Decellularization and In Vivo Recellularization of Abdominal Porcine Fascial Tissue.

BACKGROUND: Tissue decellularization has evolved as a promising approach for tissue engineering applications. METHODS: In this study, we harvested fascial tissue from porcine anterior abdominal wall and the samples were decellularized with a combination of agents such as Triton X-100, trypsin and DNAase. Afterwards, we evaluated cell removal by histological analysis and DNA quantification. Mechanical functionality was evaluated by applying a range of hydrostatic pressures. A sample of decellularized fascia was transplanted into a rabbit and after 15 days a biopsy of this tissue was examined; the animal was observed during 6 months after surgery. RESULTS: The extracellular matrix was retained with a complete decellularization as evidenced by histologic examination. The DNA content was significantly reduced. The scaffold preserved its tensile mechanical properties. The graft was incorporated into a full thickness defect made in the rabbit abdominal wall. This tissue was infiltrated by granulation and inflammatory cells and the histologic structure was preserved 15 days after surgery. The animal did not develop hernias, infections or other complications, after a 6-months of follow up. CONCLUSIONS: The protocol of decellularization of fascial tissue employed in this study proved to be efficient. The mechanical test demonstrated that the samples were not damaged and maintained its physical characteristics; clinical evolution of the rabbit, recipient of the decellularized fascia, demonstrated that the graft was effective as a replacement of native tissue.In conclusion, a biological scaffold derived from porcine fascial tissue may be a suitable candidate for tissue engineering applications.

Evaluación microbiológica de dispositivos móviles en personal quirúrgico de una institución de salud, Pereira, Colombia, 2018 / Microbiological analysis of mobile devices of surgical personnel working at a health care institution in Pereira, Colombia, 2018

Introducción: El uso del teléfono celular se ha vuelto común en áreas del hospital, incluida la sala de operaciones, aumentando el riesgo de contaminación cruzada y las altas tasas de infecciones del sitio quirúrgico. Objetivo: Determinar la contaminación microbiana en dispositivos móviles del personal quirúrgico de una Institución de Salud de Pereira, Colombia en el primer semestre del año 2018. Materiales y métodos: Estudio descriptivo observacional, transversal. Se tomaron 10 dispositivos móviles del personal del área de quirófano al azar y a cada uno se le realizó frotis con hisopo estéril al estuche o cobertura del celular. Las muestras se transportaron en tubos de ensayo con agua peptonada al 1% hasta el momento de la siembra; las muestras se analizaron por técnica microbiológica recuento en placa profunda. Resultados: En las muestras se encontró un promedio de 93 UFC (Unidades Formadoras de Colonias) de mesófilos aerobios, 13 UFC de coliformes totales, 22 UFC de mohos y levaduras. Conclusión: El análisis microbiológico permitió detectar la presencia de elevadas cantidades de unidades formadoras de colonias que podrían contribuir de manera significativa a incrementar las tasas en infecciones asociadas a la atención en salud.

Introduction: Cell phone use in hospital areas such as surgery rooms has become a common practice, which has increased both the risk of cross-contamination and the rates of surgical site infections. Objective: To determine microbial contamination of mobile devices belonging to surgical staff of a Health Care Institution in Pereira, Colombia during the first semester of 2018. Materials and methods: An observational, cross-sectional, descriptive study was conducted with a sample of ten mobile devices randomly chosen from health personnel working in the surgical room. Surface samples were collected from cell phone cases and bags using sterile swabs that were were kept in a 1% peptone salt solution until a deep plate count assay was performed on them. Results: The plate count confirmed the presence of mesophilic aerobes (93 CFUs), total coliforms (13 CFUs) as well as yeasts and molds (22 CFUs). Conclusion: The microbiological analysis showed elevated numbers of colony-forming units that could significantly increase the rates of infections associated with health care settings.

A propósito del artículo: "Conocimiento y uso de método anticonceptivo de emergencia en estudiantes universitarios, Pereira, Colombia" / A propósito del artículo: "Conocimiento y uso de método anticonceptivo de emergencia en estudiantes universitarios, Pereira, Colombia"

A propósito del artículo: "Conocimiento y uso de método anticonceptivo de emergencia en estudiantes universitarios, Pereira, Colombia"

Conocimiento y uso de método anticonceptivo de emergencia en estudiantes universitarios, Pereira, Colombia / Awareness and use of emergency contraception methods among university students in Pereira, Colombia

