Identifying the most important data for research in the field of infectious diseases: thinking on the basis of artificial intelligence.

OBJECTIVE: Clinical data on which artificial intelligence (AI) algorithms are trained and tested provide the basis to improve diagnosis or treatment of infectious diseases (ID). We aimed to identify important data for ID research to prioritise efforts being undertaken in AI programmes. METHODS: We searched for 1,000 articlesfrom high-impact ID journals on PubMed, selecting 288 of the latest articles from 10 top journals. We classified them into structured or unstructured data. Variables were homogenised and grouped into the following categories: epidemiology, admission, demographics, comorbidities, clinical manifestations, laboratory, microbiology, other diagnoses, treatment, outcomes and other non-categorizable variables. RESULTS: 4,488 individual variables were collected, from the 288 articles. 3,670 (81.8%) variables were classified as structured data whilst 818 (18.2%) as unstructured data. From the structured data, 2,319 (63.2%) variables were classified as direct-retrievable from electronic health records-whilst 1,351 (36.8%) were indirect. The most frequent unstructured data were related to clinical manifestations and were repeated across articles. Data on demographics, comorbidities and microbiology constituted the most frequent group of variables. CONCLUSIONS: This article identified that structured variables have comprised the most important data in research to generate knowledge in the field of ID. Extracting these data should be a priority when a medical centre intends to start an AI programme for ID. We also documented that the most important unstructured data in this field are those related to clinical manifestations. Such data could easily undergo some structuring with the use of semi-structured medical records focusing on a few symptoms.

Real-life use of remdesivir in hospitalized patients with COVID-19.

OBJECTIVE: Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. METHODS: We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. RESULTS: A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. CONCLUSIONS: In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.

Calidad de vida en pacientes con linfedema por cáncer de seno en la ciudad de Medellín / Quality of life of a group of patients with lymphedema due to breast cancer in the city of Medellin / Qualidade de vida em pacientes com linfedema por câncer de mama na cidade de Medellín

Objetivo: Evaluar la calidad de vida en un grupo de pacientes con linfedema por cáncer de seno en la ciudad de Medellín. Metodología: Se realizó un estudio cuantitativo de tipo descriptivo correlacional, en el que se analizó la relación de la calidad de vida con la sintomatología, tratamientos médicos recibidos y perímetros del brazo en 11 mujeres con linfedema. Se valoró el dolor, perímetros de ambos brazos y se utilizó el cuestionario de calidad de vida FACT B+4. Resultados: A partir de las correlaciones de Spearman se identificó que, para la calidad de vida y los perímetros del brazo afectado, hubo una correlación inversa y no significativa, lo que indica que no existe una percepción negativa frente a la calidad de vida pese al linfedema. Hubo una correlación inversa y significativa entre el número de tratamientos y la calidad de vida (a más número de tratamientos recibidos, menor calidad de vida según la percepción de las participantes). Así mismo, la percepción de calidad de vida se correlacionó de modo inverso con el dolor. Conclusión: La calidad de vida se ve influenciada por la cantidad de tratamientos oncológicos recibidos, dichos tratamientos tienen efectos colaterales e impactan el bienestar. El dolor es una complicación que influye negativamente en la calidad de vida, más aún si se trata no se trata oportunamente.

Objective: This study intends to evaluate the quality of life of a group of patients with lymphedema due to breast cancer in the city of Medellin. Methodology: A descriptive correlational study was carried out with a quantitative approach, with the purpose of evaluating the quality of life in patients with lymphedema due to breast cancer, analyzing its relationship with symptoms; treatments received; and arm circumferences. The analyzed population consisted of 11 women. In which pain, perimeters of both arms were evaluated, and the FACT B + 4 Quality of life questionnaire was also implemented. Results: From Spearman's correlations, it was found that, for the variables of quality of life and perimeters of the affected arm, the correlation was inverse and not significant, indicating that there is no negative perception of quality of life despite the presence of lymphedema, while, for the number of treatments received by the patients and their quality of life, the correlation was inverse and significant, indicating that an increase in the number of treatments received, affects the perception of quality of life. The same analysis was developed for the variables of quality of life and pain, finding a significant and inverse correlation; therefore, as pain increases, the perception of quality of life decreases. Conclusion: The quality of life is an element that is influenced by the amount of cancer treatments received, which increases the side effects, and impacts the well-being of patients including lymphedema, also, pain is a complication that greatly influences the quality of life, even more if it is not timely treated.

