Normal values of the fronto-occipital relationship in fetuses between 18 and 40 weeks at two maternal fetal medicine units: Bogotá, Colombia.

OBJECTIVE: To establish nomograms for linear measurements of the frontal and occipital horns of the lateral ventricle and their relationship, in pregnant patients between 18 and 40 weeks of gestation and having attended 2 units of Maternal Fetal Medicine in Bogotá-Colombia. METHODOLOGY: A descriptive cross-sectional study with an analytical component was carried out on pregnant patients who utilized the ultrasound services at 2 Maternal-Fetal Medicine units in Bogotá, between 18 and 40 weeks of pregnancy who underwent measurement. From the anterior and posterior horns of the lateral ventricles, the fronto-occipital ratio was calculated at each gestational week, and nomograms were created for each of these variables. RESULTS: Nine hundred and seventy-eight patients were included in the study. The distance of the frontal horns ranged between 6.9 and 51.6 mm with a mean of 19.1 ± 5.8 mm; that of the occipital horns had a measurement between 8.7 and 53 mm with a mean of 28, 1 ± 8.9 mm; on the other hand, the fronto-occipital ratio (FOR) yielded a mean of 0.365 ± 0.067 (0.136-0.616) without bearing any relation to gestational age. The trend of normal values for the studied population is displayed, plotted in percentile curves and nomograms for each gestational age. CONCLUSION: The measurement of the frontal and occipital horns, and the calculation of the fronto-occipital relationship is technically possible between 18 and 40 weeks, finding that the anterior and posterior horns have a positive linear relationship with gestational age. Contrarily, the FOR does not correlate with the gestational age, it was possible to establish a table of percentiles that allows determining the normal values for these measurements during pregnancy.

Anatomical structure characterization of fetal ultrasound images using texture-based segmentation technique via an interactive MATLAB application.

OBJECTIVE: To describe the texture characteristics in several anatomical structures within fetal ultrasound images by applying an image segmentation technique through an application developed in MATLAB mathematical processing software. METHODS: Prospective descriptive observational study with an analytical component. 2D fetal ultrasound images were acquired in patients admitted to the Maternal Fetal Medicine Unit of the Hospital de San José, Bogotá-Colombia. These images were loaded into the developed application to carry out the segmentation and characterization stages by means of 23 numerical texture descriptors. The data were analyzed with central tendency measures and through an embedding process and Euclidean distance. RESULTS: Forty ultrasound images were included, characterizing 54 structures of the fetal placenta, skull, thorax, and abdomen. By embedding the descriptors, the differentiation of biologically known structures as distinct was achieved, as well as the non-differentiation of similar structures, evidenced using 2D and 3D graphs and numerical data with statistical significance. CONCLUSION: The texture characterization of the labeled structures in fetal ultrasound images through the numerical descriptors allows the accurate discrimination of these structures.

Asociación del grupo sanguíneo ABO con complicaciones en covid-19: revisión sistemática y meta-análisis / Asociation between abo blood groups and covid-19 complications: systematic review and meta-analysis

Introducción: los grupos sanguíneos ABO han sido utilizados como marcadores de desenlace en diferentes enfermedades, otorgando al grupo O un factor protector y al A uno de riesgo. Durante el brote de SARS CoV-1 se planteó la posible relación entre riesgo de infección y tipo sanguíneo; se presume que en la pandemia por COVID-19 exista una relación entre determinados desenlaces y los grupos ABO. Objetivo: determinar la asociación entre los diferentes grupos sanguíneos y los desenlaces de mortalidad, ingreso a cuidados intensivos y requerimiento de intubación orotraqueal (IOT) en población con infección por COVID-19. Materiales y métodos: revisión sistemática y metanálisis entre enero 2020 y marzo 2021 en las bases de datos MEDLINE, EMBASE, SCOPUS, Latindex y LILACS, identificando los desenlaces mencionados en pacientes con COVID-19. Resultados: se incluyeron 16 estudios, la mayoría retrospectivos multicéntricos. Se evidenció que pacientes con grupo sanguíneo A tienen mayor riesgo de mortalidad (OR 1.08 ;1.01-0.17), frente al ingreso a UCI no hubo diferencia estadística significativa entre los grupos sanguíneos. Se encontró que el AB representa un factor de riesgo para intubación orotraqueal (OR 1.42 IC95% 1.02-1.96), en tanto que el A demostró proteger contra este desenlace (OR 0.84 IC95%0.73-0.97). Conclusiones: hay evidencia sobre la relación entre el grupo sanguíneo y los desenlaces, asociada con la infección por SARS-CoV-2. Se requieren estudios prospectivos que evalúen grupo sanguíneo, RH y desenlaces específicos.

