[The place of the psychologist in the orthopedics department]. / La place du psychologue dans le service d'orthopédie.

The essential place of the psychologist in the orthopedics department of Pitié-Salpêtrière is to relieve the suffering of polytraumatized patients, to work in a multidisciplinary manner, to participate in the staff of the department to have complete information of the patients, to give an informed opinion on the psychological state of the patient, so as to help in the discussion for making decisions on their trajectory. The role of the psychologist is part of the overall care of patients, care which sometimes extends to the family, the patient's loved ones and the teams who care for them.

Caso clínico: “Nadie lo hará por mí” / [Clinical case: “No one will do it for me”]

La adherencia terapéutica, es un hecho variante y complejo ya que son diversos los factores que influyen en él. En los países desarrollados la adherencia terapéutica de los pacientes que padecen enfermedades crónicas es del 50%, requiriendo acciones de prevención y promoción de la salud, que se ven intensificadas cuando la falta de adherencia terapéutica está unida al abuso de sustancias y la dependencia de alcohol. El señor D.R. es un paciente varón de 69 años con paresia crural izquierda, trastorno de la marcha, dependencia para las ABVD y AIVD, HTA, ateromatosis carotidea, mala adherencia terapéutica, abuso de alcohol, sobrepeso e hipercolesterolemia, que ingresa en el hospital en el servicio de Neurología tras sufrir un ictus isquémico. Durante este ingreso, se distingue el progreso en el nivel de implicación y compromiso del paciente con su propia salud. A través de la taxonomía NANDA-I, NOC y NIC, se llevó a cabo un plan de cuidados, aplicando un lenguaje estandarizado y con intervenciones basadas en la evidencia científica. (AU)

Chemical Element Mixtures and Kidney Function in Mining and Non-Mining Settings in Northern Colombia.

The exposure to chemical mixtures is a problem of concern in developing countries and it is well known that the kidney is the major target organ for toxic elements. This cross-sectional study aimed to estimate the individual and composite mixture effect of a large number of chemical elements on kidney function in gold-mining and surrounding non-mining populations in northeast Colombia. We measured concentrations of 36 chemical elements in hair as indicators of chronic exposure from 199 adult participants. We estimated the effect of exposure to mixtures of chemical elements on estimated glomerular filtration rate (eGFR) using weighted quantile sum regression (WQS). The WQS index of the mixture was associated with reduced eGFR (Coefficient -2.42; 95%CI: -4.69, -0.16) being Be, Cd, Pb, As, and Mn, the principal contributors of the toxic mixture. Mining activities and Hg concentration were not associated with decreased kidney function. Our results suggest that complex mixtures of chemical elements, mainly heavy metals, act as nephrotoxic in these populations and therefore the analysis of chemical element mixtures is a better approach to identify environmental and occupational chemical risks for kidney damage.

La adolescencia con Freud y Flaubert / Adolescence with Freud and Flaubert

resumen El texto aborda dos aspectos fundamentales de la crisis en la adolescencia desde las obras de Sigmund Freud y Gustave Flaubert: su encuentro con su objeto del deseo, el goce, el acto sexual y las causas del desprendimiento de la autoridad paterna y sus efectos. Se estudiaron en la obra de Flaubert las causas del enigma que el autor deja entrever en su texto Memorias de un loco: ¿Soy Otro o yo mismo?, ese sentimiento de extrañeza en el adolescente enfrentado en el despertar de un sueno, con un sentido y un deseo nuevo del objeto de amor. El deseo ardiente de ser como un grande y las mociones hacia los padres, influyen las decisiones para las que el joven no está preparado, dadas la educación acuñada y las respuestas a sus investigaciones sexuales infantiles no satisfechas. Lacan puntúa que la relación sexual no existe y Freud puntúa el amor como siendo narcisista e infantil; las primeras manifestaciones amorosas, dado el fantasma que las recubre, continúan siendo las mismas, lo que se explica a través de Flaubert y del comentario de Lacan a Wedekind, en El despertar de la primavera. En la infancia el cuerpo de goce no está comprometido, por eso es tan simple; el adolescente sería ya una representación de la división del sujeto, del corte hecho por su inconsciente, del cual su cuerpo en ciertos casos portara las marcas, estará sorprendido, desconcertado por ese deseo nuevo que produce su inconsciente hasta el paso al acto sexual.