Objetivo: Avaliar a qualidade de vida num grupo de pacientes com linfedema por câncer de mama na cidade de Medellín. Metodologia: Se realizou um estudo quantitativo de tipo descritivo de correlação, no qual se analisou a relação da qualidade de vida com a sintomatologia, tratamentos médicos recebidos e perímetros do braço em 11 mulheres com linfedema. Se valorou a dor, perímetros de ambos braços e se utilizou o questionário de qualidade de vida FACT B+4. Resultados: A partir das correlações de Spearman se identificou que, para a qualidade de vida e os perímetros do braço afetado, houve uma correlação inversa e não significativa, o que indica que não existe uma percepção negativa frente à qualidade de vida apesar do linfedema. Houve uma correlação inversa e significativa entre o número de tratamentos e a qualidade de vida (a mais número de tratamentos recebidos, menor qualidade de vida segundo a percepção das participantes). Assim mesmo, a percepção de qualidade de vida se correlacionou de modo inverso com a dor. Conclusão: A qualidade de vida se vê influenciada pela quantidade de tratamentos oncológicos recebidos, ditos tratamentos têm efeitos colaterais e impactam no bem-estar. A dor é uma complicação que influi negativamente na qualidade de vida, mais ainda se não se trata oportunamente.

Preventative laparoscopic repair of Petersen's space following gastric bypass surgery reduces the incidence of Petersen's hernia: a comparative study.

INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.

Effects of level of dietary cation-anion difference and duration of prepartum feeding on performance and metabolism of dairy cows.

The objectives were to evaluate the effects of feeding diets with 2 levels of negative dietary cation-anion differences (DCAD) during the last 42 or 21 d of gestation on performance and metabolism in dairy cows. The hypothesis was that extending feeding from 21 to 42 d and reducing the DCAD from -70 to -180 mEq/kg of dry matter (DM) would not be detrimental to performance. Holstein cows at 230 d of gestation were blocked by parity prepartum (48 entering their second lactation and 66 entering their third or greater lactation) and 305-d milk yield, and randomly assigned to 1 of 4 treatments arranged as a 2 × 2 factorial. The 2 levels of DCAD, -70 or -180 mEq/kg of DM, and 2 feeding durations, the last 21 d (short) or the last 42 d (long) prepartum resulted in 4 treatments, short -70 (n = 29), short -180 (n = 29), long -70 (n = 28) and long -180 (n = 28). Cows in the short treatments were fed a diet with DCAD of +110 mEq/kg of DM from -42 to -22 d relative to calving. After calving, cows were fed the same diet and production and disease incidence were evaluated for 42 d in milk, whereas reproduction and survival was evaluated for 305 d in milk. Blood was sampled pre- and postpartum for quantification of metabolites and minerals. Reducing the DCAD linearly decreased prepartum DM intake between -42 and -22 d relative to calving (+110 mEq/kg of DM = 11.5 vs. -70 mEq/kg of DM = 10.7 vs. -180 mEq/kg of DM = 10.2 ± 0.4), and a more acidogenic diet in the last 21 d of the dry period reduced intake by 1.1 kg/d (-70 mEq/kg of DM = 10.8 vs. -180 mEq/kg of DM = 9.7 ± 0.5 kg/d). Cows fed the -180 mEq/kg of DM diet had increased concentrations of ionized Ca in blood on the day of calving (-70 mEq/kg of DM = 1.063 vs. -180 mEq/kg of DM = 1.128 ± 0.020 mM). Extending the duration of feeding the diets with negative DCAD from 21 to 42 d reduced gestation length by 2 d (short = 277.2 vs. long = 275.3 d), milk yield by 2.5 kg/d (short = 40.4 vs. long = 37.9 ± 1.0 kg/d) and tended to increase days open because of reduced pregnancy per artificial insemination (short = 35.0 vs. long = 22.6%). Results suggest that increasing the duration of feeding diets with negative DCAD from 21 to 42 d prepartum might influence milk yield and reproduction of cows in the subsequent lactation, although yields of 3.5% fat- and energy-corrected milk did not differ with treatments. Reducing the DCAD from -70 to -180 mEq/kg of DM induced a more severe metabolic acidosis, increased ionized Ca concentrations prepartum and on the day of calving, and decreased colostrum yield in the first milking, but had no effects on performance in the subsequent lactation. Collectively, these data suggest that extending the feeding of an acidogenic diet beyond 21 d is unnecessary and might be detrimental to dairy cows, and a reduction in the DCAD from -70 to -180 mEq/kg of DM is not needed.

Effects of the level and duration of maternal diets with negative dietary cation-anion differences prepartum on calf growth, immunity, and mineral and energy metabolism.

