Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification.

Introduction: Penetrating chest trauma (PCT) represents 10% of worldwide mortality, with developing countries counting as some of the most affected by high mortality rates due to cardiac trauma. Colombia is considered one of the most violent countries due to the high mortality rate associated with war and crime, hence the validation of an own classification for penetrating cardiac injuries (PCI) is mandatory. Methods: Retrospective cross-sectional study which included adult patients with PCIs at a level 4 trauma center in Colombia, between January 2018 and April 2020. We used our own system (Bogotá Classification) and compared it with traditional systems (e.g., Ivatury's, OIS-AAST), by analyzing the mechanism of injury (MOI), the hemodynamic status of the patient at admission, the inpatient management, the individual outcomes, and some demographic variables. Bivariate statistical analysis, spearman correlation, and logistic regression were performed. Results: Four hundred and ninety-nine patients were included. Bivariate analysis demonstrated a significant relationship between mortality and hemodynamic state, MOI, its location and degree of lesion, cardiac/vessel injury, cardiac tamponade, time between injury and medical care, fluid reanimation, as well as the Ivatury's classification and the new classification (p < 0.005). The adequate correlation between Ivatury's and Bogotá classification supports the latter's clinical utility for patients presenting with PCI. Likewise, logistic regression showed a statistically significant association among mortality rates (p < 0.005). Conclusions: The Bogotá classification showed similar performance to the Ivatury's classification, correlating most strongly with mortality. This scale could be replicated in countries with similar social and economic contexts.

Rol de nuevos fármacos antidiabéticos en prevención cardiovascular e insuficiencia cardiaca / Role of newer antidiabetic drugs on cardiovascular prevention and heart failure

Más allá del control de la glucemia existen otros objetivos importantes a la hora de brindar atención integral a pacientes con diabetes mellitus. Se realizó una revisión bibliográfica con el objetivo de identificar el papel que desempeñan los nuevos fármacos antidiabéticos en la prevención cardiovascular y la insuficiencia cardiaca. El uso de SGLT2i y GLP-1a acarrea una disminución significativa de eventos cardiovasculares, sin diferencias entre ambos, exceptuando las hospitalizaciones por insuficiencia cardiaca, en donde es evidente la superioridad de estos últimos (en especial dapaglifozina y empaglifozina). La evidencia actual respecto al efecto de los DPP-4i es diversa, aunque se observa un aumento del riesgo de hospitalizaciones por insuficiencia cardiaca con el consumo de algunos fármacos de esta clase (saxagliptina).(AU)

Beyond glucemic control there are other important goals when it comes to providing integral care to patients with diabetes mellitus. A bibliographic review was made in order to identify the role played by new antidiabetic drugs in cardiovascular prevention and heart failure. The use of SLGT2i and GLP1a leads to a significant decrease in cardiovascular events, with no difference between the two, except when it comes to hospitalizations for heart failure, where the superiority of the last ones (especially dapaglifozin and empaglifozin) is evident. The current evidence regarding the effect of dpp-4i is diverse, although an increased risk of hospitalizations for heart failure is observed with the use of some drugs of this class (saxagliptin).(AU)

Role of newer antidiabetic drugs on cardiovascular prevention and heart failure. / Rol de nuevos fármacos antidiabéticos en prevención cardiovascular e insuficiencia cardiaca.

Beyond glucemic control there are other important goals when it comes to providing integral care to patients with diabetes mellitus. A bibliographic review was made in order to identify the role played by new antidiabetic drugs in cardiovascular prevention and heart failure. The use of SLGT2i and GLP1a leads to a significant decrease in cardiovascular events, with no difference between the two, except when it comes to hospitalizations for heart failure, where the superiority of the last ones (especially dapaglifozin and empaglifozin) is evident. The current evidence regarding the effect of dpp-4i is diverse, although an increased risk of hospitalizations for heart failure is observed with the use of some drugs of this class (saxagliptin).

Relación entre COVID-19 e Hipertensión Arterial / Relationship between COVID-19 and Hypertension

RESUMEN Introducción: El primer trimestre de 2020 se ha visto influenciado por la propagación de una pandemia ocasionada por el virus SARS coronavirus 2, el cual origina una afección (COVID-19) que en algunos casos llega al Síndrome de Distress Respiratorio Agudo. Objetivo: Identificar la relación existente entre COVID-19 y la Hipertensión Arterial. Material y métodos: Se realizó una revisión, utilizando bases de datos bibliográficas y buscadores. Además, se utilizó literatura de consulta obligada en Cardiología e información de sitios web oficiales gubernamentales, de la OMS/OPS y sociedades científicas. Desarrollo: Los coronavirus se unen a sus células diana a través de una proteína espícula (S), cuya unidad de superficie S1 se acopla a la enzima conversora de angiotensina 2 como receptor. En las diferentes series revisadas se observa la clara relación entre el antecedente de Hipertensión Arterial y el curso evolutivo desfavorable en pacientes con COVID-19. Al realizar una búsqueda extensa de la bibliografía no se encuentra evidencia científica que ampare la suspensión del tratamiento con inhibidores de la enzima conversora de angiotensina/ antagonistas de los receptores de angiotensina en pacientes hipertensos con COVID-19. Conclusiones: La enzima conversora de angiotensina actúa como receptor del SARS-CoV 2. Los individuos hipertensos presentan un curso evolutivo menos favorable de la afección por este virus. No es aconsejable la suspensión del tratamiento con inhibidores de la enzima conversora de angiotensina o antagonistas del receptor de angiotensina en pacientes hipertensos afectados con COVID-19.