abstract The text approaches two fundamental aspects of the adolescent crisis from the works of Sigmund Freud and Gustave Flaubert: their encounter with their object in desire, pleasure, sexual act, and the causes the detachment from parental authority and their effects. A study was made on the work of Flaubert on the causes of the enigma, which the author suggests in his Memoirs of a Madman: Am I another or myself? That feeling of strangeness the adolescent experiences on waking up in a dream, with a new feeling and desire of the love object. The ardent desire of being like a grown-up, and the motions toward their parents, influence decisions for which the young are not prepared, given their cradled education and the unsatisfactory answers to their infant sexual investigation. Lacan notes that the sexual relationship does not exist. Freud rates love as being narcissistic and childish. The first amorous manifestations, given the fantasy that cloaks them always remain the same, as explained by Flaubert and Lacan's comment to Wedekind, in The Spring Awakening. In childhood the enjoyment of body is not involved. For this reason, it is so simple, the adolescent would be a representation of the division of the subject, the cut made by their unconscious, which their body, in certain cases, will carry the marks. They will be surprised, puzzled by this new desire that produces their unconscious to step toward the sexual act.

Adolescence With Freud and Flaubert. / La adolescencia con Freud y Flaubert.

The text approaches two fundamental aspects of the adolescent crisis from the works of Sigmund Freud and Gustave Flaubert: their encounter with their object in desire, pleasure, sexual act, and the causes the detachment from parental authority and their effects. A study was made on the work of Flaubert on the causes of the enigma, which the author suggests in his Memoirs of a Madman: Am I another or myself? That feeling of strangeness the adolescent experiences on waking up in a dream, with a new feeling and desire of the love object. The ardent desire of being like a grown-up, and the motions toward their parents, influence decisions for which the young are not prepared, given their cradled education and the unsatisfactory answers to their infant sexual investigation. Lacan notes that the sexual relationship does not exist. Freud rates love as being narcissistic and childish. The first amorous manifestations, given the fantasy that cloaks them always remain the same, as explained by Flaubert and Lacan's comment to Wedekind, in The Spring Awakening. In childhood the enjoyment of body is not involved. For this reason, it is so simple, the adolescent would be a representation of the division of the subject, the cut made by their unconscious, which their body, in certain cases, will carry the marks. They will be surprised, puzzled by this new desire that produces their unconscious to step toward the sexual act.

[Cleidocranial dysplasia: a case report]. / Displasia cleidocraneal: reporte de un caso.

INTRODUCTION: Cleidocraneal dysplasia (CCD) is a rare skeletal autosomal dominant syndrome characterized by dental anomalies and bone abnormalities. These clinical manifestations do not require treatment in most cases. The disease is caused by mutation in the gene RUNX2 (CBAF1), located on the short arm of chromosome 6. OBJECTIVE: To report a case of CCD and perform a literature review focused on clinical manifestations and diagnosis. CASE REPORT: A 3 year old patient, who was clinically diagnosed with CCD since birth. The patient showed incomplete development of cranial bones, bell-shaped thorax, adequate dentition and presence of clavicles. Molecular analysis reported that the patient is carrying the pathogenic variant c.674G>A in the RUNX2 gene, confirming the diagnosis. CONCLUSIONS: The CCD is a rare condition, with special clinical features. It is important to establish early diagnosis in these patients in order to offer a better quality of life, and if necessary, appropriate treatment.

Displasia cleidocraneal: reporte de un caso / Cleidocranial dysplasia: a case report

Introducción: La displasia cleidocraneal (DCC) es un raro síndrome esquelético de herencia autosómica dominante que se caracteriza por anomalías dentales y anormalidades óseas. Estas manifestaciones clínicas no requieren tratamiento en la mayoría de los casos. La enfermedad es causada por mutación en el gen RUNX2 (CBAF1), ubicado en el brazo corto del cromosoma 6. Objetivo: Reportar un caso de DCC y realizar una revisión bibliográfica enfocada en hallazgos clínicos y diagnóstico. Caso clínico: Paciente de 3 años de edad, con diagnóstico clínico de DCC en el momento del nacimiento. Con evidencia de desarrollo incompleto de huesos craneales, tórax en campana, adecuada dentición y presencia de clavículas. El análisis molecular reportó que el paciente es portador de la variante patogénica c.674G>A en el gen RUNX2, confirmando el diagnóstico. Conclusiones: La DCC es una patología poco frecuente, con unas características clínicas específicas. Es de suma importancia establecer el diagnóstico oportuno en estos pacientes con el fin de ofrecerles una mejor calidad de vida, y si es el caso, un adecuado tratamiento.