The objectives were to investigate the effects that maternal diets containing negative dietary cation-anion differences (DCAD) fed in the last 42 d of gestation may have on the acid-base status, hematology, mineral and energy metabolism, growth, and health of calves. The experiment was a randomized block design with a 2 × 2 factorial arrangement of 2 levels of negative DCAD (-70 or -180 mEq/kg) and 2 feeding durations (the last 21 d prepartum and the last 42 d prepartum). Bulls and heifers (n = 60) born to these dams were weighted at birth and fed 3.8 L of colostrum for their first feeding, and only heifers (n = 44, 9-12/treatment) were kept thereafter. Heifer body weight was also recorded at 21 d, 42 d, 62 d, 3 mo, and 6 mo of age. Blood was collected at birth, before colostrum feeding, and at 1, 2, 3, 21, and 42 d of age and assayed for minerals, metabolites, and cell counts. Heifers born to dams fed the last 42 d prepartum weighed 2.8 and 4.8 kg less at birth and 62 d, respectively, compared with calves born to dams fed the last 21 d prepartum; however, body weight at 3 and 6 mo of age was similar. Concentrations of ionized calcium did not differ among treatments at birth, but heifers born to -180 DCAD dams had increased blood concentrations at 3 d of age, whereas those born to -70 DCAD dams did not. At birth, heifers born to -180 DCAD dams experienced a subtle and transient metabolic acidosis (pH = 7.33 ± 0.02; pCO2 = 53.0 ± 2.4 mmHg; HCO3- = 27.6 ± 0.7 mmol/L) compared with the more evident metabolic acidosis observed in those born to -70 DCAD cows (pH = 7.28 ± 0.02; pCO2 = 59.3 ± 2.4 mmHg; HCO3- = 27.8 ± 0.7 mmol/L). Heifers born to -180 DCAD dams had reduced concentrations of ß-hydroxybutric acid and nonesterified fatty acids compared with those born to -70 DCAD dams. Efficiency of IgG transfer from colostrum into blood and serum concentrations did not differ among treatments. There was no relationship between measures of metabolic acidosis and measures of efficiency of IgG absorption. Percentage of lymphocytes and neutrophils was altered by maternal treatments; however, treatments did not affect calf morbidity. Extending the duration of feeding up to 42 d or reducing the level of negative DCAD to -180 mEq/kg in maternal diets exerted a transient metabolic acidosis in the calves and slightly affected measures of mineral, energy metabolism, and growth.

Use of calcitriol to maintain postpartum blood calcium and improve immune function in dairy cows.

Our objectives were to determine the effects of an injectable formulation of calcitriol on mineral metabolism and immune function in postpartum Holstein cows that received an acidogenic diet prepartum to minimize hypocalcemia. In experiment 1, cows within 6 h of calving received calcitriol (0, 200, or 300 µg) to determine the dose needed to increase plasma concentrations of Ca; 300 µg was sufficient to sustain Ca for at least 3 d. In experiment 2, multiparous cows were assigned randomly to receive only vehicle (control, n = 25) or 300 µg of calcitriol (n = 25) subcutaneously within the first 6 h after calving. Blood was sampled before treatment and 12 h later, then daily until 15 d in milk (DIM), and analyzed for concentrations of ionized Ca (iCa), total Ca (tCa), total Mg (tMg), and total P (tP), metabolites, and hormones. Urine was sampled in the first 7 DIM and analyzed for concentrations of tCa, tMg, and creatinine. Neutrophil function was evaluated in the first week postpartum. Dry matter intake and production performance were evaluated for the first 36 DIM. Calcitriol administration increased concentrations of calcitriol in plasma within 12 h of application from 51 to 427 pg/mL, which returned to baseline within 5 d. Concentrations of iCa and tCa increased 24 h after treatment with calcitriol. Concentrations of iCa (control = 1.08 vs. calcitriol = 1.20 mM), tCa (control = 2.23 vs. calcitriol = 2.33 mM), and tP (control = 1.47 vs. calcitriol = 1.81 mM) remained elevated in cows treated with calcitriol until 3, 5, and 7 DIM, respectively, whereas concentration of tMg (control = 0.76 vs. calcitriol = 0.67 mM) was less in calcitriol cows than control cows until 3 DIM. Concentrations of parathyroid hormone decreased in calcitriol cows compared with control cows (control = 441 vs. calcitriol = 336 pg/mL). Calcitriol tended to increase plasma concentrations of ß-hydroxybutyrate and serotonin, but concentrations of glucose, nonesterified fatty acids, and C-telopeptide of type I collagen in plasma did not differ between treatments. Cows treated with calcitriol excreted more urinary tCa (control = 0.5 vs. calcitriol = 2.1 g/d) and tMg (control = 4.5 vs. calcitriol = 5.0 g/d) in the first 7 and 2 DIM, respectively, than control cows. Compared with control, calcitriol improved the proportion of neutrophils with oxidative burst (control = 31.9 vs. calcitriol = 40.6%), mean fluorescence intensity for oxidative burst (control = 90,900 vs. calcitriol = 99,746), and mean fluorescence intensity for phagocytosis (control = 23,887 vs. calcitriol = 28,080). Dry matter intake, yields of milk, and milk components did not differ between treatments. Administration of 300 µg of calcitriol at calving was safe and effective in increasing blood concentration of iCa and plasma concentrations of calcitriol, tCa, and tP for the first 6 d after treatment, and improved measures of innate immune function in early-lactation Holstein cows.

Prevalence of tuberculosis infection in healthcare workers of the public hospital network in Medellín, Colombia: a Bayesian approach.

A latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellín, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+,QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62·1% [95% credible interval (CrI) 53·0-68·2]. The probability of LTBI+ given positive results for both tests was 99·6% (95% CrI 98·1-99·9). Sensitivity was 88·5 for TST and 74·3 for QFT, and specificity was 87·8 for TST and 97·6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.

