Differences in the clinical and hormonal presentation of patients with familial and sporadic primary aldosteronism.

Purpose: To compare the clinical and hormonal characteristics of patients with familial hyperaldosteronism (FH) and sporadic primary aldosteronism (PA). Methods: A systematic review of the literature was performed for the identification of FH patients. The SPAIN-ALDO registry cohort of patients with no suspicion of FH was chosen as the comparator group (sporadic group). Results: A total of 360 FH (246 FH type I, 73 type II, 29 type III, and 12 type IV) cases and 830 sporadic PA patients were included. Patients with FH-I were younger than sporadic cases, and women were more commonly affected (P = 0.003). In addition, the plasma aldosterone concentration (PAC) was lower, plasma renin activity (PRA) higher, and hypokalemia (P < 0.001) less frequent than in sporadic cases. Except for a younger age (P < 0.001) and higher diastolic blood pressure (P = 0.006), the clinical and hormonal profiles of FH-II and sporadic cases were similar. FH-III had a distinct phenotype, with higher PAC and higher frequency of hypokalemia (P < 0.001), and presented 45 years before sporadic cases. Nevertheless, the clinical and hormonal phenotypes of FH-IV and sporadic cases were similar, with the former being younger and having lower serum potassium levels. Conclusion: In addition to being younger and having a family history of PA, FH-I and III share other typical characteristics. In this regard, FH-I is characterized by a low prevalence of hypokalemia and FH-III by a severe aldosterone excess causing hypokalemia in more than 85% of patients. The clinical and hormonal phenotype of type II and IV is similar to the sporadic cases.

Exploring resilience in public services within marginalised communities during COVID-19: The case of coal mining regions in Colombia.

This paper examines the impact of COVID-19 on marginalised communities and its effects on the provision of public services. Focusing on two coal mining regions in Colombia during the pandemic crisis, and examining Indigenous and Afro-Colombian communities, we analyze the provision of public services at a local level, identifying both shortcomings and resilience. Findings show that the lack of resilient public services amplified the effects of COVID-19 and its containment measures, exacerbating existing structural inequalities within local marginalised communities. It also reinforced the control exercised by coal mining companies within local economies. However, the substantial lack of public service provision also provided space for the development and strengthening of several resilience strategies among local communities, such as solidarity networks and schemes and the revitalization of local environmental knowledge. The study identifies multiple shortcomings in how the national and local administrations handled the COVID-19 outbreak and highlights the potential of enhancing resilience in public services to support marginalised communities in times of crisis.

Epidemiology of headache in a neurological Emergency Department in Medellin, Colombia / Epidemiology of headache in a neurological Emergency Department in Medellin, Colombia

Introduction:Headache is a common reason for presentation to emergency departments (ED) around the world. In many countries, ED are not speciality-focussed, however, in Colombia and some other countries, specialist neurological hospitals have ED with a strong neurological focus. For patients presenting with headache, these ED may have different epidemiology, investigation strategies and treatment patterns from general ED. Objective:The objective of this study was to describe the epidemiology of headache presenting to the ED of Instituto Neurológico de Colombia in Medellin, Colombia ­ an ED which is a referral centre for neurological and neurosurgical diseases. Methods:This was an observational study by chart review of adults (aged ≥18) with a main presenting compliant of headache. Demographic, clinical, imaging, diagnoses and outcome data were collected. The primary outcome of interest was the rate of serious secondary intracranial headache cause. Analysis was descriptive. Results:757 patients were studied ­ female 76%, median age 39. Most headache were of gradual onset (85%) and new neurological signs were uncommon (4%). CT was performed in 50% of cases and MRI in 20%. A wide variety of headache causes were identified. Serious secondary intracranial headache was identified in 8.9% (95% CI 7.1-11.1%) of cases. Most patients (89%) were discharged home from ED. Conclusion:Diagnosis of headache in ED is challenging with a very wide range of possible causes. A small proportion of patients (approx. 9%) have a serious cause for their symptoms ­ a proportion similar to that reported in other international emergency department cohorts.

