Epidemiología de la fibrilación auricular en una clínica de alta complejidad. Estudio de una cohorte retrospectiva / Epidemiology of atrial fibrillation in a high-complex clinic. A retrospective cohort study

Resumen Introducción: La fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano y su manejo requiere un abordaje holístico para que los resultados sean óptimos. Objetivo: Describir las características sociodemográficas y clínicas de los pacientes hospitalizados o intervenidos, con diagnóstico de fibrilación auricular, atendidos en una clínica de cuarto nivel de complejidad en Colombia. Método: Se realizó un estudio observacional, retrospectivo, a partir de registros de pacientes hospitalizados o intervenidos con diagnóstico de fibrilación auricular. Se tomó como referencia el diagnóstico de fibrilación auricular (CIE 10 I48X), durante los años 2017 y 2018. Se realizó análisis univariado y bivariado con Excel, SPSS y Epidat. Resultados: El promedio de edad de los pacientes hospitalizados fue de 69.81 años, con ligera predominancia del sexo masculino. La estancia hospitalaria fue de 6.62 en 2017 y de 5.29 días en 2018. Se encontró correlación entre los días de estancia hospitalaria y la edad de los pacientes. La comorbilidad más frecuentes en los pacientes hospitalizados fue hipertensión arterial, cardiopatía isquémica y enfermedad pulmonar obstructiva crónica. El 18.04% no tuvieron comorbilidad. Las muertes intrahospitalarias estuvieron asociadas, con mayor frecuencia, a insuficiencia cardíaca. La cardioversión eléctrica fue el procedimiento electrofisiológico más usado, seguida del aislamiento de venas pulmonares. El porcentaje de complicaciones fue menor en 2018 que en 2017. Conclusiones: Existe menor proporción de comorbilidad cuando se compara esta serie con otros reportes. Los días de estancia hospitalaria fueron superiores a los encontrados en la literatura mundial.

Abstract Introduction: Atrial fibrillation is the most frequent sustained tachyarrhythmia in humans and its management requires an integral approach in order to get optimal results. Objective: To describe the sociodemographic and clinical characteristics of patients hospitalized or on surgical procedures with a diagnosis of atrial fibrillation, managed in a Fourth level of Complexity clinic in Colombia. Method: An observational, retrospective study was conducted from records of patients hospitalized or operated with a diagnosis of atrial fibrillation. The diagnosis of atrial fibrillation (ICD-10 I48X) was taken as a reference, during the years 2017 and 2018. Univariate and bivariate analysis was performed with Excel, SPSS and Epidat. Results: The average age of hospitalized patients was 69.81 years, with a slight predominance of males. The hospital stay was 6.62 and 5.29 days, during 2017 and 2018 respectively. Correlation was found between the days of hospital stay and the age of the patients. The most frequent comorbidities in hospitalized patients were arterial hypertension, ischemic heart disease and chronic obstructive pulmonary disease. 18.04 % of patients had no comorbidities. In-hospital deaths were more frequently associated with heart failure. Electrical cardioversion was the most frequent electrophysiological procedure followed by the isolation of pulmonary veins. The percentage of complications was lower in 2018 compared to 2017. Conclusions: There are a lower proportion of comorbidities when this series is compared with other reports. The days of hospital stay were superior to those found in the world literature.

Accuracy of Delta Capnography for the Prediction of Pulmonary Vein Occlusion During Cryoablation for Atrial Fibrillation.

The purpose of this study was to quantify the relationship between a drop in end-tidal carbon dioxide (etCO2) and occlusion of pulmonary veins (PVs) to find a delta etCO2 (ΔetCO2) able to predict occlusion during PV isolation (PVI) by cryoballoon. We designed a prospective registry. Paroxysmal atrial fibrillation patients who underwent cryoballoon PVI were included. Capnography was performed. Occlusion was tested by injection. A comparison between ΔetCO2 and occlusion was performed. Eighteen subjects (138 injections) were included. A drop of >3.5 mmHg predicted occlusion of the PV (sensitivity, 80%; specificity, 86.7%). A ΔetCO2 of ≥3.5 mmHg during inflation of the cryoballoon in each PV directly correlates with PV balloon occlusion.

Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January-August 2020.