Introduction: Cleidocraneal dysplasia (CCD) is a rare skeletal autosomal dominant syndrome characterized by dental anomalies and bone abnormalities. These clinical manifestations do not require treatment in most cases. The disease is caused by mutation in the gene RUNX2 (CBAF1), located on the short arm of chromosome 6. Objective: To report a case of CCD and perform a literature review focused on clinical manifestations and diagnosis. Case report: A 3 year old patient, who was clinically diagnosed with CCD since birth. The patient showed incomplete development of cranial bones, bell-shaped thorax, adequate dentition and presence of clavicles. Molecular analysis reported that the patient is carrying the pathogenic variant c.674G>A in the RUNX2 gene, confirming the diagnosis. Conclusions: The CCD is a rare condition, with special clinical features. It is important to establish early diagnosis in these patients in order to offer a better quality of life, and if necessary, appropriate treatment.

Laboratory genetic-based reference values for cholinesterase activity in a Colombian population: A step forward in personalized diagnostics.

INTRODUCTION: The determination of cholinesterase (ChE) activity has been commonly applied in the biomonitoring of exposure to organophosphate and carbamate pesticides. However, ChE activity is influenced by genetic factors. Integrating genotype and phenotype information in clinical laboratory tests would increase the accuracy of the reference values in well-defined populations. OBJECTIVE: To establish genetic-based reference values for acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity in a Colombian population. MATERIALS AND METHODS: A total of 397 healthy adults from Bucaramanga were included in the study. AChE and BChE activities were measured in blood samples by potentiometry and spectrophotometry, respectively. Genotyping for ACHE rs17880573 and BCHE rs1803274 was performed using the TaqMan allelic discrimination assay. The statistical analyses to obtain the reference values were performed with the MedCalc® software. RESULTS: Allele frequencies were 10.58% for rs17880573 A and 8.82% for rs1803274 A. People with genotypes rs1803274 AA and AG showed a reduction of 20.69% and 10.92% respectively in mean BChE activity compared to people with genotype GG. No significant differences were identified in AChE activity between rs17880573 alleles or genotypes. In the overall sample, the corresponding reference values were as follows: for AChE activity, 0.62-0.98 D pH/h and for BChE activity, 4796.3-10321.1 U/L for people carrying the allele rs1803274A and 5768.2-11180.4 U/L for people carrying the genotype rs1803274 GG. CONCLUSION: We strongly recommend using these genetic-based reference values for ChE enzymes in our well-defined population in daily clinical practice.

Laboratory genetic-based reference values for cholinesterase activity in a Colombian population: A step forward in personalized diagnostics / Valores de referencia basados en el contexto genético de la actividad enzimática de la colinesterasa en una población colombiana: un paso hacia el diagnóstico personalizado

Introduction: The determination of cholinesterase (ChE) activity has been commonly applied in the biomonitoring of exposure to organophosphate and carbamate pesticides. However, ChE activity is influenced by genetic factors. Integrating genotype and phenotype information in clinical laboratory tests would increase the accuracy of the reference values in well-defined populations. Objective: To establish genetic-based reference values for acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity in a Colombian population. Materials and methods: A total of 397 healthy adults from Bucaramanga were included in the study. AChE and BChE activities were measured in blood samples by potentiometry and spectrophotometry, respectively. Genotyping for ACHE rs17880573 and BCHE rs1803274 was performed using the TaqMan allelic discrimination assay. The statistical analyses to obtain the reference values were performed with the MedCalc® software. Results: Allele frequencies were 10.58% for rs17880573 A and 8.82% for rs1803274 A. People with genotypes rs1803274 AA and AG showed a reduction of 20.69% and 10.92% respectively in mean BChE activity compared to people with genotype GG. No significant differences were identified in AChE activity between rs17880573 alleles or genotypes. In the overall sample, the corresponding reference values were as follows: for AChE activity, 0.62-0.98 D pH/h and for BChE activity, 4796.3-10321.1 U/L for people carrying the allele rs1803274A and 5768.2-11180.4 U/L for people carrying the genotype rs1803274 GG. Conclusion: We strongly recommend using these genetic-based reference values for ChE enzymes in our well-defined population in daily clinical practice.