Effects of oral calcium supplementation on mineral and acid-base status, energy metabolites, and health of postpartum dairy cows.

Two experiments were conducted to characterize blood concentrations of minerals and acid-base status after oral dosing of Ca salts and to determine the effects of oral Ca on mineral and metabolic status and incidence diseases. The hypotheses were that administration of oral Ca as CaCl2 and CaSO4 maintains blood total Ca (tCa) concentrations ≥2.125 mM and reduces the incidence of diseases in early lactation. In experiment 1, 18 Holstein cows on the day of calving were assigned to receive a single dose of 0, 43, or 86g of Ca as an oral bolus. Blood was sampled before and after treatments to characterize acid-base status and concentrations of minerals. In experiment 2, 450 Holstein cows considered of low (LRM; normal calving) or high risk (HRM; dystocia, twins, stillbirth, retained placenta, vulvo-vaginal laceration, or a combination of these) of metritis (primiparous-LRM=84; primiparous-HRM=84; multiparous-LRM=138; multiparous-HRM=138) on the day of calving were blocked by parity and then randomly assigned to control, no Ca supplementation; 86g of Ca on d 0 and 1 postpartum (CaS1); or 86g of Ca on d 0 and 1 postpartum followed by 43g/d on d 2 to 4 postpartum (CaS4). Blood was sampled before and 30 min after treatment on d 0, and 30 min after treatments on d 1 to 4, and d 7 and 10 for determination of concentrations of minerals and metabolites and blood acid-base responses. Disease incidence was evaluated for the first 30 DIM. Concentrations of ionized Ca (iCa) increased for 2h in cows supplemented with 43g of Ca and fewer than 8h in cows supplemented with 86g of Ca. The changes in iCa concentrations from pretreatment to 30 min after 86g of Ca supplemented on d 0 were 0.11±0.03 mM in multiparous cows and 0.25±0.03 mM in primiparous cows. Oral Ca reduced the incidence of subclinical hypocalcemia (SCH; tCa <2.125mM) in the first 4 d in the experiment (control=69.3%; CaS1=57.5%; CaS4=34.2%). Calcium supplementation decreased the prevalence of SCH on d 0 and 1 postpartum in all cows. Stopping oral Ca in CaS1 on d 1 postpartum, however, caused a rebound in SCH on d 2 to 4 postpartum in primiparous cows. Oral Ca increased the incidence of metritis (control=22.7%; CaS1=34.8%; CaS4=32.8%), primarily because of an increase in LRM primiparous cows (control=17.9%; CaS1=35.7%; CaS4=42.9%). Oral Ca increased morbidity in primiparous cows (control=38.1%; CaS1=61.8%; CaS4=60.3%) but had no effect on multiparous cows (control=38.2%; CaS1=35.1%; CaS4=30.1%). Large doses of oral Ca as salts of chloride and sulfate in the first days postpartum should be avoided in primiparous cows and used only in cows at risk of clinical hypocalcemia.

Efectos de un programa multiprofesional de tratamiento de la obesidad sobre los factores de riesgo para síndrome metabólico en niños prepúberes, púberes y adolescentes: diferencias entre géneros / Effects of a multidisciplinary program of obesity treatment on risk factors for metabolic syndrome in children in prepubertal, pubertal and adolescent stages: differences between genders

Objetivo. Analizar los efectos de un programa multidisciplinar de tratamiento de la obesidad (PMTO) sobre los factores de riesgo del Síndrome Metabólico (SM) en niños prepúberes, púberes y adolescentes de acuerdo con el género. Método. Participaron en el estudio 69 niños y adolescentes obesos entre 10 y 18 años de edad divididos en dos grupos: grupo de intervención (GI) (n = 37) y grupo control (GC) (n = 32). En el GI había 23 niñas, en el GC 14. El GI fue sometido a intervención multidisciplinar, con duración de 16 semanas. Se evaluaron parámetros antropométricos, aptitud cardiorrespiratoria y factores de riesgo para SM. Resultados. Se observó que el GI obtuvo reducción en la prevalencia de SM (- 35,8 % para género masculino y - 8,7 % para femenino), entre tanto se mantuvo el valor en las niñas del grupo GC y aumentó en los niños del GC (+ 11,1 %). En relación a dislipidemias, hubo una reducción en el GI para ambos géneros (- 7,2 % para el masculino; - 17,4 % para el femenino), y para el GC se observó aumento para el masculino (+ 22,2 %) y femenino (14,3 %). Las niñas del GI tuvieron mejoras significativas para las variables índice de masa corporal, circunferencia de cintura y cadera, y sensibilidad a la insulina, que no fueron observadas en el género masculino del GI, que presentaron aumento de masa magra. Conclusión. Los resultados del estudio muestran que 16 semanas de intervención multidisciplinar, basada en una terapia cognitivo-conductual, son suficientes para promover reducción de la prevalencia de SM y dislipidemias en niños y adolescentes obesos (AU)

