Stroke in a Patient With Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is characterized by the occurrence of thrombotic events and/or obstetric complications in the presence of antiphospholipid antibodies. It is considered one of the most common acquired thrombophilias. The presentation of stroke in patients with APS has been described in some studies; however, it is not frequent enough and there is not much information available regarding the indications for pharmacological thrombolysis and the safety of thrombolytic treatment. Likewise, current evidence does not describe contraindications to thrombolytic therapy in cases of this diagnosis, which makes management with fibrinolysis safe in these cases. A clinical case of stroke is presented in which pharmacological thrombolysis is performed with a successful outcome, without complications of angioedema or bleeding. Likewise, concerning the case, the main neurological manifestations associated with APS, especially in its association with stroke, are described.

Predicting intensive care unit-acquired weakness: A multilayer perceptron neural network approach.

In this editorial, we comment on the article by Wang and Long, published in a recent issue of the World Journal of Clinical Cases. The article addresses the challenge of predicting intensive care unit-acquired weakness (ICUAW), a neuromuscular disorder affecting critically ill patients, by employing a novel processing strategy based on repeated machine learning. The editorial presents a dataset comprising clinical, demographic, and laboratory variables from intensive care unit (ICU) patients and employs a multilayer perceptron neural network model to predict ICUAW. The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW. This editorial contributes to the growing body of literature on predictive modeling in critical care, offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

Projectile Embolism From a Firearm Injury: A Case Report.

Projectile embolism resulting from firearm injuries is a rare but highly lethal complication when not diagnosed early. This report presents a case of projectile embolism from a firearm injury with an unusual entry site, the cerebral venous circulation, which subsequently migrates to the pulmonary circulation with a fatal outcome. A 24-year-old male patient was admitted to a high-complexity hospital due to a gunshot wound. A plain skull computed tomography (CT) revealed a left laminar subdural hematoma and traumatic subarachnoid hemorrhage with multiple metallic fragments embedded in the skull, some penetrating the galeal sinus, with perilesional bleeding. Contrast-enhanced chest tomography showed non-thrombotic embolism of metallic fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions. Transthoracic echocardiography revealed a hyperechoic image of 3 mm in the subvalvular apparatus toward the interventricular septum. Subsequently, the patient experienced neurological deterioration with signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles. Measures to counteract cerebral edema were initiated. Later, the patient developed mydriasis, the absence of brainstem reflexes, and experienced cardiac arrest. This report delineates a case of projectile embolism, highlighting a distinctive aspect characterized by an unusual entry point.

Applications of Lab on a Chip in Antimicrobial Susceptibility of Staphylococcus aureus: A Systematic Review.

Background and Objectives: Staphylococcus aureus is a prevalent bacterium capable of inducing various infections, including skin and soft tissue infections, bloodstream infections, pneumonia, and surgical site infections. The emergence of antimicrobial resistance in S. aureus, particularly methicillin-resistant S. aureus, has raised substantial concerns within global healthcare settings. Prior to antibiotic prescription, the ideal approach is antimicrobial susceptibility testing (AST); however, this is frequently perceived as excessively complex and time-intensive. Lab-on-a-chip (LOC) technology holds promise in addressing these challenges and advancing fundamental microbiological research while also aiding in the development of therapeutic strategies. This systematic review aims to evaluate the potential utility of LOC for AST of S. aureus. Materials and Methods: This study adhered to the PRISMA guidelines. Various databases, including SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS, in addition to gray literature sources, were employed in the review process. Results: Sixteen studies were included in this systematic review. All these studies detailed the effectiveness, rapidity, and predictability of LOC systems for assessing S. aureus susceptibility to various antibiotics. When comparing the LOC approach to traditional manual methods, it was evident that LOC requires a minimal quantity of reagents. Furthermore, most studies reported that the entire LOC procedure took 10 min to 7 h, with results being equally accurate as those obtained through traditional AST protocols. Conclusions: The potential application of LOC for AST of S. aureus is emphasized by its ability to provide rapid access to minimum inhibitory concentration data, which can substantially aid in selecting the most suitable antibiotics and dosages for treating challenging infections caused by this microorganism. Moreover, the rapid AST facilitated by LOC holds promise for enhancing the appropriateness and efficacy of therapy in clinical settings.

PoCUS for the management of Fournier's gangrene in the emergency department: A case report.