BACKGROUND: Understanding the impact of the burden of COVID-19 is key to successfully navigating the COVID-19 pandemic. As part of a larger investigation on COVID-19 mortality impact, this study aims to estimate the Potential Years of Life Lost (PYLL) in 17 countries and territories across the world (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States [USA]). METHODS: Age- and sex-specific COVID-19 death numbers from primary national sources were collected by an international research consortium. The study period was established based on the availability of data from the inception of the pandemic to the end of August 2020. The PYLL for each country were computed using 80 years as the maximum life expectancy. RESULTS: As of August 2020, 442,677 (range: 18-185,083) deaths attributed to COVID-19 were recorded in 17 countries which translated to 4,210,654 (range: 112-1,554,225) PYLL. The average PYLL per death was 8.7 years, with substantial variation ranging from 2.7 years in Australia to 19.3 PYLL in Ukraine. North and South American countries as well as England & Wales, Scotland and Sweden experienced the highest PYLL per 100,000 population; whereas Australia, Slovenia and Georgia experienced the lowest. Overall, males experienced higher PYLL rate and higher PYLL per death than females. In most countries, most of the PYLL were observed for people aged over 60 or 65 years, irrespective of sex. Yet, Brazil, Cape Verde, Colombia, Israel, Peru, Scotland, Ukraine, and the USA concentrated most PYLL in younger age groups. CONCLUSIONS: Our results highlight the role of PYLL as a tool to understand the impact of COVID-19 on demographic groups within and across countries, guiding preventive measures to protect these groups under the ongoing pandemic. Continuous monitoring of PYLL is therefore needed to better understand the burden of COVID-19 in terms of premature mortality.

Disyunción del anillo mitral como marcador de riesgo en prolapso de válvula mitral / The mitral annulus disjunction as a risk marker in mitral valve prolapse

Resumen La disyunción del anillo valvular mitral es una anormalidad estructural que consiste en un desplazamiento auricular del punto de articulación de la válvula mitral, lo que lleva a una relación espacial alterada entre la válvula y la pared ventricular posterior adyacente. Los estudios han demostrado una relación entre la disyunción del anillo mitral, las arritmias ventriculares y la degeneración fibrosa miocárdica, lo que incrementa el riesgo de muerte súbita, en especial en mujeres jóvenes. Se presenta el caso de una mujer de 30 años, sin antecedentes relevantes, con palpitaciones frecuentes, en quien se documentó un aumento del automatismo ventricular con incremento progresivo de la carga arrítmica hasta el 20% a pesar del manejo farmacológico. En la resonancia cardiaca se apreció un desplazamiento de 15 mm hacia la aurícula de las valvas de la mitral compatible con disyunción del anillo mitral, además de focos de realce tardío de distribución mesocárdica, no coronariana. Ante los hallazgos y la persistencia de los síntomas, se llevó a estudio electrofisiológico, mapeo 3D y ablación. En la ecografía intracardiaca se apreciaron dos regiones hiperecoicas, en la longitud del músculo papilar anterior y en el mesocardio de la base del músculo papilar posterior; ambos focos relacionados con los sitios morfológicos de interés, en los cuales se aplicó energía de radiofrecuencia. Durante el procedimiento presentó un episodio de fibrilación ventricular que se consideró una extrasistolia ventricular maligna, por lo que se implantó un cardiodesfibrilador para prevención de muerte súbita. Se revisa la literatura y se analizan las relaciones fisiopatológicas existentes entre la disyunción del anillo mitral, los complejos ventriculares prematuros y el riesgo de muerte súbita.

Abstract Disjunction of the mitral valve annulus is a structural abnormality consisting of an atrial displacement of the articulation point of the mitral valve, leading to an altered spatial relationship between the valve and the adjacent posterior ventricular wall. Studies have shown the relationship between mitral annular disjunction, ventricular arrhythmias, and myocardial fibrous degeneration, which increases the risk of sudden death, especially among young women. The case of a 30-year-old woman with no relevant pathological history with frequent palpitations is presented, in whom an increase in ventricular automatism with a progressive increase in the arrhythmic load of up to 20% with a weight of pharmacological management is documented. In a cardiac magnetic resonance, a 15 mm displacement towards the atrium of the mitral leaflets compatible with mitral annular disjunction and late enhancement foci of mesocardial, non-coronary distribution were observed. Given the findings and the persistence of symptoms, an electrophysiological study, 3D mapping, and ablation were performed. Two hyperechoic regions were seen on intracardiac ultrasound, one in the length of the anterior papillary muscle and the other in the mesocardium of the base of the posterior papillary muscle. Both foci related to the morphological sites of interest in which radiofrequency energy was applied. During the procedure presented an episode of ventricular fibrillation. A malignant ventricular extrasystole was considered and therefore a cardio defibrillator was implanted for the secondary prevention of sudden death. The literature was reviewed and the specific pathophysiological relationships between mitral annular disjunction, premature ventricular complexes, and risk of sudden death were analyzed. The role of electrophysiological study and ablation in symptomatic patients refractory to pharmacological treatment is described.

Presence of a Septal Occluder Is No Longer an Obstacle for Pulmonary Vein Isolation by Cryoablation.

Cryoablation for pulmonary vein isolation in atrial fibrillation has been considered a relative contraindication in the presence of a septal occluder device. We describe the successful conduct of this technique with a multimodality imaging approach.

Velamentous cord insertion, ischemic-hypoxic encephalopathy, and neurological rehabilitation: A case report / Inserción "velamentosa", encefalopatía hipóxico-isquémica y rehabilitación neurológica: reporte de caso.