Introdução: A cefaleia é um motivo comum de apresentação aos departamentos de emergência (DE) em todo o mundo. Em muitos países, os PS não são focados em especialidades, no entanto, na Colômbia e em alguns outros países, os hospitais neurológicos especializados têm PS com um forte foco neurológico. Para pacientes que apresentam cefaleia, esses DE podem ter epidemiologia, estratégias de investigação e padrões de tratamento diferentes dos DE geral. Objetivo: O objetivo deste estudo foi descrever a epidemiologia da dor de cabeça apresentada ao pronto-socorro do Instituto Neurológico de Colômbia em Medellín, Colômbia ­ um pronto-socorro que é um centro de referência para doenças neurológicas e neurocirúrgicas. Métodos: Este foi um estudo observacional por meio de revisão de prontuários de adultos (idade ≥18) com apresentação principal complacente de cefaleia. Dados demográficos, clínicos, de imagem, diagnósticos e resultados foram coletados. O desfecho primário de interesse foi a taxa de causa grave de dor de cabeça intracraniana secundária. A análise foi descritiva. Resultados: Foram estudados 757 pacientes ­ 76% do sexo feminino, idade mediana de 39 anos. A maioria das cefaleias foi de início gradual (85%) e os novos sinais neurológicos foram incomuns (4%). A tomografia computadorizada foi realizada em 50% dos casos e a ressonância magnética em 20%. Uma grande variedade de causas de dor de cabeça foi identificada. Cefaleia intracraniana secundária grave foi identificada em 8,9% (IC 95% 7,1-11,1%) dos casos. A maioria dos pacientes (89%) recebeu alta do pronto-socorro. Conclusão: O diagnóstico de cefaleia no DE é desafiador, com uma ampla gama de causas possíveis. Uma pequena proporção de pacientes (aproximadamente 9%) tem uma causa grave para os seus sintomas ­ uma proporção semelhante à relatada em outras coortes internacionais de serviços de emergência.

ANCA vasculitis and membranoproliferative glomerulonephritis associated with Sjögren's syndrome: Case report and literature review

ANCA-associated vasculitis may occur concomitantly with primary Sjögren's syndrome (SS) or arise during its evolution. We present the case of a patient who underwent dry symptoms, a positive Schirmer test and an SS-compatible autoimmunity profile and, simultaneously, deterioration of renal function, anaemia, and dyspnoea, requiring renal biopsy and fibro-bronchoscopy. Complementary studies documented acute necrotizing glomerulonephritis with extracapillary proliferation, and membranoproliferative pattern with immune complex deposition. Bronchoalveolar lavage was compatible with alveolar haemorrhage. Kidney lung syndrome secondary to ANCA vasculitis was diagnosed and treatment with steroid and intravenous cyclophosphamide with clinical and paraclinical improvement was instituted. Mixed renal involvement found in this case is uncommon in patients with SS, and treatment changes significantly, hence the importance of differential diagnosis and reporting in the literature.

La vasculitis asociada con anticuerpos anticitoplasma de neutrófilos-ANCA puede presentarse concomitantemente con síndrome de Sjögren primario o surgir durante su evolución. Se presenta el caso de una paciente que cursó con síntomas secos, test de Schirmer positivo, perfil de autoinmunidad compatible con síndrome de Sjögren y, de forma simultánea, deterioro de la función renal, anemia y disnea, por lo que requirió biopsia renal y fibrobroncoscopia. Los estudios complementarios documentaron glomerulonefritis aguda necrosante con proliferación extracapilar y patrón membranoproliferativo con depósito de complejos inmunes. El lavado broncoalveolar fue compatible con hemorragia alveolar. Se hizo diagnóstico de síndrome de pulmón-rinón secundario a vasculitis ANCA y se instauró tratamiento con esteroide y ciclofosfamida intravenosa, con mejoría clínica y paraclínica. El compromiso renal mixto encontrado en este caso es infrecuente en pacientes con SS, y el tratamiento cambia ostensiblemente, de ahí la importancia del diagnóstico diferencial y el reporte en la literatura.

The death valley of coal - Modelling COVID-19 recovery scenarios for steam coal markets.