Resumen Introducción: Los métodos anticonceptivos de emergencia o también llamados contracepción poscoital, es una de las alternativas que pueden ser utilizadas para evitar un embarazo no deseado en mujeres que han tenido relaciones sexuales sin protección, hasta 72 horas después de la relación. Objetivo: Establecer el nivel de conocimiento y el uso de los métodos anticonceptivos de emergencia utilizados en estudiantes universitarios. Materiales y métodos: Estudio observacional, descriptivo y transversal. Se incluyeron estudiantes de 15 a 25 años de una Institución de Educación Superior en el Municipio de Pereira, Colombia con vida sexual activa. Con un total de 127 estudiantes donde se incluyeron variables sociodemográficas de conocimiento y uso de métodos. Resultados: Se encuestaron 127 estudiantes donde la mediana en la edad fue de 19 años en sexo femenino con un rango intercuartílico de 3 y el sexo masculino presento una mediana de 21 años con un rango intercuartílico de 5. El condón fue el método más utilizado por los encuestados con un 35,4%, seguido de las píldoras con un 26,8%. Conclusiones: El método de elección fue el condón y existe alta prevalencia de consumo de métodos anticonceptivos de emergencia, con desconocimiento frente a su uso.

Abstract Introduction: The emergency contraceptive method, also known as post-coital contraception, is one of the alternatives that can be used to avoid an unwanted pregnancy up to 72 hours after a woman has had unprotected sexual intercourse. Objective: To establish the level of awareness and practice of emergency contraceptive methods among university students. Materials and methods: An observational, descriptive and cross-sectional study. The sample included 15- to 25-year-old students of a Higher Education Institution from the Municipality of Pereira- Colombia, with an active sexual life. The study included sociodemographic variables with respect to awareness and practice of contraceptive methods. Results: 127 students were surveyed, where the median age for female students was 19 years (IQR of 3), whereas male students showed a median age of 21 years old (IQR of 5). The condom was the most commonly used contraceptive method, used by 35.4% of the students, followed by contraceptive pills, which was used by 26.8% of students. Conclusions: The birth control method of choice was condom and although there is a high prevalence of consumption of emergency contraceptive methods, students show little awareness of their use.

Enfermedad de Ménétrier en niños: reporte de dos casos / Two cases of Menétrier's disease in children

Resumen Se presentan 2 casos de enfermedad de Ménétrier (EM) remitidos a nuestra institución por síndrome edematoso. Esta enfermedad de poca prevalencia es una gastropatía hipertrófica perdedora de proteínas que en la mayoría de los casos es de causa desconocida, aunque se ha asociado con procesos infecciosos. Se caracteriza por edema, hipoproteinemia, hipoalbuminemia y, en la infancia, es de carácter benigno y autolimitado.

Abstract We present two cases of Menétrier's Disease (MS) referred to our institution due to edema. The prevalence of this disease is low. It is a hypertrophic gastropathy which causes loss of proteins and which has unknown causes in the majority of cases although it has been associated with infectious processes. It is characterized by edema, hypoproteinemia, hypoalbuminemia. In childhood it is benign and self-limited.

[Morbidity of Chronic Obstructive Pulmonary Disease in Colombia. Results of the study SANEPOC-2] / Morbilidad de la Enfermedad Pulmonar Obstructiva Crónica en Colombia. Resultados del Estudio SANEPOC-2.

Objective: to relate the morbidities of patients belonging to the COPD program of a health institution in Anserma, Caldas (Colombia). Material and Methods: a descriptive study was presented with a sample of 51 patients who underwent exploratory spirometry, the findings were contrasted with the main commodities reported by the patients or the Medical Record through descriptive and inferential statistics. Results: 50% of the evaluated population had at least one recorded comorbidity; the main morbidity found was Arterial Hypertension followed by Chronic Kidney Disease; an associated behavior was found between the GOLD classification and the presence of symptoms with non-statistically significant values; no statistically significant association was found between comorbidities and spirometric values. Conclusions: new research is needed that clearly values causality in the Colombian population.

OBJETIVO: relacionar las morbilidades de los pacientes pertenecientes al programa de EPOC de una institución de salud del municipio de Anserma, Caldas (Colombia). MATERIAL Y MÉTODOS: estudio descriptivo de 51 pacientes a quienes les fueron tomadas espirometrías exploratorias, los hallazgos fueron contrastados con las principales comorbilidades registradas en la Historia Clínica a través de estadística descriptiva e inferencial. RESULTADOS: 50% presentaron al menos una comorbilidad registrada, principalmente la Hipertensión Arterial seguida de la Enfermedad Renal Crónica, se encontró un comportamiento asociado entre la clasificación GOLD y la presencia de síntomas con valores no estadísticamente significativos; no se encontró asociación estadísticamente significativa entre las comorbilidades y los valores espirométricos. CONCLUSIONES: se hacen necesarias nuevas investigaciones que valoren de forma clara la causalidad en la población colombiana.

Hyperbaric Oxygen Increases Stem Cell Proliferation, Angiogenesis and Wound-Healing Ability of WJ-MSCs in Diabetic Mice.