Hypoxic-ischemic encephalopathy is a frequent and important cause of neurological problems in term and preterm newborns. A sentinel event of this entity is the vasa previa, specifically when there is an abnormality of the placenta such as a velamentous cord insertion. Some reports have shown the association between these two entities, but those regarding the recovery process and the neurological prognosis of children with both conditions are scarce. We present the case of a patient with a history of velamentous cord insertion and hypoxicischemic encephalopathy who received therapeutic hypothermia (cool cap). We describe his neurological rehabilitation process and we calculated the percentage of probability of presenting this condition compared to the population without these factors. The patient was a five-year-old boy with an Apgar index at birth equal to zero at one minute and equal to two at fifteen minutes who developed severe hypoxic-ischemic encephalopathy secondary to a velamentous cord insertion without prenatal diagnosis and a marked initial neurological and multisystemic compromise. The recovery process included early multidisciplinary management in the neonatal intensive care unit and a focus on early neurological habilitation. The patient is currently in school and he undergoes comprehensive therapies; on physical examination, he presents no motor or sensory deficiencies. His neuropsychological test suggests the risk of attention deficit hyperactivity disorder. Children with severe hypoxicischemic encephalopathy usually have disabilities due to motor, cognitive, and/or behavioral deficiencies.

La encefalopatía hipóxico-isquémica es una causa frecuente e importante de daño neurológico en recién nacidos a término y prematuros. Un evento centinela de esta condición es la vasa previa, específicamente cuando existe anormalidad de la placenta como la inserción "velamentosa" del cordón umbilical. Algunos reportes evidencian la asociación entre estas dos condiciones, pero son escasos los que dan cuenta del proceso de recuperación y del pronóstico neurológico de los niños afectados por ellas. Se presenta el caso de un paciente, con antecedentes de inserción "velamentosa" del cordón umbilical y encefalopatía hipóxico-isquémica, que recibió hipotermia terapéutica (cool cap). Se describe su proceso de rehabilitación neurológica y se calculó el porcentaje de probabilidad de presentar esta condición frente a la población sin estos factores. El niño tenía cinco años y el puntaje en su prueba de Apgar fue de 0 al minuto y de 2 a los 15 minutos. Desarrolló encefalopatía hipóxico-isquémica grave secundaria a una inserción "velamentosa" del cordón umbilical sin diagnóstico prenatal, con gran compromiso neurológico y multisistémico inicial. El proceso de recuperación incluyó el manejo inicial multidisciplinario en la unidad de cuidados intensivos neonatales y el inicio temprano de habilitación neurológica. Hoy el niño está escolarizado y en terapia integral, no presenta deficiencias motoras ni sensoriales en el examen físico, aunque la prueba neuropsicológica sugiere un riesgo de trastorno por déficit de atención e hiperactividad. Habitualmente, los niños con encefalopatía hipóxico-isquémica grave presentan discapacidad por deficiencias motoras, cognitivas o conductuales.

Inserción "velamentosa", encefalopatía hipóxico-isquémica y rehabilitación neurológica: reporte de caso / Velamentous cord insertion, ischemic-hypoxic encephalopathy, and neurological rehabilitation: A case report

Resumen. La encefalopatía hipóxico-isquémica es una causa frecuente e importante de daño neurológico en recién nacidos a término y prematuros. Un evento centinela de esta condición es la vasa previa, específicamente cuando existe anormalidad de la placenta como la inserción "velamentosa" del cordón umbilical. Algunos reportes evidencian la asociación entre estas dos condiciones, pero son escasos los que dan cuenta del proceso de recuperación y del pronóstico neurológico de los niños afectados por ellas. Se presenta el caso de un paciente, con antecedentes de inserción "velamentosa" del cordón umbilical y encefalopatía hipóxico-isquémica, que recibió hipotermia terapéutica (cool cap). Se describe su proceso de rehabilitación neurológica y se calculó el porcentaje de probabilidad de presentar esta condición frente a la población sin estos factores. El niño tenía cinco años y el puntaje en su prueba de Apgar fue de 0 al minuto y de 2 a los 15 minutos. Desarrolló encefalopatía hipóxico-isquémica grave secundaria a una inserción "velamentosa" del cordón umbilical sin diagnóstico prenatal, con gran compromiso neurológico y multisistémico inicial. El proceso de recuperación incluyó el manejo inicial multidisciplinario en la unidad de cuidados intensivos neonatales y el inicio temprano de habilitación neurológica. Hoy el niño está escolarizado y en terapia integral, no presenta deficiencias motoras ni sensoriales en el examen físico, aunque la prueba neuropsicológica sugiere un riesgo de trastorno por déficit de atención e hiperactividad. Habitualmente, los niños con encefalopatía hipóxico-isquémica grave presentan discapacidad por deficiencias motoras, cognitivas o conductuales. El haber recibido hipotermia terapéutica y un manejo estructurado de rehabilitación redujo en gran medida las deficiencias esperadas y ha promovido un satisfactorio desarrollo físico y neurológico.