This paper examines medium and long-term perspectives for global steam coal production and trade, considering the potential impacts of the COVID-19 pandemic and plausible recovery scenarios in its aftermath. We use an interdisciplinary approach to develop a range of stylized global coal demand scenarios until 2040 depicting the influence of the COVID-19 pandemic and resulting recovery stimuli. Additional insights are gained by adjusting trade restrictions of key countries within the coal sector model COALMOD-World to resemble plausible post-COVID-19 policy and market dynamics. Results indicate that the COVID-19 pandemic might cause an "L" or "\" shape instead of the hoped for "V" or "U" shaped recovery of the coal industry. Regional effects vary, as the Atlantic market dries out first, causing shifts in trade patterns in the Pacific market. Moreover, announced trade restrictions could change dramatically the composition of the international steam coal trade. However, even significantly reduced coal consumption levels in low-coal post-COVID-19 scenarios would still be too high to comply with the global climate targets. This emphasizes the importance of concentrated policy efforts in the pandemic aftermath to manage a coal decline consistent with global climate targets while bringing just transitions efforts substantially forward, in particular in vulnerable coal-dependent countries and regions.

Lucha Contra el Narcotráfico vs. Protección de Derechos Humanos: análisis desde el Consumo de Drogas en Colombia / Fight Against Drug Trafficking vs. Protection of Human Rights: Analysis from Drug Consumption in Colombia / Luta Contra o narcotráfico vs. Proteção dos Direitos Humanos: Análise desde o Consumo de Drogas na Colômbia

Resumen Introducción. Para los Estados y los organismos internacionales, una de las principales preocupaciones en materia de drogas es hallar un balance entre la lucha contra el narcotráfico y el respeto al Derecho Internacional de los Derechos Humanos. Objetivo. Este artículo pretende analizar si existe un tratamiento internacional para la protección de los derechos de los consumidores de drogas en el Sistema Universal e Interamericano de Derechos Humanos y si los elementos abordados por estos se han implementado en la legislación y jurisprudencia colombiana, en desarrollo de los compromisos internacionales sobre derechos humanos adquiridos por Colombia. Materiales y métodos. La investigación se desarrolló en tres fases, siguiendo una metodología cualitativa, dogmática y prescriptiva, cuyo insumo principal fue la recolección de normas nacionales e instrumentos del marco internacional de los Derechos Humanos, relacionados con el consumo de drogas y su tratamiento, durante el periodo 2010-2019. Resultados. Los principales hallazgos evidenciaron que no existen estándares internacionales con enfoque especial para la protección y reconocimiento de los derechos de los consumidores de drogas. Así mismo, no se han observado avances representativos en las leyes nacionales e internacionales, y aunque la jurisprudencia colombiana propone algunas referencias a normas internacionales, no hay un desarrollo profundo del tema. Conclusiones. Se plantea como reto principal que el Estado colombiano aborde el tema desde una perspectiva distinta a la punitiva.

Abstract Introduction: For states and international organizations, one of the main concerns regarding drugs is finding a balance between the fight against drug trafficking and respect for International Human Rights law. Objective: This article aims to analyze whether there is an international treatment for the protection of consumer rights in the Universal and Inter-American Human Rights System and if the elements addressed by these have been implemented in Colombian legislation and jurisprudence, in the development of international obligations on human rights adopted by Colombia. Materials and method: The research was carried out in three phases, following a qualitative, dogmatic and prescriptive methodology, the main input of which was the collection of national laws and instruments of the international framework of Human Rights, related to drug consumption and treatment, during the period 2010-2019. Results: The main findings showed that there are no international standards with a special focus for the protection and recognition of the rights of drug users. Likewise, no representative progress has been observed in national and international regulations, and although Colombian jurisprudence proposes some references to international laws, there is no in-depth development of the subject. Conclusions: The main challenge is for the Colombian State to approach the subject from a different perspective other than just puni shment.

