Interatrial Septum Stenting for Hypoplastic Left Heart Syndrome in Ex Utero Intrapartum Therapy.

Patients with hypoplastic left heart syndrome (HLHS) with intact atrial septum have an increased mortality rate. This presentation occurs in 6% to 10% of cases. We present a patient with fetal diagnosis of HLHS with restrictive atrial septum. We performed a cesarean section at 37 weeks of gestation, and under ex utero intrapartum treatment proceeded with a median sternotomy and transatrial stenting for left atrial decompression due to findings of intact atrial septum on the fetal echocardiogram performed during the procedure. Subsequently, the patient underwent hybrid stage I palliation followed by a comprehensive stage II procedure at five months of age, but unfortunately died from postoperative complications.

Schwannoma and Post-vaccine Changes: A Case Report.

Schwannomas are benign sheaths of Schwann cells that can present with degenerative and morphological changes; necrosis or hemorrhage are rare findings in these tumors. We present the case of a 28-year-old man with a C2-C4 cervical Schwannoma who experienced upper limb paresthesia in 2020 while presenting with COVID-19 symptoms. The patient later recovered and came to our institution, where surgery was scheduled one year after the initial diagnosis. One week before surgery, the patient received the first dose of the Moderna vaccine. Despite being asymptomatic, the patient underwent successful total resection of the schwannoma, which was confirmed histologically. However, extensive necrosis with abundant foamy macrophages was observed, suggesting a possible link to post-vaccine effects.

Adaptation of the Endolithic Biome in Antarctic Volcanic Rocks.

Endolithic microorganisms, ranging from microeukaryotes to bacteria and archaea, live within the cracks and crevices of rocks. Deception Island in Antarctica constitutes an extreme environment in which endoliths face environmental threats such as intense cold, lack of light in winter, high solar radiation in summer, and heat emitted as the result of volcanic eruptions. In addition, the endolithic biome is considered the harshest one on Earth, since it suffers added threats such as dryness or lack of nutrients. Even so, samples from this hostile environment, collected at various points throughout the island, hosted diverse and numerous microorganisms such as bacteria, fungi, diatoms, ciliates, flagellates and unicellular algae. These endoliths were first identified by Scanning Electron Microscopy (SEM). To understand the molecular mechanisms of adaptation of these endoliths to their environment, genomics techniques were used, and prokaryotic and eukaryotic microorganisms were identified by metabarcoding, sequencing the V3-V4 and V4-V5 regions of the 16S and 18S rRNA genes, respectively. Subsequently, the sequences were analyzed by bioinformatic methods that allow their metabolism to be deduced from the taxonomy. The results obtained concluded that some of these microorganisms have activated the biosynthesis routes of pigments such as prodigiosin or flavonoids. These adaptation studies also revealed that microorganisms defend themselves against environmental toxins by activating metabolic pathways for the degradation of compounds such as ethylbenzene, xylene and dioxins and for the biosynthesis of antioxidant molecules such as glutathione. Finally, these Antarctic endolithic microorganisms are of great interest in astrobiology since endolithic settings are environmentally analogous to the primitive Earth or the surfaces of extraterrestrial bodies.

Treatment of gaseous streams polluted with H2S: Comparison of electrolytic and electro-Fenton assisted absorption processes.

H2S is a gaseous compound that contributes to air pollution. In this work, the electrochemical oxidation treatment of gaseous streams polluted with H2S is evaluated using a jet mixer and electrochemical cell device, in which the performance of electrolytic and electro-Fenton assisted absorption processes are compared. Results demonstrate the feasibility of both processes to remove H2S, reaching coulombic efficiencies of nearly 100% in the electrolytic assisted absorption, and 70-80% in the electro-Fenton assisted absorption. Aqueous solutions containing phosphate salts as electrolyte were found to be suitable as absorbents for the process. Efficiency in the cathodic production of H2O2 in these solutions using the experimental device was found to be as high as 32.8% (1.184 mgH2O2/min) at 12 °C and atmospheric pressure. Sequential formation of SO2 and SO3 is obtained by the oxidation of H2S contained in the gas. These species are hydrolysed, and a part remained in the absorbent as SO32- and SO42-, while the rest is dragged in the outlet gas. SO3 production is promoted by electrolytic assisted absorption and polysulphides by the electro-Fenton technology. Low concentrations of elemental sulphur are detected in the solid suspensions formed during the process.