Introducción. La determinación de la actividad enzimática de la colinesterasa se utiliza comúnmente en la vigilancia biológica de la exposición a pesticidas organofosforados y carbamatos. Sin embargo, los factores genéticos afectan la actividad de la colinesterasa, por lo que la integración de la información sobre genotipos y fenotipos en las pruebas de laboratorio clínico, incrementaría la precisión de los valores de referencia. Objetivo. Establecer los valores de referencia basados en el contexto genético para la actividad enzimática de la acetilcolinesterasa (AChE) y la butirilcolinesterasa (BChE), en una población colombiana. Materiales y métodos. Se incluyeron 397 adultos sanos. La actividad de la acetilcolinesterasa y la de la butirilcolinesterasa, se determinaron en muestras de sangre por potenciometría y espectrofotometría, respectivamente. Los genotipos de los ACHE rs17880573 y BCHE rs1803274 se obtuvieron mediante el ensayo TaqMan y los valores de referencia se estimaron con el programa MedCalc®. Resultados. La frecuencia alélica fue de 10,58 % para rs17880573 A y de 8,82 % para rs1803274 A. Las personas con los genotipos rs1803274 AA y AG, mostraron una reducción en el promedio de la actividad de la butirilcolinesterasa de 20,69 % y de 10,92 %, respectivamente, comparados con aquellas con el genotipo GG. No se encontraron diferencias significativas en la actividad de la acetilcolinesterasa con respecto a los alelos y genotipos del rs17880573. Los valores de referencia determinados para esta población fueron de 0,62-0,98 D pH/h para acetilcolinesterasa y de 4796,3-10321,1 U/L para butirilcolinesterasa, en las personas portadoras del alelo rs1803274 A, y de 5768,2-11180,4 U/L, en las portadoras del genotipo rs1803274 GG. Conclusión. Se recomienda el uso de estos valores de referencia basados en el contexto genético para las colinesterasas, en la práctica clínica diaria en esta población.

Caracterización de pacientes con lesiones pigmentarias de piel con riesgo de transformación maligna / Characterization of patients with skin pigmented lesions at risk of malignant transformation

Fundamento: el melanoma es el más terrible y mortífero de los cánceres de piel. Se origina frecuentemente a partir de un nevo melanocítico con riesgo de transformación maligna. Estas lesiones pigmentadas se diagnostican cada vez más en edades tan tempranas como la adolescencia.Objetivo: caracterizar los pacientes en edades pediátricas con signos de lesiones pigmentarias de la piel, con riesgo de transformación maligna.Métodos: se realizó un estudio prospectivo de corte transversal en un grupo de 50 pacientes en edades entre 5 y 19 años, que asistieron a la consulta de dermatología del Hospital Pediátrico de Centro Habana en el año 2010, con signos de lesiones pigmentarias de la piel con riesgo de transformación maligna. Se aplicó un instrumento de recogida de datos, con previo consentimiento informado. Se utilizó la estadística descriptiva para el procesamiento de los datos.Resultados: en la población de estudio predominó la adolescencia temprana, el grupo de riesgo con daño actínico crónico y el fototipo III. Estuvo presente el antecedente familiar de cáncer de piel no-melanoma. La lesión más frecuente fue la de nevo melanocítico displásico. Además, se reportó un caso de carcinoma basal en paciente de fototipo II, perteneciente al grupo de riesgo de xeroderma pigmentoso.Conclusiones: se evidenció la transformación maligna de lesiones pigmentarias en piel de pacientes de grupos de riesgo (AU)

Foundation: melanoma is the most terrible and deadly of skin cancers. It often results from a melanocytic nevus at risk of malignant transformation. These pigmented lesions are increasingly diagnosed at so early ages as adolescence.Objective: to characterize patients in pediatric patients with signs of pigmented skin lesions at risk of malignant transformation.Methods: a prospective and cross-sectional study was performed in a group of 50 patients aged between 5 and 19 years old, who attended the dermatology consultation office at Children's Hospital of Centro Habana in 2010, with signs of pigmented skin lesions at risk of malignant transformation. An instrument of data collection, prior informed consent was applied. Descriptive statistics for data processing was used.Results: the early adolescence, the risk group with chronic actinic damage and skin type III prevailed in the study population. There was family history of non-melanoma skin cancer. The most common lesion was dysplastic melanocytic nevus. In addition, one case of basal cell carcinoma was reported in a phototype II patient, belonging to the risk group of xeroderma pigmentosum.Conclusions: malignant transformation of skin pigmented lesions in patients of risk groups was evident (AU)

Epidemiología de la leptospirosis humana: propuesta de intervención educativa / Epidemiology of human leptospirosis: educational intervention proposal