Objetive. To analyze the effects of a multidisciplinary program of obesity treatment (PMTO) on risk factors for metabolic syndrome (MS) in children and adolescents at prepubertal, pubertal and adolescents stages according to gender. Method. he study included 69 obese children and adolescents aged 10 to 18 years. They were allocated to the intervention group (GI) (n = 37) and control group (GC) (n = 32). There were 23 girls in GI and 14 in GC. The GI was submitted to the multidisciplinary intervention, lasting 16 weeks. It was assessed anthropometric parameters, cardiorespiratory fitness and risk factor for MS. Results. We found that the GI achieved a reduction in the prevalence of MS (7.1 % for boys and 8.7 % for girls), and in GC a maintenance for girls and increasing for boys. For dyslipidemia, a reduction in GI for both genders (boys 78.6 % to 71.4 %; girls 82.6 % to 65.2 %), and increasing in GC for both genders. GI Girls had significant improvements for the variables, body mass index, waist circumference, hip circumference and insulin sensibility which was not observed in GI boys who increased lean body mass. Conclusion. The findings show that 16 weeks of multidisciplinary intervention based on cognitive behavioral therapy are sufficient to promote decreasing in the prevalence of MS and dyslipidemia in obese children and adolescents (AU)

First Report of Phytophthora infestans Causing Late Blight on Solanum viarum in Colombia.

Solanum viarum Dunal (tropical soda apple) belongs to the section Acanthophora in the genus Solanum, which includes nearly 20 neotropical species of herbs and small shrubs (2). The species in this section are sometimes called the 'spiny Solanums' (2) and are adapted mainly to highly disturbed habitats and open secondary forests. The center of diversity is eastern Brazil (3). Since the early 1990s, S. viarum has been a problematic weed in Florida where it was listed as a noxious weed in 1993, followed in 1994 by its addition to the Federal Noxious Weed List of the USDA. On 17 April 2010, 12 plants of S. viarum located close to a S. betaceum crop (tree tomato) in the province of Caldas (Department of Antioquia, central northwestern Colombia) were found with symptoms similar to late blight caused by Phytophthora infestans on S. tuberosum (potato). Fifteen leaves from 12 plants with blackish, water-soaked lesions showing a white sporulation on the abaxial side were collected and processed within 3 days. The leaves were placed in a humid chamber and incubated in darkness at room temperature (18°C mean temperature) until sporulation was observed. Microscopic characteristics were consistent with Phytophthora spp. Only one axenic culture was obtained by successive subcultures in rye B agar plates. After an incubation period of 8 days, plates were washed with distilled water and ovoid, semipapillate caduceus sporangia ranging from 38 to 41 µm long (average 39; N = 86) and 23 to 29 µm wide (average 26; N = 86) were observed. To fulfill Koch's postulates and test the isolate for the ability to infect potato as well as Solanum spp. associated with potato crops in Colombia, triplicate pathogenicity tests were carried out on three detached leaves of S. viarum, S. tuberosum, and S. americanum (American nightshade). A 1 × 104 sporangia/ml suspension of the Phytophthora isolate, estimated using a haemocytometer, was obtained from 8-day-old cultures grown on rye B agar. The suspension was incubated at 4°C for 2 h to induce zoospore release. The leaves were then inoculated by spraying them until runoff. After an incubation period of 5 days at 18°C in a humidity chamber, mycelia, sporangia, and brownish lesions, similar to those described above, were observed in the leaves of all three hosts, indicating pathogenicity. DNA extraction was performed from the P. infestans isolate (4). Four nuclear loci, ITS, ß-tubulin, Ras, and Avr3a, as well as one mitochondrial gene, cytochrome c oxidase 1 (Cox1), were amplified and sequenced. Sequences were compared with GenBank databases using Blastn. In all cases, the best hits corresponded to P. infestans (GenBank Accession No. HQ639930 for Avr3A, HQ639931 for ß-tubulin, HQ639932 for Cox1, HQ639933 for iRas, HQ639934 for Ras, and JF419363 for ITS). Reports of P. infestans causing typical late blight symptoms on wild solanaceous plants are becoming more frequent and have been made from other countries such as Peru (1). To our knowledge, this is the first time that P. infestans has been observed and isolated from S. viarum in Colombia, introducing the possibility of this wild solanaceous weed as another late blight host. References: (1) G. Garry et al. Eur. J. Plant Pathol. 113:71, 2005. (2) R. Levin et al. Am. J. Bot. 92:603, 2005. (3) M. Nee. A Revision of Solanum Section Acanthophora. Ph.D. diss. University of Wisconsin, Madison, 1979. (4) A. M. Vargas et al. Phytopathology 99:82, 2009.