Abstract. Hypoxic-ischemic encephalopathy is a frequent and important cause of neurological problems in term and preterm newborns. A sentinel event of this entity is the vasa previa, specifically when there is an abnormality of the placenta such as a velamentous cord insertion. Some reports have shown the association between these two entities, but those regarding the recovery process and the neurological prognosis of children with both conditions are scarce. We present the case of a patient with a history of velamentous cord insertion and hypoxic-ischemic encephalopathy who received therapeutic hypothermia (cool cap). We describe his neurological rehabilitation process and we calculated the percentage of probability of presenting this condition compared to the population without these factors. The patient was a five-year-old boy with an Apgar index at birth equal to zero at one minute and equal to two at fifteen minutes who developed severe hypoxic-ischemic encephalopathy secondary to a velamentous cord insertion without prenatal diagnosis and a marked initial neurological and multisystemic compromise. The recovery process included early multidisciplinary management in the neonatal intensive care unit and a focus on early neurological habilitation. The patient is currently in school and he undergoes comprehensive therapies; on physical examination, he presents no motor or sensory deficiencies. His neuropsychological test suggests the risk of attention deficit hyperactivity disorder. Children with severe hypoxic-ischemic encephalopathy usually have disabilities due to motor, cognitive, and/or behavioral deficiencies. Having received therapeutic hypothermia and a structured rehabilitation process greatly reduced the expected deficiencies according to prognosis and have promoted satisfactory physical and neurological development.

The mitral annulus disjunction as a risk marker in mitral valve prolapse / Disyunción del anillo mitral como marcador de riesgo en prolapso de válvula mitral

Disjunction of the mitral valve annulus is a structural abnormality consisting of an atrial displacement of the articulation point of the mitral valve, leading to an altered spatial relationship between the valve and the adjacent posterior ventricular wall. Studies have shown the relationship between mitral annular disjunction, ventricular arrhythmias, and myocardial fibrous degeneration, which increases the risk of sudden death, especially among young women. The case of a 30-year-old woman with no relevant pathological history with frequent palpitations is presented, in whom an increase in ventricular automatism with a progressive increase in the arrhythmic load of up to 20% with a weight of pharmacological management is documented. In a cardiac magnetic resonance, a 15 mm displacement towards the atrium of the mitral leaflets compatible with mitral annular disjunction and late enhancement foci of mesocardial, non-coronary distribution were observed. Given the findings and the persistence of symptoms, an electrophysiological study, 3D mapping, and ablation were performed. Two hyperechoic regions were seen on intracardiac ultrasound, one in the length of the anterior papillary muscle and the other in the mesocardium of the base of the posterior papillary muscle. Both foci related to the morphological sites of interest in which radiofrequency energy was applied. During the procedure presented an episode of ventricular fibrillation. A malignant ventricular extrasystole was considered and therefore a cardio defibrillator was implanted for the secondary prevention of sudden death. The literature was reviewed and the specific pathophysiological relationships between mitral annular disjunction, premature ventricular complexes, and risk of sudden death were analyzed. The role of electrophysiological study and ablation in symptomatic patients refractory to pharmacological treatment is described.

La disyunción del anillo valvular mitral es una anormalidad estructural que consiste en un desplazamiento auricular del punto de articulación de la válvula mitral, lo que lleva a una relación espacial alterada entre la válvula y la pared ventricular posterior adyacente. Los estudios han demostrado una relación entre la disyunción del anillo mitral, las arritmias ventriculares y la degeneración fibrosa miocárdica, lo que incrementa el riesgo de muerte súbita, en especial en mujeres jóvenes. Se presenta el caso de una mujer de 30 años, sin antecedentes relevantes, con palpitaciones frecuentes, en quien se documentó un aumento del automatismo ventricular con incremento progresivo de la carga arrítmica hasta el 20% a pesar del manejo farmacológico. En la resonancia cardiaca se apreció un desplazamiento de 15 mm hacia la aurícula de las valvas de la mitral compatible con disyunción del anillo mitral, además de focos de realce tardío de distribución mesocárdica, no coronariana. Ante los hallazgos y la persistencia de los síntomas, se llevó a estudio electrofisiológico, mapeo 3D y ablación. En la ecografía intracardiaca se apreciaron dos regiones hiperecoicas, en la longitud del músculo papilar anterior y en el mesocardio de la base del músculo papilar posterior; ambos focos relacionados con los sitios morfológicos de interés, en los cuales se aplicó energía de radiofrecuencia. Durante el procedimiento presentó un episodio de fibrilación ventricular que se consideró una extrasistolia ventricular maligna, por lo que se implantó un cardiodesfibrilador para prevención de muerte súbita. Se revisa la literatura y se analizan las relaciones fisiopatológicas existentes entre la disyunción del anillo mitral, los complejos ventriculares prematuros y el riesgo de muerte súbita.