Hyperbaric oxygen therapy (HBOT) is effective for the medical treatment of diverse diseases, infections, and tissue injury. In fact, in recent years there is growing evidence on the beneficial effect of HBOT on non-healing ischemic wounds. However, there is still yet discussion on how this treatment could benefit from combination with regenerative medicine strategies. Here we analyzed the effects of HBOT on three specific aspects of tissue growth, maintenance, and regeneration: (i) modulation of adult rodent (Mus musculus) intestinal stem cell turnover rates; (ii) angiogenesis dynamics during the development of the chorio-allantoic membrane (CAM) in Gallus gallus embryos; (iii) and wound-healing in a spontaneous type II diabetic mouse model with a low capacity to regenerate skin. To analyze these aspects of tissue growth, maintenance, and regeneration, we used HBOT alone or in combination with cellular therapy. Specifically, Wharton Jelly Mesenchymal Stem cells (WJ-MSC) were embedded in a commercial collagen-scaffold. HBOT did not affect the metabolic rate of adult mice nor of chicken embryos. Notwithstanding, HBOT modified the proliferation rate of stem cells in the mice small intestinal crypts, increased angiogenesis in the CAM, and improved wound-healing and tissue repair in diabetic mice. Moreover, our study demonstrates that combining stem cell therapy and HBOT has a collaborative effect on wound-healing. In summary, our data underscore the importance of oxygen tension as a regulator of stem cell biology and support the potential use of oxygenation in clinical treatments.

Papilomatosis biliar: presentación de un caso con trasplante hepático / Biliary Papillomatosis: A Case Report

Las neoplasias papilares intraductales de los ductos biliares (NPIB), tradicionalmente llamadas "papilomatosis biliar", son raras y se caracterizan por una apariencia macroscópica papilar y, en muchos casos, secreción visible de mucina. Ocurren con mayor frecuencia en pacientes con antecedente de litiasis biliar. Presentamos el caso de una paciente de 47 años de edad, a quien se le realizó un trasplante hepático por cirrosis biliar secundaria a litiasis intra y extrahepática, quien presentó durante muchos años episodios de colangitis recurrente, los cuales fueron manejados entre otros, con una anastomosis bilioentérica. En los estudios de imagen previos al trasplante, además de los cambios por cirrosis, se encontró una importante dilatación de la vía biliar intra y extrahepática, con cálculos de la vía biliar. La patología del explante mostró papilomatosis de la vía biliar. La paciente desarrolló recurrencia temprana en la vía biliar extrahepática nativa. Ha recibido manejo conservador hasta este momento.

Intraductal papillary neoplasias of the bile ducts (IPNB), traditionally called "biliary papillomatosis", is a rare entity characterized by macroscopic papillary appearance and in many cases visible secretion of mucin. It occurs more frequently in patients with history of biliary lithiasis. We present the case of a 47 years old patient who underwent liver transplantation due to biliary cirrhosis secondary to intra- and extrahepatic lithiasis, which suffered for many years episodes of recurrent cholangitis managed among others, with a bilioenteric anastomosis. At pre-transplant imaging studies, in addition to changes due to cirrhosis, a significant intra- and extra- hepatic biliary tract dilation was found with multiple calculi within. Pathology results reported the presence of bile duct papillomatosis. The patient developed early recurrence into the native extrahepatic bile duct. She has so far received conservative management.

Structural and functional identification of vasculogenic mimicry in vitro.

Vasculogenic mimicry (VM) describes a process by which cancer cells establish an alternative perfusion pathway in an endothelial cell-free manner. Despite its strong correlation with reduced patient survival, controversy still surrounds the existence of an in vitro model of VM. Furthermore, many studies that claim to demonstrate VM fail to provide solid evidence of true hollow channels, raising concerns as to whether actual VM is actually being examined. Herein, we provide a standardized in vitro assay that recreates the formation of functional hollow channels using ovarian cancer cell lines, cancer spheres and primary cultures derived from ovarian cancer ascites. X-ray microtomography 3D-reconstruction, fluorescence confocal microscopy and dye microinjection conclusively confirm the existence of functional glycoprotein-rich lined tubular structures in vitro and demonstrate that many of structures reported in the literature may not represent VM. This assay may be useful to design and test future VM-blocking anticancer therapies.