Exploring the technological acceptance of a mobile learning tool used in the teaching of an indigenous language.

Language is the primordial element for cultural transfer in indigenous communities; if it is not practiced, there is a risk of losing it and with it, a large part of the history of a community. Ecuador is a multicultural and multiethnic country with 18 indigenous peoples. Currently, in this country, some native languages are at risk of disappearing due to factors such as racial discrimination, underestimation of the language, and, above all, the lack of interest and motivation of the new generations to learn this language. Information technologies have made it possible to create mobile applications such as games, dictionaries, and translators that promote the learning of the Kichwa language. However, the acceptance of technology has not been evaluated, nor the intention to involve mobile devices in the process of teaching this language. Subsequently the objective of this work is to explore the acceptance of technology and the use of mobile devices to motivate the learning of the Kichwa language. For this purpose, the mobile application "Otavalo Rimay" was used with several students of a Kichwa language learning center. The methodology used to verify the hypothesis of this work was Design Sciences Research (DSR) together with the theory of acceptance and use of technology (UTAUT). The instrument used for this evaluation was a survey carried out after the use of the mobile application. The statistical analysis of the results obtained indicates characteristics such as the utility and perceived ease of use, positively influence students to motivate the use of mobile devices in learning a language. The results also show the great technological acceptance by students for learning and confirm that currently, mobile learning is accepted for use in education.

Short Communication: Integrase Strand Transfer Inhibitors Drug Resistance Mutations in Puerto Rico HIV-Positive Individuals.

The HIV-1 integrase viral protein is responsible for incorporating the viral DNA into the genomic DNA. The inhibition of viral integration into host cell DNA is part of recent therapeutic procedures. Combination therapy with protease and reverse transcriptase inhibitors has demonstrated good synergistic results in reducing viral replication. The purpose of this study is to assess the occurrence of integrase drug resistance mutations from the period comprising 2013 through 2018 in Puerto Rico (PR). We analyzed 131 nucleotide sequences available in our HIV genotyping database, and we performed drug resistance mutation analyses using the Stanford HIV Drug Resistance Database. Twenty-one sequences (16.03%) harbored major or resistance-associated mutations. We identified the Q148HKR, G140S, Y143R, N155H, S147G, and E138EA major drug resistance mutations and the D232DN, T97TA, E157Q, G163GART accessory mutations. We detected high-level drug resistance to Elvitegravir and Raltegravir (76.19% and 85.71%). Moreover, we identified sequences harboring drug resistance mutations that could provide resistance to Dolutegravir. The transmission of strains with integrase antiretroviral resistance has been previously documented in treatment naïve patients. Given the increase of patients treated with integrase inhibitors, surveillance of drug resistance mutations is an essential aspect of PR's clinical management of HIV infection.

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease.

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) infection is the most common cause of hemolytic uremic syndrome (HUS). Only few studies correlated serotypes and stx genotypes with disease severity. This study aimed to update STEC serotypes, stx genotypes, and virulence factors (eae and ehxA) in a cohort of patients with STEC-HUS and investigate whether they influence the severity of disease. METHODS: In this multicentric study, children hospitalized between 2005 and 2016 with STEC-HUS confirmed by the National Reference Laboratory were included. Serotypes (O157, O145, O121, and others), stx genotypes (stx1a, stx2a, stx2c, stx2d, and others), and virulence factors were analyzed, and their association with dialysis requirement (>10 days); severe neurological, cardiovascular, and/or bowel involvement; and death was assessed. RESULTS: The records of 280 patients were reviewed; 160 females, median age 21 months (IQR18m). STEC O157 was isolated in 206 (73.6%) patients, O145 in 47 (16.8%), O121 in 15 (5.4%), and other serotypes in 12 (4.2%). The stx2a/2c genotype was carried by 179 (63.9%) strains, stx2a by 94 (33.6%), stx1a/stx2a by five (1.8%), and stx1a only by two (0.7%). All strains except six harbored eae and ehxA genes. Fifty-nine (21.1%) patients had severe neurological involvement, 29 (10.4%) severe bowel injury, 14 (5%) cardiovascular involvement, 53 (18.9%) required > 10 days of dialysis, and 12 (4.3%) died. Neither serotypes nor stx genotypes detected were significantly linked to severity. CONCLUSIONS: Serotype O157 and virulence stx2a/2c, eae, ehxA genotype are prevalent in Argentina, and no relationship was found between severity and serotypes and genotypes of STEC detected.