Introducción: la leptospirosis es una enfermedad causada por la bacteria patógena leptospira que permanece en los túbulos renales de ciertos animales. Objetivo: definir una propuesta de intervención educativa según riesgos de leptospìrosis definidos en el municipio Guane en el período enero de 2011 a diciembre de 2012. Material y método: se realizó un estudio descriptivo y transversal en Guane. El universo estuvo representado por un total de 448 pacientes con diagnóstico de leptospìrosis humana (por clínica, evidencia epidemiológica de exposición y resultados del laboratorio). Se tomó el total del universo entre los 18 y 75 años de edad. Se estudiaron variables como la edad, el sexo y cuadro clínico; epidemiológicamente se estudiaron los factores de riesgo, ocupación, medidas de protección y fuentes de infección. Resultados: se caracterizaron los casos probables de leptospìrosis humana en el área de salud Guane, se aportaron evidencias clínico-epidemiológicas y serológicas de esta entidad, y se identificaron los principales factores de riesgo relacionados con la enfermedad. Conclusiones: el desarrollo de la investigación generó un impacto positivo tanto en el personal de salud como en la población con riesgo de leptospìrosis humana, con la propuesta de intervención educativa.

Introduction: leptospirosis is a disease caused by the pathogenic leptospira bacteria remaining in the renal tubules of certain animals. Objective: to define a proposed educational intervention defined as risk of leptospirosis in the town of Guane in the period January 2011 to December 2012. Material and Methods: a descriptive cross-sectional study was conducted in Guane. The target group was represented by a total of 448 patients diagnosed with leptospirosis (for clinical, epidemiological evidence of exposure and laboratory results). The total universe took between 18 and 75 years old. Variables such as age, sex and clinical picture were studied; epidemiological risk factors, occupation, protection measures and sources of infection were studied. Results: probable cases of leptospirosis were characterized in the health area of Guane, clinical-epidemiological and serological evidence of this entity is provided, and the main risk factors associated with the disease were identified. Conclusions: the development of research generated a positive impact on both health workers and the population at risk of leptospirosis, with the proposed educational intervention.

Epidemiología de la leptospirosis humana: propuesta de intervención educativa / Epidemiology of human leptospirosis: educational intervention proposal

La leptospirosis es una enfermedad causada por la bacteria patógena leptospira que permanece en los túbulos renales de ciertos animales.Objetivo: definir una propuesta de intervención educativa según riesgos de leptospìrosis definidos en el municipio Guane en el período enero de 2011 a diciembre de 2012. Se realizó un estudio descriptivo y transversal en Guane. El universo estuvo representado por un total de 448 pacientes con diagnóstico de leptospìrosis humana (por clínica, evidencia epidemiológica de exposición y resultados del laboratorio). Se tomó el total del universo entre los 18 y 75 años de edad. Se estudiaron variables como la edad, el sexo y cuadro clínico; epidemiológicamente se estudiaron los factores de riesgo, ocupación, medidas de protección y fuentes de infección. Se caracterizaron los casos probables de leptospìrosis humana en el área de salud Guane, se aportaron evidencias clínico-epidemiológicas y serológicas de esta entidad, y se identificaron los principales factores de riesgo relacionados con la enfermedad. El desarrollo de la investigación generó un impacto positivo tanto en el personal de salud como en la población con riesgo de leptospìrosis humana, con la propuesta de intervención educativa(AU)

Leptospirosis is a disease caused by the pathogenic leptospira bacteria remaining in the renal tubules of certain animals. The objective was to define a proposed educational intervention defined as risk of leptospirosis in the town of Guane in the period January 2011 to December 2012. A descriptive cross-sectional study was conducted in Guane. The target group was represented by a total of 448 patients diagnosed with leptospirosis (for clinical, epidemiological evidence of exposure and laboratory results). The total universe took between 18 and 75 years old. Variables such as age, sex and clinical picture were studied; epidemiological risk factors, occupation, protection measures and sources of infection were studied. Probable cases of leptospirosis were characterized in the health area of Guane, clinical-epidemiological and serological evidence of this entity is provided, and the main risk factors associated with the disease were identified. The development of research generated a positive impact on both health workers and the population at risk of leptospirosis, with the proposed educational intervention

Antibiotic resistance patterns of Acinetobacter calcoaceticus–A. baumannii complex species from Colombian hospitals