Nesidioblastosis del adulto tras derivación gástrica / Nesidioblastosis in the adult following gastric bypass

La hipoglucemia por hiperinsulinismo endógeno ha sido descrita como una complicación de la cirugía bariátrica. Se presenta el caso de un hombre de 34 años con tríada de Whipple que se manifestó ocho años después de someterse a derivación (bypass) gástrica. La hipoglucemia se asociaba con niveles elevados de insulina y péptido C, pero la localización del hiperinsulinismo endógeno solo se pudo precisar mediante cateterismo de arterias pancreáticas con estimulación intraarterial selectiva con calcio. Se decidió practicar una pancreatectomía subtotal laparoscópica, después de la cual el paciente presentó una excelente evolución posoperatoria y mejoró significativamente su sintomatología. Mediante la evaluación histopatológica e inmunohistoquímica, se confirmó una nesidioblastosis del adulto. Es importante reconocer esta enfermedad como una complicación de la cirugía bariátrica, más aún cuando estos procedimientos son tan frecuentes en la actualidad debido a la epidemia de obesidad. Los síntomas se pueden confundir con los de un síndrome de evacuación gástrica rápida (dumping), el cual no tiene repercusiones tan graves sobre la salud del paciente, como sí la tiene la nesidioblastosis

Hypoglycemia due to endogenous hyperinsulinism has been described as a complication of bariatric surgery. We present the case of a 34-year-old man who developed a Whipple's triad eight years after undergoing gastric bypass. Hypoglycemia was associated with high serum levels of insulin and C peptide; anatomic localization of endogenous hyperinsulinism was finally demonstrated with a selective intra-arterial calcium-stimulation test. Patient was offered a laparoscopic subtotal pancreatectomy, which resulted in an excellent postoperative course and significant symptoms resolution. Pathology report and inmunohistochemical analysis confirmed the diagnosis of adult nesidioblastosis. We believe it is important to recognize this condition as a complication of bariatric surgery, a procedure performed more frequently nowadays due to the obesity epidemic. Symptoms might be confused with those of dumping syndrome which does not have severe consequences in the patient´s health as nesidioblastosis does

Calidad microbiológica del agua en dos instituciones de salud del eje cafetero, Colombia 2015 / Microbiological quality of water in two health institutions in the Eje Cafetero, Colombia 2015

Objetivo: analizar la calidad microbiológica del agua de los servicios de hospitalización, Unidad de cuidados intensivos y Cirugía pre y pos desinfección de grifos de dos instituciones de salud del Eje Cafetero durante el tercer trimestre del 2015. Materiales y métodos: estudio descriptivo observacional, transversal, Se tomaron muestras de agua de tres puntos críticos como son área de quirófanos, hospitalización y unidad de cuidados intensivos. Se realizó una toma de muestras antes de realizar la desinfección del grifo, y otra después de la desinfección para de esta manera determinar si el filtro instalado en los grifos influía en los resultados microbiológicos, las muestras se analizaron por filtración por membrana. Resultados: se encontró que en una de las instituciones existen gran presencia de mohos y levaduras, aerobios mesófilos, en concentraciones mayores e inviables sanitariamente antes de realizar desinfección del grifo. Y con presencia en menor concentración pos-desinfección posiblemente debido a la ausencia de desinfección de grifos y almacenamiento en tanques. En la segunda institución no se presentaron recuentos significativos de microorganismos.Conclusiones: una de las instituciones cuenta con agua inviablemente sanitaria en uno de sus puntos críticos, debido a la alta presencia de Mohos y Levaduras, y aerobios mesófilos, el cual imposibilita su consumo según el decreto 2115 de 2007, y normas internacionales...(AU)

Objective: analyze the microbiological quality of water services hospitalization, ICU and surgery two health institutions in the Eje Cafetero during the third quarter of 2015.Materials and methods: observational, cross-sectional study water samples were taken three critical points as are operating rooms, hospital and intensive care unit.One sample was performed prior to disinfection tap and another after disinfection to thereby determine if the filter installed on the taps influenced microbiological results, the samples were analyzed by membrane filtration. Results: we found that in one of the institutions there are large presences of molds and yeasts, mesophilic aerobic; in older and unviable before performing disinfection sanitary tap concentrations. And present in lower concentration post-disinfection possibly due to the lack of disinfection of storage tanks and faucets. In the second institution no significant counts of microorganisms were presented. Conclusions: an institution has health unfeasibly water in one of its critical points due to the high presence of molds and yeasts, and mesophilic aerobic, which precludes their consumption by decree 2115 of 2007, and international standards...(AU)

Trasplante hepático en hemangioendotelioma epitelioide: reporte de dos casos y revisión de la literatura / Two Case Reports and a Literature Review of Liver Transplantation for Epithelioid Hemangioendothelioma