Desarrollo y caracterización de micropartículas de ácido fólico formadas por secado por aspersión, utilizando goma arábiga y maltodextrina como materiales de pared / Development and characterization of folic acid microparticles formed by spray-drying with gum arabic and maltodextrin

El ácido fólico es una vitamina esencial, que participa en la biosíntesis de aminoácidos esenciales y en algunos procesos asociados al ADN. Es una vitamina con limitaciones en su estabilidad frente a factores como la luz, pH y oxígeno. Por esta razón se hace necesario desarrollar estrategias que permitan su estabilización sin afectar su actividad biológica. Así pues, se propone la obtención de micropartículas utilizando mezclas de goma arábiga y maltodextrina, con el método de secado por aspersión, que presenten características adecuadas para actuar como un reservorio del ácido fólico con potencialidades para su estabilización.En este estudio se obtienen micropartículas de ácido fólico utilizando cuatro mezclas diferentes de goma arábiga y maltodextrina, caracterizadas mediante los siguientes parámetros: distribución de tamaño de partícula, porcentaje de humedad, morfología, eficiencia de encapsulación y perfil de disolución. Los resultados de la caracterización muestran diferentes aspectos: la morfología de las micropartículas obtenidas por este método varía con la relación goma arábiga- maltodextrina, la eficiencia de encapsulación es elevada para los cuatro tipos de micropartículas estudiadas, la distribución de tamaño de partícula no cambia con la relación de los materiales de la pared y los perfiles de disolución muestran un porcentaje de disolución limitado, siendo el mejor el que corresponde a micropartículas con la relación goma arábiga- maltodextrina 70-30. La goma arábiga es efectiva para el atrapamiento del ácido fólico y cuando se mezcla con maltodextrina se mejoran las características de morfología, eficiencia y disolución de las micropartículas, lo cual sugiere que existe una mezcla óptima de los dos materiales de pared que optimizan las características de las micropartículas.

Medicina basada en la evidencia: nutrición en la obesidad / Evidence-based medicine: nutrition in obesity

El tratamiento dietético hipocalórico es la piedra angular del planteamiento terapéutico de la obesidad. En la mayoría de los estudios controlados la distribución de macronutrientes de la dieta no parece marcar la diferencia en términos de pérdida de peso. Así, por ejemplo, las dietas bajas en hidratos de carbono consiguen pérdidas significativas de peso frente a las dietas bajas en grasa, en períodos cortos de tiempo (6 meses), pero no hay diferencias tras un seguimiento a más largo plazo (12 meses). Existe un consenso general acerca de que una reducción energética comprendida entre 500 y 1.000 kcal diarias, respecto a la dieta habitual, consigue pérdidas promedio de 0,5 a 1 kg a la semana durante los primeros 6 meses de tratamiento, lo que representa una reducción entre el 5-10% del peso corporal, una proporción suficiente para atenuar el impacto de las comorbilidades asociadas con la obesidad. Pero los resultados a largo plazo (más de un año) con las dietas bajas en grasas son desalentadores (promedio de 0-3 kg), mientras que la seguridad de las dietas bajas en hidratos de carbono está pendiente de demostrar. En esta revisión se analizan los niveles de evidencia que diferentes tipos de dieta (incluidas las de muy bajo contenido calórico) tienen sobre el peso corporal a medio y largo plazo, poniendo de relieve que, posiblemente, los planteamientos terapéuticos de pérdida de peso deban ser diferentes de aquellos dirigidos al mantenimiento del peso perdido. Por último, cualquiera que sea el planteamiento dietético de la obesidad, no cabe duda de que el refuerzo a través de un programa estructurado de cambios en el estilo de vida y de actividad física constituye una herramienta esencial para asegurar un éxito a largo plazo (AU)

The mainstay of the therapeutic approach to obesity is the low calorie diet. In most controlled studies the distribution of micronutrients in the diet does not seem to influence weight loss. Thus, for example, low carbohydrate diets achieve significant weight loss compared with low-fat diets in short periods (6 months), but there are no differences after longer follow-up (12 months). There is general consensus that a reduction of between 500 and 1,000 kcal daily with respect to the normal diet achieves an average weight loss of 0.5 to 1 kg per week for the first 6 months of treatment, representing a reduction of 5-10% of body weight, a proportion that is sufficient to attenuate the impact of obesity-related comorbidities. However the long-term results (more than 1 year) with low-fat diets are discouraging (0-3 kg), while the safety of low carbohydrate diets remains to be demonstrated. The present review analyzes the levels of evidence for the effect of distinct types of diet (including very low calorie diets) on body weight in the medium and long term, highlighting that possibly the therapeutic approaches to weight loss should differ from the strategies used to maintain weight loss. Lastly, whatever the dietary approach to obesity, there is no doubt that reinforcement through a structured program of lifestyle changes and physical activity is an essential tool to ensure long-term success (AU)

Cirugía de colon y recto videoasistida: experiencia inicial / Videoassisted colon and rectal surgery: initial experience