Community perception of malaria in a vulnerable municipality in the Colombian Pacific.

BACKGROUND: Malaria primarily affects populations living in poor socioeconomic conditions, with limited access to basic services, deteriorating environmental conditions, and barriers to accessing health services. Control programmes are designed without participation from the communities involved, ignoring local knowledge and sociopolitical and cultural dynamics surrounding their main health problems, which implies imposing decontextualized control measures that reduce coverage and the impact of interventions. The objective of this study was to determine the community perception of malaria in the municipality of Olaya Herrera in the Colombian Pacific. METHODS: A 41-question survey on knowledge, attitudes, and practices (KAP) related to malaria, the perception of actions by the Department of Health, and access to the health services network was conducted. RESULTS: A total of 134 adults were surveyed, in whose households a total of 671 people lived. According to the survey data, about 80% of the household members included teenagers and children, out of which 61% had malaria at one time, and for 75.3%, this disease is a persistent problem. In spite of this, 57.2% of people who fell ill due to malaria were never visited by health personnel for a follow up. This population claimed that responsibility for who should prevent the disease is shared between each person and the Department of Health. However, personal actions were focused on using mosquito nets, ignoring other important practices to prevent bites. Despite campaigns by the Department of Health, 11.9% of respondents did not know how malaria was transmitted, and 8.96% thought it was transmitted through water. Also, 43.5% said that the Department of Health did not do any work to control malaria and 16% did not know if any action was taken. CONCLUSIONS: In spite of the knowledge about malaria and the efforts of the Department of Health to prevent it, the community actions do not seem to be consistent with this knowledge, as the number of cases of malaria is still high in the area.

An investigation into the knowledge, perceptions and role of personal protective technologies in Zika prevention in Colombia.

BACKGROUND: Arboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging. METHODOLOGY/PRINCIPAL FINDINGS: To gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction. CONCLUSIONS/SIGNIFICANCE: Achieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies.

Efecto antimicrobiano del aceite esencial de Citrus reticulata sobre Fusobacterium nucleatum asociada a enfermedad periodontal / Antimicrobial effect of essential oil of Citrus reticulata on Fusobacterium nucleatum associated with periodontal disease

Resumen La clorhexidina como tratamiento de la enfermedad periodontal ha logrado efectos bactericidas sobre periodontopatógenos y biopelícula oral. Su uso genera efectos adversos, por lo tanto se presentan alternativas naturales con efecto antimicrobiano similar. Los aceites esenciales han demostrado efectividad en el control de la placa dental, sin los efectos adversos de la clorhexidina. El objetivo de este estudio fue determinar el efecto bacteriostático y bactericida del aceite esencial de mandarina contra Fusobacterium nucleatum. Se realizó extracción por expresión del aceite esencial de cáscaras de mandarina (variedades Arrayana y Oneco). Se evaluaron concentraciones al 20%, 40%, 60%, 80% y 100% del aceite esencial diluido en Tween al 0,02%. El efecto bacteriostático y bactericida se determinó por pruebas de sensibilidad antimicrobiana por difusión en disco. Como control positivo se utilizó Clorhexidina 0,2% y agua como control negativo. Se midió halo de inhibición (mm) y se determinó ausencia o presencia de crecimiento bacteriano a partir de unidades formadoras de colonias. Para comparación de proporciones de la actividad bacteriostática y bactericida, se realizó prueba de Fisher y T student (IC 95% p = 0,05). El halo de inhibición a una concentración del 100% mostró comportamiento similar a clorhexidina (p<0,05). Concentraciones al 100% y 80% fueron bactericidas, al 60%, 40% y 20% presentaron comportamiento bacteriostático. No se encontraron diferencias significativas en las proporciones de inhibición entre las dos variedades de mandarina (p>0,05). El uso de aceites esenciales de mandarina podría ser una alternativa complementaria al tratamiento de la enfermedad periodontal.

Abstract Chlorhexidine as a treatment of periodontal disease has achieved bactericidal effects over periodontopathogens and oral biofilm. Its use generates adverse effects; therefore natural alternatives are presented with a similar antimicrobial effect. Essential oils have proved effective in controlling dental plaque without the adverse effects of chlorhexidine. The aim of this study was to determine the bacteriostatic and bactericidal effect of essential oil of tangerine against Fusobacterium nucleatum. The extraction of the essential oil was performed by expression of tangerine peels (Arrayana and Oneco varieties). Concentrations at 20%, 40%, 60%, 80% and 100% of the essential oil diluted in 0,02% Tween were evaluated. The bacteriostatic and bactericidal effect was determined by antimicrobial susceptibility testing by disk diffusion. As a positive control 0,2% chlorhexidine and water as negative control were used. Inhibition zone (mm) was measured and presence or absence of bacterial growth was determined from colony forming units. To compare proportions of bacteriostatic and bactericidal activity, Fisher and T student test (95% CI p = 0,05) were performed. The 100% concentration zone of inhibition showed a similar behavior as chlorhexidine (p <0,05). 100% and 80% concentrations were bactericides, 60%, 40% and 20% showed bacteriostatic behavior. No significant differences between the proportions of inhibition of the two varieties of tangerine (p> 0,05). The use of essential oils of tangerine could be a complementary alternative to treatment of periodontal disease.