ABSTRACT Introduction: The first three months of 2020 have been influenced by the spreading of a pandemic caused by the SARS-coronavirus 2, which causes COVID-19 infection that in some cases is associated with acute respiratory distress syndrome. Objective: To identify the relationship between COVID-19 and hypertension. Material and Methods: A bibliographic review was carried out using database search engines. In addition, reference literature in Cardiology was used as well as information from official government websites such as WHO/PAHO and other scientific societies. Development: Coronaviruses enter into target cells through a spike S protein, whose S1 surface unit is coupled to the angiotensin-converting enzyme 2 as a receptor. In the different revised series, the clear relationship between the history of arterial hypertension and the unfavorable evolution is observed in patients with COVID-19. In an extensive literature search, there is no scientific evidence for discontinuation of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in hypertensive patients with COVID-19. Conclusions: The angiotensin-converting enzyme acts as a SARS-CoV2 receptor. Hypertensive individuals have a less favorable evolution course of the condition caused by this virus. Discontinuation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is not advisable in hypertensive patients with COVID-19.

Prácticas de riesgo para transmisión de VIH en estudiantes de medicina de Latinoamérica y el Caribe, 2017 / Risk practices for HIV transmission among medical students in Latin America and the Caribbean, 2017

El objetivo del trabajo fue determinar las prácticas de riesgo para transmisión de VIH en estudiantes de medicina de Latinoamérica y el Caribe durante los meses de Enero a Febrero de 2017. Se realizó un estudio observacional, descriptivo de corte transversal, con muestreo no probabilístico por conveniencia en estudiantes de medicina de Latinoamérica y el Caribe, desde enero a febrero de 2017. Se escogió a estudiantes de medicina del primer al séptimo año de la carrera. Se procedió a la publicación en redes sociales del cuestionario electrónico mediante Google Doc©. Los resultados se expresan en tablas de frecuencias. Fueron incluidos 638 estudiantes de medicina, teniendo el 67,08% (428) una edad comprendida entre 20 a 24 años. Del total de encuestados el 56,02% ha practicado sexo anal, 88,65% ha practicado sexo oral, y 57,06% sexo vaginal en los últimos 6 meses. El 24,43% de los encuestados nunca ha utilizado condón durante sus relaciones sexuales. El 3,49% han pagado alguna vez por sexo, 27,57% ha ingerido alcohol durante las relaciones sexuales y 4,36% ha mantenido relaciones sexuales con usuarios de drogas intravenosas mientras que 63,88% nunca se ha hecho una prueba rápida para VIH. Las prácticas de riesgos más frecuentes fueron la baja utilización de condón durante la última relación sexual, la utilización de alcohol durante la relación sexual y la baja realización de prueba para VIH(AU)

The objective was to determine the risk practices for HIV transmission among medical students from Latin America and the Caribbean from January to February 2017. This was an observational descriptive cross-sectional study with non-probabilistic sampling for convenience in medical students from Latin America and the Caribbean that was carried out from January to February 2017. Medical students were selected from the first to the seventh year of the career. The electronic questionnaire was published in social networks using Google Doc ©. The data were expressed in tables of frequencies. Six hundred and thirty eight medical students were included, 67.08% (428) with ages between 20 and 24 years. Of the total number of respondents, 56.02% had anal sex, 88.65% had oral sex, and 57.06% had vaginal sex in the last 6 months. The 24.43% of the respondents have never used a condom during their sexual relations, 3.49% have paid for sex, 27.57% drank alcohol during sex, and 4.36% have had sex with intravenous drug users while 63.88% have never had a quick test for HIV. The most frequent risk practices were the low condom use during the last sexual intercourse, the use of alcohol during intercourse and the low HIV test performance(AU)

Conocimientos, actitudes y prácticas sobre el Oropouche, en estudiantes de medicina de Latinoamérica, 2017

Resumen Objetivo: Determinar los conocimientos, actitudes y prácticas sobre el Oropouche, en estudiantes de Latinoamérica de marzo a abril del 2017. Material y métodos: Estudio observacional, descriptivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Para la recolección de los datos se realizó mediante un instrumento validado para el efecto. Los datos se expresan en medidas de tendencia central, dispersión y proporciones. Resultados: Fueron incluidos 1046 estudiantes de medicina, de 18 a 28 años de edad, con una mediana de 21 años (P25=20 P75=22), de los cuales el 58,51 % (612) perteneció al sexo femenino, siendo de los cursos cuarto en 40,15 % (420). El nivel de conocimiento fue en 88,72%(928) bajo, las actitudes el 36,90% (386) de los estudiantes están indecisos y/o dudosos sobre si los entes gubernamentales podrían evitar la propagación del OROV. El 52,96%(554) de los estudiantes de medicina no usan repelentes y otros métodos preventivos en ningún momento del día Conclusión: el nivel de conocimiento en general fue bajo, las actitudes indecisas y/o dudosas y con malas prácticas respecto al oropouche.

Abstract Objective: To determine the knowledge, attitudes and practices on the Oropouche, in Latin American students from March to April 2017. Material and methods: Observational, descriptive cross-sectional study with non-probabilistic sampling of consecutive cases. The data were collected using a validated instrument for the effect. The data are expressed in measures of central tendency, dispersion and proportions. Results: A total of 1046 medical students, aged 18 to 28 years, with a median age of 21 (P25 = 20 P75 = 22) were included, of which 58.51% (612) were females. The fourth courses at 40.15% (420). The level of knowledge was at 88.72% (928) low, attitudes 36.90% (386) of students are undecided and/or doubtful about whether government entities could prevent the propagation of OROV. 52.96% (554) of medical students do not use repellents and other preventive methods at any time of the day Conclusion: the level of knowledge in general was low, the attitudes indecisive and/or dubious and with bad practices regarding the oropouche.