflamatoria en el 99% y de H. pylori en el 98% de los pacientes. El grupo control estuvo formado por 1.100 pacientes con otros tipos de gastritis crónica diferente a la folicular, 698 mujeres y 412 hombres, edad promedio de 48,3 años y presencia de actividad inflamatoria y de H. pylori en el 72,1% y 63,3% respectivamente.Se determinó, en el género femenino, un aumento mínimo del riesgo, sin significancia estadística de presentar cambios de gastritis crónica folicular OR = 1,48 (IC 95% 0,93-2,41). En los pacientes jóvenes menores de 35 años y en los infectados por H. pylori se observó un riesgo aumentado de presentar cambios de gastritis folicular OR = 7,57 (IC 95% 4,82- 11,97) y OR =28,94 (IC 95% 7,72- 243,23) respectivamente. Se observó mayor actividad inflamatoria en los pacientes con gastritis crónica folicular, OR = 38,96 (IC 95% 6,76-1558,64).

Resistencia primaria a metronidazol en aislamientos de Helicobacter pylori en pacientes adultos de Bogotá, Colombia / Primary resistance to Metronidazole in Helicobacter pylori isolates in adult patients in Bogotá, Colombia

Objetivo. Determinación de la susceptibilidad a metronidazol en aislamientos de Helicobacter pylori obtenidos de pacientes colombianos durante el periodo de abril de 2006 a marzo de 2007. Materiales y métodos. Se les realizó la prueba de susceptibilidad a metronidazol por el método de E test a 53 aislamientos de H. pylori obtenidos por cultivo de biopsias gástricas procedentes de pacientes adultos a quienes se les practicó una endoscopia de vías digestivas altas. Resultados. Se obtuvieron 53 aislamientos de H. pylori provenientes de 26 hombres y 27 mujeres. El método de susceptibilidad antimicrobiana E test demostró que el 72% de los aislamientos de H. pylori fueron resistentes a metronidazol. Conclusiones. La resistencia de H. pylori a MTZ en la actualidad continúa siendo alta y es comparable a la publicada hace 10 años (72% y 84% respectivamente). Por ser mayor del 40% sería recomendable no utilizar este antimicrobiano en los esquemas de erradicación en Colombia.

Objective. To determine susceptibility to Metronidazole when isolates Helicobacter pylori obtained from Colombian patients during the period April 2006 to March 2007. Materials and methods. The susceptibility test to Metronidazole was realized using the E Test Method to 53 isolates of H. pylori obtained through cultures of gastric biopsies, coming from adult patients to whom endoscopies of upper gastrointestinal tracts were practiced. Results. Fifty-three isolates of H. pylori were obtained from 26 men and 27 women. The antimicrobial susceptibility E Test method showed that 72% of the isolates of H. pylori were resistant to Metronidazole. Conclusion. Resistance of H. pylori to MTZ currently continues being high and is comparable to the one published 10 years ago (73% and 84% respectively). For being greater than 40%, it is recommended not to use this antimicrobial agent in the Colombian eradication programs.

Divertículo gigante del esófago torácico / Giant midesophgeal diverticula

Los divertículos del tercio medio del esófago (esófago torácico) son una rara entidad. Es diagnosticada de manera incidental pues la mayoría de pacientes no manifiesta síntomas. Son verdaderos divertículos de pulsión y en más de 2/3 de los casos se asocian con alteraciones de la motilidad esofágica. Sólo requieren tratamiento endoscópico o quirúrgico los pacientes con síntomas y en especial con manifestaciones respiratorias secundarias a episodios de broncoaspiración. Se presenta el caso de un hombre con esta alteración atendido en nuestra institución.

The midesophageal diverticula (in the thoracic esophagus) are strange entities. They are diagnosed unexpectedly since most of the patients do not show any symptoms. They are Zenker diverticula and epiphrenic diverticula and in more than 2/3 of the cases they are associated with cases of esophageal motility disorders. Only the patients with symptoms and specially those with secondary respiratory signs and inhalation episodes require endoscopic or surgical treatment. We have a case of one man with this disease who was treated at our institution.

La asociación de divertículo de zenker y acalasia / Zenker`s diverticulum and acalasia

Se presenta el caso de un paciente de 88 años, con disfagia y antecedentes de acalasia no tratada de veinte años de evolución y síntomas de disfagia oro faríngea. Los exámenes radiológicos y endoscópicos identificaron además de la acalasia un divertículo de Zenker. Se realizó terapia paliativa con inyección de toxina botulínica en el esfínter esofágico inferior, con mejoría de los síntomas. Se hace una revisión de la rara coexistencia de estas dos patologías.

An 88 year old patient has been observed. He is suffering from dysphagia and has a medical history of achalasia, which has had an evolution and has not bee treated for twenty years. He also has oropharynx dysphagia symptoms. In addition to the achalasia, the X-ray and endoscopy exams identified a Zenker diverticulum.Palliative or mitigating therapy was realized using botulinum toxin injection in the lower esophageal sphincter, withsymptom improvement. A study is being made concerning the rare co-existence of these two pathologies.

Úlceras esofágicas por medicamentos / Esophagic ulcers caused by medications

Se presenta el caso de una mujer joven, que consultó por disfagia y odinofagia de corta evolución; como antecedente inmediato informó el consumo de tetraciclina en cápsulas para el tratamiento del acné. El examen endoscópico demostró dos (2) pequeñas úlceras en el tercio medio del esófago sin disminución del calibre del órgano. Se dio manejo con sucralfato con resolución de los síntomas. Se hace una revisión del tema y se recomiendan medidas para evitar esta patología.

Determinación de los niveles de etanol, metanol y acetaldehído en el guarapo elaborado en los municipios de Cundinamarca / Determination of ethanol, methanol y acetaldehido levels in guarapo prepared in Cundinamarca`s municipalities

Objetivos: determinar la concentración de etanol, acetaldehído y metanol en el guarapo consumido por los pacientes con cirrosis hepática alcohólica en el departamento de Cundinamarca.Fechas y lugares de ejecución: Hospital Universitario de La Samaritana en Bogotá DC y 41 municipios del departamento de Cundinamarca, Instituto de Medicina Legal y Ciencias Forenses Bogotá DC.Métodos: Primera parte: estudio retrospectivo de las historias clínicas de los pacientes con cirrosis hepática por consumo crónico de guarapo remitido al hospital Universitario de la Samaritana. Segunda parte: estudio de campo y de laboratorio, con la visita y obtención de las muestras de guarapo en los municipios designados; análisis de las muestras en el laboratorio por la técnica de cromatografía de gas high perfomance.Resultados: todas las muestras analizadas tuvieron concentraciones de etanol que variaron entre 0,5 por ciento y 6,94 por ciento. En ninguna muestra se encontró la presencia de metanol y en 41 muestras se determinaron niveles de acetaldehído. El mayor porcentaje de etanol se encontró en las provincias de Gualivá, Río Negro y Tequendama, lo que coincide con las provincias con mayor número de pacientes con cirrosis alcohólica por guarapo remitidos al Hospital Universitario de la Samaritana. Conclusiones: el guarapo es una bebida tradicional, con niveles significativos de etanol, su consumo en grandes cantidades y por largo tiempo supera ampliamente el umbral tóxico asociado al desarrollo de cirrosis hepática