Serious soft tissue infections in the spectrum of rapidly progressive necrosis of the fascia and subcutaneous tissue represent a clinical challenge in emergency department clinical practice. Fournier's gangrene (FG) is a presentation thereof that compromises the urogenital area. A low threshold of clinical suspicion complementary to laboratory evaluation and imaging is necessary to act rapidly and perform diagnostic and therapeutic surgical intervention for this condition. The present study reported the case of a 63-year-old woman who was admitted with buttock skin changes for 72 h. The diagnostic impression was septic shock due to FG. Point-of-care ultrasound (PoCUS) was performed, indicating free fluid in the muscle planes, discontinuity of the muscle fascia and the presence of gas in the subcutaneous cellular tissue. The patient was taken to surgery 2 h after admission. PoCUS was indicated to have an acceptable diagnostic performance that may optimize the care of this type of patient depending on the conditions of the emergency department and the availability of other resources.

ST­segment elevation associated with intraparenchymal hemorrhage: A case report.

The electrocardiogram (ECG) changes in patients with intraparenchymal hemorrhage (IPH) have remained largely elusive and no case reports are currently available in the scientific literature. The medical management of a patient with ST-segment elevation associated with IPH was described in the present study. The case report describes a 78-year-old male patient who presented with ST-segment elevation in V1, V2, V3 and V4 on ECG. Initially, the case was managed therapeutically as an acute myocardial infarction. Later, the patient was transferred to a higher-level hospital, where a new ECG confirmed ST-segment elevation. Simple skull tomography was also performed, which revealed a spontaneous right basal ganglion in the context of an acute cerebrovascular accident of hypertensive origin. A transthoracic ECG was ordered, which revealed an ejection fraction of 65% with type I diastolic dysfunction due to relaxation disorders and without any signs of ischemia, intracavitary masses or thrombi. In addition to the presence of nonspecific ECG findings, clinicians should consider immediate brain computed tomography to confirm intracranial hemorrhage.

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies.

This systematic scoping review aims to answer questions related to the main characteristics of primary headache, the need for neuroimaging, and the presence of red flags in these patients. A review of prospective studies including the MEDLINE/PubMed, Scopus, LILACS, and SCIELO databases, as well as the grey literature, was conducted. The methodological quality of the selected investigations was also assessed. Six investigations met the selection criteria. The mean age of people with primary headache was less than 43 years, with ages ranging from 39 to 46 years. Most of the studies reported the presence of nausea/vomiting, between 12% and 60% of the patients studied. To a lesser extent, there was also the presence of intense and moderate pain, loss of consciousness, stiff neck, presence of aura, and photophobia. The most frequent diagnoses were unspecified headache, migraine, and tension headache. The studies did not recommend neuroimaging and no red flags were reported. Primary headache occurred more frequently in women, in those under 46 years of age with a history of migraine and similar episodes. Moreover, the presence of red flags and the need for neuroimaging in patients with primary headaches were not evidenced.

Point­of­care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report.

A liver abscess is an entity that is rarely observed in the emergency department; therefore, it requires timely diagnosis by the clinicians who support this service. The early diagnosis of a liver abscess is challenging as variable and non-specific symptoms are present; furthermore, symptoms may differ in patients with human immunodeficiency virus (HIV) infection. To date, reports on the presentation of diagnostic ultrasound with point-of-care ultrasonography (PoCUS) are limited. The present case report study describes a patient diagnosed with HIV and the presence of a liver abscess confirmed by PoCUS performed in an emergency department. The patient presented with abdominal pain upon palpation in the right hypochondrium and in the thoracoabdominal area, which became more severe with inspiration. PoCUS revealed a hypodense intrahepatic image observed between segments VII and VI, with internal echoes suggestive of a liver abscess. Moreover, it was decided to perform tomography-guided percutaneous drainage of the liver abscess. Antibiotic treatment with ampicillin/sulbactam and IV metronidazole was also commenced. The patient presented clinical improvement and was discharged on the third day.

Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials.

To estimate the efficacy of three-dimensional (3D) models for medical education. METHODS: A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted. RESULTS: Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced. CONCLUSIONS: Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Accuracy of point­of­care ultrasonography in the diagnosis of necrotizing fasciitis: A case report.

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult.

Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm H2O collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications.

Kounis Syndrome Secondary to Laxative Administration.