Aspectos clínicos del tratamiento de la hiperglucemia no complicada en la unidad de cuidados intensivos / Clinical aspects of the treatment of uncomplicated hyperglycemia in the intensive care unit

Resumen Introducción: La glucosa es una variable dinámica en el paciente crítico. La hiperglucemia (mayor a 140 mg/dL) es frecuente en este grupo de pacientes, existiendo distintos enfoques terapéuticos para el control adecuado de la misma. Objetivo: Revisar los aspectos clínicos de la glucemia y la importancia del control glucémico en el paciente crítico adulto. } Metodología de búsqueda: En base de datos Pubmed, utilizando los términos MeSH: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Se incluyeron artículos de revisión y originales, en inglés y español. Conclusiones: El manejo de la hiperglucemia en el paciente crítico es un objetivo primordial en el enfoque integral del paciente de la unidad de cuidados intensivos, dada su asociación con mortalidad, morbilidad y estancia hospitalaria. MÉD. UIS.2020;33(2): 49-54.

Abstract Introduction: Glucose is a dynamic variable in the critically ill patient. Hyperglycemia (greater than 140 mg/dL) is frequent in this group of patients, and there are different therapeutic treatments for its adequate control. Objectives: To evaluate the clinical aspects of glycemia and the importance of glycemic control in the critically ill adult patient. Methodology: Search in Pubmed database using the MeSH terms: "critical illness", "insulin infusion", "insulin protocol", "hyperglycemia". Original and review articles are included, in English and Spanish. Conclusions: The management of hyperglycemia in the critically ill patient is a primary objective in the comprehensive approach of the patient in the intensive care unit due to its association with mortality, morbidity and hospital stay.MÉD.UIS.2020;33(2): 49-54.

Unravelling the environmental and economic impacts of innovative technologies for the enhancement of biogas production and sludge management in wastewater systems.

The retrofitting of wastewater treatment plants (WWTPs) should be addressed under sustainability criteria. It is well known that there are two elements that most penalize wastewater treatment: (i) energy requirements and (ii) sludge management. New technologies should reduce both of these drawbacks to address technical efficiency, carbon neutrality and reduced economic costs. In this context, the main objective of this work was to evaluate two real plants of different size in which major modifications were considered: enhanced recovery of organic matter (OM) in the primary treatment and partial-anammox nitrification process in the secondary treatment. Plant-wide modelling provided an estimate of the input and output flows of each process unit as well as the diagnosis of the main performance indicators, which served as a basis for the calculation of environmental and economic indicators using the LCA methodology. The combination of high-rate activated sludge (HRAS) + partial nitrification Anammox can decrease the environmental impacts by about 70% in the climate change (CC) category and 50% in the eutrophication potential (EP) category. Moreover, costs can be reduced by 35-45% depending on the size of the plant. In addition, the enhanced rotating belt filter (ERBF) can also improve the environmental profile, but to a lesser extent than the previous scenario, only up to 10% for CC and 15% for EP. These positive results are only possible considering the production of energy through biogas valorization according to the waste-to-energy scheme.

Aportes desde la universidad pública a la construcción de paz: prácticas formativas de Terapia Ocupacional y Fonoaudiología con un grupo de personas en proceso de reincorporación en Cali, Colombia / Contributions from the public university to the construction of peace: Occupational Therapy and Speech Therapy training practices with a group of people in process of reinstatement in Cali, Colombia / Contribuições da universidade pública para a construção da paz: práticas de treinamento em Terapia Ocupacional e Fonoaudiologia com um grupo de pessoas em processo de reincorporação em Cali, Colômbia