Reportamos las primeras 20 operaciones de colon y recto videoasistidas, realizadas entre marzo de 1999 y junio de 2001. Las edades variaron entre los 8 y los 80 años, con un promedio de 53,3 años. Las indicaciones fueron: diverticulitis del sigmoides (n=6), carcinoma colorrectal (n=6), volvulo del sigmoides (n=3), polipo colonico (n=2), procidencia rectal (n=2) y estenosis benigna del sigmoides (n=l). Se realizó sigmoidectomia en 13 pacientes, sigmoidectomia más rectosacropexia en 2 pacientes y una reseccion parcial del ángulo esplenico, una reseccion anterior baja, una reseccion abdominoperineal, una hemicolectomia derecha y una reseccion en cuna de colon. Se requirio conversion en dos pacientes por dificultad tecnica; 40 por ciento de los pacientes presento complicaciones: filtracion de la anastomosis (n=3), infeccion del sitio operatorio (n=2), atelectasia pulmonar (n=l), hemorragia del tracto digestivo inferior (n=l) y lesion de intestino delgado (n=l). La tasa de mortalidad fue 5 por ciento (un paciente). El tiempo quirurgico promedio fue 165 minutos La longitud promedio del especimen quirurgico fue 29,5 centimetros. El inicio de la via oral promedio fue de 3,1 dias en promedio y la estancia hospitalaria promedio fue 6,4 dias. No se ha presentado recidiva tumoral en el sitio del puerto laparoscopico en los 5 pacientes con enfermedad maligna manejados por tecnica laparoscopica despues de 13,4 meses/paciente de seguimiento (julio 2001). Las primeras colectomias laparoscopicas fueron descritas en 1991; desde entonces, esta tecnica ha sido utilizada con creciente frecuencia en enfermedades tanto benignas como maligna del colon y del recto. Sin embargo, las ventajas teoricas de la cirugia minimamente invasiva, como el menor requerimiento intraoperatorio de productos sanguineos, menor dolor posquirurgico, menor estancia hospitalaria, incapacidad más corta y el beneficio estetico, deben comprobarse en relacion a la tecnica abierta...

Colecistectomía laparoscópica en colecistitis aguda / Laparoscopic cholecystectomy in acute cholecystitis

Entre enero de 1999 y junio de 2001 se realizaron 148 colecistectomias laparoscopicas (CL) en pacientes con colecistitis aguda (CA) en la Clinica CES, Medellin. Se excluyo un paciente por hallazgo incidental de cancer de colon. Todas las vesiculas se extrajeron protegiendo la pared con una endobolsa. El 72,8 por ciento de las intervenciones correspondio a pacientes del sexo femenino. El promedio de edad fue de 42,9 años, con edades que oscilaron entre 19 y 82 años. La etiologia fue litiásica en el 97,3 por ciento de los casos y acalculosa en el 2,7 por ciento restante. El 56 por ciento de los pacientes presento una colecistitis edematosa simple (grado 1), el 28,6 por ciento un plastron vesicular (grado 2), el 13,6 por ciento una colecistitis gangrenosa (grado 3) y el 2,8 por ciento un absceso perivesicular (grado 4). La tasa de conversion fue 10,9 por ciento. Esta se relaciono significativamente con la edad (44,4 por ciento para >65 años y 9,l por ciento para <65 años) y con la clasificacion laparoscopica de la colecistitis (grado I en 2,5 por ciento, grado 2 en 20,0 por ciento, grado 3 en 26,3 por ciento y grado 4 en 25 por ciento; en el sexo femenino fue de 9,3 por ciento y de 15 por ciento en el masculino; segun el tiempo de evolucion de la enfermedad y el momenta de la cirugia: <72 horas, 6,0 por ciento, y 13 por ciento para > 72 horas; ni la clasificacion de ASA, ni la presencia de fiebre, leucocitosis y velocidad de sedimentacion globular influyeron en forma significativa. El tiempo quirurgico promedio fue de 63,7 minutos. El porcentaje de complicaciones fue de 9,5 por ciento (3 pacientes con absceso intraabdominal, 2 con fuga biliar menor y uno con lesion de la via biliar, uno con coleperitoneo, uno con infeccion de la herida quirurgica, uno con derrame pleural derecho y uno con seroma de la herida quirurgica). El promedio de la estancia hospitalaria fue 2,9 dias y la mortalidad a 30 dias fue nula. En conclusion, la CL es una tecnica segura en pacientes con CA. Esta puede ser clasificada en grados dependiendo de la severidad de la enfermedad y el pronostico de la CL de urgencia realizada en pacientes con CA grado I es similar al de la realizada en casos electivos.

Estadísticas del Servicio Dermatología del Instituto de Ciencias de la Salud –CES- de 1995 a 1999 / Dermatology Service statistics of the Health Science Institute – CES from 1995 to 1999

Durante los años 1995 a 1999 fueron atendidos en el servicio de dermatología del CES en promedio 6870 pacientes por año, de los cuales el 70 por ciento de ellos fueron mujeres. La procedencia de los pacientes fue constante en los diferentes centros de atención siendo la mitad de los pacientes de Medellín y luego en su orden de Envigado, Itaguí, Sabaneta y otros municipios. Las primeras cinco causas de consultas fueron acné, melasma, verrugas, insuficiencia venosa y en quinto lugar otras como dermatitis atópica, psoriasis, nevus y carcinoma basocelular.