Blattella germánica (Blattodea: Blattellidae) como potencial vector mecánico de infecciones asociadas a la atención en salud (IAAS) en un centro hospitalario de Villavicencio (Meta-Colombia) / Blattella germánica (Blattodea: Blattellidae) as potential mechanical vector of health-care associated infections in a hospital in Villavicencio (Meta-Colombia)

Objetivo. Identificar las especies de cucarachas y bacterias asociadas a su exoesqueleto en un centro hospitalario de la ciudad de Villavicencio (Meta, Colombia). Métodos. Se realizaron capturas manuales de cucarachas en cocina, urgencias, UCI intermedia, consulta externa y neonatos. Los individuos colectados fueron sometidos a un aislamiento primario en caldo BHI, para luego pasar a medios sólidos (sangre y MacConkey). Se realizó identificación y antibiograma por método automatizado. Resultados. Se colectaron 24 ninfas y adultos de Blattella germánica. Se aisló e identificó Klebsiella pneumoniae con sensibilidad intermedia a meropenem (CMI 4) y resistencia a cefalosporinas (cefepima y cefuroxima) (>16), Proteus vulgaris con resistencia a cefalosporinas (ceftriaxona, cefuroxima) (CMI >16), Enterobacter cloacae con resistencia a cefalosporinas (cefoxitina, cefuroxima, ceftriaxona) (CMI > 16), Enterococcus faecium, Enterococcus rafinosus, Staphylococcus xylosus y Enterococcus faecalis. El 80% de las bacterias aisladas presentaron algún grado de resistencia a antibióticos. Conclusiones. Estos insectos podrían jugar un papel importante en la transmisión de las Infecciones asociadas a la atención en salud (IAAS). Debido a su presencia en hospitales y el reporte de IAAS y resistencia bacteriana en varios centros asistenciales en el Departamento del Meta, se hace necesario establecer la relación de estos insectos con estos eventos.

Objective. Identify the species of cockroaches and bacteria associated with their exoskeleton in a hospital in Villavicencio (Meta, Colombia). Methods. The cockroaches were captured manually in kitchen, emergency room, intermediate intensive care unit, outpatient service and newborn nursery. The collected individuals were subjected to a primary isolation in BHI broth, then move on to solid media (blood and MacConkey). Identification and sensitivity testing was performed by automated method. Results. 24 nymphs and adults ofBlattella germanica were collected. It was isolated and identified Klebsiellapneumoniae with intermediate susceptibility to meropenem (MIC 4) and resistance to cephalosporins (cefepime and cefuroxime) (> 16), Proteus vulgaris with cephalosporin resistance (Ceftriaxone, Cefuroxime) (MIC > 16), Enterobacter cloacae resistant to cephalosporins (cefoxitin, cefuroxime, ceftriaxone) (MIC > 16), Enterococcus faecium, Enterococcus rafinosus, Staphylococcus xylosus and Enterococcus faecalis. 80% of the isolated bacteria showed some degree of resistance to antibiotics. Results. These insects could play an important role in the transmission of health care associated infections (HCAI). Due to the presence of cockroaches in hospitals and the report of HCAI and bacterial resistance in several health centers in the Department of Meta, it is necessary to establish the relationship of these insects with these events.

Modalidades de intervención de los psicólogos clínicos en Medellín, Colombia / Intervention Modalities of Clinical Psychologists at Medellín, Colombia

El presente Estado del Arte tuvo como objetivo delimitar las especificidades de las modalidades de intervención de los psicólogos clínicos usando dos técnicas: la matriz analítica de contenido y una encuesta previamente diseñada según el sistema categorial definido para el proyecto. En total se revisaron 151 documentos bibliográficos de origen nacional e internacional y respondieron a la encuesta virtual 71 psicólogos residentes en Medellín que inscriben su práctica en el campo clínico. Los resultados en ambas fuentes de datos indican una predominancia de la psicoterapia como modalidad de intervención, aunque la asesoría, la consultoría y la intervención en crisis también se destacan como otras opciones de los psicólogos clínicos para responder a las demandas de atención de las personas, diferenciándose cada una de acuerdo a sus objetivos y la correspondencia de estos con las técnicas y estrategias enunciadas por autores y encuestados. Finalmente se propone una clasificación de las modalidades y su relación con los niveles de intervención conocidos como promoción de la salud, prevención de la enfermedad y tratamiento.