En el marco de la firma del Acuerdo de Paz entre el Gobierno colombiano y las Fuerzas Armadas Revolucionarias de Colombia ­ Ejército del Pueblo (FARC-EP), la Universidad del Valle implementó un programa que promueve el desarrollo de prácticas profesionales. Esto permitió a docentes y estudiantes de Terapia Ocupacional y Fonoaudiología elaborar una propuesta que se desarrolló en la ciudad de Cali con la población en proceso de reincorporación y sus familias, como parte del convenio entre la Universidad y la Agencia para la Reincorporación y la Normalización, durante el primer semestre del 2018. La experiencia tuvo el propósito de favorecer los procesos de lectura y escritura en los participantes, promoviendo su participación social y la construcción de ciudadanía. La propuesta privilegió un enfoque de construcción conjunta. Participaron diez personas adultas y seis infantes. Se realizaron cinco encuentros, en los cuales se identificaron necesidades e intereses relacionados con leer y escribir, y se construyeron de manera conjunta actividades de promoción de la lectura y la escritura a través de la poesía, el cuento y el teatro. La propuesta posibilitó un ejercicio de reconocimiento y resignificación mutua que permite la construcción de ciudadanía y de profesionales como sujetos políticos.

Within the framework of the signing of the Peace Agreement between the Colombian Government and the Revolutionary Armed Forces of Colombia ­ People's Army (FARC-EP), Universidad del Valle implemented a program that promotes the development of professional practices, which allowed the preparation of a proposal from teachers and students of Occupational Therapy and Speech Therapy, which was carried out within the framework of the agreement with the Agency for Reincorporation and Standardization. It was carried out in the city of Cali with the population in the process of reinstatement and their families during the first half of 2018 with the purpose of supporting the reading and writing processes in the participating population, thus favoring their social participation and the construction of citizenship. The proposal favored a joint construction approach among all involved. 10 adults and 6 children participated. Five meetings were held which allowed identifying the needs and interests of the participants in relation to reading and writing, and jointly build activities that promoted reading and writing through poetry, storytelling and theater. The proposal enabled an exercise of recognition and mutual resignification that allows the construction of citizenship and professionals as political subjects.

No âmbito da assinatura do Acordo de Paz entre o Governo da Colômbia e as Forças Armadas Revolucionárias da Colômbia - Exército Popular (FARC-EP), a Universidad del Valle implementou um programa que promove o desenvolvimento de práticas profissionais. Isso permitiu que professores e alunos de Terapia Ocupacional e Fonoaudiologia elaborassem uma proposta - desenvolvida na cidade de Cali com a população no processo de reincorporação e suas famílias -, como parte do acordo entre a Universidade e a Agência de Reincorporação e Padronização, durante o primeiro semestre de 2018. A experiência teve como objetivo favorecer os processos de leitura e escrita dos participantes, promovendo sua participação social e a construção da cidadania. A proposta privilegiou uma abordagem de construção conjunta. Participaram dez adultos e seis meninos. Foram realizados cinco encontros, nos quais foram identificadas necessidades e interesses relacionados à leitura e à escrita, e foram construídas, conjuntamente, atividades para promover a leitura e a escrita através da poesia, contos e teatro. A proposta possibilitou um exercício de reconhecimento e ressignificação mútuos, que permite a construção da cidadania e dos profissionais como sujeitos políticos.

Sanger and Next Generation Sequencing Approaches to Evaluate HIV-1 Virus in Blood Compartments.

The implementation of antiretroviral treatment combined with the monitoring of drug resistance mutations improves the quality of life of HIV-1 positive patients. The drug resistance mutation patterns and viral genotypes are currently analyzed by DNA sequencing of the virus in the plasma of patients. However, the virus compartmentalizes, and different T cell subsets may harbor distinct viral subsets. In this study, we compared the patterns of HIV distribution in cell-free (blood plasma) and cell-associated viruses (peripheral blood mononuclear cells, PBMCs) derived from ART-treated patients by using Sanger sequencing- and Next-Generation sequencing-based HIV assay. CD4⁺CD45RA-RO⁺ memory T-cells were isolated from PBMCs using a BD FACSAria instrument. HIV pol (protease and reverse transcriptase) was RT-PCR or PCR amplified from the plasma and the T-cell subset, respectively. Sequences were obtained using Sanger sequencing and Next-Generation Sequencing (NGS). Sanger sequences were aligned and edited using RECall software (beta v3.03). The Stanford HIV database was used to evaluate drug resistance mutations. Illumina MiSeq platform and HyDRA Web were used to generate and analyze NGS data, respectively. Our results show a high correlation between Sanger sequencing and NGS results. However, some major and minor drug resistance mutations were only observed by NGS, albeit at different frequencies. Analysis of low-frequency drugs resistance mutations and virus distribution in the blood compartments may provide information to allow a more sustainable response to therapy and better disease management.