Introduction: ABO blood groups have been used as outcome markers in various diseases, conferring group O a protective factor and group A a risk factor. During the SARS CoV-1 outbreak, it was suggested that blood type appeared to have a relationship with the risk of infection; it is believed that in the COVID-19 pandemic, ABO blood types, are relevant for certain outcomes. Objective: to determine the association between blood types and death, admission to intensive care and risk of intubation among COVID-19 patients. Materials and methods: a systematic review and meta-analysis from MEDIA, EMBASSY, SCOPUS, Latindex and LILACS databases, identifying the abovementioned outcomes among COVID 19 patients, conducted between January 2020 and March 2021. Results: 16 studies were included, most of them retrospective multicenter studies. It was evidenced that patients with blood group A have a higher mortality risk (OR 1.08:1.01-0.17). There was no statistically significant difference between blood groups for ICU admission. AB was found to be a risk factor for intubation (OR 1.42: CI95% 1.02 -1.96), while type A had a protective effect against this outcome (OR 0.84: CI95% 0.73 -0.97). Conclusions: there is evidence on a relationship between blood groups and outcomes in SARS CoV-2 infection. Prospective studies evaluating ABO and Rh(D) blood types and specific outcomes, are required.

Condiciones de vulnerabilidad, sociodemográficas y clínicas de la población diagnosticada con COVID-19 incluida en la estrategia de atención primaria en salud del municipio de Mosquera 2020 / Vulnerability, socio-demographic and clinical conditions of the Covid 19 affected population included in the 2020 primary health care strategy of the municipality of Mosquera

Introducción: en diciembre de 2019 la Comisión Municipal de Salud y Sanidad de Wuhan, China, reportó 27 casos de neumonía de causa desconocida llegando a Colombia. Los municipios implementaron estrategias para minimizar contagios como lo hizo Mosquera, Cundinamarca, sin embargo no se conoció la caracterización de la población afectada por COVID-19. Objetivo: analizar las condiciones de vulnerabilidad, sociodemográficas y clínicas de la población con COVID-19 incluida en la estrategia de atención primaria en salud. Metodología: estudio cuantitativo, observacional, de corte transversal, retrospectivo, con análisis de condiciones de vulnerabilidad, características sociodemográficas y clínicas de la población diagnosticada con COVID-19 del municipio de Mosquera en la época de la pandemia durante el año 2020. Resultados: 4.610 casos positivos para COVID-19, 99% en la zona urbana, edad 5% entre 0-11 años, 4% entre 12-17 años, 21% entre 18-28 años, 59% entre 29-59 años y 12% más de 60 años. La población más afectada fueron adultos 58%, régimen contributivo 82% y mujeres 56%. Del total 73% fue sintomático, 92% no requirió hospitalización y la mayoría de los positivos tuvieron entre 2 a 3 contactos estrechos (29%), de los cuales 82% fue asintomático. Conclusiones: la pandemia por COVID-19 ha tenido impactos negativos desproporcionados en poblaciones desfavorecidas y desatendidas en todo el mundo. La desigualdad y los determinantes sociales relacionados que afectan a ciertos grupos, están en relación directamente con los resultados de salud adversos de las poblaciones vulnerables durante la pandemia.

