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Objetivos: determinar la seguridad al referir pacientes triage 4 y 5 desde un servicio de urgencias a centros de atención primaria, conociendo su disposición final y las posibles complicaciones por esta estrategia. Métodos: estudio observacional retrospectivo de 333 pacientes clasificados como triage 4 y 5 que fueron referidos desde el servicio de urgencias a un centro de atención primaria en febrero 2019. A través de la aseguradora se obtuvo la información sobre si asistieron o no a dicha cita programada y la conclusión final de la consulta. Resultados: 52 pacientes (15,6%) no asistieron a la cita programada sin que esto causara alguna complicación para su salud. De los 281 que sí asistieron, 1,4% fueron referidos a valoración especializada urgente sin que requirieran ingreso hospitalario y 98,6% fueron atendidos y manejados en forma ambulatoria por el médico de atención primaria. Se encontraron diferencias entre los no asistentes a la atención primaria en los subgrupos de edad entre 3 a 17 (p=0,009) y 18 a 37 años (p=0,04). Conclusiones: la estrategia de referencia de pacientes clasificados en 4 o 5 desde un servicio de urgencias a centros de atención primaria es segura, incluso si estos no asisten a la cita programada
Objectives: to determine the safety of referral of triage category 4 and 5 patients from the emergency room to primary care centers, aware of their final disposition and the potential complications of this strategy. Methods: a retrospective observational study of 333 triage category 4 and 5 patients who were referred from the emergency room to a primary care center in February 2019. Information on scheduled appointment attendance, and final consultation diagnosis was obtained from the insurer. Results: 52 patients (15.6%) failed to attend their scheduled appointment presenting no health complications. Of the 281 who attended their clinic appointment, 1.4% were referred for urgent specialist consultation without requiring hospital admission. The primary care physician provided care and management to 98.6% of studied patients on an outpatient basis. Differences were found among those failing to attend primary care in the 3 to 17 (p=0.009) and 18 to 37 years (p=0.04) age subgroups. Conclusions: triage category 4 and 5 patients referral strategy from the emergency service to primary care centers is safe, even if patients fail to attend their scheduled appointment
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HumanosRESUMEN
BACKGROUND: Urticaria is one of the most common causes of emergency room visits. It is defined as an acute inflammatory dermatosis, characterized by localized degranulation of mast cells, with consequent dermal microvascular and formation of edematous and pruritic plaques called hives. Urticaria affects the skin and tissues of the superficial mucosa. Sometimes it is accompanied by angioedema, which is characterized by deeper edema of the dermis and subcutaneous cellular tissue known as the urticarial-angioedema syndrome. About 15%-25% of the general population has suffered at least one type of urticaria at some point during their lifetime and hyperpermeability estimated at 7.6%-16% and has experienced acute urticaria that is usually self-limited and spontaneously resolves without requiring medical attention. CASE SUMMARY: We present the case of a young male patient who was referred to our department with a clinical picture of 4 mo of pruritus associated with hives of variable sizes, irregular borders, with interlesional confluence, that were non-painful, without involvement of the palms and soles of the feet but with a tendency to progression in a generalized manner. He had multiple emergency room visits and poor response to antihistamines and systemic corticosteroids. Imaging studies demonstrated nodules in the lower lingula segment, at the level of the greater fissure and in the anterior contour of the left anterior basal segment associated with parahiliar adenopathies in the absence of findings suggestive of infectious or autoimmune etiology. Segmental lobectomy was performed by thoracoscopy with resection of a lung nodule in the lingula and biopsy of the para-aortic mediastinal ganglion. The histopathological report showed the presence of poorly differentiated invasive adenocarcinoma with a solid morphological and acinar pattern with immunohistochemical description of lung tissue that expresses strong positive and diffuse reaction for thyroid transcription factor 1 (TTF-1) with negativity to P40 for a histopathological diagnosis of malignant epithelial neoplasia with expression of infiltrating adenocarcinoma. Spontaneous chronic urticaria is considered possibly secondary to lung adenocarcinoma. CONCLUSION: Chronic spontaneous urticaria is considered a paraneoplastic dermatosis with a controversial association in the literature. In the presented case, a young patient presented with chronic refractory urticaria and after an exhaustive clinical work-up was found to have a diagnosis of poorly differentiated lung adenocarcinoma with high expression of TTF-1. According to the Curth criteria, the urticaria presented by the patient is related to the oncological diagnosis. In addition, the high expression of TTF-1 documented in this case could be acting as an autoantigen that would cause chronic spontaneous urticaria. Further research evaluating a causal relationship between the TFF-1 protein and urticaria in lung cancer is needed.