Kounis syndrome (KS) is defined as an acute coronary syndrome triggered by the release of inflammatory mediators after an allergic attack. It usually occurs secondary to allergic injuries from foods, medications, and insect bites. However, there are no known reports of KS secondary to the intake of laxatives. This article reports the case of a 43-year-old woman who, after ingesting a dose of sodium phosphate monobasic/sodium phosphate dibasic, presented a maculopapular rash on the trunk and extremities. The electrocardiogram showed ST depression in V4-V5-V6 and signs of prolonged QTc; troponin I uptake was positive. Due to presumed myocardial injury and high suspicion of coronary disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis, thus confirming the presence of KS secondary to the ingestion of a laxative.

Remolinos mesentéricos en la angiotomografía de paciente con hernia de Petersen y aparente trombosis mesentérica / Mesenteric swirl on angiotomography of a patient with Petersen's hernia and apparent mesenteric thrombosis

RESUMEN Introducción: Las imágenes diagnósticas son fundamentales para diagnosticar la trombosis de la vena mesentérica y la hernia de Petersen. Objetivo: Describir el tratamiento de una paciente que en angiotomografía presentó aparente trombosis de la vena mesentérica y hernia de Petersen. Caso clínico: Una paciente consultó por dolor abdominal tipo cólico, de predominio en epigastrio, irradiado a región dorsal. Por el cuadro clínico sugestivo de emergencia vascular se solicitó inmediatamente angiotomografía de vasos del tórax y abdomen. Las imágenes revelaron permeabilidad de la arteria mesentérica superior en su origen y en tercio proximal, se aprecia un giro de vasos (signo de remolino) a aproximadamente 7 cm de su origen, con aparente oclusión completa, por trombosis. En el mismo sitio donde se evidenció el giro de vasos, se apreció aparente inicio de trombosis de la vena mesentérica superior. Se realizó procedimiento quirúrgico en el cual se encontró espacio de Petersen y herniación de todo el intestino delgado a través de dicho espacio. La laparotomía evidenció que la paciente no cursó con trombosis, sino que era un efecto dado por la imagen y el hallazgo que se veía era secundario a la hernia de Petersen. Conclusiones: La presencia del signo de remolino en una angiotomografía es muy importante pero no definitiva en el diagnóstico de la hernia de Petersen.

ABSTRACT Introduction: Diagnostic images are essential for the diagnosis of mesenteric vein thrombosis and Petersen's hernia. Objective: To describe the treatment of a patient who presented apparent thrombosis of the mesenteric vein and Petersen's hernia on angiotomography. Clinical case: A patient consulted for colicky abdominal pain predominantly in the epigastrium, radiating to the dorsal region. Due to the clinical picture suggestive of vascular emergency, an angiotomography of the vessels of the thorax and abdomen was immediately requested. The images revealed patency of the superior mesenteric artery at its origin and in the proximal third, appreciating a vessel turn (swirl sign) approximately 7 cm from its origin with apparent complete occlusion due to thrombosis. In the same place where the twisting of the vessels was evident, the initiation of apparent thrombosis of the superior mesenteric vein was appreciated. A surgical procedure was performed in which Petersen's space and herniation of the entire small intestine through this space were found. The laparotomy showed that the patient did not have thrombosis at any time, but that it was an effect given by the image and the finding that was seen was secondary to Petersen's hernia. Conclusions: The presence of the swirl sign on an angiotomography is very important but not definitive in the diagnosis of Petersen's hernia.

Conservative Medical Management of a Tracheal Perforation after Blunt Trauma in a Patient with SARS-CoV-2.

This article reports the case of a woman with tracheal perforation due to closed neck trauma and the presence of SARS-CoV-2. The physical examination revealed subcutaneous emphysema in zone II of the neck. The tomography revealed an anterior and proximal tracheal lesion, a 2-mm solution of continuity of the anterior infraglottic airway in the proximal third with subcutaneous emphysema and a decrease in the diameter of the airway at the level of the glottis. The PCR result for SARS-CoV-2 was positive. The medical procedure consisted of orotracheal intubation to guarantee the safety of the airway, in addition to close surveillance in the intensive care unit and constant monitoring of vital signs. In tracheal perforation due to closed neck trauma, it is recommended to evaluate the clinical parameters periodically, including the stability of respiration and subcutaneous emphysema.

Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2 / Education in faculties of medicine around the world during the contingency period due to SARS-CoV-2 / Educação em faculdades de medicina em todo o mundo durante o período de contingência SARS-COV-2

Introducción. La pandemia del SARS-CoV-2 se empezó a reportar desde diciembre de 2019 en la localidad de Wuhan, China, luego se presentaron miles de casos en el mundo. Dentro de las medidas adoptadas a nivel mundial en todos los aspectos, se encuentra el distanciamiento social, lo que ha conllevado al cierre de distintos sectores de la economía; entre ellos la educación superior. La educación médica sufre un cambio repentino al suspender las clases presenciales y los campos de práctica; de este modo, se tuvo que afrontar distintos cambios e innovaciones en sus procesos educativos. El objetivo de este trabajo es realizar una revisión sobre las modalidades implementadas y reportadas en la literatura mundial durante la pandemia en las facultades de medicina. Temas a tratar. Educación médica durante pandemia, facultades de medicina, educación virtual, medidas de educación médica durante tiempos de pandemia, experiencias en educación médica previas a la pandemia, educación a distancia y presencialidad asistida por tecnología, plataformas digitales en el proceso de enseñanza, situación futura e interrogantes. Conclusiones. La implementación de la tecnología en la educación médica de una manera única permitirá a los estudiantes desarrollar habilidades de colaboración y mejorar la adaptabilidad. Es todo un reto la educación médica frente a la pandemia de SARS-CoV-2. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942

Introduction. The SARS-CoV-2 pandemic started being reported in December 2019 in the locality of Wuhan, China. Subsequently, thousands of cases arose around the world. Among the measures adopted worldwide in all aspects is social distancing, which has led to closure of various sectors of the economy, among which is higher education. Medical education experienced a sudden change when on-site classes and fields of practice were suspended. In this way, people had to face different changes and innovations in their educational processes. The objective of this study is to review the implemented and reported modalities in the global literature of faculties of medicine during the pandemic. Areas to be Addressed. Medical education during the pandemic, faculties of medicine, virtual education, medical education measures during the pandemic, experiences in medical education prior to the pandemic, e-learning and on-site education assisted by technology, digital platforms in the teaching process, future situations and questions. Conclusions. Uniquely implementing technology in medical education will allow students to develop collaborative skills and improve their adaptability. This is a challenge to medical education during the SARS-CoV-2 pandemic. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942

Introdução. A pandemia SARS-CoV-2 começou a ser relatada em dezembro de 2019 na cidade de Wuhan, China, depois milhares de casos foram notificados em todo o mundo. Entre as medidas adotadas mundialmente em todos os aspectos, está o distanciamento social, que tem levado ao fechamento de diversos setores da economia, entre eles, o ensino superior. Aeducação médica sofreu uma mudança repentina com a suspensão de aulas presenciais e dos campos de prática; dessa forma, diferentes mudanças e inovações tiveram de ser enfrentadas em seus processos educacionais. O objetivo deste trabalho é realizar uma revisão sobre as modalidades implementadas e relatadas na literatura mundial durante a pandemia nas faculdades de medicina. Tópicos a abordar. Educação médica durante a pandemia, faculdades de medicina, educação virtual, medidas de educação médica em tempos de pandemia, experiências na educação médica antes da pandemia, educação a distância e educação presencial assistida por tecnologia, plataformas digitais no processo de ensino, situação futura e questões. Conclusões. A implementação da tecnologia na educação médica de uma maneira única permitirá que os alunos desenvolvam habilidades colaborativas e melhorem a adaptabilidade. A educação médica face à pandemia da SARS-CoV-2 é um grande desafio. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942

Decisiones relevantes desde urgencias en la infección por la COVID-19: abordaje del paro cardíaco y respiratorio / Relevant decisions at emergency in COVID-19 infection: Approach to cardiac and respiratory arrest

Resumen La infección por coronavirus 2019 (SARS-CoV-2) ha conllevado a desenlaces fatales por compromiso cardiovascular o respiratorio, por lo que el personal de la salud debe estar atento y alerta a las recomendaciones sobre su abordaje y, al mismo tiempo, evitar su contaminación y contagio. Se hacen unas precisiones en cuanto al abordaje de la vía aérea y el paro circulatorio y cardíaco, que son diferentes al abordaje habitual de otros pacientes críticos. Se presenta una revisión de la literatura con información reportada hasta el momento sobre decisiones relevantes que puedan ser útiles en la intubación, protección personal, parámetros cardiovasculares y abordaje del paro cardiorrespiratorio.