Bottom-up approach in the assessment of environmental impacts and costs of an innovative anammox-based process for nitrogen removal.

In recent decades, the wastewater treatment sector has undergone a shift to adapt to increasing discharge limits. In addressing the evaluation of innovative technologies, it is necessary to determine the scale at which reliable and representative values of environmental impacts and costs can be obtained, ensuring that the system under assessment follows the direction of eco-efficiency. This study has evaluated the environmental and economic indicators of an autotrophic nitrogen removal technology (ELAN®) from laboratory conception (1.5 L) to full scale (2 units of 115 m3) using the Life Cycle Assessment (LCA) methodology. Indirect emissions related to electricity consumption are the main contributor in all impact categories except eutrophication. Electricity consumption referred to the functional unit (1 m3 of treated wastewater) decreases as the scale increases. The rationale behind this can be explained, among other reasons, by the low energy efficiency of small-scale equipment (pumps and aerators). Accordingly, a value of approximately 25 kg CO2eq per m3 of treated water is determined for laboratory scale, compared to only 5 kg CO2eq per m3 at full-scale. When it comes to assessing the reliability of data, a pilot scale system of 0.2 m3 allowed to perform a trustworthy estimation of environmental indicators, which were validated at full-scale. In terms of operational costs, the scale of approximately 1 m3 provided a more accurate estimate of the costs associated with energy consumption.

Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome.

OBJECTIVES: (1) Evaluate mortality rate in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, (2) determine the leading causes of death, and (3) identify predictors of mortality at hospital admission. METHODS: We conducted a multicentric, observational, retrospective, cross-sectional study. It included patients under 18 years old with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome hospitalized between January 2005 and June 2016. Clinical and laboratory data were obtained from the Argentine National Epidemiological Surveillance System of Hemolytic Uremic Syndrome. Clinical and laboratory variables were compared between deceased and non-deceased patients. Univariate and multivariate analyses were performed. ROC curves and area under the curve were obtained. RESULTS: Seventeen (3.65%) out of the 466 patients died, being central nervous system involvement the main cause of death. Predictors of death were central nervous system involvement, the number of days since the beginning of diarrhea to hospitalization, hyponatremia, high hemoglobin, high leukocyte counts, and low bicarbonate concentration on admission. In the multivariate analysis, central nervous system involvement, sodium concentration, and hemoglobin were independent predictors. The best cut off for sodium was ≤ 128 meq/l and for hemoglobin ≥ 10.8 g/dl. CONCLUSIONS: Mortality was low in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, being central nervous system involvement the main cause of death. The best mortality predictors found were central nervous system involvement, hemoglobin, and sodium concentration. Hyponatremia may be a new Shiga toxin-producing Escherichia coli hemolytic uremic syndrome mortality predictor.

Molecular Epidemiology of HIV-1 Virus in Puerto Rico: Novel Cases of HIV-1 Subtype C, D, and CRF-24BG.

HIV-1 subtype B virus is the most prevalent subtype in Puerto Rico (PR), accounting for about 90% of infection in the island. Recently, other subtypes and circulating recombinant forms (CRFs), including F(12_BF), A (01_BF), and CRF-39 BF-like, have been identified. The purpose of this study is to assess the distribution of drug resistance mutations and subtypes in PR. A total of 846 nucleotide sequences from the period comprising 2013 through 2017 were obtained from our "HIV Genotyping" test file. Phylogenetic and molecular epidemiology analyses were performed to evaluate the evolutionary dynamics and prevalence of drug resistance mutations. According to our results, we detected a decrease in the prevalence of protease inhibitor, nucleoside reverse transcriptase inhibitor (NRTI), and non-NRTI (NNRTI) resistance mutations over time. In addition, we also detected recombinant forms and, for the first time, identified subtypes C, D, and CRF-24BG in PR. Recent studies suggest that non-subtypes B are associated with a high risk of treatment failure and disease progression. The constant monitoring of viral evolution and drug resistance mutation dynamics is important to establish appropriate efforts for controlling viral expansion.

Teaching Principal Components Using Correlations.