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BACKGROUND: The National Examination of Knowledge in Medicine establishes the knowledge profile (PdC) a physician must possess to practice public medicine in Chile. However, no study has evaluated the perception of dermatology training regarding the acquisition of the minimum competencies required. This study described and compared the impressions of the dermatology training received by the University of Chile (UCh) graduates with graduates from other national and international faculties of medicine. MATERIALS AND METHODS: This was a cross-sectional study, based on a single survey model, applied via E-mail to registered physicians in an online database, with emphasis on UCh medicine graduates, from the generations 2012 to 2016. The data were collected anonymously, tabulated, and analyzed in MINITAB. RESULTS: From 908 UCh graduates, 141 surveys were answered (15.5%). Nine of 10 physicians considered "important" to obtain knowledge in dermatology. About 68.8% found the information they received was adequate. When comparing UCh graduates with other Chilean universities, UCh graduates had a slightly better impression of their training. When comparing Chilean versus foreign graduates, the latter presented a better perception of their preparation in cutaneous pathology. CONCLUSION: UCh graduates were satisfied with their dermatological training at the undergraduate level and felt better prepared than colleagues from other Chilean universities when facing cutaneous pathologies.
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Academic stress is an emotion that students experience during their time at the university, sometimes causing physical and mental health effects. Because of the COVID-19 pandemic, universities worldwide have left the classroom to provide the method of teaching virtually, generating challenges, adaptations, and more stress in students. In this pilot study, a methodology for academic stress detection in engineering students at the University of Pamplona (Colombia) is proposed by developing and implementing an artificial electronic nose system and the galvanic skin response. For the study, the student's stress state and characteristics were taken into account to make the data analysis where a set of measurements were acquired when the students were presenting a virtual exam. Likewise, for the non-stress state, a set of measurements were obtained in a relaxation state after the exam date. To carry out the pre-processing and data processing from the measurements obtained previously by both systems, a set of algorithms developed in Python software were used to perform the data analysis. Linear Discriminant Analysis (LDA), K-Nearest Neighbors (K-NN), and Support Vector Machine (SVM) classification methods were applied for the data classification, where a 96 % success rate of classification was obtained with the E-nose, and 100 % classification was achieved by using the Galvanic Skin Response.
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Resumen Introducción: Las secuencias de difusión en resonancia magnética, incluido el coeficiente de difusión aparente (ADC), representan una herramienta fundamental para el radiólogo en el diagnóstico clínico. Sin embargo, no existe estandarización para las medidas entre los límites normales o un rango de valores normales del ADC. Objetivo: Determinar valores normales del ADC en el tejido encefálico para la población clínica y radiológicamente sana. Métodos: Estudio de corte transversal sobre datos retrospectivos, se midieron valores del ADC para 21 regiones encefálicas (sustancia gris frontal, parietal y temporal, sustancia blanca frontal y parietal, núcleo caudado, putamen, tálamo, cápsula interna, hemisferios cerebelosos bilateralmente y puente del tallo cerebral) en 90 sujetos clínica y radiológicamente sanos, en dos clínicas privadas de Bogotá. Resultados: Valores normales del ADC, en población clínica y radiológicamente sana, en 21 territorios encefálicos, análisis comparativo de los resultados según el sexo y edad de los pacientes, y correlación entre las mediciones realizadas por dos investigadores. Conclusiones: Los hallazgos sirven como referencia para la población colombiana y latinoamericana normal, establecen un punto de comparación para la evaluación de patologías intracraneanas, y abre la posibilidad a desarrollar nuevos proyectos de investigación que busquen determinar valores de ADC en población enferma.