Resumo Introdução. Para os Estados e os organismos internacionais, uma das principais preocupações no tema de drogas é encontrar um equilíbrio entre a luta contra o narcotráfico e o respeito ao Direito Internacional dos Direitos Humanos. Objetivo. Este artigo pretende analisar se existe um tratamento internacional para a proteção dos direitos dos consumidores de drogas no Sistema Universal e Interamericano de Direitos Humanos e se os elementos abordados por estes se têm implementado na legislação e jurisprudência colombiana, no desenvolvimento dos compromissos internacionais sob direitos humanos adquiridos pela Colômbia. Materiais e métodos. Apesquisa foi desenvolvida em três fases, seguindo uma metodologia qualitativa, dogmática e prescritiva, cujo insumo principal foi a coleta de normas nacionais e instrumentos do marco internacional dos Direitos Humanos, relacionados com o consumo de drogas e seu tratamento, durante o período 2010-2019. Resultados. As principais descobertas evidenciaram que não existem padrões internacionais com a abordagem especial para a proteção e reconhecimento dos direitos dos consumidores de drogas. Mesmo assim, não se têm observado avances representativos nas leis nacionais e internacionais, e embora a jurisprudência colombiana propõe algumas referências às normas internacionais, não têm um desenvolvimento profundo do tema. Conclusões. Se coloca como reto principal que o Estado colombiano aborde o tema desde uma perspectiva distinta da punitiva.

Effectiveness of a single session protocol of behavioral activation in college students with depressive symptomatology

Previous research has analyzed the effectiveness of a single session intervention of Behavioral Activation (BA) for reducing depressive symptoms, however, it is important to replicate findings in different populations. The aim of this study was to determine the effectiveness of a single session intervention protocol of BA in college students with depressive symptomatology. The study was experimental pretest posttest with reference group in waiting list (N= 60). Students who scored more than 36 points in the Zung Self-Rating Depression Scale (SDS) were selected and were randomly distributed to the reference group or experimental group. The results showed a remarkable decrease of depressive symptomatology in experimental group students compared to control group and it was found that the effect size of the treatment was 0.74, which contributes to the empirical evidence about BA especially regarding college population

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Allogeneic hematopoietic cell transplantation is potentially curative in mantle cell lymphoma: results from a single institution study.

Allogeneic hematopoietic cell transplantation (allo-HCT) is the only curative treatment for mantle cell lymphoma (MCL). We retrospectively analyzed outcomes of 36 patients, median age of 54 (41-68) years, who underwent allo-HCT, mostly (66%) receiving a myeloablative (MAC) regimen. Median overall survival (OS) was 86 months and 5-year OS was 54%. Median progression-free survival (PFS) was 54 months and 5-year PFS was 49%. Cumulative incidence (CI) of non-relapse mortality (NRM) and 2-year progression were 20.1 and 22.1%, respectively. Day +100 CI of grade II-IV acute graft-versus-host disease (GVHD) was 38.1%; 2-year CI of moderate/severe chronic GVHD was 31.7%. Seven patients received allo-HCT as frontline consolidation and had better OS (median = not reached versus 54 months, p = .045). Notwithstanding the small sample size and retrospective study design, our findings suggest a role for allo-HCT in selected MCL patients. Future prospective studies would be needed to better define the role of allo-HCT in this disease.

Atención Selectiva y sostenida de trabajadores en dos jornadas del día / Selective and sustained attention of workers of two different shifts in the day

Resumen Aun cuando se ha reconocido la importancia del proceso psicológico de la atención por contribuir a la capacidad productiva y la consecución de resultados eficientes y eficaces durante el desarrollo de diversas tareas cotidianas, no ha sido suficientemente estudiado en trabajadores de empresas u organizaciones. Esta investigación buscó identificar cómo es la atención selectiva y sostenida de los trabajadores en dos jornadas diferentes del día (mañana y tarde); adicionalmente, se exploró si variables como la edad, escolaridad y género afectan el desempeño. Se aplicó el programa computarizado Vienna Test System subprueba cognitron forma S1 a 184 trabajadores de una universidad. Los datos fueron analizados mediante un modelo de regresión y prueba t para muestras independientes. Los hallazgos mostraron que la atención selectiva es mayor en horas de la mañana, mientras que la atención sostenida se mantiene a lo largo del día. En cuanto a las otras variables analizadas, se evidenció que la edad fue la única predictora del rendimiento, por cuanto a menor edad mejores desempeños. Estos resultados aportan para la planeación de actividades en el ámbito laboral y complementa los estudios en el área de los procesos psicológicos básicos.