Introducing principal components (PCs) to students is difficult. First, the matrix algebra and mathematical maximization lemmas are daunting, especially for students in the social and behavioral sciences. Second, the standard motivation involving variance maximization subject to unit length constraint does not directly connect to the "variance explained" interpretation. Third, the unit length and uncorrelatedness constraints of the standard motivation do not allow re-scaling or oblique rotations, which are common in practice. Instead, we propose to motivate the subject in terms of optimizing (weighted) average proportions of variance explained in the original variables; this approach may be more intuitive, and hence easier to understand because it links directly to the familiar "R-squared" statistic. It also removes the need for unit length and uncorrelatedness constraints, provides a direct interpretation of "variance explained," and provides a direct answer to the question of whether to use covariance-based or correlation-based PCs. Furthermore, the presentation can be made without matrix algebra or optimization proofs. Modern tools from data science, including heat maps and text mining, provide further help in the interpretation and application of PCs; examples are given. Together, these techniques may be used to revise currently used methods for teaching and learning PCs in the behavioral sciences.

Intervención de enfermería a paciente con síndrome coronario agudo y síndrome compartimental abdominal / Nursing interventions to patients with acute coronary syndrome and abdominal compartment syndrome

Introducción: Las enfermedades cardiovasculares son la primera causa de muerte en el mundo, México no es la excepción llegando a ser la primera causa de muerte, esto debido a que en la mayoría de los pacientes no se diagnostica ni reciben atención oportuna, mientras que los sobrevivientes llegan a sufrir infartos por falta de orientación para la modificación de sus factores de riesgo. Objetivo: Aplicar las intervenciones de enfermería a paciente con síndrome coronario agudo y síndrome compartimental abdominal. Metodología: Estudio de caso clínico, descriptivo, transversal y prospectivo, a paciente de 83 años de edad con demencia senil, factores de riesgo cardiovasculares; síndrome coronario agudo y síndrome compartimental abdominal. Se estructuran los cuidados de acuerdo con las cinco etapas del proceso de enfermería. Se utiliza un instrumento de valoración con base en los patrones funcionales de Marjory Gordon; las taxonomías de la North American Nursing Diagnosis Association, la Clasificación de Intervenciones y de Resultados de Enfermería. Resultados: Se realizaron las intervenciones de enfermería dando prioridad a dos patrones: eliminación y actividad ejercicio. Conclusión: Las intervenciones de enfermería se priorizaron con base en las manifestaciones clínicas presentadas en las cinco semanas de hospitalización del paciente, sin embargo, los factores de riesgo complicaron el pronóstico.

Introduction: Cardiovascular diseases are the leading cause of death in the world, Mexico is not the exception becoming the leading cause of death, that because in the majority of patients not diagnosed or receive timely care, while survivors arrive to seffer heart attacks from lack of guidance for modifyingtrisk factors. Objective:Toapply the nursing interventions to patients whit acute coronary syndrome and abdominal compartment syndrome. Methodology:Clinical study, descriptive, transversal and prospective case, a patients of 83 year-old, senile dementia, cardiovascular risk factors; acute coronary syndrome and abdominal compartment syndrome. Care according to the five stages of the nursing process are structured: an assessment tool based on the functional patterns Marjory Gordon is used; taxonomies of the North American Nursing Diagnosis Association, Interventions Classification and Nursing Outcomes. Results: The nursing interventions were made by prioritizing two patterns: elimination and the activity-exercise pattern. Conclusion: Nursing interventions were priorized based on clinic manifestations presented in the five weeks of hospitalization, however the risk factors complicated the forecast.

Perforación duodenal post colangiopancreatografía retrógrada endoscópica: Hospital de San José febrero de 2001 a febrero de 2007 / Duodenal perforation after endoscopic retrograde cholangiopancreatography: Hospital San José in February 2001 to 2007