Abstract Coronavirus 2019 infection (SARS-CoV-2) has led to fatal outcomes due to cardiovascular or respiratory involvement. So health care personnel must be attentive and alert to recommendations on how to deal with it while avoiding contamination and contagion. Some clarifications are made regarding the approach of the airway and circulatory and cardiac arrest, which are different from the usual approach of other critical patients. A review of the literature is presented with information reported so far on relevant decisions that may be useful in intubation, personal protection, cardiovascular parameters and approach to cardiorespiratory arrest.

Estrategias para la medición y el manejo de la sobreocupación de los servicios de urgencias de adultos en instituciones de alta complejidad con altos volúmenes de consulta. Revisión de la literature / Strategies for the measurement and management of overcrowding in the adult emergency services of high complexity and high consultation volumes hospitals. A literature review

RESUMEN La sobreocupación de los servicios de urgencias es un problema global que cada vez afecta más las instituciones de salud que atienden pacientes de mediana y alta complejidad, haciendo que estos permanezcan más tiempo en una sala de espera con la consiguiente demora en los tiempos de atención, bajo nivel de satisfacción de los usuarios, retraso en la toma de ayudas diagnósticas, retrasos al definir altas del servicio y favorecimiento de complicaciones médicas, entre otros. Para mejorar esta situación se han desarrollado estrategias como la creación de unidades de observación, unidades fast track o asignación de citas prioritarias para los pacientes que no requieren una atención urgente, de modo adicional el triaje, los exámenes point of care y la vinculación de especialistas en medicina de urgencias. Todo esto con el fin de mejorar la calidad de la atención de los pacientes, evitar que se presenten eventos adversos durante su proceso y disminuir la sobreocupación del servicio.

SUMMARY The over-occupation of emergency services is a global problem that has worsened in recent years. In the health institutions that serve patients of medium and high complexity, the attention of the patients is delayed and they can stay longer in a waiting room presenting longer attention times, a low level of satisfaction of the patients and users, delay in taking diagnostic aids and in defining discharge, medical complications and progression of their diseases, among others. To improve this situation, strategies have been developed such as the creation of observation units, fast track units or assignment of priority appointments for patients who do not require urgent attention, triage, point-of-care examinations and the involvement of specialists in emergency medicine. All of this in order to improve the quality of patient care, avoid adverse events during their process and reduce the over-occupation of the service.

Discrepancias entre las frecuencias de los desenlaces primarios propuestos y obtenidos en ensayos clínicos aleatorizados / Differences between the proposed frequencies of the research protocols of randomized clinical trials with outcomes obtained at the end of the primary study outcomes

Resumen Objetivo: Determinar las diferencias entre las frecuencias de los desenlaces propuestos en el protocolo inicial de los ensayos clínicos aleatorizados respecto a los desenlaces obtenidos al final del estudio. Metodología: Estudio observacional, de corte transversal, que incluyó ensayos clínicos de cardiología publicados en The New England Journal of Medicine desde 2002 a 2013. Resultados: Se identificaron 28 ensayos clínicos. En el 60,7 % de los estudios la incidencia estimada del desenlace fue mayor que la encontrada, y se presentó discrepancia (diferencia mayor al 10 %) en 13 (46.4 %) estudios. El 10,7 % de los estudios presentaba discrepancia entre el tamaño de muestra estimado por los autores y el calculado por nosotros. Conclusión: Encontramos de que a pesar que los autores de los ensayos clínicos tienen un buen cálculo del tamaño de la muestra, sus supuestos no son buenos, ya que la incidencia esperada en el grupo control suele ser sobreestimada en el 60 % de los casos.

Abstract Objective: To determine the differences between the frequencies of the outcomes proposed in the initial protocol of randomized clinical trials for the outcomes obtained at endpoint. Methods: An observational, cross-sectional that included cardiology clinical trialspublished in The New England Journal of Medicine from 2002-2013. Results: We identified 28 trials. In 60.7 % of the estimated outcome studies incidence was higher than that found, showing discrepancy (differencegreater than 10 %) in 13 (46.4%) studies. 10.7 % of the studies showed a discrepancy between the size estimated by the authors and the sample calculated by us. Conclusión: We found that although the authors of clinical trials have a good estimate of the sample size, its assumptions are not good, because the expected incidence in the control group is often overestimated in 60 % of cases.