Abstract Although the importance of the psychological process of attention and how it to contributes productive capacity and achieving efficient and effective results during the development of daily tasks has been recognized, it has not been sufficiently studied in workers of companies or organizations. This research sought to identify what selective and sustained attention is like in the workers to two different shifts in the day (morning and afternoon); Additional variables such as age, schooling and gender were investigated to see if they affected performance. We applied the computer program Vienna Test System sub-test cognition form S1 to 184 university workers. Data was analyzed using a regression model and t-test for independent samples. The findings showed that selective attention is greater in the morning, while sustained attention is maintained throughout the day. As for the other variables analyzed, it was evidenced that age was the only predictor of performance, as workers of a younger age performed better. These results contribute to the planning of activities in the workplace and complements the studies in the area of the basic psychological processes.

Cambios cognitivos en la forma de explicar la historia en estudiantes de quinto grado / Cognitive Changes in the Way of Explaining History by Fifth Grade Students / Mudanças cognitivas na forma de explicar a história em estudantes de quinto grado

Objetivo. Identificar la manera en que los estudiantes transforman el modelo explicativo de la historia, a partir de una secuencia de aprendizaje de seis sesiones de clase, basada en la teoría de la complejidad. Método. Se seleccionaron por conveniencia 21 estudiantes de quinto grado, a quienes se les enseñaron las propiedades ontológicas emergentes que explican las relaciones multinivel de la violencia bipartidista y sus diferencias con las propiedades ontológicas directas. Se codificó la presencia o la ausencia de las propiedades ontológicas emergentes y directas en las producciones escritas de los estudiantes (n = 126), y se analizó cualitativamente la forma en la que se generaron las transformaciones en el reconocimiento y el uso de los atributos ontológicos que configuraron o no un cambio conceptual para explicar la historia. Resultados. Los estudiantes usaron y articularon piezas o atributos ontológicos de dos modelos explicativos (directo y emergente), y se identificaron tres tipos de transformación en la comprensión de la historia durante las sesiones. Conclusión. Aunque los estudiantes no lograron identificar todas las propiedades emergentes como un conjunto coherente de conocimiento, se encontró que articularon atributos directos y emergentes para explicar la historia, lo cual generó sesgos en la comprensión del fenómeno histórico.

Objective. This paper answered how students transformed their historical explanatory model, from a learning sequence based on complexity theory (in six class sessions). Method. Twenty-one fifth grade students were chosen by convenience, to whom we taught emergent ontological properties to explain the multilevel relationships of bipartisan party violence, and their differences with direct ontological properties. The presence or absence of the emerging and direct ontological properties were codified in the written work of the students (n = 126). We analyzed qualitatively how the transformations in the acknowledgement and the use of ontological attributes were generated in order to configure or not a conceptual change in the historical explanation. Results. The findings revealed that students used and articulated some ontological attributes from two different explanatory models (direct and emergent), and we identified three ways to change the historical explanations. Conclusion. Despite students failing to identify all emergent properties as a coherent body of knowledge, they articulated direct and emerging attributes to explain history, which generated biases in understanding the historical phenomenon.

Escopo. Identificar a forma na que os estudantes transformam o modelo explicativo histórico a partir de uma sequência de aprendizagem de seis sessões de aula baseada na teoria da complexidade. Metodologia. Foram selecionados por conveniência 21 estudante de quinto grado, os quais receberam ensino das propriedades ontológicas emergentes que explicam as relações multinível da violência bipartidária e suas diferenças com as propriedades ontológicas diretas. Foi codificada a presencia ou a ausência das propriedades ontológicas emergentes e diretas nas produções escritas dos estudantes e foi analisado qualitativamente a forma na que foram geradas as transformações no reconhecimento e o uso dos atributos ontológicos que configuraram ou não uma mudança conceitual na sua explicação histórica. Resultados. Os estudantes usaram e articularam peças ou atributos ontológicos de dois modelos explicativos diferentes (direito e emergente) e foram identificados três tipos de transformação na compreensão histórica durante as sessões. Conclusão. Embora os estudantes não conseguiram identificar todas as propriedades emergentes como um conjunto coerente de conhecimento, foi achado que eles articularam atributos direitos e emergentes para explicar a História, o qual gerou sesgos na compreensão do fenómeno histórico.