Introducción: la perforación duodenal es una de las principales complicaciones de la instrumentación endoscópica de la vía biliar y se encuentra asociada con alta mortalidad. Su manejo tradicional ha sido quirúrgico aunque algunos autores han propuesto el expectante con resultados significativos. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, tipo serie de casos en pacientes con perforación duodenal post CPRE, que fueron manejados en el servicio de cirugía general del Hospital de San José, en el período comprendido entre febrero de 2001 y febrero de 2007. Se recolectaron los datos demográficos, las indicaciones del procedimiento, síntomas y tiempo de iniciación, métodos diagnósticos utilizados, hallazgos quirúrgicos y mortalidad. Resultados: en el período comprendido entre febrero de 2001 y febrero de 2007 se realizaron 1.200 CPRE en el Hospital de San José. Trece pacientes fueron diagnosticados con perforación duodenal; el principal síntoma presente en todos fue dolor abdominal, aunque solo en tres de ellos se encontraron signos de irritación peritoneal. La mayoría fueron diagnosticados en forma tardía (más de 24 horas), tres presentaron choque previo al procedimiento quirúrgico, que independiente del tipo de lesión encontrada en cirugía se asoció con mortalidad. De manera retrospectiva se clasificó cada uno de los pacientes según Stapfer et al. El procedimiento quirúrgico de elección fue la exclusión pilórica y la mortalidad fue de 38,46%. Conclusiones: la perforación duodenal secundaria a la CPRE es una entidad poco frecuente, pero asociada con alta mortalidad, la cual aumenta con la severidad de la lesión y el manejo tardío de la misma.

Introduction: duodenal perforation is one of the mayor complications of endoscopic instrumentation of the bile ducts and carries a high death rate. Traditionally duodenal perforation has been managed surgically however some authors advocate an expectant approach obtaining significant results. Ma-terials and Methods: this is a descriptive, retrospective, case series study conducted in patients with ERCP-related duodenal perforation treated by the General Surgery Department at San José Hospital, between February, 2001 and February, 2007. Data was collected on: demographics, indications for ERCP, symptoms and time to diagnosis, diagnostic methods, surgical findings and death rates.Results: 1,200 ERCPs were conducted between February, 2001 and February, 2007 at San José Hospital. Duodenal perforation was diagnosed in 13 patients; abdominal pain was the main symptom present in all patients, however only 3 patients presented signs of peritoneal irritation. Diagnosis was delayed in most of them (achieved after more than 24 hours), 3 patients were in shock prior to surgery and died regardless of the type of lesion found. Patients were classified retrospectively according to the classification proposed by Stapfer et al. The preferred surgical procedure was pyloric exclusion and death rate was 38.46%. Conclusions: duodenal perforation secondary to ERCP is uncommon but carries a high death rate which increases according to seriousness of the lesion and delayed initiation of treatment.

Perfil lipídico en una comunidad de Calarcá, Colombia / Outline lipid profile in a community of Calarcá, Colombia

Las enfermedades cardiovasculares (EC), en general, y la cardiopatía isquémica, en particular, constituyen un importante problema de salud pública por su alta mortalidad, morbilidad, costos médicos-hospitalarios e impacto laboral por su poder incapacitante. Estas patologías constituyen la primera causa de muerte en la población adulta en Colombia después de las muertes por violencia. Dado que, en nuestro país, no se han determinado con exactitud parámetros propios del comportamiento de los lípidos sanguíneos en la población, se hace necesaria su caracterización para que se puedan establecer políticas de intervención para la prevención y control de EC, tanto a nivel individual como poblacional. Este trabajo intenta contribuir al estudio poblacional del comportamiento de los niveles de lípidos en poblaciones colombianas. Se determinaron los niveles de colesterol total (CT), colesterol en lipoproteínas de baja densidad (C-LDL), colesterol en lipoproteínas alta densidad (C-HDL) y triglicéridos (TG), en sueros de 71 varones escogidos al azar con edades comprendidas entre 20 y 70 años. Se utilizaron métodos enzimáticos con reactivos Boehringer Manheinn. Los resultados de este estudio muestran que 21,1 por ciento de la población presenta colesterol mayor de 200 mg/dL, 66,2 por ciento C-HDL menor de 35 mg/dL, 5,6 por ciento presentan C-LDL mayor de 150 mg/dL y 36,6 presenta TG mayor de 150 mg/dL. Estos datos indican que, para esta población, el factor protector para las EC (C-HDL) está seriamente afectado y, además, presenta una hipertrigliceridemia aislada. Se encontró una alta incidencia sobre los valores del perfil lipídico de los factores de riesgo no lipídicos como son el índice de masa corporal, el fumar, los antecedentes familiares y la edad. Los resultados obtenidos en el presente estudio se semejan a los encontrados para poblaciones de países en desarrollo y los encontrados en estudios de poblaciones colombianas, por tal motivo deben iniciarse estrategias de prevención y educación para el control de la EC