This state of the art aimed to define the specific modalities of intervention clinical psychologists using two techniques: the rubric of content and a survey previously designed according to the categorical system defined for the project. In total 151 bibliographic records of national and international sources were reviewed and responded to the online survey 71 psychologists in Medellin residents who enroll their practice in the clinical field. The results in both data sources indicate a predominance of psychotherapy as a form of intervention, although the advisory, consulting and crisis intervention also highlights other options of clinical psychologists to meet the demands of care for people, differentiating each according to their objectives and their correspondence with the techniques and strategies expressed by authors and respondents. Finally rated modalities and its relationship to the levels of intervention known as health promotion, disease prevention and treatment is proposed.

Main plants used in traditional medicine for the treatment of snake bites n the regions of the department of Antioquia, Colombia.

ETHNOPHARMACOLOGY RELEVANCE: In Colombia, more than 4.000 ophidian accidents occur per year and due to the scarce distribution and limited availability of antivenom, the use of traditional medicine has been perpetuated in some of its rural communities, in which initially, those affected are treated by healers and shamans using medicinal plants in different ways. METHODS: Research was conducted with renowned healers or connoisseurs of plants on the ethnobotany of ophidian accidents in five different areas and their municipalities of Antioquia: Magdalena Medio (Caracolí, Puerto Berrío); Bajo Cauca (Caucasia, Zaragoza); Nordeste (San Roque, Yalí); Norte (Gómez Plata, Valdivia); Suroeste (Ciudad Bolívar, Salgar); collecting information related to experience and time of use of plants in the treatment of these poisonings, amounts used, ways of use (beverage, bathing, ointment, chupaderas, vapors), preparation types (maceration or decoction) and treatment duration. RESULTS: 71 plant species were identified and collected, 49.29% of them without previous reports as antiophidian and 38.0% employed for the same purpose in other geographical areas. The leaves (24.82%), stems (11.68%) and flowers (10.95%) were found to be the most frequently employed structures in the preparation of the extracts, which are usually prepared by decoction (83.94%), maceration (6.57%). CONCLUSIONS: In this work, specimens lacking previous ethnobotanical reports have been found, plants used by ethnic groups from other regions of Antioquia and the world to treat snake bites; and herbaceous plants whose inhibitory activity of symptoms produced by some snake venoms, has been experimentally verified by in vivo and in vitro tests.

Differential expression of apoptosis related genes in selected strains of Aedes aegypti with different susceptibilities to dengue virus.

Aedes aegypti is the principal vector of Dengue viruses worldwide. We identified field collected insects with differential susceptibility to Dengue-2 virus (DENv-2) and used isofemale selection to establish susceptible and refractory strains based on midgut infection barriers. Previous experiments had identified higher expression of apoptosis-related genes in the refractory strain. To identify potential molecular mechanisms associated with DENv susceptibility, we evaluated the differential expression of Caspase-16, Aedronc, Aedredd, Inhibitor of apoptosis (AeIAP1) and one member of the RNAi pathway, Argonaute-2 in the midguts and fat body tissues of the selected strains at specific times post blood feeding or infection with DENv-2. In the refractory strain there was significantly increased expression of caspases in midgut and fatbody tissues in the presence of DENv-2, compared to exposure to blood alone, and significantly higher caspase expression in the refractory strain compared with the susceptible strain at timepoints when DENv was establishing in these tissues. We used RNAi to knockdown gene expression; knockdown of AeIAP1 was lethal to the insects. In the refractory strain, knockdown of the pro-apoptotic gene Aedronc increased the susceptibility of refractory insects to DENv-2 from 53% to 78% suggesting a contributing role of this gene in the innate immune response of the refractory strain.

[Ventricular septal defects in adults: 15 years of surgical experience in a single Colombian cardiovascular center]. / Comunicación interventricular en adultos: experiencia quirúrgica de 15 años en un centro cardiovascular Colombiano.

OBJECTIVE: To review the surgical experience with ventricular septal defects in adults in Colombia. METHOD: Descriptive, retrospective study of surgically repaired patients between 1995 and 2010. Clinical, echocardiographic, hemodynamic, and surgical findings were related to hospital and outpatient outcomes. RESULTS: Fifty-two patients were analyzed (mean age 29.3 ± 9.9 years, 54% women). Ventricular septal defects were classified, according to the Society of Thoracic Surgeons, as type 2 (membranous, 84.6%), type 1 (subarterial, 13.5%), and type 3 (inlet, 1.9%). Dyspnea, Qp/Qs ≥ 2, and pulmonary hypertension were the most common indications for surgery. No peri-operative deaths were found. Outpatient mean follow-up was 2.7 ± 3.6 years and was possible for 90% of the original cohort and late mortality was 5% (one case). Despite that residual ventricular septal defects (29%) were frequent, no patient required surgical re-intervention for this reason. Improvements in functional class and pulmonary artery systolic pressure were also observed. CONCLUSIONS: Surgical closure of ventricular septal defects in adults is a safe procedure without early mortality and a low complications index. Residual ventricular septal defects underline the need for life-long follow-up.