Introduction Only automated phenotypic methods are currently used in Colombian hospitals for identifying isolates of the Acinetobacter calcoaceticus-A. baumannii complex (ACB). The phenotypical similarities in these species mean that they cannot be differentiated by manual or automated methods, thereby leading to their identification as A. baumannii, or ACB complex in clinical settings. Our objective was to identify to the species level 60 isolates, from four hospitals, evaluate their antibiotic susceptibility, and detect resistance-related genes.Methods16S–23S rRNA internal transcribed spacer (ITS) region and rpoB gene partial sequences were amplified. Resistance genes for cephalosporin, carbapenem and aminoglycoside were detected by PCR. Possible mutations in the quinolone resistance-determining region (QRDR) were evaluated. The association of ISAba-1 with blaOXA and blaADC genes was determined by PCR. Amplification products of ITS region, rpoB gene and some resistance genes were sequenced and compared using the BLAST tool. Results: 16S-23S rRNA ITS region and partial rpoB gene sequence analysis allowed 51isolates to be identified as A. baumannii, 8 as A. nosocomialis, and 1 isolate as A. pitti. A. baumannii isolates were highly resistant to all antibiotics tested, while the others were susceptible to ciprofloxacin and ampicillin/sulbactam. Quinolone resistance, found only in A. baumannii, was associated with mutations in the QRDR region of gyrA and parC genes. Conclusion This is the first investigation in Colombia that has identified ACB complex species using molecular methods, and determined differences in antibiotic resistance and resistance genes among the species. It is of the highest importance to identify isolates to the species level for future resistance and epidemiology studies in our region (AU)

Introducción Actualmente, los hospitales en Colombia utilizan únicamente métodos fenotípicos automatizados para la identificación de aislamientos del complejo Acinetobacter calcoaceticus - baumannii (ACB). La similitud entre estas especies no permite que se diferencien por métodos fenotípicos ya sean estos manuales o automatizados, llevando a que los aislamientos se identifiquen como A. baumannii o como pertenecientes al complejo ACB en las instituciones hospitalarias. Nuestro objetivo fue identificar a nivel de especie, 60 aislamientos de cuatro hospitales, identificados como del complejo ACB, evaluar su resistencia a antibióticos y detectar genes de resistencia. Métodos Para la identificación de especies se amplificaron la región intergénica espaciadora de los genes 16S y 23S rRNA y la secuencia parcial del gen rpoB. Estos amplificados y algunos genes de resistencia se secuenciaron y se compararon utilizando la herramienta BLAST. Se detectaron por PCR genes de resistencia a cefalosporinas, carbapenemes y aminoglicósidos. Se evaluaron posibles mutaciones en la región determinante de resistencia a quinolonas (QRDR). Se determinó por PCR la asociación de ISAba-1con los genes blaOXA y blaADC. Resultados Con las secuencias de la región ITS 16S-23S rRNA y el gen rpoB, se identificaron 51 aislamientos (..) (AU)

Antibiotic resistance patterns of Acinetobacter calcoaceticus-A. baumannii complex species from Colombian hospitals.

INTRODUCTION: Only automated phenotypic methods are currently used in Colombian hospitals for identifying isolates of the Acinetobacter calcoaceticus-A. baumannii complex (ACB). The phenotypical similarities in these species mean that they cannot be differentiated by manual or automated methods, thereby leading to their identification as A. baumannii, or ACB complex in clinical settings. Our objective was to identify to the species level 60 isolates, from four hospitals, evaluate their antibiotic susceptibility, and detect resistance-related genes. METHODS: 16S-23S rRNA internal transcribed spacer (ITS) region and rpoB gene partial sequences were amplified. Resistance genes for cephalosporin, carbapenem and aminoglycoside were detected by PCR. Possible mutations in the quinolone resistance-determining region (QRDR) were evaluated. The association of ISAba-1 with blaOXA and blaADC genes was determined by PCR. Amplification products of ITS region, rpoB gene and some resistance genes were sequenced and compared using the BLAST tool. RESULTS: 16S-23S rRNA ITS region and partial rpoB gene sequence analysis allowed 51isolates to be identified as A. baumannii, 8 as A. nosocomialis, and 1 isolate as A. pitti. A. baumannii isolates were highly resistant to all antibiotics tested, while the others were susceptible to ciprofloxacin and ampicillin/sulbactam. Quinolone resistance, found only in A. baumannii, was associated with mutations in the QRDR region of gyrA and parC genes. CONCLUSION: This is the first investigation in Colombia that has identified ACB complex species using molecular methods, and determined differences in antibiotic resistance and resistance genes among the species. It is of the highest importance to identify isolates to the species level for future resistance and epidemiology studies in our region.