Evolution of glycated haemoglobin in adults on growth hormone replacement therapy / Comportamiento de la hemoglobina glicada en adultos con déficit de GH en tratamiento sustitutivo

OBJECTIVES: To evaluate the effects of GH replacement therapy (GHR) for 3 years on glycated haemoglobin (HbA1c) and on the presence of dysglycaemia at any time during follow-up in Spanish adult patients with growth hormone deficiency (GHD). Study design: A retrospective study of 41 patients with GHD was conducted using baseline and long-term data. Changes in HbA1c values during the first 3 years of GHR were studied in both the overall population and patients with or without dysglycaemia during follow-up. Dysglycaemia was defined as FPG ≥ 100 mg/dl and/or HbA1c ≥ 5.7%. RESULTS: Mean HbA1c value (5.4 ± 0.4% at baseline) increased during the first and second years of GHR (HbA1c5.5 ± 0.4%, p = 0.05, and 5.5 ± 0.4%, p = 0.006 respectively). This increase was not maintained during the third year (HbA1c 5.4 ± 0.3%, p = 0.107) of GHR. Twenty-eight patients (68.2%) had dysglycaemia during follow-up, 9 of them since baseline. In the 19 patients without baseline dysglycaemia, HbA1cincreased during the first year and remained stable in the next 2 years (mean HbA1c 5.2 ± 0.4% at baseline; 5.5 ± 0.4% at 1 year, p < 0.050; 5.4 ± 0.4% at 2 years, p = 0.004, and 5.4 ± 0.4% at 3 years, p = 0.016). In the 9 patients with baseline dysglycaemia, HbA1c did not significantly change during the 3 years of GHR therapy. CONCLUSIONS: HbA1c values increased during the first 2 years of GHR therapy. In patients with no dysglycaemia before treatment, HbA1c steadily increased over the 3 years. However, it did not change in patients with baseline dysglycaemia

OBJETIVO: Evaluar, en una cohorte de pacientes españoles con déficit de GH (GHD), el efecto de 3 años de tratamiento sustitutivo con hormona de crecimiento (GHR) sobre la hemoglobina glicada (HbA1c) y la presencia de disglucemia en cualquier momento del seguimiento. DISEÑO: Estudio retrospectivo de 41 pacientes con GHD en GHR. Se analizaron los cambios durante los tres primeros años de GHR, en los valores de la HbA1c tanto en la población general como en los subgrupos de pacientes con y sin disglucemia durante el seguimiento. Se definió disglucemia como una glucemia basal ≥ 100 mg/dl y/o HbA1c ≥ 5,7%. RESULTADOS: La HbA1c media (inicialmente 5,4 ± 0,4%) aumentó durante el primer y segundo año de GHR (HbA1c5,5 ± 0,4%, p = 0,05 y 5,5 ± 0,4%, p = 0,006, respectivamente); esta tendencia no se mantuvo durante el tercer año (HbA1c 5,4 ± 0,3%, p = 0,107). Veintiocho pacientes (68,2%) presentaron disglucemia durante el seguimiento, 9 de ellos desde el inicio del seguimiento. En los 19 pacientes sin disglucemia basal, la HbA1c se incrementó durante el primer año, permaneciendo estable durante los siguientes dos años (HbA1c media basal 5,2 ± 0,4%, 1er año 5,5 ± 0,4%, p < 0,050; 2do año 5,4 ± 0,4% p = 0,004 y 3er año 5,4 ± 0,4% p = 0,016). En los 9 pacientes con disglucemia basal la HbA1c no cambió en forma significativa durante los 3 años de GHR. CONCLUSIONES: Los valores de HbA1c aumentaron durante los dos primeros años de GHR. En los pacientes sin disglucemia pre-tratamiento la HbA1c presentó un incremento continuo durante los tres años. Sin embargo, no cambió en aquellos pacientes con disglucemia basal

Correlations among symptoms, signs, and clinical tests in evaporative-type dry eye disease caused by Meibomian gland dysfunction (MGD).