Comunicación interventricular en adultos: experiencia quirúrgica de 15 años en un centro cardiovascular colombiano / Ventricular septal defects in adults: 15 years of surgical experience in a single Colombian cardiovascular center

Objetivo: Revisar la experiencia en la cirugía de comunicación interventricular en adultos. Método: Estudio descriptivo en pacientes con comunicación interventricular intervenidos quirúrgicamente entre los años 1995 y 2010. Se analizaron los hallazgos clínicos, ecocardiográficos, hemodinámicos, quirúrgicos y los relacionados con desenlaces intrahospitalarios y ambulatorios. Resultados: Fueron incluidos 52 casos, edad 29.3 ± 9.9 años, 54% mujeres. Según la clasificación de la Sociedad de Cirujanos del Tórax, las comunicaciones interventriculares fueron: tipo 2 (membranosa), 84.6%, tipo 1 (subarterial), 13.5%, y tipo 3 (tracto de entrada), 1.9%. La disnea de esfuerzos, el índice Qp/Qs ≥ 2 y la hipertensión pulmonar fueron las principales indicaciones de intervención. No se presentaron muertes perioperatorias. El seguimiento posterior al alta fue posible en el 90% de los casos, en promedio 2.7 ± 3.6 años, y solo hubo un caso de mortalidad tardía. Los defectos residuales fueron frecuentes (29%), sin embargo, ningún paciente fue sometido a reintervenciones por este motivo. La mayoría de los pacientes mejoraron su clase funcional y las cifras de presión sistólica pulmonar. Conclusiones: La cirugía de cierre de la comunicación interventricular en adultos es un procedimiento seguro, sin mortalidad temprana y con un bajo índice de complicaciones perioperatorias. La presencia de defectos residuales enfatiza la necesidad de seguimiento vitalicio en este grupo de pacientes.

Objective: To review the surgical experience with ventricular septal defects in adults in Colombia. Method: Descriptive, retrospective study of surgically repaired patients between 1995 and Heart septal defects; 2010. Clinical, echocardiographic, hemodynamic, and surgical findings were related to hospital Pulmonary and outpatient outcomes. Results: Fifty-two patients were analyzed (mean age 29.3±9.9 years, 54% women). Ventricular septal defects were classified, according to the Society of Thoracic Surgeons, as type 2 (membranous, 84.6%), type 1 (subarterial, 13.5%), and type 3 (inlet, 1.9%). Dyspnea, Qp/Qs ≥ 2, and pulmonary hypertension were the most common indications for surgery. No peri-operative deaths were found. Outpatient mean follow-up was 2.7±3.6 years and was possible for 90% of the original cohort and late mortality was 5% (one case). Despite that residual ventricular septal defects (29%) were frequent, no patient required surgical re-intervention for this reason. Improvements in functional class and pulmonary artery systolic pressure were also observed. Conclusions: Surgical closure of ventricular septal defects in adults is a safe procedure without early mortality and a low complications index. Residual ventricular septal defects underline the need for life-long follow-up.

El sujeto y el lazo social en el psicoanálisis / Subject and social fabric in psychoanalysis / Le sujet et le lien social dans la psychanalyse

La psicología hace equivalentes las nociones de sujeto, persona, individuo y yo, y define su natu-raleza en función de su condición gregaria; no existen diferencias formales y se usan indiscrimi-nadamente estos términos. En el psicoanálisis hay una clara diferencia entre el yo y el sujeto, que corresponde a la definición freudiana de la descomposición de la personalidad psíquica, e interroga la concepción psicológica de unidad representativa de la personalidad. En el psicoa-nálisis el lazo social se define en términos de discurso y no diferencia entre sujeto individual y sujeto social, en tanto el discurso es el regulador del goce en todo lazo social donde está inscrito el sujeto...

Psychology becomes equivalent the notion of subject, person, individual, and the ego; and it defines its nature according to his/her gregarious condition: there are not any formal difference and its terms are used indiscriminately. There is a clear difference between the ego and the subject in psychoanalysis, this difference belongs to Freudian's definition of the decomposition of the psychical personality; it also questions the psy-chological notion of personality representative unit. Social fabric in psychoanalysis is defined on discursive terms and it does not make difference between individual subject and social subject, meanwhile the speech regulates the enjoyment in every social fabric where subject is registered...

La psychologie fait des notions de sujet, personne, individu et je, des équivalents et définit leur nature en fonction de leur condition grégaire. Il n’existe pas en psychologie de différences formelles de ces termes et ils sont utilisés indistinctement. Par contre dans la psychanalyse, il existe une diffé-rence claire entre le Je et le Sujet, qui correspond à la définition freudienne de la décomposition de la personnalité psychique, et qui interroge la con-ception psychologique de l’unité représentative de la personnalité. Dans la psychanalyse, le lien so-cial se défini en termes de discours et non pas de différence entre sujet individuel et sujet social, car le discours est le régulateur de la jouissance en tout lien social où le sujet est inscrit...