Imaging human reward processing with positron emission tomography and functional magnetic resonance imaging.

Functional neuroimaging (fMRI) studies show activation in mesolimbic circuitry in tasks involving reward processing, like the Monetary Incentive Delay Task (MIDT). In voltammetry studies in animals, mesolimbic dopamine release is associated with reward salience. This study examined the relationship between fMRI activation and magnitude of dopamine release measured with Positron emission tomography study (PET) in the same subjects using MIDT in both modalities to test if fMRI activation is related to dopamine release. Eighteen healthy subjects were scanned with [¹¹C]raclopride PET at baseline and after MIDT. Binding potential (BP(ND)) was derived by equilibrium analysis in striatal subregions and percent change across conditions (∆BP(ND)) was measured. Blood oxygen level dependence (BOLD) signal changes with MIDT were measured during fMRI using voxelwise analysis and ROI analysis and correlated with ∆BP(ND). ∆BP(ND) was not significant in the ventral striatum (VST) but reached significance in the posterior caudate. The fMRI BOLD activation was highest in VST. No significant associations between ∆BP(ND) and change in fMRI BOLD were observed with VST using ROI analysis. Voxelwise analysis showed positive correlation between BOLD activation in anticipation of the highest reward and ∆BP(ND) in VST and precommissural putamen. Our study indicates that endogenous dopamine release in VST is of small magnitude and is related to BOLD signal change during performance of the MIDT in only a few voxels when rewarding and nonrewarding conditions are interspersed. The lack of correlation at the ROI level may be due to the small magnitude of release or to the particular dependence of BOLD on glutamatergic signaling.

Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease.

INTRODUCTION AND OBJECTIVES: The aim was to investigate the clinical effectiveness of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease, including their effect on the maintenance of sinus rhythm. METHODS: In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6 and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated. RESULTS: Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs. CONCLUSIONS: In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year.

Utilidad en la práctica clínica del tratamiento antiarrítmico tras cardioversión eléctrica en pacientes sin cardiopatía estructural / Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease

Introducción y objetivos. Conocer en la práctica clínica el uso de antiarrítmicos tras cardioversión eléctrica en pacientes sin cardiopatía y su repercusión en el mantenimiento del ritmo sinusal. Métodos. Se realizó un seguimiento a un año de 528 pacientes con fibrilación auricular persistente sin cardiopatía significativa tras una cardioversión eléctrica efectiva en 96 hospitales españoles, con controles clínicos 1, 3, 6 y 12 meses después. Se analizó el uso y la utilidad de los fármacos antiarrítmicos en la prevención de recurrencias de fibrilación auricular persistente. Resultados. Se trató al alta con fármacos antiarrítmicos al 80% de los pacientes, y el más utilizado fue la amiodarona. Ningún factor clínico se relacionó con un mayor uso de antiarrítmicos. El 37% de los pacientes siguió en ritmo sinusal en todos los controles. En el control a los 12 meses, se mantuvo el tratamiento antiarrítmico al 59% de los pacientes que seguían en ritmo sinusal. En el análisis multivariable de la regresión de Cox, el peso (hazard ratio [HR] por cada kilo = 1,01; p = 0,04) y la ausencia de tratamiento antiarrítmico (HR = 1,59; p = 0,001) fueron factores independientes relacionados con la recurrencia de fibrilación auricular persistente. La amiodarona tendía a ser superior a los otros antiarrítmicos. Conclusiones. En la práctica clínica habitual, tras una cardioversión eléctrica efectiva, la gran mayoría de los pacientes sin cardiopatía estructural recibe fármacos antiarrítmicos, especialmente amiodarona, que es el principal factor relacionado con el mantenimiento del ritmo sinusal 1 año más tarde (AU)

Introduction and objectives. The aim was to investigate the clinical effectiveness of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease, including their effect on the maintenance of sinus rhythm. Methods. In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6 and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated. Results. Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs. Conclusions. In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year (AU)

Infección por virus del papiloma humano en una muestra de mujeres jóvenes con citología normal / Human Papillomavirus infection in a sample of young women with normal PAP smear