Introduction: as of December 2019, the Municipal Health Commission of Wuhan, China, reported 27 cases of pneumonia of unknown etiology coming to Colombia. The municipalities implemented strategies to minimize contagions as did Mosquera, Cundinamarca. However, information describing the characteristics of the COVID-19 affected population was limited. Objective: to analyze the vulnerability, sociodemographic and clinical conditions of the population with COVID-19 included in the primary health care strategy. Methodology: quantitative, observational, cross-sectional, retrospective study, analyzing the vulnerability, sociodemographic and clinical conditions of COVID-19 confirmed cases reported in the municipality of Mosquera during the 2020 phase of the pandemic. Results: 4,610 COVID-19 positive cases were included, of which 99% lived in the urban area. Five percent were between 0 -11 years old, 4% between 12 -17, 21% between 18-28, 59% between 29-59 and 12% over 60. The most affected populations were adults (58%), people covered by the contributory health regime (82%) and women (56%). Of the total number of participants, 73% were symptomatic, 92% did not require hospital admission and most of the positive cases reported 2 to 3 close contacts (29%), of which 82% were asymptomatic. Conclusions: the COVID-19 pandemic has had disproportionate negative impacts on disadvantaged and underserved populations worldwide. Inequality and social determinants affecting certain groups are directly related to adverse health outcomes among vulnerable populations during the pandemic.

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique - A systematic review.

BACKGROUND/OBJECTIVES: Prenatal myelomeningocele (MMC) repair has been shown to improve neurological outcomes. It has been suggested that decreases in the hysterotomy diameter during surgery can improve perinatal outcomes without altering neurologic outcomes. The objective of this study is to describe and compare the main maternal and fetal outcomes of fetuses undergoing open surgery for MMC repair, through the different modifications (standard-classical, mini-hysterotomy, and microneurosurgery). DATA SOURCE: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, SciELO, LILACS, PROSPERO. RESULTS: From a total of 112 studies, seven case series were selected including 399 fetuses with open fetal surgery, five studies using the classical technique (n = 181), one with mini-hysterotomy (n = 176), and one with the microneurosurgery technique (n = 42). The mini-hysterotomy and microneurosurgery techniques presented a lower risk of preterm delivery (21.4% and 30%, respectively) compared to the classic technique (47.3%), premature rupture of membranes (78%, 62%, and 72.5 %, respectively), oligohydramnios (0% and 72.5%, respectively), dehiscence of hysterotomy, maintaining the same frequency of Chiari reversion (78%, 62%, and 72.5%, respectively), postnatal correction requirement (0%, 4.8%, and 5.8%, respectively), and lower frequency of requirement for a ventriculoperitoneal shunt placement (13.0%, 7.5%, and 29.1%, respectively). CONCLUSION: The least invasive techniques (minihysterotomy-microneurosurgery) are possible and reproduceable, as they are associated with better maternal and perinatal outcomes.

Banco de leche humana (BLH): una estrategia de apoyo para la atención de neonatos / Human milk bank (HMB): a support strategy for newborn care

Introducción: la lactancia materna ha demostrado grandes beneficios para el recién nacido. En vista de que hay factores que afectan la correcta lactancia, en 2007 se crearon los bancos de leche materna y Colombia hace parte de esta iniciativa en pro de la niñez. Objetivo: identificar la utilización del banco de leche humana (BLH) de la ESE Hospital San Rafael de Fusagasugá, Colombia entre julio 2012 y junio 2016. Metodología: estudio descriptivo de corte transversal, con muestra de 1282 nacidos en el período que utilizaron el BLH. Resultados y discusión: entre los factores que llevaron al uso del BLH en estos menores están la baja producción de leche en la madre en 53,7%, cirugía materna 3,5%, mamá con bajo nivel cognitivo 0,2%, succión leve o pobre en 9,6%, madre ausente 0,4%, recién nacido que requirió hospitalización 4,6%, pezón invertido o plano 2,5% y labio leporino 0,5%. Conclusión: se pudo determinar que 22,7% de los niños que nacieron en el municipio necesitaron el servicio del banco de leche materna, logrando visualizar las bondades del mismo, brindando la oportunidad para que lo pudieran utilizar en la misma zona de nacimiento sin necesidad de desplazarse, evitando las subsiguientes consecuencias que ello desencadena en la familia y el recién nacido.