El hemangioendotelioma epitelioide hepático es un tumor raro, de naturaleza agresiva y comportamiento impredecible, con una incidencia de menos de 1 caso por millón de personas al año. Se presenta especialmente en mujeres jóvenes y con síntomas no específicos como dolor abdominal y pérdida de peso. La presentación radiológica es con múltiples nódulos o masas periféricas y bilaterales, con retracción de la cápsula, en algunos casos con calcificaciones y compromiso vascular. Debe realizarse biopsia hepática para confirmar el diagnóstico y para descartar diagnósticos alternativos como angiosarcoma, hepatocarcinoma, colangiocarcinoma y metástasis. El manejo depende de la extensión al momento de presentación, aunque solo el 10% de los casos es susceptible de resección. En las últimas décadas, el trasplante hepático se ha convertido en una opción de manejo, con series de casos aisladas reportadas por centros de trasplante en el mundo. En este artículo se presenta la experiencia de 2 pacientes con diagnóstico de hemangioendotelioma epitelioide hepático sin posibilidad de resección, confirmado histológicamente, sin compromiso extrahepático y que fueron llevados a trasplante de hígado exitoso y sin recurrencia de la enfermedad a 4 y 6 años después del trasplante.

Hepatic epithelioid hemangioendothelioma is a rare, aggressive and unpredictable tumor. Its incidence is less than one case per million people per year. Most commonly, it occurs in young women who exhibit nonspecific symptoms such as abdominal pain and weight loss. Radiologically it presents as multiple bilateral and peripheral nodules or masses with retraction of the capsule of the liver. In some cases there is calcification and vascular compromise. A liver biopsy should be performed to confirm the diagnosis and to rule out alternative diagnoses such as angiosarcoma, hepatocellular carcinoma, cholangiocarcinoma and metastasis. Management depends on the extension at presentation, but only 10% of cases are amenable to resection. Although in recent decades liver transplantation has become a management option, only studies of isolated cases reported by various transplant centers around the world have been published so far. In this article, we report our experience with two patients who were diagnosed with hepatic epithelioid hemangioendothelioma in which there were no possibilities of resection. Diagnoses were histologically confirmed, and since the patients had no extra-hepatic compromises, liver transplantations were performed. Both were successful and without recurrence at 4 and 6 years after transplantation.

Factors associated with recurrence and survival in liver transplant patients with HCC--a single center retrospective study.

INTRODUCTION: Hepatocellular carcinoma is the most common primary tumor of the liver and is diagnosed in more than a half million people worldwide each year. This study aims to assess factors associated with the recurrence and survival of patients with hepatocellular carcinoma and liver transplantation in a cohort of patients from Medellín, Colombia. MATERIAL AND METHODS: This was a descriptive retrospective study of a consecutive series of liver transplant patients from the Pablo Tobon Uribe Hospital of Medellín from January 2004 to May 2013. Demographic, clinical, imaging, and pathology variables were analyzed. RESULTS: Three hundred thirty liver transplants were performed during the study period, 54 cases (16.4%) had one or more hepatocellular carcinomas in the explant, and 79.6% of these patients were men. Cirrhotic patients had different etiologies, but most of them were due to alcohol abuse (22.2%), followed by hepatitis B virus infection (20.4 %), and hepatitis C virus infection (18.5%). In the pathology specimen, 51.9% had only one focus of hepatocellular carcinoma, 22.2% had two foci and 12.9% had three tumors. Recurrence of hepatocellular carcinoma occurred in 7.4% patients with an average time of 81 months. During follow-up, 25.9% of the patients died in an average time of 67.9 months (CI95 59.1-80.1 months). CONCLUSION: Recurrence and survival of patients with liver transplantation for hepatocellular carcinoma in this study had a similar behavior as that reported in the world literature. The factors associated with these outcomes were vascular invasion, poor tumor differentiation and satellitosis.

Wnt/beta-catenin signaling pathway in hepatocellular carcinomas cases from Colombia.

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is the most common primary liver cancer diagnosed worldwide. Deregulation of Wnt/beta-catenin pathway has been associated with the development of HCC in a substantial number of cases in Europe and far less in Asia. Nothing is known about this pathway in HCC cases from South America. This study aimed to investigate the frequency of mutations in beta-catenin gene (CTNNB1) and the subcellular localization of beta-catenin in HCC cases from Colombia. MATERIAL AND METHODS: We determine by direct sequencing the frequency of mutations in exon 3 of CTNNB1 gene and by immunohistochemistry the subcellular localization of beta-catenin in 54 samples of HCC obtained from three pathology units in Bogota and Medellin cities. RESULTS: Only three HCC cases (5.6%) were found mutated at residues (G34E, S45P, P44S, T41I) important for phosphorylation and ubiquitination of beta-catenin protein. Strikingly, nuclear or cytoplasmic accumulation of beta-catenin, hallmark of Wnt pathway activation, was found in 42.6% HCC cases (23/54). Interestingly, beta-catenin accumulation was significantly more frequent in young patients and hepatitis B virus-related HCC. CONCLUSIONS: Although, CTNNB1 exon 3 mutations are not frequent in HCC from Colombian patients, our findings indicate that Wnt/beta-catenin signaling is activated in 42.6% of HCC samples. Furthermore, Wnt signaling was demonstrated in HCC cases associated of HBV infection, one of the most important HCC risk factors in Colombia.