Introducción: En Colombia, el cáncer de cuello uterinoes la primera causa de muerte por cáncer de mujeres en edad reproductiva. El VPH se considera un factor etiológico necesario pero no suficiente, ya que sólo una minoría de las infecciones progresan a cáncer, lo cual señala la existencia de otros cofactores requeridos para la transformación. Objetivos: Determinar factores asociados a la infección por VPH en una muestra de 218 mujeres jóvenes de Bogotá con citología normal. Materiales y métodos: La presencia de VPH en cepillado cervical se determinó mediante PCR GP5+/GP6+ y se recolectó información sobre factores asociados a infección. Resultados:La prevalencia de VPH fue de 17,4por ciento. Se encontró un mayor riesgo de infección en mujeres que han tenido más de cinco compañeros sexuales (OR=2,65; IC95por ciento 1,16-6,03)y cuya pareja no usa condón (OR=2,8;IC95por ciento 1,12-7,03). En cuanto al número de embarazos a término, se encontró que las mujeres con hijos tenían menor riesgo de infección y que el riesgo era menor entre mayor fuera el número de hijos. No se observaron asociaciones significativas con respecto a las otras variables analizadas. Coclusiones: los resultados muestran una alta prevalencia de infección por VPH en mujeres jóvenes con citología normal,similar a las reportadas en otros países. Se encontró asociación de la infección con factores sexuales como el número de compañeros sexuales, la carencia de compañero sexual habitual, la carencia de hijos y el no uso de condon

Age-related vascular changes in the epiphysis, physis, and metaphysis: normal findings on gadolinium-enhanced MRI of piglets.

OBJECTIVE: We sought to study the normal enhancement patterns seen on MRIs of the epiphysis, physis, and metaphysis and age-related vascular changes in piglets using gadoteridol, a nonionic gadolinium chelate. MATERIALS AND METHODS: We quantitatively and qualitatively analyzed the normal changes on sequential T1-weighted images after the IV administration of gadoteridol. In an investigation approved by the research animal care committee at our hospital, we studied the proximal and distal femurs of 26 piglets 1-6 weeks old and correlated the enhanced images with findings on intermediate-weighted, T2-weighted, and gradient-recalled echo images and at histologic examination. RESULTS: We observed early enhancement of the epiphyseal vascular canals, the main physis, the physis of the secondary ossification center, and a metaphyseal band adjacent to the physis. Enhancement of the epiphyseal and metaphyseal marrow and of the epiphyseal cartilage was slower. In the epiphyseal cartilage, we saw three phases of enhancement: vascular, canalicular, and cartilaginous. As the piglets matured, enhancement of the epiphyseal cartilage decreased, and the epiphyseal vascular canals were less conspicuous. Physeal enhancement was greatest during the first week of life, declined at 3 weeks, and subsequently increased again as the physis came to lie adjacent to a larger segment of the epiphyseal ossification center. CONCLUSION: Gadoteridol-enhanced MRIs showed multiple cartilaginous and vascular structures of the growing skeleton. With maturity and progressive epiphyseal ossification, epiphyseal cartilage enhancement decreased, and physeal cartilage enhancement increased.

Tipificación de virus del papiloma humano mediante secuencia directa en mujeres con citología normal / HPV typing by direct DNA sequencing among women with normal prap smears

Introducción: el virus del pailoma de humano (VPH) se considera un factor etiológico necesario, pero no suficiente, en la carcinogénesis cervical. Aunque la prevalencia de esta infección es homogéa a nivel mundial, la prevalencia tipo-específica varía según la región geográfica. El objetivo de este estudio es determinar mediante secuencia directa la prevalencia tipo-específico de la infección por VPH en una muestra de mujeres jóvenes de Bogotá (Colombia) con citología normal. Materialea y métodos: se determinó la presencia de VPH en cepillados cervicales en 230 mjeres entre 18 y 36 años con citología normal mediante PCR GP5+/GP6+, y mediante la técnica SSCP y secuencia directa se realizó la tipificación de VPH. Resultados: Se encontró una prevalencia de la infección por VPH de 18,2 por ciento. Se detectaron quince tipos de VPH, de los cuales cuatro no se hubieran podido tipificar por métodos convencionales de hibridación. Los cinco tipos más prevalentes fueron el VPH16, VPH31, candidato VPH90, VPH59 y VPH18. La prevalencia de los tipos de alto riesgo fue de 10,4 por ciento y la de los de bajo riesgo, de 4,3 por ciento. de dos tipos identificados se desconoce su potencial oncogénico (HPGA6053 y L1AE9). Conclusión: la secuencia directa de ADN permitió identificar tipos VPH que no hubieran podido ser tipificados con otros métodos, en particular el candidato VPH90, el cual se encontró como el tercero más frecuente en esta muestra. Se confirmó la alta prevalencia de VPH59,tipo viral poco frecuente en regiones diferentes a Centro y Suramérica.