Introduction: breastfeeding has shown great benefits for the newborn. In view of the fact that there are factors affecting proper breastfeeding, nursing mothers ́ milk banks were created in 2007 and Colombia is part of this initiative on behalf of children. Objective: to identify the use of the human milk bank (HMB) at ESE Hospital San Rafael in Fusagasugá, Colombia between July 2012 and June 2017. Methodology: descriptive cross-sectional study, with a sample of 1282 newborns delivered in said period using HMB. Results: among the factors that led to the use of HMB in these children are the mother ́s low milk production in 53.7%, maternal surgery 3.5%, mother with low cognitive level 0.2%, mild or poor suction 9.6%, absent mother 0.4%, newborn requiring hospitalization 4.6%, inverted or flat nipple 2.5% and cleft lip 0.5%. Conclusion: it could be determined that 22.7% of the children born in the municipality needed the service of the mother ́s milk bank, managing to visualize the benefits of it, providing the opportunity for them to use it in the same area of birth without having to move, avoiding the subsequent consequences that this triggers in the family and newborn.

Valoración de la comunicación ambiental en las instituciones de salud de la cámara sectorial de salud de la ANDI ­ Colombia / Evaluation of environmental communication in healthcare institutions registered in the andi health sector chamber of Colombia

La comunicación desde el enfoque organizacional se conecta con la responsabilidad social corporativa, entendida como el reconocimiento de los impactos que genera la empresa, creando con ello valor a sus accionistas y a la sociedad a través del empleo de buenas prácticas, en especial las sociales y ambientales. Objetivo: evaluar el desarrollo de la comunicación ambiental en las instituciones prestadoras de servicios de salud vinculadas a la Cámara Sectorial de Salud de la ANDI- Colombia. Metodología: estudio descriptivo donde se realizó análisis de contenido de la comunicación ambiental y su socialización en el direccionamiento estratégico y táctico vinculando lo ambiental, los componentes de intervención ambiental operativa de las 31 instituciones valoradas, teniendo en cuenta documentos oficiales, publicaciones, páginas web, informes de gestión y sostenibilidad. Resultados: se evidenció que 22,58% de las instituciones prestadoras de salud (IPS) comunican e incorporaron en su direccionamiento estratégico de manera explícita el concepto ambiental como parte de su estrategia corporativa; se encontró que el 35,48% de las IPS reveló en su comunicación la vinculación del área de gestión ambiental en su estructura organizacional. Conclusión: es de gran importancia la comunicación ambiental en las organizaciones de salud a través de políticas, programas y acciones, socializadas de manera efectiva, adicionalmente esta información divulgada a los diversos grupos de interés no solo quede en la tendencia de generar informes de sostenibilidad con reportes de iniciativas operativas de lo ambiental.

Communication in organizations is connected to corporate social responsibility, defined as the recognition of the impacts generated by the company, thus creating value to its shareholders and society through the use of good practices, especially social and environmental practices. Objective: to evaluate the development of environmental communication in healthcare institutions registered in the ANDI Health Sector Chamber of Colombia. Methodology: a descriptive study including the analysis of the content of environmental communication and its socialization in the strategic and tactical direction involving environmental operations, the components of the operational environmental intervention of the 31 institutions undergoing evaluation, through official documents, publications, websites and management and sustainability reports. Results: it was evidenced that 22.58% of the healthcare institutions (IPS) explicitly communicate and incorporate the environmental concept in their strategic direction as part of their corporate strategy; in addition 35.48% of IPSs revealed the involvement of the environmental management area in their organizational structure, in their communication. Conclusion: environmental communication socialized in an effective manner, through policies, programs and actions, play a very important role in health care organizations. Additionally the information, disclosed to the diverse groups of interest, will not only remain in the tendency to generate sustainability reports describing environmental operational initiatives.

Criptococosis diseminada en paciente positivo para COVID-19 / Disseminated cryptococcosis in a patient with COVID-19

Paciente de 59 años quien ingresa al servicio de urgencias con un cuadro de 2 días de evolución de cefalea holocraneana de intensidad moderada 7/10, picos febriles no cuantificados, disnea grado III, adinamia, hiporexia, ageusia y tos no productiva, refiriendo contacto estrecho con hermana confirmada para infección por COVID-19, por lo que se investiga antígeno para COVID-19 con resultado positivo. Se confirma la existencia del síndrome respiratorio agudo grave (SARS-CoV-2) con coinfección por Cryptococus neoformans. El manejo con corticoide sistémico genera un importante inmunocompromiso que predispone al paciente a coinfecciones por gérmenes comunes y oportunistas, como lo es la infección por Cryptococcus neoformans/ Gatti. En este caso la infección por COVID-19 y el desarrollo de SARS-CoV-2 fue la etiología de la infección micótica por cryptococo.