Metástasis en el puerto laparoscópico posterior a colecistectomía laparoscópica / Portsite metastases following laparoscopic cholecystectomy

En una serie de 898 colecistectomias laparoscopicas se presentaron 4 casos de carcinoma de vesicula biliar (0.5 por ciento), y 2 de estos pacientes recidivaron como metastasis en el sitio del puerto laparoscopico umbilical. Un paciente con una lesion T2 recidivo a los 8 meses y su sobrevida fue de 11 meses. Este paciente presento recidiva en el bilio hepático. El segundo paciente presento un tumor T3, recidivo a los 10 meses y su sobrevida fue de 30 meses. Ambas neoplasias fueron insospechadas, por lo tanto no se protegio el puerto durante la extraccion. Ninguno recibio tratamiento adyuvante. Al primer paciente se le realizó una laparotomia sin tratamiento curativo y el segundo paciente no recibio tratamiento.

Colecistectomía laparoscópica: experiencia en hospital de segundo nivel / Laparoscopic cholecystectomies: perfomed at second level care institution

Se realizo un estudio descriptivo retrospectivo que incluyo todas las colecistectomias laparoscopicas (CL) realizadas entre marzo de 1993 y mayo de 1999, en el Hospital Manuel Uribe Angel, de Envigado, Se practicaran 898 procedimientos y se describieron los datos de 739. En el 76 por ciento la CL se practico en mujeres, y el promedio de edad fue de 42.5 años. La colelitiasis no complicada (90.9 por ciento) y la colecistitis aguda calculosa (6.8 por ciento) se describieron como las indicaciones más frecuentes de CL. El porcentaje de conversion fue del 2.6 por ciento; para el sexo femenino fue de 1.8 por ciento, y para el masculino, de 6.1 por ciento (p=0.005). Asimismo. Para la colelitiasis no complicada fue del 1.9 por ciento, y para la colecistitis aguda calculosa, de 8.0 por ciento (p=0.01). La edad y la clasificacion de ASA no fueron factores de riesgo de conversion. Se presentaron complicaciones mayores en el 3.8 por ciento de los pacientes, siendo la hemorragia la más importante en el 1.2 por ciento. En el 0.5 por ciento de los pacientes se produjo lesion de la via biliar. El 4.5 por ciento presento complicaciones menores; la infeccion del puerto umbilical fue la más frecuente en un 3.8 por ciento de los pacientes. El procedimiento se realizó ambulatoriamente en el 75.4 por ciento de los pacientes y solo se encontro la clasificacion de ASA como un factor de riesgo para dicho procedimiento (p=0.00001).

Colecistectomía laparoscópica en pacientes de riesgo quirúrgico bajo: tratamiento ambulatorio vs. hospitalario / Laparoscopic cholecystectomy in patients of low surgical risk

Con la introduccion de la colecistectomia laparoscopica (CL), el numero de colecistectomias aumentó significativamente. El tratamiento ambulatorio de pacientes de bajo riesgo con litiasis vesicular y cirugia laparoscopica ha demostrado ser seguro y costo - efectivo. El objetivo del presente estudio es demostrar la seguridad clinica del tratamiento ambulatorio en pacientes de bajo riesgo quirurgico a quienes se les practica CL; asimismo, determinar que factores pudieran permitir dicha práctica. Se realizó un estudio de evaluacion de efectividad entre septiembre de 1997 y abril de 1998 en pacientes sometidos a CL, ASA I y II. Se incluyeron 124 pacientes, 68 con tratamiento ambulatorio y 56 con tratamiento hospitalario. El 84.7 por ciento de los pacientes eran de sexo femenino. En el grupo de pacientes ambulatorios, el dolor del postoperatorio inmediato se presento más frecuentemente (p=0.04) al igual que la omalgia para el grupo hospitalizado (p=0.04). Las complicaciones menores fueron iguales en ambos grupos, no se presentaron complicaciones tempranas mayores ni mortalidad. La tasa de rehospitalizacion fue similar en ambos grupos, pero fue significativamente mayor en pacientes ASA II (p=0.04). Se concluyo que el tratamiento ambulatorio en pacientes ASA I y II es igualmente seguro que el tratamiento hospitalario en un grupo amplio de enfermos con litiasis vesicular sintomática. Los pacientes ASA II y/o el hallazgo de una vesicula esclerosa y retráctil, cálculo enclavado en el cistico, vesicula intrahepática parcial y las variantes anatomicas, no contraindican la CL ambulatoria.

Carcinoma papilar del tiroides, variante de células altas / Papillary cancer of the thyroid gland. Tall cell variant

El carcinoma papilar del tiroides, variante de celulas altas, fue descrito en 1976 como un tumor agresivo, con una incidencia de recurrencia y mortalidad mayor que la variante usual. Ocurre entre el 7 y el 9.1 por ciento del total de los carcinomas papilares, pero no es frecuentemente descrito en los estudios de carcinomas tiroideos bien diferenciados. Presentamos 1 caso en una mujer de 55 años, con un tumor de esta variante con un comportamiento agresivo y hacemos una revision de la literatura reciente sobre esta neoplasia.