Caracterización de las investigaciones sobre equidad en salud en Bogotá, D. C. (2006-2010) / Characterization of Research on Health Equity in Bogotá, D. C. (2006-2010) / Caracterização da investigação sobre a equidade em saúde de Bogotá, D. C. (2006-2010)

Introducción: Se presenta el análisis de doce investigaciones sobre equidad en salud, realizadas entre 2006-2010, para caracterizarlas y presentar sus resultados. Objetivo: Caracterizar las investigaciones que sobre el tema de equidad en salud se han llevado a cabo en Bogotá entre 2006-2010, así como describir sus metodologías y analizar sus resultados. Métodos: Sistematización de los informes finales de las investigaciones que indagaban por las causas y los determinantes de las inequidades en salud ­no de las causas de los problemas de salud­. Se elaboró una matriz analítica comparativa, con los siguientes aspectos, para su contrastación: Objeto de estudio. • Problema.• Enfoque teórico.• Metodología.• Análisis de la información.• Resultados.• Aportes. Diseño: Estudio observacional, descriptivo, de tipo retrospectivo. Resultados: Se presentan dos tipos generales de abordaje de la equidad en salud, deducidos de las investigaciones analizadas: 1) las investigaciones que abordan el problema de la equidad en salud desde las demandas de equidad de los diferentes grupos poblacionales, y 2) las investigaciones que abordan el problema de la equidad en salud desde el análisis del funcionamiento del Sistema General de Seguridad Social en Salud (SGSSS); más específicamente, desde la estructura, la organización, la financiación, la cobertura, el aseguramiento, el acceso y la calidad. Conclusiones: En Bogotá persisten las inequidades en salud según grupos poblacionales y según el tipo de afiliación al SGSSS. Se recomienda integrar a las investigaciones sobre equidad en salud el concepto de calidad de vida, por cuanto ella condiciona en varios sentidos el estado de salud de la población, al hacerla más o menos vulnerable a los daños en la salud y potenciar o limitar su capacidad de respuesta a esos daños. Así, el análisis no se centraría exclusivamente en los resultados del sistema de salud, sino que abordaría los determinantes sociales de la salud.

Introduction: This article presents the analysis of twelve different investigations about health equity carried out in Bogotá during 2006-2010, to be characterized and to portray their results. Objective: Characterize the investigations about health equity that have been carried out in Bogotá during 2006-2010, to describe the methodologies and analyze their results. Methods: Systematization of the final reports of the investigations that studied the causes and determinants of inequalities in health. Those that studied other health problems were not included. A comparative analytic matrix was constructed, with the following aspects to be contrasted: • Problem. • Theoretical approach. • Methodology. • Information analysis.• Results. • Contributions.Design: Retrospective, descriptive, observational study. Results: Two different approaches of health equity are presented, parting from the analyzed investigations. The first group includes studies that approach the topic from the demands for health equity for each population group. On the second hand, there are those studies that approach the topic from the analysis of the Sistema General de Seguridad Social en Salud (SGSSS). Most specifically, from the structure, organization, financing, coverage, access, and quality points of view. Conclusions: Inequities in health, in Bogota, still happen across population groups and across types of affiliation to the health system (SGSSS). It is recommended to include the concept of life quality to the investigations regarding health equity. This concept conditions the health status of the population under different scopes. It makes it more or less vulnerable to health hazards, and strengthens or limits its response capabilities towards these hazards. This way, the analysis wouldn't be exclusively centered towards the results of the health system, as it would take into account thesocial determinants of health.