Here, we report a case of a 59-year-old patient with a 2-day history of moderate intensity (7/10) holocranial headache, unquantified febrile peaks, grade III dyspnea, adynamia, hyporexia, ageusia and nonproductive cough admitted to the emergency department. He referred close contact to a sister with confirmed COVID-19. His COVID-19 antigen test results were positive. Severe acute respiratory syndrome (SARS-CoV-2) associated with Cryptococcus neoformans infection was confirmed. The use of systemic corticosteroid therapy leads to immunocompromise and predisposes the patient to common and opportunistic infections such as Cryptococcus neoformans and Cryptococcus gatiii infection. In this case COVID-19 infection and the development of SARS-CoV-2 was the etiology of the Cryptococcus fungal infection.

Utilidad del [99m] Tc TRODAT-1 en el diagnóstico de la enfermedad de Parkinson / Utility of (99m) Tc TRODAT-1 imaging in diagnosing Parkinson's disease

Propósito de la revisión: la enfermedad de Parkinson (EP) es un trastorno degenerativo caracterizado clínicamente por presentar temblor en reposo, rigidez y bradicinesia. El propósito es determinar la utilidad de la molécula TRODAT-1 en el diagnóstico de la EP. Metodología: se realizó una búsqueda en las bases de datos: PUBMED, COCHRANE , MEDLINE , LILACS y SCIE LO en un periodo de 10 años desde enero de 1998 a enero de 2008. Se obtuvieron 26 artículos, éstos se analizaron y se seleccionaron 10, de los cuales sólo seis respondían a las necesidades del estudio, de acuerdo con los criterios de inclusión. De los seis artículos analizados, cuatro fueron clasificados como evidencia grado (+) y los dos restantes evidencia grado (-) de acuerdo con las guías NI CE. Todos los artículos revisados reportan una disminución importante en la captación del TRODAT-1 a nivel estriatal, su utilidad en el diagnóstico de EP en estadios tempranos, bajo costo y seguridad. Sólo tres reportan valores de sensibilidad y especificidad, pero su nivel de calidad no permite hacer una comparación de los mismos. Conclusiones: se propone realizar estudios de prueba diagnóstica comparados con el diagnóstico clínico de la enfermedad, que tengan un acuerdo en la forma de plantear las mediciones semicuantitativas de las unidades de captación utilizando las mismas fórmulas para hacerlos comparables (Acta Med Colomb 2010; 35: 119-125).

Purpose: Parkinson disease (PD) is a degenerative disorder. The clinical symptoms of this disease are resting tremor, rigidity and bradykinesia. The purpose of this literature review is to determine the utility of TRODAT -1 in the diagnosis of PD. A search covered PUBMED, COCHRANE, MEDLINE, LILACS and SCIELO databases, between January 1998 and January 2008. Study selection: twenty six articles were obtained with their respective abstracts. After the first review, ten of them were chosen and only six of them met the inclusion criteria. Four articles were classified as grade evidence (+) and two as grade evidence (-) according to NICE guides. All the articles reviewed report significantly decreased striatal uptake of TRODAT-1 in early PD patients, suggesting that this is a useful, safe, and inexpensive tool in the diagnosis of early PD. It was not possible to perform a meta-analysis with the chosen articles because only three of them reported sensitivity and specificity, and each of these used different criteria for their semi-quantitative analyses. This variability makes comparison of the semiquantitative uptake criteria impossible. Conclusions: establishment of a universal technique for quantitation of TRODAT-1 uptake is necessary in order to make meta-analysis viable and allow comparison of the usefulness of this agent among large numbers of patients and multiple populations (Acta Med Colomb 2010; 35: 119-125).