El virus Chikungunya en Colombia: aspectos clínicos y epidemiológicos y revisión de la literatura / Chikungunya virus in Colombia: Clinical and epidemiological aspects, and literature review / Vírus chicungunha na Colômbia: aspectos clínicos e epidemiológicos e revisão da literatura

En años recientes, con el movimiento de las poblaciones y la globalización, algunas infecciones y enfermedades han cambiado su patrón endémico por uno epidémico; es el caso del virus chikungunya, un arbovirus reemergente que ha activado las alarmas mundiales. Según datos de los Centros para el Control y Prevención de Enfermedades (CDC), de los Estados Unidos, hasta enero del 2015 se habían detectado más de un millón de casos sospechosos y alrededor de treinta mil habían sido confirmados por laboratorio en 42 países del Caribe, Centroamérica, Suramérica y Norteamérica. Según el Instituto Nacional de Salud de Colombia, el número total de casos de esta infección confirmados por clínica era de 231.392; por laboratorio se habían confirmado 1.528 y había 3.848 casos sospechosos, para un total general de 236.768. En esta revisión se incluyen los siguientes aspectos de la infección por el virus chikungunya: virología, transmisión por vector, patogenia, epidemiología, manifestaciones clínicas, pruebas de laboratorio, medidas de prevención y perspectivas futuras.

In recent years, with the movement of populations and with globalization, some infections and diseases have changed from endemic to epidemic in certain regions. Such is the case of chikungunya virus (CHIKV), a re-emerging arbovirus that has triggered global alarm. According to the Center for Disease Control and Prevention (CDC), until January 2015, there had been case reports from 42 countries in the Caribbean, and Central, South, and North America, with more than one million suspected cases and about thirty thousand laboratory-confirmed cases. The latest report in Colombia by Instituto Nacional de Salud refers to a total of 231.392 clinically confirmed cases (suggestive symptoms associated with CHIKV), 1.528 cases confirmed by laboratory, and 3.848 suspected cases, for an overall total of 236.768. In this review, the following aspects of CHIKV infection are included: virology, transmission by vector, pathogenesis, epidemiology, clinical manifestations, laboratory tests, preventive measures and future prospects.

Nos anos recentes, com o movimento das populações e a globalização, algumas infecções e doenças mudaram seu padrão endémico por um epidêmico; é o caso do vírus chicungunha, um arbovírus reemergente que ativou os alarmes mundiais. Segundo dados do Centro para o Controle e Prevenção de Doenças (CDC), dos Estados Unidos, até janeiro de 2015 se tinham detectado mais de um milhão de casos suspeitos e ao redor de trinta mil tinham sido confirmados por laboratório em 42 países do Caribe, América Central, América do Sul e América do Norte. Segundo o Instituto Nacional de Saúde da Colômbia, o número total de casos desta infecção confirmados por clínica era de 231.392; por laboratório se tinham confirmado 1.528 e tinha 3.848 casos suspeitos, para um total geral de 236.768. Nesta revisão se incluem os seguintes aspectos da infecção pelo vírus chicungunha: virologia, transmissão por vector, patogenia, epidemiologia, manifestações clínicas, provas de laboratório, medidas de prevenção e perspectivas futuras.

Artritis postestreptocócica en un paciente adulto: reporte de caso / Post-streptococcal arthritis in an adult patient: case report

La artritis postestreptocóccica es una entidad que se manifiesta por compromiso articular secundario a infección orofaríngea secundaria a Streptococcus beta hemolítico del grupo A. Se presenta el caso de un paciente de 43 años, previamente sano, que siete semanas después de un episodio de faringoamigdalitis desarrolló un cuadro oligoarticular, aditivo, no migratorio, con lesiones dermatológicas. Se documentaron títulos elevados de antiestrep-tolisina O, cumpliendo con los criterios propuestos por Ayoub y Ahmed, y se diagnosticó artritis postestreptocóccica. El paciente presentó respuesta adecuada a dosis moderadas de corticoesteroides.

Post-streptococcal reactive arthritis is an entity that includes joint involvement secondary to oropharyngeal infectious process associated with beta hemolytic group A Streptococcus. We report a clinical case of 43 year-old man, previously healthy, that seven weeks after a tonsillopharyngitis, developed an additive, non-migratory oligoarthritis, with skin lesions. High titers of antistreptolysin O antibodies are documented, with fulfillment of Ayoub and Ahmed proposed criteria for post streptococcal reactive arthritis. The patient presented adequate response to moderate doses of corticosteroids.