Abstract Introduction: The diffusion sequences in magnetic resonance, including the apparent diffusion coefficient (ADC), represent a fundamental tool for the radiologist in the clinical diagnosis. However, there is no standardization for measurements between normal limits or a range of normal ADC values. Objective: To determine normal ADC values in the brain tissue for the clinical and radiologically healthy population. Methods: Cross-sectional study on retrospective data, ADC values were measured for 21 encephalic regions (frontal gray, parietal and temporal substance, frontal and parietal white matter, caudate nucleus, putamen, thalamus, internal capsule, cerebellar hemispheres bilaterally and bridge of the brainstem) in 90 clinically and radiologically healthy subjects, in two private clinics in Bogotá. Results: Normal ADC values, in a clinical and radiologically healthy population, in 21 encephalic territories, comparative analysis of the results according to the sex and age of the patients, and correlation between the measurements made by two researchers. Conclusions: The findings serve as a reference for the Colombian and normal Latin American population, establish a point of comparison for the evaluation of intracranial pathologies, and open the possibility to develop new research projects that seek to determine ADC values in sick population.
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ABSTRACT Introduction: Histoplasmosis is an opportunistic granulomatous fungal infection. Peritoneal histoplasmosis (PH) is a rare form of disseminated histoplasmosis (DH). Case description: A 44-year-old male patient with history of HIV infection, systemic lupus erythematosus with lupus nephritis, and chronic kidney disease on peritoneal dialysis, presented with recurrent ascites without clear etiology in the serial study of ascitic fluid. Contrast computed tomography of the abdomen showed a nonspecific peritoneal nodule, for which laparoscopy and biopsy were performed, identifying Histoplasma capsulatum infection. The subject received 15 days of in-hospital treatment with amphotericin B deoxycholate with good evolution, no recurrence of ascites, and indefinite outpatient management with itraconazole. Discussion: The first case of PH was described in 1970 but this is the first case reported in Colombia. Most cases of PH have been associated with peritoneal dialysis. Its diagnosis is based on the study of ascitic fluid and its treatment follows the guidelines of other forms DH. Conclusions: PH is a rare entity that requires high clinical suspicion, especially in immunocompromised patients.
RESUMEN Introducción. La histoplasmosis es una infección micótica oportunista granulomatosa. La histoplasmosis peritoneal (HP) es una forma rara de histoplasmosis diseminada (HD). Presentación del caso. Paciente masculino de 44 años con antecedentes de infección por VIH, lupus eritematoso sistémico con nefropatia lúpica y enfermedad renal crónica en diálisis peritoneal, quien presenta ascitis recurrente sin etiología en estudio seriado de líquido ascítico. Se realiza tomografía de abdomen contrastada que evidencia lesión peritoneal inespecífica, luego estudiada con laparoscopia y biopsia, documentándose infección por Histoplasma capsulatum. El sujeto recibe 15 días de tratamiento intrahospitalario con anfotericina B deoxicolato con buena evolución, sin recurrencia de ascitis, y continúa con manejo ambulatorio indefinido con itraconazol. Discusión. El primer caso de HP se describe en 1970 y el primero en Colombia es el que aquí se presenta. La mayoría de los casos de este tipo de infección se han asociado a diálisis peritoneal, su diagnóstico se basa en el estudio de líquido ascítico y su tratamiento depende de los lineamientos de otras formas de HD. Conclusiones. La HP es una entidad rara que requiere alta sospecha clínica, principalmente en pacientes con inmunocompromiso.