PURPOSE: To evaluate changes in symptoms, objective tests, and signs after medical treatment of subjects with evaporative-type dry eye disease (EDE) caused by Meibomian gland dysfunction (MGD), and to analyze correlations among symptoms, signs and test results in the worse eyes (W-eyes) of the subjects. METHODS: Prospective clinical study of 21 symptomatic subjects with EDE caused by MGD. Subjects who were diagnosed with EDE in a first visit were treated for 6 weeks and re-evaluated in a second visit. The differences between initial and second visits were evaluated. Correlations among clinical symptoms, signs, and test results were performed using the data of the W-eyes. Variables evaluated included: dry eye symptoms, best corrected visual acuity (BCVA), contrast sensitivity, conjunctival hyperemia, phenol red thread test, tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein and conjunctival rose Bengal staining, tear lysozyme concentration, Schirmer test, and lid margin assessment. RESULTS: All items evaluated improved after treatment, but only conjunctival hyperemia and TMH improved significantly. TBUT and lid margin changes improved, but still remained abnormal. There were significant correlations among symptoms questionnaires and some clinical tests (TBUT, conjunctival hyperemia, TMH, and conjunctival rose Bengal staining). CONCLUSION: Despite the instability of the tear film and lid margin alterations that continued after treatment, subjects with MGD improved symptomatically. The low degree of correlations among W-eye signs, symptoms, and tests reflects the independency of symptoms and signs in this complex pathology.

Factores de riesgo en enfermedad cerebro vascular isquémica en paciente menores de 45 años / Risk factors of stroke in young people

Un Evento Cerebro Vascular (ECV) es un suceso dramático en un paciente joven, al considerar la discapacidad, el impacto social y los altos costos en procesos de rehabilitación. Por lo anterior, se han creado programas de prevención para los factores de riesgo implicados en la presentación de éstos. Con este trabajo, se pretende realizar una revisión teórica de los factores de riesgo, etiologías implicadas en la presentación de un ECV, además se presenta un informe de las historias clínicas de los pacientes que consultaron al Hospital San Juan de Dios, en el período comprendido entre enero de 1995 y junio del 2000, con el fin de describir los factores de riesgo, enfermedades asociadas en esta población y aportar una información preliminar

Trombosis de senos venosos cerebrales / Cerebral venous thrombosis

La trombosis de los senos venosos cerebrales ocurre como consecuencia de una alteración en los factores trombogénicos y fibrinolíticos, a su vez ocasionada por diversos factores locales o sistémicos. Entre las causas mejor conocidas se hallan las infecciosas, las alteraciones de la coagulación que acompañan la anticoncepción, el embarazo y el parto, el trauma y los neoplasmas. La prevalencia e incidencia de esta patología se ha aproximado mediante registros de casos, pero su notificación no es obligatoria y el subregistro es amplio. La presentación clìnica es variable por lo cual resulta más fácil tratar de reconocerla en diversos síndrome como: la hipertensión endocranea benigna, la cefalea aguda con signos focales y depresiòn de la conciencia, las convulsiones con paresia post ictal transitoria entre otros. El diagnóstico por imágenes ha sufrido un gran cambio con la aparición de la TAC y la resonancia magnética y han permitido una pronta confirmación, en la sospecha clìnica, frente a la bien conocida positividad de la angiografía. El tratamiento continua generando controversia pues algunos pacientes mejoran sin intervención alguna. Empero la anticoagulación con heparina a dosis plenas continùa siendo un tratamiento seguro y eficaz, incluso en presencia de hemorragia. La trombolisis local está indicada en aquellos casos en los cuales la anticoagulación no produce resultado. Se presentan para ilustración del lector, cinco casos atendidos en el Hospital San Juan de Dios de Bogotá

Estado actual del diagnóstico y el manejo de la hiperplasia prostática benigna / Present state on the diagnosis and treatment of benign prostatic hyperplasia

La Hiperplasia prostática benigna es hoy por hoy un problema común que afecta a un gran porcentaje de hombres en la edad avanzada. Dada la ubicación anatómica de la glándula prostática, esta entidad se manifiesta en los pacientes con un complejo sintomático obstructivo primario e irritativo secundario del tracto urinario inferior. El siguiente artículo describe el enfoque diagnóstico y terapéutico de la hiperplasia prostática benigna en la actualidad y menciona algunas técnicas desarrolladas en los últimos años que buscan ofrecer cada vez un mayor beneficio para los pacientes, reduciendo los riesgos y las complicaciones de las técnicas tradicionales