Resumo Introdução: Apresenta-se uma análise de doze investigações sobre equidade em saúde que foi realizada em Bogotá, entre 2006-2010, para caracterizar e apresentar os seus resultados. Objetivo: Caracterizar as investigações sobre o tema da equidade em saúde realizadas em Bogotá, entre 2006-2010, descrever as metodologias e analisar seus resultados. Métodos: Sistematização dos relatórios finais das investigações que inquiriram para as causas e determinantes de desigualdades em saúde -não as causas de problemas de saúde- Foi elaborada uma matriz analítica comparativa, com os seguintes aspectos para constatação: Objeto de estudo. • Problema. • Abordagem teórica. • Metodologia. • Análise de informação. • Resultados. • Contribuições. Desenho: Estudo observacional, descritivo e retrospectivo. Resultados: Presenta-se dois tipos gerais de abordagem da equidade em saúde, deduzidos das investigações analisadas: Em primeiro, aquelas investigações que abordam o problema de equidade em saúde a partir de demandas de equidade de diferentes grupos populacionais. Em segundo, as investigações que abordam o problema da equidade em saúde a partir da análise do funcionamento do Sistema Geral de Segurança Social em Saúde (SGSSS), mais especificamente a partir da estrutura, organização, financiamento, cobertura, seguro, acesso e qualidade. Conclusões: Em Bogotá persistem as inequidades em saúde por grupos populacionais e por tipo de filiação ao Sistema Geral de Segurança Social em Saúde. Recomenda-se integrar as investigações sobre equidade em saúde, o conceito de qualidade de vida, já que está condicionada ao estado de saúde da população em vários aspectos, tornando-o mais ou menos vulnerável aos danos para a saúde e potencializando ou limitando sua capacidade de resposta esses danos. Assim, a análise não se concentraria apenas sobre os resultados do sistema de saúde, como também abordaria os determinantes sociais da saúde.

Phylloid hypermelanosis: a cutaneous marker of several different disorders?

Phylloid hypermelanosis is a less clearly defined pigmentary disturbance than its hypopigmented counterpart, phylloid hypomelanosis. We report the case of a 32-month-old boy who had multiple melanotic macules arranged in a typical phylloid pattern since birth. He also had an abnormal facial appearance, with macrocephaly, frontal bossing, hypertelorism, internal strabismus, and auricular deformities. Psychomotor delay, multiple cystic brain lesions, and bilateral sensorineural hearing loss were also found. A review of associated anomalies as described in this and five previously reported patients with phylloid hypermelanosis shows some vague and inconsistent similarities, such as unusual facial appearance, malformed ears, hearing loss, and mental deficiency, but it is likely that phylloid hypermelanosis represents a class of heterogeneous phenotypes. Future clinical and genetic research may show how many distinct entities can be placed in this group of disorders.

Descripción del rechazo celular en pacientes con trasplante hepático en el hospital Pablo Tobón Uribe (HPTU) en el periodo 2005-2010 / Description of cellular rejection in liver transplant patients at the Hospital Pablo Tobón Uribe 2005-2010

Introducción: El rechazo celular agudo es una complicación del trasplante ortotópico de hígado (TOH). Se presenta entre 30 y 70% de los pacientes trasplantados en el primer año del procedimiento. Objetivo: Describir las principales variables asociadas al rechazo celular en pacientes con trasplante hepático en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, en el periodo 2005-2010. Metodología: De forma retrospectiva se evaluaron las historias clínicas de 248 pacientes a quienes se les realizó TOH con donante cadavérico y se identificaron aquellos pacientes que presentaron pruebas histológicas, clínicas y bioquímicas de rechazo celular según los criterios universalmente aceptados. Resultados: En los 248 trasplantes de hígado realizados en el periodo 2005-2010 se confirmaron 44 episodios de rechazo celular en 34 pacientes, para una incidencia de 13,7%; 30 pacientes (88,2%) presentaron un episodio de rechazo; 2 (5,8%) tres episodios y 2 (5,8%) cuatro episodios. Conclusión: Se describen las características principales del rechazo celular agudo en esta serie y se comparan con la literatura internacional ya que no encontramos reportes nacionales. La mayoría de casos fueron rechazo celular agudo leve y moderado con buena respuesta al manejo médico y sin repercusiones para la supervivencia del injerto o del paciente.

Introduction: Acute cellular rejection is a complication of orthotopic liver transplantation (OLT) which occurs in between 30% and 70% of transplant patients in the first year after the procedure. Objective: The objective of this study was to describe the main variables associated with cellular rejection in liver transplant patients at the Hospital Pablo Tobon Uribe in Medellin from 2005 to 2010. Methods: Medical records of 248 patients who had undergone OLTs with cadaveric donor grafts were evaluated retrospectively. Patients with histological, clinical and biochemical evidence of cellular rejection were identified in accordance with universally accepted criteria. Results: 44 episodes of cellular rejection in 34 patients were confirmed from among 248 liver transplantations performed in from 2005 to 2010. The incidence of rejection was 13.7%. Thirty patients (88.2%) had one episode of rejection, two (5.8%) had three episodes and two others (5.8%) had four episodes. Conclusions: We describe the main features of acute cellular rejection in this series and compare them with reports in the international literature. No other reports from Colombia were found. Most cases were mild to moderate acute cellular rejection which responded well to medical management without implications for graft or patient survival.

Human papillomavirus genotype detection in recurrent respiratory papillomatosis (RRP) in Colombia.

BACKGROUND: Knowledge on human papillomavirus (HPV) genotype distribution in recurrent respiratory papillomatosis (RRP) is essential to assess the impact of HPV vaccine. It is provided information for Colombia. METHODS: In all, 189 RRP primary cases diagnosed between 1985 and 2009 were identified from 5 pathology laboratories of Cali and Medellin, Colombia. HPV DNA testing in 129 cases that fulfilled inclusion criteria (available paraffin blocks, amplifiable DNA, and confirmed histologic diagnosis of RRP) was performed by the SPF-10/LiPA25 assay (version 1). RESULTS: Of all cases 36.1% were juvenile (<12 years old) and a majority of adults were males (p = .09); 95% of cases were HPV positive. HPV 6, 11, and 16 contributed to 69%, 27.1%, and 7.8% of all HPV positive cases. Twelve cases (9.3%) showed multiple infections; 8 of these were HPV 6 or 11 positive. CONCLUSIONS: HPV prophylactic vaccine including HPV 6 and 11 may have a major impact against RRP.

Síndrome de Alagille experiencia clínica de catorce casos en Medellín, Colombia / Alagille syndrome, clinical experience of fourteen cases in Medellin, Colombia

Introducción: El Síndrome de Alagille corresponde a una alteración autosómica dominante con expresión variable. Se caracteriza por colestasis crónica con escasez de los conductos biliares interlobulares asociada a alteraciones cardiovasculares, oftálmicas, sistema esquelético, riñones y facies característica. Su distribución es mundial con frecuencia de 1 por cada 100000 nacidos vivos. Objetivo: Describir las características clínicas, la evolución y la sobrevida de catorce pacientes, con diagnóstico de Síndrome de Alagille atendidos en un período de 16 años en Medellín, Colombia. Materiales y métodos: Es un trabajo observacional descriptivo de reporte de casos de los hallazgos morfológicos y la evolución de los pacientes con diagnóstico de Síndrome de Alagille. Resultados: Grupo compuesto por ocho niños y seis niñas, con edades entre los dos meses y los diez años al momento de diagnóstico. El síndrome completo se presentó en 28%. Los hallazgos más frecuentes, estenosis valvular de la arteria pulmonar y la alteración vertebral se presentaron en el 79%. Tres pacientes 21%, fallecieron, uno de ellos después de recibir trasplante hepático. De los once sobrevivientes dos niñas fueron sometidas a trasplante y se encuentran en buenas condiciones. Los nueve restantes padecen hepatopatía colestásica crónica y reciben tratamiento médico. Conclusión: El Síndrome de Alagille se debe tener en cuenta en el diagnóstico de colestasis crónica infantil. Para establecer la distribución y frecuencia de esta enfermedad en nuestro país es necesario desarrollar investigaciones que idealmente incluyan el estudio de la mutación genética en los pacientes y su familia cercana.

Introduction: The Alagille Syndrome is an autosomic dominant disorder with variable expression. Chronic cholestasis, characteristic facial appearance and abnormalities heart, skeleton, eye, kydnes with hypoplasia of the biliary ducts. Initial description in France, with mundial distribution her frecuence is 1/100000. Objective: To describe the clinical characteristic and evolutions of fourteen patients with diagnosis Alagille Syndrome in Medellín Colombia. Materials and methods: Descriptive retrospective study with variables obtained from clinical records of patients with diagnosis Alagille Syndrome. Results: Eight boys and six girls. The age at diagnosis varied two months at nine years. Complete syndrome was present in 28%. The most frecuent alterations were valvular stenosis pulmonary artery and failure of anterior vertebral arch fusion (butterfly vertebrae) 79%. The clinical evolution was variable, death occurred in three patients 21%, one girl post liver transplantation. Nine children had chronic hepatopathy controlled with medical treatment and two girls had liver transplantation with satisfactory evolution. Conclusions: In Colombia, the poblational incidence is not defined it is necessary to know the distribution of syndrome at future study.

Hepatitis B and Hepatitis C Infection Biomarkers and TP53 Mutations in Hepatocellular Carcinomas from Colombia.

Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death worldwide. Globally, the most important HCC risk factors are Hepatitis B Virus (HBV) and/or Hepatitis C Virus (HCV), chronic alcoholism, and dietary exposure to aflatoxins. We have described the epidemiological pattern of 202 HCC samples obtained from Colombian patients. Additionally we investigated HBV/HCV infections and TP53 mutations in 49 of these HCC cases. HBV biomarkers were detected in 58.1% of the cases; HBV genotypes F and D were characterized in three of the samples. The HCV biomarker was detected in 37% of the samples while HBV/HCV coinfection was found in 19.2%. Among TP53 mutations, 10.5% occur at the common aflatoxin mutation hotspot, codon 249. No data regarding chronic alcoholism was available from the cases. In conclusion, in this first study of HCC and biomarkers in a Colombian population, the main HCC risk factor was HBV infection.